Failure to Uphold Resident’s Healthcare Decision-Making Rights
Penalty
Summary
The facility failed to ensure a resident’s right to make healthcare decisions was upheld when the resident’s Power of Attorney for Healthcare (POAHC) had not been activated, yet the designated POAHC agent signed multiple medical and admission documents. The resident was admitted with diagnoses including encounter for palliative care, severe protein calorie malnutrition, malignant neoplasm of the bladder, and type 2 diabetes, and had a BIMS score of 6/15 indicating severely impaired cognition. The medical record contained a POAHC document listing the POAHC-F as the number 2 agent, but the resident had not been deemed incapacitated upon admission and remained their own decision maker throughout the stay. Despite this, the record showed that POAHC-F signed an influenza vaccination consent, a COVID-19 vaccination declination, Do Not Resuscitate (DNR) paperwork, and admission paperwork. During interviews, the Social Worker confirmed that the POAHC was never activated during the resident’s stay and acknowledged that there was only discussion of activating it prior to the resident’s death. The Social Worker stated that the resident had difficulty signing documents, so POAHC-F signed on the resident’s behalf. The Nursing Home Administrator also confirmed that the POAHC was not activated while the resident was in the facility and that POAHC-F signed a hospice agreement for the resident. Both staff members confirmed that the facility lacked documentation showing that the resident had agreed to allow POAHC-F to sign documents on their behalf, resulting in the resident’s healthcare decisions being executed without documented consent or an activated POAHC.
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