Failure to Provide Contracture Management and Follow-Up for Resident
Penalty
Summary
The facility failed to provide appropriate care and services for a resident with a hand contracture. The resident, who had severe Alzheimer's dementia with agitation, was noted to have contracted and painful fingers in the left hand. Staff reported the issue and attempted to contact the primary care physician (PCP) for an occupational therapy (OT) order, but the PCP was unavailable and there was no evidence that the secondary provider was contacted or that follow-up occurred. The care plan did not include a focus area for the hand contracture, and although a rolled washcloth was attempted as an intervention, the resident refused due to pain and no alternative interventions were documented. Further review of the resident's records showed no evidence that an OT evaluation was completed, nor were other interventions or monitoring for complications such as skin breakdown attempted. Minimum Data Set (MDS) assessments indicated that no physical therapy, OT, range of motion (ROM) exercises, or splint/bracing assistance were provided in the relevant periods. Staff interviews confirmed the lack of additional interventions and the absence of a facility policy on contracture management. Observations confirmed the resident's hand remained tightly closed.