Failure to Maintain Resident Dignity in Use of Behavior Contract
Penalty
Summary
The facility failed to ensure that care was provided in a manner that maintained or enhanced the dignity of a resident, specifically by using a behavior contract in a way that was perceived as a threat. The resident in question, who was cognitively intact but dependent on staff for several activities of daily living due to a history of stroke with left-sided paralysis and aphasia, expressed concern about being removed from the facility. During interviews, the resident repeatedly asked if he was in trouble and referenced a fear of being discharged, indicating anxiety related to the behavior contract and its implications. Review of the resident's care plan and behavior contract revealed that the contract, initially set with a specific goal date, remained in place beyond that date without updates. Documentation showed that after an incident where the resident expressed frustration over waiting for assistance, staff reminded him of the behavior contract and stated that another aggressive episode could result in consideration of transfer to another facility. This interaction contributed to the resident's ongoing concern about his status and potential discharge. Staff interviews confirmed that the resident was the only one in the facility with a behavior contract and that there was a lack of clarity regarding the contract's current status and purpose. The social services director and MDS coordinator were unaware of the resident's uncertainty about the contract and the previous communication that linked contract violations to possible discharge. The behavior contract was not updated as intended, and the resident was not adequately informed about his standing, leading to a failure to support his right to a dignified existence and self-determination.