Failure to Involve Social Services in Addressing Resident's Refusals of Care
Penalty
Summary
The facility failed to ensure that medically-related social services were provided for a resident who was reviewed for nutrition and demonstrated a pattern of refusing care. The resident, who had intact memory and diagnoses including respiratory failure, reduced mobility, and pressure injuries, was dependent on staff for transfers and was on a diuretic requiring daily weights. Despite a care plan that identified social services staff as responsible for addressing refusals of care, the social services department was not informed of the resident's frequent refusals to be weighed, nor were they involved in problem-solving these refusals. Documentation showed the resident refused daily weights on 18 out of 41 occasions, as well as other treatments such as constipation management and weekly skin assessments. Staff interviews revealed that while nursing staff attempted to discuss risks and benefits with the resident and involved the resident's spouse in signing a Risks vs. Benefits form, the social services staff were unaware of the extent of the refusals and had not been engaged to address the resident's behavioral health needs. The social services coordinator expressed that they could have intervened if they had been informed. This lack of involvement from social services in managing the resident's ongoing refusals of care constituted a failure to provide necessary medically-related social services as required.