Resident's Rights Violated by Withholding Smoke Breaks as Punishment
Penalty
Summary
The facility failed to ensure that a resident was treated in a dignified manner and allowed to exercise their rights, specifically regarding the withholding of smoke breaks as a form of punishment. The incident involved a resident with multiple diagnoses, including dementia, major depressive disorder with psychotic symptoms, anxiety disorder, and PTSD. The resident was noted to have moderate cognitive impairment and a history of verbal and physical aggression, requiring substantial assistance with activities of daily living. On the day in question, the Social Services Director (SSD) accompanied the resident to the social security office, where the resident exhibited disruptive behaviors, including yelling and making threats about the facility. Following these behaviors, the SSD withheld the resident's smoke breaks for the remainder of the day as a consequence. Interviews with staff revealed inconsistent understanding and application of residents' rights regarding the withholding of privileges such as smoke breaks. Several staff members, including CNAs, a CMT, and the DON, stated that it was against residents' rights to withhold smoke breaks as punishment, especially for residents who are their own legal decision-makers and do not have a guardian. Some staff believed that smoke breaks could only be withheld if a guardian had given explicit permission, but this was not the case for the resident involved. The DON and other staff confirmed that the resident was his/her own person and that the action taken by the SSD was not appropriate. The facility's policy on residents' rights emphasizes the right to a dignified existence, self-determination, and freedom from interference or reprisal in exercising those rights. The SSD's decision to withhold smoke breaks as a punitive measure was not in accordance with this policy, and staff interviews confirmed that this action was recognized as a violation of the resident's rights. The incident was attributed to a miscommunication and a lack of clarity among staff regarding the proper procedures for managing resident behaviors and upholding resident rights.