Failure to Fully Inform Resident Representative of Care and Treatment Options
Penalty
Summary
The facility failed to fully inform a resident's representative in advance about the care to be provided and available treatment options, resulting in a violation of the resident's and representative's right to be fully informed and to participate in treatment decisions. The resident in question was admitted with multiple complex diagnoses, including severe vascular dementia, spinal stenosis, obstructive sleep apnea, overactive bladder, and major depressive disorder, and was unable to participate in interviews due to cognitive impairment. The representative reported being pressured to sign a Medicare-related form without adequate explanation and was not made aware of the right to appeal the decision to discontinue skilled services. The representative also stated that the facility did not clearly communicate the care plan after admission, leading to confusion about the resident's eligibility for skilled therapy versus long-term care. Interviews revealed that the admissions coordinator confirmed the form in question was a Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNF ABN), which should have been explained by a licensed nurse. However, the representative felt coerced and was denied a copy of the signed form when requested. The representative made multiple attempts to seek clarification in person but was turned away without answers. Documentation showed that the representative's concerns were not addressed, and a grievance was not logged or followed up on, despite the admissions coordinator offering to file one. Further review indicated that the facility's grievance officer only contacted the family after being prompted by the surveyor and had not previously noticed the complaint due to a preference for in-person notifications. The facility's own resident rights documentation states that residents and their representatives have the right to be fully informed of available services, charges, and to participate in care planning and treatment decisions. These rights were not upheld in this instance, as evidenced by the lack of communication, failure to provide necessary information, and inadequate grievance handling.