Neglect of Resident with Mental Health Needs and Refusal of Care
Penalty
Summary
A resident with a history of schizophrenia, depression, and back pain was admitted to the facility with significant mental health needs and a self-care deficit. The resident consistently refused assessments, hygiene care, and interventions from staff since admission, including skin checks and bathing. Despite being identified as at risk for skin breakdown, malnutrition, and having altered mobility, the resident's refusals were documented, and staff reported ongoing concerns about her hygiene, malodor, and declining condition. The care plan included interventions such as regular skin assessments, turning and repositioning, and nutritional support, but these were not effectively implemented due to the resident's persistent refusals. Over a period of several weeks, the resident's condition deteriorated. Staff, including nurses and providers, noted malodor, suspected wounds, and poor hygiene, but were unable to perform thorough assessments or provide adequate care due to the resident's lack of cooperation. The resident remained mostly in bed, was unkempt, and had poor oral hygiene. Despite these observations and the resident's ongoing refusal of care, the facility did not escalate her care to a higher level or seek alternative interventions to address her worsening condition. Communication among staff, providers, and the interdisciplinary team acknowledged the refusals, but no decisive action was taken to ensure the resident's safety and well-being. The situation culminated when the resident called EMS due to dizziness, vomiting, and inability to move her lower extremities. Upon EMS arrival, the resident was found adhered to her mattress, covered in urine and feces, and in a severely neglected state. Hospital admission revealed malnutrition, maggots in the groin area, an embedded bra hook causing deep tissue injury, multiple pressure ulcers ranging from stage one to stage four, and significant skin tears. The facility and its staff were aware of the resident's refusals and deteriorating condition but failed to provide necessary care or transfer her to a higher level of care, resulting in a finding of neglect.
Removal Plan
- Completed a full house skin check audit.
- If a resident had refused, a skin check was done.
- Audited all care plans for refusing skin checks.
- Updated target behavior orders to include a section regarding refusal of cares, showers, and skin checks.
- Clinical team attends ACP meetings to discuss concerning behaviors and update care plans.
- Morning meeting agenda includes a section for refusal of care.
- In case of refusal staff updates the individual department team meetings, schedules care conference, does a behavior contract or other individual specific interventions.