Failure to Honor Resident Refusals and Grooming Preferences
Penalty
Summary
The facility failed to honor a resident’s rights to dignity, self-determination, and personal preferences regarding hygiene and grooming. Facility policy required that residents be groomed as they wished, including maintaining preferred hair style and length. The resident involved had chronic pain syndrome, major depressive disorder, and anxiety, and her MDS showed she was alert, oriented, reported feeling down or hopeless several days per week, and was dependent on staff for personal hygiene. Her care plan indicated she often refused care due to personal preference, that staff were to postpone activities if refused, and that it was important for her to choose between a shower or bed bath. Despite this, the nurse aide Kardex directed staff to provide bed baths twice weekly, and documentation showed that staff provided a shower instead of a bed bath on a specific date. During interviews, the resident stated she did not want to go for a shower but staff took her anyway, and that staff cut her hair with an electric razor despite her repeated refusals. She was observed in bed with visibly short, uneven hair, rubbing her hand over her head and moving her head from side to side, and reported that staff had shaved her head, removed her ponytail, and made her feel like a prisoner. A nurse aide reported that the DON instructed her to cut the resident’s hair and that the resident screamed “no” until after the hair was cut, then became silent. Two other nurse aides confirmed the resident had refused a shower but was given one regardless. The DON confirmed she told staff to cut the resident’s hair, acknowledged that the resident objected and “freaked out,” and confirmed that scissors and an electric razor were used and no other options were discussed or attempted. The resident’s roommate reported that after staff cut the resident’s hair, the resident was in the room crying.
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