Failure to Maintain Resident Dignity During Assisted Feeding
Penalty
Summary
The deficiency involves the facility’s failure to ensure a resident was assisted with eating in a manner that promoted dignity, as required by resident rights and facility policy. A female resident with Alzheimer’s disease, chronic kidney disease, generalized muscle weakness, dysphagia, cognitive communication deficit, and a need for assistance with personal care was care planned to require total assistance by one staff member for eating. Her quarterly MDS showed a BIMS score of 2, indicating severely impaired cognition, and documented that she required partial/moderate assistance for eating. During a lunch observation, a CNA was seen feeding this resident while standing to the resident’s left side, despite a chair being available behind the CNA. The CNA remained standing until an ADON moved a chair behind her, at which point she sat down a few minutes later. The resident was not interviewable and was observed to be without injury or distress. In interviews, the CNA, ADON, and DON all stated that facility protocol and training required staff to sit at the resident’s level when feeding to maintain dignity, and the ADON additionally cited aspiration prevention and dignity as reasons staff should not stand while feeding. The DON stated that feeding a resident while standing constituted a dignity issue and that, although there was no negative physical outcome or injury, the resident might have felt uncomfortable or rushed. The facility’s written Resident Rights, Dignity and Respect policy stated that all residents must be treated with kindness, dignity, and respect, and that staff must display respect for residents as affirmation of their individuality and dignity.
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