Failure to Honor Resident's Smoking Preferences and Choices
Penalty
Summary
The facility failed to honor a resident's right to make choices about his daily routine and preferences, specifically regarding his request for additional smoke breaks. The resident, who had a history of chronic obstructive pulmonary disease (COPD), alcohol abuse, hypertension, bipolar disorder, and depression, was assessed as having the capacity to make medical decisions and was noted to have moderately impaired cognition. His care plan documented his enjoyment of smoke breaks and indicated that staff should respect his preferences and rights. Despite these documented preferences, the resident reported that he was only permitted to participate in two scheduled smoke breaks per day, although he preferred at least one additional break in the evening. The resident stated that his requests for an extra smoke break were repeatedly ignored by nursing staff, and when he asked the Activities Department, they deferred the request to the Social Services Director without follow-up. Staff interviews confirmed that additional smoke breaks required approval and that residents often became anxious when not allowed to smoke as desired. It was also noted that the facility previously allowed an additional evening smoke break, which had a calming effect on residents. The Director of Nursing acknowledged that residents could be accommodated for additional smoke breaks to honor their preferences and that arrangements could be made as long as safety was maintained. The facility's policy on dignity emphasized supporting resident choices and preferences, yet the resident's requests were not consistently communicated or honored, resulting in the resident feeling ignored and his choices unmet.