Failure to Honor Resident's Right to Participate in Treatment Decisions
Penalty
Summary
The facility failed to ensure that a resident was given the opportunity to participate in decisions regarding their treatment, specifically related to dialysis, feeding tube, and advance directives. The resident, who had multiple complex medical diagnoses including end stage renal disease, heart disease, and a history of traumatic brain injury, expressed frustration about not being included in discussions about his care and not being able to communicate with his legal guardian. Despite being cognitively able to express his wishes and understanding the risks of refusing dialysis, the resident reported that neither the facility staff nor his legal guardian engaged him in meaningful conversations about his treatment preferences or goals of care. Documentation and interviews revealed that the resident refused dialysis on several occasions, preferring to attend only twice a week instead of the physician-recommended three times. Staff responses included contacting the resident's daughter to convince him to comply, notifying the provider, and ultimately involving the legal guardian, who had not visited or communicated directly with the resident since admission. There was no evidence that the facility or the guardian discussed the reasons for the resident's refusals or his wishes regarding his care. Instead, the facility attempted to petition for involuntary psychiatric evaluation, citing non-compliance with dialysis, despite EMS and staff acknowledging the resident was of sound mind and not in distress. Further, the resident expressed a desire to have his feeding tube removed and to have input on his code status and hospice care, but reported that no one had discussed these options with him. Social services documentation showed that hospice was discussed with the guardian but not with the resident, and the resident was not included in care conferences or decisions about his code status. The facility's own policy required that residents or their representatives be informed and included in decisions about treatment and advance directives, but this was not followed in the resident's case.