Failure to Implement and Document Advance Directive/POA for Resident
Penalty
Summary
The facility failed to follow its advance directive and life-sustaining treatment policy by not ensuring that a power of attorney (POA) was properly implemented for a resident with moderate cognitive impairment and multiple medical conditions, including heart failure, atrial fibrillation, urinary retention, UTI, history of falls, and benign prostatic hyperplasia. Interviews revealed confusion among staff and family members regarding who was designated as the resident's POA. The nurse practitioner reported that the resident's daughter was making decisions, but the daughter questioned why the facility was not contacting the individual who actually held the POA. The social service staff was unsure who the POA was and indicated they would need to ask the administrator. The resident's son-in-law stated he was the POA but was not informed about the resident's condition or decline until after the resident passed away, and noted that the facility always contacted another family member instead. The administrator confirmed that the facility did not have any POA paperwork on file for the resident and that staff had mistakenly documented the son-in-law as the POA. The facility's policy required the social service director or designee to assess, care plan, and implement advance directives within 30 days of admission, but the resident's medical record did not contain documentation designating a POA in writing. This lack of proper documentation and implementation of the advance directive policy resulted in the facility not honoring the resident's right to have a designated representative make decisions on their behalf.