Failure to Involve POA in Financial Decision-Making for Cognitively Impaired Resident
Penalty
Summary
The deficiency involves the facility’s failure to allow a resident’s representative/POA to assist a cognitively impaired resident with decision-making regarding a significant financial decision related to Medicaid eligibility. The resident had a BIMS score of 10, indicating moderate cognitive impairment, and progress notes over several days documented that he was alert only to person (and sometimes place) and was confused and forgetful. The Social Services Director (SSD) worked directly with the resident on a Medicaid application and identified a final expense life insurance policy with a cash value of approximately $3,277.81 and a face value of $15,000, which the SSD believed would likely need to be cashed out to reduce the resident’s resources below $2,000. The SSD documented that the resident was okay with cashing out the policy if the POA agreed, and emailed the POA explaining that the resident needed to be below $2,000 in assets and that she could assist the resident with this. The POA questioned what was meant by “cashing out” the policy and indicated she needed to handle this herself, later stating she told the SSD to wait until she could contact the insurance company. Despite this, an insurance company form requesting cash surrender value was completed with the resident’s signature and the SSD as witness. The clinical record did not contain documentation of the resident’s cognitive status at the time he signed the cash surrender form, and the SSD acknowledged she had no documentation of dates or times of her discussions with the POA. The POA later reported that the resident did not want to cancel his life insurance policy, that his mental status had declined and he was not in a condition to make that decision, and that she learned from the insurance company that the policy had been cancelled. The SSD also stated she was not aware of other available options for handling the life insurance policy in the Medicaid spend-down process.
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