Failure to Accommodate Resident Needs for Bed Mobility and Transfers
Penalty
Summary
The facility failed to reasonably accommodate the needs and preferences of two residents by not providing assist bars or side rails, which were previously used to maximize their independence with transfers and bed mobility. For one resident with chronic obstructive pulmonary disease, spinal issues, and generalized muscle weakness, assist bars had been assessed as beneficial and low risk for entrapment. Despite this, the assist bars were removed following a corporate directive to reduce device use, without consulting therapy or conducting a new individualized assessment. The resident reported increased difficulty with bed mobility and transfers after the removal, and staff interviews confirmed that the resident had previously been independent with these activities when assist bars were in place. Another resident with chronic kidney disease and cervical disc degeneration also had side rails removed, which she had used to reposition herself in bed. The removal was carried out by staff without a documented risk assessment or observation, and the resident was not consistently able to follow directions according to the unit manager. The resident reported that she now required staff assistance to roll in bed, whereas she had previously been mostly independent. Therapy staff indicated that the resident would benefit from side rails to improve her bed mobility, and nurse aides confirmed the resident's increased dependence on staff since the removal of the side rails. The decision to remove assistive devices was based on a corporate directive to use the least restrictive interventions and reduce device use for safety reasons. However, the process did not consistently involve therapy input or individualized assessments prior to device removal. Residents and therapy staff were not always consulted, and documentation of risk assessments was lacking. As a result, residents who had previously demonstrated independence with the use of assistive devices experienced a decline in their ability to perform bed mobility and transfers independently.