Failure to Implement Person-Centered Toileting Programs for Cognitively Intact Residents
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate, person-centered services and treatment to promote bowel and bladder continence for two cognitively intact residents. One resident was admitted with acute respiratory failure and muscle weakness and had a care plan identifying risk for altered bladder elimination, with goals for regaining prior elimination status and an intervention for a 3‑day voiding diary to establish the need for bladder training. The admission MDS showed this resident required partial to moderate assistance for transfers and was occasionally incontinent of bladder and frequently incontinent of bowel. Despite this, the Kardex lacked evidence of a formulated toileting program, and the resident reported not knowing about any toileting program, stating that staff only changed her when she was wet and that she was wet at the time of the interview. CNAs confirmed they changed her in bed when she was wet and did not assist her to the toilet, despite describing her as needing only minimal assistance with transfers. Record review showed 41 episodes of urinary incontinence out of 51 opportunities for continence, and although the facility stated a voiding diary was done on admission, they could not provide evidence that it was assessed. The second resident was admitted with a left lower extremity fracture and congestive heart disease and had quarterly MDS assessments documenting a BIMS score of 15. Initially, the record documented that the resident was always incontinent of bowel and bladder and dependent on staff for toileting, but a later MDS documented that the resident remained always incontinent while now requiring only partial to moderate assistance to get on and off the toilet. The clinical record lacked evidence of any assessment or interventions for a toileting program when the resident’s transfer status improved. The resident stated a desire to use the toilet, to stop using diapers, and to possibly move back to assisted living if able to toilet, and reported being wet at the time of the interview. CNAs reported they did not know if the resident was on a toileting program, stated they changed the resident in bed when wet, and one CNA described the resident as easy to care for, using a walker to stand while being changed. Record review showed 79 episodes of urinary incontinence out of 90 opportunities for continence. The DON stated that 3‑day voiding diaries were completed for both residents but that person-centered toileting interventions were not implemented because the residents were incontinent on admission.
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