Failure to Obtain Legal Representative for Severely Cognitively Impaired Resident
Penalty
Summary
The facility failed to ensure that a resident who was severely cognitively impaired and lacked decision-making capacity had a legal representative to assist with medical decisions. The resident, who had diagnoses including major depressive disorder, schizophrenia, cataracts, and anxiety disorder, was documented in both the Minimum Data Set and History & Physical as being unable to understand or make decisions. Despite this, the facility obtained verbal consent from the resident for psychotropic medication and had the resident sign an Advance Health Care Directive and other documents, with staff acting as witnesses, rather than involving a legal representative. Interviews with staff confirmed that the resident had periods of confusion and limited vision, and that staff were aware of the resident's lack of capacity. The Social Services Assistant acknowledged not knowing the facility's advance directives policy, and the DON confirmed the resident's incapacity. The Medical Director stated that in cases of cognitive decline, a bioethics meeting and possible appointment of a conservator should occur. The facility's policy indicated residents have the right to appoint a legal representative, but this was not followed for the resident in question.