Failure to Implement Individualized Interventions for Resident with Dementia-Related Behaviors
Penalty
Summary
The facility failed to implement additional individualized interventions for a resident with moderate cognitive impairment and dementia who exhibited behavioral issues during toileting assistance. The resident, who required substantial assistance for transfers and toileting and was frequently incontinent, refused staff help to use the bathroom and to be checked or changed when incontinent. Staff interactions revealed that the resident became upset and combative when told she needed to use a mechanical lift, refusing both the equipment and staff assistance, and using verbal aggression toward staff members. Staff interviews indicated that after the resident refused care, the CNAs and the LPN did not attempt further individualized approaches or interventions beyond documenting the refusal. The LPN declined to assist further, stating that nothing more could be done if the resident refused, and the CNAs continued to check on the resident but were unable to provide care due to her continued refusals. The staff did not attempt to involve other potential interventions, such as involving the nurse in a different approach or contacting the resident's family, despite the facility's policy on problematic behavior management and the DON's later statements about possible alternative strategies. The care plan for the resident included directions for staff to use calm communication and not to argue, but there was no evidence that additional or individualized non-pharmacological interventions were attempted when the resident refused care. The facility's policy required staff to identify and manage problematic behaviors with appropriate interventions, but in this instance, staff actions were limited to initial attempts and documentation, without further escalation or adaptation to the resident's behavioral needs.