Failure to Honor Resident's Right to Self-Determination and Outdoor Access
Penalty
Summary
The facility failed to honor a resident's right to self-determination and a dignified existence by not allowing an alert and oriented resident to leave the facility at will. The resident, who had diagnoses including dementia, sensorineural hearing loss, anxiety, and depression, was assessed as alert and oriented with a BIMS score of 15/15 and was able to communicate daily needs using a communication board. The care plan and physician orders permitted the resident to go on leave of absence with medications and a responsible party, and the resident was not considered at risk for elopement. Despite this, after an incident where the resident attempted to board a city bus, the court-appointed conservator revoked outdoor privileges, and facility staff subsequently restricted the resident from going outside, even though the resident had previously been allowed to do so to feed birds and had not attempted to leave the premises before. Facility documentation and interviews confirmed that staff, including the DON and social worker, enforced the conservator's directive to restrict the resident from going outside, despite acknowledging the resident's rights and alert status. The restriction led to increased agitation and aggressive behaviors from the resident, culminating in a physical altercation and transfer to the hospital. The facility did not update the resident's care plan or conduct a new elopement and wandering assessment after the change in outdoor privileges. The facility's own policy states that residents have the right to make choices about their activities and participate in community life both inside and outside the facility, but this was not upheld in this case.