Failure to Provide Required Twice-Weekly Facility Baths for Hospice Resident
Penalty
Summary
The deficiency involves the facility’s failure to ensure that a hospice resident received the required number of baths per the facility’s own Shower Expectations procedure. That procedure required that residents on hospice be offered two showers per week from facility staff in addition to two baths from hospice staff, for a total of four baths weekly. The procedure also required that bed baths be limited and approved, that all shower declines be immediately reported to the charge nurse and, if ongoing, to the DON or Administrator, and that all showers and refusals be documented and signed on shower sheets. For the sampled hospice resident, the care plan did not address the resident’s bathing capabilities, level of assistance needed for bathing, or any resistance to bathing, despite documenting extensive assistance needs for other ADLs. The resident had multiple diagnoses including heart failure, hypertension, diabetes, hyperlipidemia, GERD, arthritis, stroke, traumatic brain injury, anxiety, and depression, and was alert with minimal cognitive impairment. The MDS showed the resident required maximum assistance with bathing, dressing, toileting, hygiene, and transfers, used a wheelchair, and was receiving hospice care. Later hospice documentation indicated the resident became bedbound, required at least 40% assistance with ADLs, no longer got out of bed, used a full-body mechanical lift, had increased confusion, poor appetite, and required oxygen. Hospice notes stated that the hospice bath aide visited daily to complete care, bathing, and feeding/drinking assistance. Review of bath sheets showed that in November one bath was refused and another scheduled bath had no documentation of being offered or given. In December, one bath was refused and multiple baths were documented as completed by hospice staff, with no evidence that facility staff provided their required baths. In January, all documented baths were completed by the hospice aide, with no documentation that facility nursing staff or the bath aide provided any baths, and the resident did not receive the minimum number of baths required by facility policy. Observations on two separate days showed the resident in bed, dressed appropriately, on oxygen, resting comfortably, and without odor. Interviews with the bath aide, a CNA, and the DON confirmed that hospice residents were expected to receive four baths weekly (two from hospice and two from facility staff), that the bath aide prioritized non-hospice residents due to workload, that CNAs and nursing staff were supposed to assist with baths when the bath aide could not complete them, and that the baths facility staff were supposed to provide to hospice residents were not being completed.
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