Conflicting Advance Directive Documentation and Lack of Legal Authorization
Penalty
Summary
The facility failed to ensure that a resident's advance directive documentation accurately reflected the resident's wishes regarding life-sustaining treatment. Record review revealed that the resident, who was admitted with severe cognitive impairment and multiple medical diagnoses including dementia and chronic kidney disease, had conflicting information documented regarding their code status. Specifically, two separate acknowledgment forms were signed by a family member—one indicating a Do Not Resuscitate (DNR) order and another indicating a desire for all life-sustaining treatments. Additionally, the family member who signed these documents was not documented as having legal authority as the resident's healthcare Power of Attorney (POA). Further review and interviews confirmed that the facility did not have a healthcare POA on file for the resident, and the family member who signed the forms stated they did not possess POA authority, as the resident was not competent to appoint one. The facility's policy requires that advance directives be honored only if completed prior to a resident being deemed incompetent, and that such directives must be legally valid. The presence of conflicting documentation and lack of a legally authorized decision-maker resulted in unclear and potentially invalid advance directive status for the resident.