Verbal Abuse of Cognitively Impaired Resident by CNA During Personal Care
Penalty
Summary
The facility failed to protect a resident from verbal abuse by a CNA during in-room care. The resident was an elderly male with dementia, aphasia, overactive bladder, urinary incontinence, and a need for assistance with personal care, and his MDS showed severely impaired cognitive skills for daily decision-making. On the morning in question, a social worker (SW A) was entering her office when she overheard a staff member down the hall say, "You're being a complete [expletive]." SW A then entered the resident’s room and found one CNA (CNA B) bagging trash and observed another CNA (CNA/Perpetrator E) quickly leaving the room. When SW A informed CNA B of what she had overheard, CNA B indicated that CNA/Perpetrator E had made the statement toward the resident. In a later interview, CNA B reported that she had been assisting the resident with a brief change and, although the resident was known to be combative at times, he was initially in a good mood and cooperative. When CNA B could not complete fastening the brief alone, she called CNA/Perpetrator E for help and believed the loud tone and speed of CNA/Perpetrator E’s work may have upset the resident. The resident then stood up, removed his brief, and moved toward the door; CNA B attempted to redirect him by closing the curtain, during which he nudged her and laid hands on CNA/Perpetrator E. CNA B stated the resident eventually lay back down and made a rude remark under his breath, prompting CNA/Perpetrator E to say, "You're being a complete [expletive]." In a separate interview, CNA/Perpetrator E confirmed that after the resident had twisted her wrist and arm, attempted to push CNA B, and later kicked her in the back as she turned to leave, she called him an "[expletive]" while still in the room and acknowledged he probably heard her. The facility’s abuse policy defines verbal abuse as willful use of disparaging or derogatory language within a resident’s hearing, regardless of their ability to comprehend, and the incident was substantiated as mental abuse causing psychosocial harm and mental anguish based on a reasonable person standard.
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