Failure to Involve POA in Advance Directive for Cognitively Impaired Resident
Penalty
Summary
A deficiency was identified when a resident with moderate cognitive impairment was admitted to the facility. The resident's admission Minimum Data Set (MDS) documented a Brief Interview for Mental Status (BIMS) score of 11, indicating moderate cognitive impairment. The resident's electronic medical record (EMR) listed their daughter as the primary emergency contact and included a notarized Power of Attorney (POA) document naming the daughter as the sole POA for both medical and financial matters. Despite this, the facility's social worker completed the Advance Directive Acknowledgment form with the resident alone, who printed her name incorrectly on the signature line, using a different first name and misspelling her last name. Interviews with facility staff revealed inconsistent practices regarding the involvement of family representatives or POAs in the completion of advance directive paperwork for residents with cognitive impairment. The social work director stated that there was no formal cutoff BIMS score for determining decision-making capacity and that the process was based on judgment. The DON indicated that typically, if a resident's BIMS score is below 12, the family or POA is involved in signing paperwork. However, in this case, the POA was not included in the acknowledgment process, despite the resident's documented cognitive impairment and existing POA documentation.