Failure to Provide Social Services and Advocacy for Advanced Directives
Penalty
Summary
The facility failed to provide medically related social services and to advocate for a cognitively impaired resident regarding the development and documentation of advanced directives. The facility's policy required review and updating of advanced directives upon admission, quarterly, and with any change in condition, with the social services director or designee responsible for documenting conversations and assisting with revisions. Despite these requirements, there was a lack of documented conversations with the resident or their collateral contacts about advanced directives, wishes, or rights, and insufficient assistance was provided in obtaining appropriate legal support for the development of a power of attorney (POA). The resident in question had a history of developmental and intellectual disability, anxiety, depression, and significant urinary tract issues, with cognitive assessments indicating severe impairment at multiple points. The resident's mental status fluctuated, and during periods of decline, they became non-communicative and unable to make informed decisions. Despite these challenges, there was minimal documented engagement by social services with the resident or their contacts regarding the resident's wishes for care, advanced directives, or the POA process. Attempts by a family friend to coordinate POA paperwork and discuss advanced directives were not adequately supported or facilitated by facility staff, and care conferences did not consistently include relevant parties or discussions about the resident's preferences. Interviews with staff and collateral contacts revealed that the resident required significant support to make decisions and that there was confusion and lack of clarity regarding who was responsible for advocating for the resident's wishes. The facility did not ensure that the resident's rights and preferences were thoroughly explored, documented, or honored, as evidenced by the absence of care conference notes addressing advanced directives and the lack of communication with the resident's contacts. This failure to provide comprehensive social services and advocacy placed the resident at risk of not having their rights and wishes respected.