Failure to Support Resident Self-Determination in Consent Process
Penalty
Summary
A deficiency occurred when the facility failed to promote and facilitate a resident's right to self-determination regarding the signing of multiple consents upon admission. The resident was admitted with diagnoses including prostate cancer with metastasis to the bone and brain and was listed as his own responsible party. Documentation showed conflicting cognitive assessments: a speech therapy evaluation recorded a BIMS score of 14/15 (normal cognition), while a subsequent BIMS by a social worker and the admission MDS both recorded a score of 10/15 (moderate impairment). Despite the initial indication of cognitive intactness, the facility allowed a friend (not a legal representative) and staff to sign various consent forms, including those for CPR/DNR, treatment, care management, and vaccinations, rather than obtaining the resident's own signature. Staff interviews revealed that the admitting nurse did not obtain the required consents, and another nurse completed them later, relying on the lower BIMS score to justify not seeking the resident's signature. The nurse was unaware of the higher BIMS score documented by speech therapy and stated that she was told the friend was the resident's brother, which was later found to be untrue. The facility's failure to verify the resident's cognitive status and responsible party status led to the omission of the resident's participation in consent decisions, thereby not supporting the resident's right to self-determination.