Failure to Ensure Proper Guardianship and POAHC Procedures for Cognitively Impaired Resident
Penalty
Summary
The facility failed to provide medically-related social services to ensure a resident achieved the highest practicable level of well-being. A resident with severe cognitive impairments, as evidenced by a Brief Interview for Mental Status (BIMS) score of 6 out of 15 and multiple diagnoses including hemiplegia, schizophrenia, and cognitive communication deficit, was admitted with a court-ordered temporary guardianship. The facility did not ensure that permanent guardianship was established before the expiration of the temporary guardianship, resulting in a lapse in legal decision-making authority for the resident. Following the expiration of the temporary guardianship, facility staff determined that the resident was their own healthcare decision maker and proceeded to complete a Power of Attorney for Health Care (POAHC) document with the resident. However, there was no assessment conducted to confirm the resident's cognitive ability to comprehend and execute the POAHC document, despite the resident's documented severe cognitive impairment. Staff relied on brief interactions and the resident's momentary clarity, but did not perform or document a formal assessment of capacity. Additionally, the staff member who witnessed the resident's signature on the POAHC document was not a certified Social Worker as defined by Wisconsin State Statute, which is a requirement for employees of the facility serving as witnesses to such documents. Both the Social Services Director and Social Services Coordinator lacked the necessary certification, and this was confirmed by the Nursing Home Administrator. The facility did not have documentation to support that the witnessing staff met the legal requirements, nor that the resident's capacity to execute the POAHC was properly evaluated.