Failure to Honor Resident Choice for Showering Versus Bed Bath
Penalty
Summary
The facility failed to honor a cognitively intact resident’s right to choose their preferred method of personal hygiene, specifically bathing versus showering. During an observation and interview, a malodorous smell was noted in the resident’s room, and the resident reported that he is always given a bed bath because he requires a mechanical lift, but that he would prefer a shower. In a follow-up interview, the resident reiterated his preference for showers but stated he felt it was too much work for staff, so he did not insist. Review of the EMR showed the resident was admitted with morbid obesity, systolic heart failure, atrophic skin disorder, xerosis cutis, bipolar disorder, and major depressive disorder, and the most recent MDS reflected a BIMS score of 14, indicating he was cognitively intact, required two staff for care, used a mechanical lift for transfers, and was incontinent of bowel and bladder. Record review of shower sheets for December and January showed only five entries in December and three in January, all documented as bed baths, with no documentation of refusals and no indication that the resident was ever assisted with a shower. Staff interviews revealed that a CNA stated the resident is particular about who showers him and that this usually occurs on second shift, while an RN who had worked at the facility for three years was unaware that the resident preferred showers over bed baths. The RN described the facility’s process that CNAs should document refusals on shower sheets and notify the charge nurse, who then confirms refusals and signs the sheet. The DON and Administrator both stated that residents should have two shower sheets per week documenting type of bath, refusals, and skin issues, and that resident choice and accommodations for those choices are expected. The facility’s Residents’ Rights policy stated that residents have the right to choose schedules and health care, including aspects of life in the facility that are significant to them, but this was not implemented for this resident’s bathing preference.
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