Failure to Provide Advance Directive Information and Education
Penalty
Summary
The facility failed to provide written information and education regarding advance directives to residents and their representatives, as required. Record reviews for 19 out of 22 residents revealed that there was no documentation indicating that residents or their representatives were given information about advance directives or offered the opportunity to formulate one. This deficiency was identified regardless of the residents' code status, which included both full code and do not resuscitate (DNR) orders, and spanned a range of medical conditions such as heart failure, diabetes, hypertension, chronic kidney disease, dementia, and others. Interviews with facility staff further confirmed the lack of compliance with advance directive requirements. The Admissions Director stated that while a blank template for advance directives was available, it was not routinely discussed with residents or their representatives during the admission process. Instead, the Admissions Director only reviewed existing advance directives from the hospital if provided and verified code status from the discharge summary. There was no process in place to ensure that all residents were educated about or given the opportunity to create an advance directive upon admission. The Social Services Director acknowledged only recently becoming aware that providing advance directive education was her responsibility. The Administrator also confirmed that the need for advance directive education had not been previously identified and that it had been missed. The responsibility for ensuring advance directive discussions and documentation was assigned to the Social Services Director, but this process was not being followed at the time of the survey.