Failure to Educate and Offer Advance Directives to Residents
Penalty
Summary
The facility failed to ensure that two of three residents reviewed for advance directives were properly educated and given the opportunity to formulate an advance directive for their healthcare wishes. In the case of one resident with a history of cerebral ischemia and aphasia, documentation showed that although the resident was able to communicate and expressed a preference for a specific family member to make decisions on his behalf, there was no evidence that the facility had a meaningful conversation with him about advance directives or code status. The clinical record lacked documentation of an advance directive, and the process for determining decision-making capacity and pursuing guardianship was inconsistently documented and communicated among staff, the resident, and his family. Staff interviews revealed confusion about the resident's capacity and the steps taken to establish a legal guardian, with conflicting statements about whether the resident was able to make his own decisions and whether his son had been designated as DPOA. For another resident with diagnoses including hemiplegia, hemiparesis, and anxiety disorder, and who was noted to have intact cognition, there was no documentation in the medical record that the resident had been educated about or offered the opportunity to formulate an advance directive. Staff interviews confirmed that the process for educating and offering advance directives was inconsistently applied, with the Director of Social Work stating that not all residents received this conversation, particularly those with short stays. The Director of Nursing also indicated that while nurses asked about existing advance directives on admission, they did not provide education on the topic. Facility policy required that all competent adult residents be provided information on advance directives at admission or shortly thereafter, and that this be documented in the social services progress notes. However, the records for both residents lacked this required documentation, and staff interviews confirmed that the policy was not consistently followed. There was also a lack of clear communication and documentation regarding the roles and responsibilities of staff in the advance directive process, as well as the steps taken when a resident was deemed unable to make medical decisions.