Inaccessible Resident Bathrooms Resulting in Loss of Dignity During Toileting
Penalty
Summary
The deficiency involves the facility’s failure to treat a resident with respect and dignity and to provide care in an environment that promoted maintenance or enhancement of quality of life, specifically by not providing an accessible toilet in the resident’s room. The resident was admitted with Alzheimer’s disease, psychotic disorder with delusions due to a known physiological condition, anxiety disorder due to a known physiological condition, and major depressive disorder. A quarterly MDS showed a BIMS score of 12/15, indicating moderate cognitive impairment, frequent bowel and bladder incontinence, and a need for setup or clean assistance with toileting. Her care plan documented moderate cognitive impairment and a need for supervision with toileting. During observation, the bathroom door in her room was found screwed shut and nonfunctional. The resident reported she could not use the toilet in her own bathroom because it was locked, resulting in accidents when she could not reach another bathroom in time. She stated she felt “yucky” and embarrassed when she had accidents and did not like having to use a different bathroom. Staff interviews revealed that four bathrooms in the secured women’s unit had doors screwed shut after a contractor began but did not complete shower remodeling, and that these bathrooms had been inaccessible since around July or August of the prior year. CNAs reported that the resident was redirected to use toilets in other resident rooms, the shower room, or a bathroom across from the shower room, which were located down the hall, and that affected residents disliked going to these distant areas, especially at night when it was cold. A CNA described an incident where she was leading the resident to the room next door to use the toilet, but the resident did not make it in time and urinated on the floor, became very upset, and started crying. The CNA stated that the resident and other affected residents complained frequently about the bathroom situation, and that some residents questioned why others were entering their rooms. The resident’s family member reported that the resident could not remember which bathrooms were designated for her use and had to be led by CNAs. The family member also described an episode where the resident urinated on the floor in another room, cried frantically with tears falling down her face, and said, “I feel ashamed.” Facility leadership, including the ADON, ADM, DON, and maintenance staff, acknowledged that four bathroom doors in the women’s secured unit were screwed shut for months, that residents from those rooms were directed to use other residents’ bathrooms or common bathrooms, and that this was an inconvenience, a privacy issue, and, if it led to accidents, a dignity issue for the residents.
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