Failure to Provide Timely Specialized Rehabilitative Services
Penalty
Summary
A deficiency occurred when a resident with a history of stroke, hemiplegia, and expressive aphasia was not provided with specialized rehabilitative services, including physical therapy (PT), occupational therapy (OT), and speech therapy (ST), as ordered upon admission. The resident's admission records included standing orders for PT, OT, and ST to evaluate and treat as indicated, and her comprehensive MDS assessment and Care Area Assessment (CAA) identified communication and ADL functional/rehabilitation potential as areas of concern. Despite these triggers, the care plan was incomplete and did not address her rehabilitative needs, and no therapy evaluations or screenings were conducted in a timely manner. Interviews with facility staff revealed that the process for initiating therapy services relied on nursing staff to notify therapy of a decline or need, rather than automatically screening all new admissions as required by facility policy. The speech-language pathologist (SLP) and director of rehabilitation (DOR) both stated that they had not been informed by nursing about the resident's communication board or potential need for therapy. The SLP only became aware of the need for a screening after being interviewed by surveyors, and subsequently determined that the resident could benefit from a higher-tech communication device and PT for a right leg contracture. Nursing staff were unclear about the resident's needs and the process for referring residents for therapy, leading to further delays. The resident herself reported difficulty communicating with staff, emotional distress when staff did not take the time to listen, and a desire for help with her speech and right leg. Her family member confirmed her ongoing communication difficulties and recent decline in mobility following a fall. Facility policies required therapy screenings for all new admissions and for residents identified by the interdisciplinary team as needing rehabilitation, but these policies were not followed, resulting in the resident not receiving timely and appropriate rehabilitative services.