Failure to Provide Individualized Dementia Care and Activity Engagement
Penalty
Summary
The facility failed to provide appropriate treatment and services to a resident diagnosed with dementia, resulting in the resident not attaining or maintaining their highest practicable physical, mental, and psychosocial well-being. The resident, who had severe cognitive impairment, agitation, anxiety, depression, unsteadiness, and generalized muscle weakness, was observed repeatedly sitting inactive in a Broda chair in the lobby, often with empty hands and attempting to pull on his blanket. Despite documented interests in activities such as music, animals, current events, group activities, and going outside, the resident was not actively engaged or offered participation in activities, even when activity staff were present and notifying other residents. The care plans indicated the importance of individualized activities and engagement, but interventions were not consistently implemented or updated to reflect the resident's current needs and preferences. The resident's clinical record showed a history of multiple falls, including one resulting in major injury and hospitalization, and a significant decline in function and activity level. Progress notes indicated the resident was restless, attempted to get up unassisted, and was often unable to be redirected, leading to frequent administration of antianxiety medication and increased sedation. Physical therapy evaluations noted functional decline, muscle atrophy due to inactivity, and adverse effects from medication. Despite these findings, there was no evidence of a coordinated approach to address the resident's restlessness or to provide meaningful engagement tailored to his interests and abilities. Interviews with staff revealed a lack of specialized programming or individualized interventions for dementia care. The Activities Director, new to the facility, expressed a desire to implement more engaging activities for dementia residents but had not yet done so. The DON was unaware of any special measures in place for dementia residents, and the resident's wife and therapy staff both noted that the resident's restlessness and attempts to get up were likely due to boredom rather than anxiety. Facility policy emphasized the importance of person-centered care and activity engagement for residents with dementia, but these practices were not observed or documented in the resident's care.