Failure to Provide Recommended Occupational Therapy and Hand Orthotic for Resident on Hospice
Penalty
Summary
The facility failed to provide continued Occupational Therapy (OT) services as recommended for a resident with significant upper extremity impairment and severe cognitive impairment. The resident, who had diagnoses including Parkinsonism, a stage 4 pressure ulcer, and malnutrition, was dependent on staff for all activities of daily living and had a clenched left hand with limited range of motion. Observations over multiple days confirmed that no hand orthotic or splinting device was in use, despite recommendations from the OT and Nurse Practitioner for splinting to address the resident's hand positioning and stiffness. Documentation showed that the resident was referred to OT for assessment and splinting due to increased tightness and limited range of motion in the left hand. The OT evaluation confirmed the need for splinting and recommended continued OT services. However, after the resident was admitted to hospice care, OT services were discontinued, and the care plan did not include any interventions for hand orthotics or therapy. Interviews with staff revealed a lack of awareness and follow-through regarding the OT recommendations, with both the Director of Rehab and the DON acknowledging that coordination with hospice and implementation of therapy recommendations did not occur as required. The facility's policy required therapy services to be scheduled and coordinated according to the resident's treatment plan, with nursing responsible for implementing therapy recommendations. Despite these requirements, the resident did not receive the recommended OT services or hand orthotic, and there was no documentation or evidence of a care plan addressing these needs during the survey period.