Resident's Right to Refuse Shower Not Honored
Penalty
Summary
A deficiency occurred when a resident with severe cognitive impairment, chronic obstructive pulmonary disease (COPD), Alzheimer's disease, chronic pain syndrome, and anxiety disorder was not treated with respect and dignity regarding her right to refuse care. On the evening in question, the resident verbally refused a shower multiple times, stating she was cold and did not want a shower. Despite her refusals, a CNA physically lifted her from the bed by her armpits, placed her in a shower chair, and, with the assistance of another CNA, proceeded to shower her. The resident continued to express her refusal and distress throughout the process, including stating she would contact her attorney and the police. The resident's care plan specifically included interventions to immediately stop if she refused a shower, and to avoid touching her if she was escalated, unless necessary for safety. Multiple interviews and record reviews confirmed that the resident was able to communicate her wishes and had the capacity to make informed decisions. Staff statements and documentation indicated that the CNAs were aware of the resident's right to refuse a shower and the facility's policy for handling refusals, which included notifying a nurse and completing a refusal form. However, the CNA disregarded these protocols, insisting the resident would feel better after a shower and proceeding without her consent. The incident was corroborated by the resident's roommate, who overheard the exchange, and by subsequent interviews with other staff members who acknowledged that forcing a resident to shower against their will was a violation of resident rights. The event resulted in the resident feeling angry and distraught, as documented in her statements to staff, the social worker, and a psychologist. The resident reported the incident to her nurse, family, and external parties. Progress notes and interviews indicated that the resident had no physical injuries directly attributed to the incident, but she experienced significant emotional distress. The facility's policies on resident rights and bathing clearly outlined the necessity of honoring resident preferences and refusals, but these were not followed in this instance, leading to the identified deficiency.