Failure to Obtain Replacement Wheelchair Resulting in Prolonged Use of Damaged Equipment
Penalty
Summary
The deficiency involves the facility’s failure to obtain and arrange for a replacement wheelchair for a dependent resident, resulting in prolonged use of a wheelchair in disrepair. The resident had multiple neurologic and functional diagnoses, including hemiplegia and hemiparesis following cerebral infarction affecting the right dominant side, right foot drop, aphasia, expressive language disorder, major depressive disorder, recurrent pain, and unsteadiness on feet. The resident’s MDS documented use of a manual wheelchair for mobility, and the MAR showed ongoing use of extended-release Tylenol for pain management up to the date of discharge. Physician orders documented that the resident required a wheelchair and cushion for discharge, specifying wheelchair dimensions, cushion thickness, and bilateral swing-away footrests. Surveyor observation at the supportive living facility after discharge found the resident using a wheelchair with the left arm in visible disrepair: the plastic side panel holding the armrest was cracked into several pieces, with a two-inch section of broken plastic bent inward and wrapped in thin elastic bandage tape, abutting the resident’s left hip. A five-inch section of plastic was missing from the same armrest, and the right armrest was wrapped in disposable elastic bandage material. The resident reported that the cushion was worn, tattered, flat, and caused discomfort to her buttocks, and that the broken plastic side panel poked and hurt her hip, requiring her to be extra careful to avoid being jabbed. The discharge summary documented that the resident left with her several-years-old wheelchair and hemi-walker, which belonged to her, and did not indicate that a new wheelchair had been provided. The resident stated she had asked and begged for a new wheelchair for months while at the facility, including after becoming eligible for Medicare, and that facility staff, including the Administrator, repeatedly told her they would check into it but did not follow through. She reported that the facility at one point said they were purchasing a wheelchair and later said they were not, and that she remained uncomfortable in her old wheelchair, which she had used for years since her stroke. The Meridian Medicaid social worker reported attempting to obtain a new wheelchair for the resident since 9/12/22, repeatedly requesting necessary paperwork from the facility and being told the paperwork was lost under both old and new ownership. The social worker stated that the resident’s wheelchair was in bad shape and cutting into her side, and that Medicaid would have provided a new wheelchair if the facility had supplied the required documentation. The Administrator confirmed that the facility did not purchase the resident’s wheelchair and that the resident had repeatedly requested a new one over the past year.
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