Failure to Assist Residents with Advance Directive Formulation
Penalty
Summary
The facility failed to ensure that residents and their representatives received assistance to exercise their right to formulate an Advance Directive. For three residents reviewed, documentation showed that while each had a POST (Physician Orders for Scope of Treatment) form on file, there was no evidence that information about Advance Directives was provided or that discussions regarding Advance Directives took place as required. In each case, the admission documentation indicated the resident did not wish to create an Advance Directive at that time, but there was no follow-up or further documentation regarding their wishes or any subsequent discussion. Staff interviews revealed that social services staff misunderstood the difference between a POST and an Advance Directive, believing them to be the same. As a result, they did not follow up with the residents or their representatives about formulating an Advance Directive, nor did they document any such discussions. This lack of action and documentation was consistent across the three residents, each of whom had significant medical conditions such as stroke, diabetes, chronic respiratory failure, chronic pain, cerebral infarction, and dementia.