Failure to Honor Resident Dignity and Provide Individualized Toileting Assistance
Penalty
Summary
Surveyors found that two residents who were continent of bladder and/or bowel were routinely placed in incontinence briefs and instructed by staff to urinate or defecate in the briefs rather than being assisted to use the toilet or bedpan. One resident, who had moderate cognitive impairment and required assistance for transfers, was not reassessed for toileting after their transfer status improved. Despite being able to verbalize the need to use the bathroom and having the physical ability to transfer with assistance, this resident was denied toileting assistance and told to use the incontinence brief, including during their menstrual cycle. Staff interviews confirmed that the resident was not provided with regular toileting opportunities and that care plans were not updated to reflect the resident's improved abilities. Another resident, with intact cognition and a history of anxiety disorder and morbid obesity, was also continent but was made to wear incontinence briefs for staff convenience. This resident preferred to use a bedpan but was told that if they returned to bed for toileting, they would have to remain there for the rest of the day, limiting their participation in activities. The resident was left in soiled briefs and on urine-soaked lift pads for extended periods, leading to embarrassment and distress. Staff acknowledged that the resident was continent and that the use of incontinence briefs was not appropriate, but cited lack of underwear and staff availability as reasons for this practice. Observations and interviews revealed that both residents experienced psychosocial harm as a result of being denied appropriate toileting assistance and being left in soiled briefs. Staff and clinical leadership, including the Director of Rehabilitation, LPNs, and the Medical Director, confirmed that the residents should not have been told to use incontinence briefs and that this practice was a violation of their dignity and quality of life. The facility failed to update care plans, reassess residents' needs, and provide individualized care, resulting in a lack of respect for resident rights and dignity.