Failure to Properly Execute Advance Directives for Residents Lacking Capacity
Penalty
Summary
The facility failed to ensure that advance directive forms were properly executed by residents or their legally authorized representatives for six residents with severe cognitive impairment. In multiple cases, residents with diagnoses such as dementia, schizoaffective disorder, and other mental health conditions were found to lack the capacity to make informed decisions, as documented in their medical records, Minimum Data Set (MDS) assessments, and History and Physical (H&P) notes. Despite this, advance directive forms were either left unsigned by the resident or, in some instances, were signed by the facility's social worker instead of the resident or a legally authorized representative. Interviews with facility staff, including the Social Services Director and the Director of Nursing, confirmed that the process for obtaining and documenting advance directives was not followed appropriately. Staff acknowledged that residents with severe cognitive impairment should not have been asked to sign these forms and that responsible parties or legal representatives should have been involved. In some cases, the facility did not reoffer the advance directive after admission, and there was no evidence that public guardianship was pursued for residents unable to make decisions and without family involvement. The facility's policies and job descriptions require that residents or their representatives be provided with written information about advance directives and that the process be overseen by the Social Services Director. However, documentation and interviews revealed that these requirements were not met, resulting in incomplete or improperly executed advance directive forms for residents who lacked decision-making capacity.