Failure to Ensure Resident Choice in Discharge Planning
Penalty
Summary
The facility failed to ensure that a resident was provided with choice and self-determination regarding discharge planning. The resident, who had diagnoses including cerebral infarction, non-traumatic intracerebral hemorrhage, aphasia, dysphagia, and memory deficit, was admitted with three daughters named as healthcare POAs. Despite a Brief Interview of Mental Status (BIMS) score indicating intact cognition, a physician letter later stated the resident had cognitive impairment and required assistance with decision making, also mentioning possible financial abuse. Progress notes documented the resident's attempts to change POA paperwork, her request for facility representation during family visits, and her expressed desire for a court-appointed guardian. The resident also stated she did not want two of her daughters involved, citing family conflict. Facility staff reported they would follow POA paperwork and the resident's wishes, but interviews with the DON and Social Services confirmed there was no documented evidence that the resident participated in or agreed to her discharge plan. The timing of the physician letter and the family's request for transfer was noted as suspicious, especially as it followed the resident's request for a court-appointed guardian. Social Services acknowledged that no conversations with the resident regarding her involvement in the discharge process or her agreement to the plan were documented, resulting in a failure to honor the resident's right to self-determination in discharge planning.