Failure to Individualize Dementia Care Plans for Residents with Aggressive Behaviors
Penalty
Summary
The facility failed to ensure that residents diagnosed with dementia received appropriate treatment and services to maintain their highest practicable physical, mental, and psychosocial well-being. Specifically, two residents with dementia and behavioral disturbances did not have individualized care plans with interventions to address their verbal and physically aggressive behaviors. For one resident with severe cognitive impairment and a history of behaviors such as kicking, hitting, biting, abusive language, and threatening actions, there was no documented evidence that the care plan was reviewed or revised to include specific approaches for managing these behaviors, despite multiple documented incidents and a physician order requiring behavior notes and interventions each shift. Another resident, diagnosed with Alzheimer's disease and schizoaffective disorder, also exhibited verbal and physical aggression, as well as rejection of care. Although this resident had a general cognitive/dementia care plan, it did not include individualized interventions to address the aggressive behaviors. Multiple behavior incidents were documented in nursing notes, and a physician order was in place for behavior documentation and intervention, but the care plan was not updated to reflect these needs. Interviews with the Director of Nursing revealed that care plans are expected to be initiated and updated by the appropriate discipline, and that staff documentation should prompt the initiation of behavior management care plans. However, the Director of Nursing was unable to explain why behavior care plans were not initiated or updated for these residents, even after incidents of aggression and abuse were reported and documented.