Failure to Provide and Review Advance Directives for Multiple Residents
Penalty
Summary
The facility failed to provide residents with the opportunity to formulate an advance directive or to conduct periodic reviews of existing advance directives as part of the comprehensive care planning process. This deficiency was identified for four out of eight residents reviewed. For each of these residents, a review of their clinical records did not show evidence that the facility had offered the chance to create an advance directive or had periodically reviewed the residents' care instructions and whether the residents or their designated surrogates wished to change or continue these instructions. The affected residents had various medical conditions, including heart failure, depression, anxiety, cerebrovascular disease, hypothyroidism, aphasia, skin cancer, osteoarthritis, and Alzheimer's disease. Cognitive assessments such as the Brief Interview for Mental Status (BIMS) indicated varying levels of cognitive impairment among these residents, with some being moderately to severely impaired. Despite these conditions, there was no documentation in the clinical records to show that the facility had addressed advance directives in accordance with its policy and regulatory requirements. The Nursing Home Administrator confirmed this failure during an interview.