Failure to Care Plan for Intrusive Behaviors in Resident With Dementia
Penalty
Summary
The deficiency involves the facility’s failure to develop and implement a comprehensive, person-centered care plan to address a resident’s intrusive behaviors toward other residents. The resident had diagnoses of severe dementia with psychotic disturbances and an adjustment disorder with mixed anxiety and depressed mood, and the admission MDS showed severely impaired cognition with a BIMS score of 4 and a need for supervision with transfers and ambulation. The existing Resident Care Plan addressed distressed or fluctuating mood, impaired cognitive function related to dementia, and impaired communication due to hearing impairment, with interventions such as providing consistent caregivers, structured routines, simplified communication, reassurance, and referral to a behavioral health specialist as needed. However, the care plan did not identify or address intrusive behaviors toward other residents. Nursing notes documented specific incidents of intrusive behavior, including the resident entering another resident’s room and following that resident down the hallway, and a separate incident in which the resident was observed tugging the front collar area of another resident’s shirt in a brief, non-aggressive, non-threatening manner. Staff interviews indicated the resident frequently attempted to “help” others by obtaining plastic cups from nurse carts and passing out drinks, pushing other residents in wheelchairs, and at times following other residents, reflecting a belief that the resident was at work and enjoyed staying busy. The Director of Nursing acknowledged awareness of these behaviors and that the interdisciplinary team had discussed the need for a behavioral care plan after an incident, but the care plan was not updated to include intrusive behaviors or person-centered interventions, contrary to the facility’s Person-Centered Care Plan policy requiring individualized care plans that are reviewed and revised to reflect changing needs and goals.
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