Failure to Develop Individualized Behavioral Health Strategies for Agitated Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide necessary and individualized behavioral health care and services for a resident with dementia and behavioral disturbances, particularly related to agitation and a desire to go home. The resident had diagnoses of cerebral infarction and unspecified dementia with behavioral disturbances, with MDS documentation of moderate cognitive impairment and daily use of a wander/elopement alarm. Care plans identified the resident as an elopement risk with impaired safety awareness, memory impairment, potential wandering, exit seeking to go home, and multiple behavior problems including hoarding, yelling, verbal abuse, twisting staff wording, fabricating stories, and rejection of care. Interventions listed included distraction with pleasant diversions, structured activities, food, conversation, television, books, cueing and reorientation, consistent routines and caregivers, use of a wander guard, administering medications, anticipating and meeting needs, and assisting the resident to develop more appropriate coping methods. However, the care plans lacked specific strategies on how staff were to engage the resident when anxious, what coping methods were actually successful, what activities were most effective, and what level of supervision was necessary to maintain safety. Surveyor observations and staff interviews further demonstrated the lack of individualized behavioral health strategies. The resident’s private room contained limited personal belongings or activities despite the resident stating she loved to read, enjoyed activities, wanted to return home, and felt she did not need facility care. The resident reported having nothing to do in the room. An RN acknowledged that care plan revisions had not been completed since an elopement incident and was not aware of staff using interventions beyond those listed in the care plan, though she noted the resident attended activities that could be helpful when agitated. An LPN described using pictures of babies and talking about motherhood to distract the resident when agitated, but this intervention was not included in the care plan and was not consistently effective. The social worker, who developed the behavioral portion of the care plan, stated she did not find it necessary to revise it and believed there was nothing more to personalize, despite acknowledging the resident was an avid reader, had only a couple of books in the room, and that the facility had not worked with the family to update the care plan or explore bringing in more familiar items from home. This was inconsistent with the facility’s own policy requiring person-centered care plans based on careful data gathering and individualized interventions addressing underlying causes rather than just symptoms.
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