Failure to Provide Necessary Behavioral Health Services for Resident on Psychotropic Medications
Penalty
Summary
The deficiency involves the facility’s failure to provide necessary behavioral health care and services to support a resident’s highest practicable mental and psychosocial well-being. One resident with major depressive disorder, bipolar disorder, generalized anxiety disorder, and schizophrenia was admitted to the facility and was receiving multiple psychotropic medications, including venlafaxine, cariprazine, and fluoxetine for bipolar disorder and major depressive disorder. A quarterly MDS assessment documented that the resident was cognitively intact, had psychiatric/mood disorders including anxiety, depression, and bipolar disorder, and was receiving antipsychotic and antidepressant medications, with self-reported feelings of being down, depressed, or hopeless on several days during the assessment period. Despite these diagnoses and ongoing psychotropic medication use, the facility was unable to provide any documentation of mental health provider visits for this resident since the last recertification survey. The facility assessment indicated that there were no behavioral or mental health providers such as psychiatrists, psychologists, or licensed counselors available, and that mental health and behavior services were instead provided by the attending physician and the social worker. The facility’s provider matrix showed that 16 of 20 residents were prescribed psychotropic medications, yet there was no dedicated mental health provider serving them. The resident reported being unable to recall the last time she spoke with a doctor specifically about her mental health and expressed a desire to talk to a doctor when she began to feel down. Staff interviews further demonstrated that the resident experienced ongoing and worsening hallucinations, including seeing animals and people who were not present, along with episodes of crying. A nurse aide and a nurse both reported that the resident had a history of hallucinations and that staff attempted to calm her by talking and reassurance. The social worker confirmed that the facility did not have a mental health provider, acknowledged that the resident’s hallucinations were worsening, and stated uncertainty about how to engage with the resident during these episodes, although she provided emotional and psychosocial support. The DON and the administrator both confirmed that there was no mental health provider currently seeing residents and that the attending internist physicians were relied upon to manage residents’ mental health needs and medications, with no clear indication of specialized behavioral health services being provided to address the resident’s ongoing symptoms.
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