Failure to Protect Resident From Mental and Emotional Abuse by Caregiver
Penalty
Summary
The deficiency involves the facility’s failure to protect a resident from mental and emotional abuse by his visitor/caregiver. The resident was admitted with multiple diagnoses including neuromuscular dysfunction of the bladder, protein calorie malnutrition, dysphagia, and congestive heart failure, and had a BIMS score indicating moderate cognitive impairment. An order documented that the resident did not have capacity to make decisions, and the visitor/caregiver was identified as the responsible party and healthcare decision maker. On one occasion, the resident’s roommate reported to a CNA that the responsible party was physically abusing the resident. When a licensed nurse spoke with the resident, he laughed and said they were just fooling around. Another CNA reported that the responsible party became violent after discovering that a pair of scissors had been removed from the resident’s drawer, kicking the wall and the bedside drawer. Subsequent documentation and interviews described a pattern of verbally and physically aggressive behavior by the caregiver in the resident’s room. A nurse’s note indicated that a Report of Suspected Dependent Adult/Elder Abuse was completed for alleged verbal abuse, and the resident stated that the caregiver had never been physical but did yell and was an angry person. A social worker’s note documented that the caregiver denied physical abuse but admitted to verbal abuse toward the resident, describing frequent arguments and profanity as normal between them. The resident also told the social worker that he did not view their interactions as abuse, although the social worker explained that such conduct in this setting is considered abuse when witnessed as verbally or physically abusive toward a resident. Interviews with staff and the roommate further detailed the caregiver’s conduct. The resident reported that the caregiver became angry when shaving cream was missing, yelled, and slammed the door. The roommate, who also had moderate cognitive impairment, stated that the caregiver had anger issues, yelled when the resident did not do things right or fast enough, pounded on the wall, threw a cup of water at the resident but missed, and slammed the bedside table, and that he was worried about the resident. A CNA described an incident where the caregiver became angry about a missing razor, talked loudly, kicked the closet door and trash can, and appeared to be losing control, which the CNA viewed as potential abuse. The licensed nurse who received the report from the CNA did not recognize the incident as abuse because the resident did not indicate he was being abused and the roommate was considered not always reliable, and she only documented the incident in the chart. These actions and inactions occurred despite a facility abuse prohibition policy that defines abuse to include intimidation and mental abuse through verbal or nonverbal conduct that causes or has the potential to cause mental anguish.
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