Failure to Honor Residents' Rights to Leave Facility
Penalty
Summary
The facility failed to honor the rights of two residents to leave the facility, as required, by restricting their leave of absence (LOA) privileges through physician orders. One resident, who had diagnoses including type 2 diabetes, infection, pain, weakness, and substance abuse, was assessed as low risk for elopement but had her LOA privileges revoked due to suspected drug and alcohol use. The care plan and physician order specifically indicated that the resident was not allowed to leave the facility, and staff interviews confirmed that the restriction was based on suspicions of substance use and refusal to comply with urinalysis requests. There was no evidence that less restrictive alternatives were considered prior to revoking the resident's right to leave. Another resident, with diagnoses including depression, head laceration, anemia, tobacco use, and alcohol dependence, also had his LOA privileges revoked due to a history of impaired decision-making and risk for self-harm related to chemical dependency. The care plan and physician orders documented the suspension of LOA privileges due to safety concerns. Despite this, written agreements were made between the resident and the administrator to allow limited, supervised outings, which were to be reported to the physician. Staff interviews indicated that the resident had previously engaged in unsafe behaviors and had not returned to the facility on time, leading to the revocation of LOA privileges. Facility policy recognizes residents' rights to leave the facility for therapeutic reasons and outlines procedures for granting and documenting LOA privileges. However, the policy also allows for the revocation of these privileges by the physician. Staff interviews revealed a belief that leaving the facility is a privilege rather than a right, and that the facility's safety policy could override resident rights. There was no documentation or evidence that less restrictive measures were explored before restricting the residents' ability to leave, resulting in a failure to fully honor their rights to self-determination and a dignified existence.