Failure to Provide Adequate Meal Assistance for Resident with Parkinson's Disease
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs), specifically meal assistance, to a resident diagnosed with Parkinson's disease, anxiety, OCD, and depression. Although the resident was assessed as cognitively intact and independent with eating on the most recent MDS, direct observations revealed significant difficulty with eating due to persistent hand tremors. The resident struggled to cut food and consume beverages, often losing food or being unable to eat without help. On multiple occasions, the resident attempted to get staff assistance but did not receive timely help, and at times, another resident had to intervene to assist with cutting food. Interviews with the resident confirmed that he was supposed to receive help with eating due to his tremors but only received assistance if he specifically asked, and even then, help was not always provided. The resident reported that adaptive utensils were not effective when his tremors were severe, and he often had trouble getting staff attention during meals. Staff interviews indicated a belief that the resident only needed help when requested, but observations contradicted this, showing that staff did not consistently provide the necessary assistance even when the resident attempted to ask for help. A review of the care plan and interdisciplinary team notes revealed that while the resident was at risk for decreased nutritional status and had experienced unplanned weight loss, the care plan did not specify the need for meal assistance such as cutting food. The root cause analysis identified the resident's tremors as a likely cause of weight loss due to incomplete meal consumption. Despite this, there was no referral for therapy evaluation or adjustment to the diet order to provide pre-cut meals, and the registered dietitian had not observed the resident eating or considered additional interventions to facilitate meal intake.