Failure to Monitor and Manage Escalating Dementia-Related Behaviors
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate supervision, documentation, and individualized interventions for a resident with severe cognitive impairment and Alzheimer’s disease with early onset, who exhibited escalating behavioral symptoms. The resident’s MDS showed severe cognitive impairment and diagnoses including Alzheimer’s disease and non-traumatic brain dysfunction, with the ability to ambulate with supervision and a history of physical behaviors toward others. Existing care plans documented verbal behaviors such as yelling and cursing, physical aggression toward staff and others related to delusional beliefs that others were in her home, and delusions and hallucinations, with interventions such as allowing the resident to calm, having other staff approach, offering snacks or beverages for redirection, speaking in a calm manner, and removing the resident from situations as needed. Progress notes documented specific incidents, including the resident striking a staff member and becoming aggressive with another resident, yelling and grabbing the other resident and being difficult to redirect. Staff interviews revealed that the resident’s aggression had increased over the prior months, with reports that she had become more physically aggressive with other residents, including randomly hitting or smacking them as she walked by, screaming in another resident’s face, and shoving a resident’s shoulder. Staff described trying to watch the resident at all times and attempting to keep her busy, but reported that these efforts were not consistently effective. There was confusion and inconsistency regarding behavior documentation, with some staff believing behaviors should be charted in progress notes and others in behavior notes, and the Unit Manager stating CNAs could not chart behaviors. The Social Services Director reported there were no behavior sheets completed for this resident and that she was only aware of behaviors documented by nurses in progress notes, despite additional staff reports of resident-to-resident aggression and an earlier altercation. This pattern of incomplete behavior monitoring and lack of systematic reporting and adjustment of interventions occurred despite a facility dementia protocol requiring progressive or persistent worsening of symptoms and increased need for staff support to be reported to the IDT so that interventions and the overall plan could be adjusted.
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