Failure to Provide Support for Advance Directive Completion
Penalty
Summary
The facility failed to ensure that a resident was provided with an opportunity to create a Power of Attorney (POA) document or designate an alternate decision maker in the event of incapacity, as required by facility policy and the Patient Self Determination Act. Upon admission, the resident, who had multiple complex medical diagnoses including spina bifida, paraplegia, and a stage 4 pressure ulcer, was not offered adequate support to complete a POA document despite expressing discomfort with making healthcare decisions and being unable to read or write. The resident reported that a previous POA designation had been revoked by Adult Protective Services (APS) and expressed a desire for a new POA or Guardian to assist with decision-making. Staff interviews revealed that the social worker was unaware of the resident's illiteracy and was uncertain about the existence of a current POA document. Attempts to obtain information from APS were unsuccessful, and APS confirmed that the resident was their own decision maker and entitled to complete a new POA if desired. Despite the resident's request and the facility's policy to discuss and verify advanced care planning upon admission and at care conferences, no further action was taken by the facility to assist the resident in completing a new POA document.