Failure to Hold Interdisciplinary Quarterly Care Conferences
Penalty
Summary
The facility failed to ensure that residents received quarterly care conferences attended by members of the interdisciplinary team (IDT), as required. For three residents reviewed, care conferences were either not held quarterly or, when held, did not include participation from the full IDT. In one case, a resident with multiple diagnoses including hemiplegia, diabetes, and heart failure had only a single care conference documented with the social worker present and no other IDT members. In another instance, a resident with cognitive intactness and multiple psychiatric and neurological diagnoses had not had a documented care conference since the previous year, and while the social worker communicated with the resident's guardian, these interactions were not documented as care conferences nor did they include the IDT. For a third resident with chronic illnesses and moderate cognitive impairment, the last care conference was conducted by phone between the social worker and the legal representative, without the resident or other IDT members present. Interviews with the social worker confirmed that quarterly care conferences were not consistently held and that the IDT was not routinely involved. The social worker cited reasons such as the resident's cognitive status, lack of response from other team members, and challenges in reaching legal representatives. Facility policy indicated that residents and their representatives should be encouraged to participate in the care planning process and be given advance notice of care conferences, but this was not consistently followed for the residents reviewed.