Failure to Involve Residents and Representatives in Quarterly Care Conferences
Penalty
Summary
The facility failed to ensure residents and/or their legal representatives were able to participate in the development and implementation of person-centered plans of care, as required by facility policy. The Care Conference policy, revised 6/20/23, states that residents and/or responsible parties are to receive advance communication of scheduled care conferences and that the Interdisciplinary Team (including MDS, nursing, therapy, activities, social services, and dietary) will review key clinical areas and complete a Care Conference User Defined Assessment (UDA) for attendance and discussion tracking. Record review showed that one resident with Parkinson’s disease, dementia, OCD, anxiety, depression, osteoarthritis, and chronic pain, with a BIMS score of 11 (moderate cognitive impairment) and a court-appointed Guardian, had only two care conferences documented in the last year, with no evidence that additional quarterly conferences were offered or declined, and no documentation that the Guardian was invited to quarterly care conferences. Another resident with dementia, left-sided hemiplegia, type 2 diabetes, mood disorder, and chronic kidney disease, with a BIMS score of 10 and an activated POAHC, had only one care conference documented in the last year, with no indication that other quarterly conferences were offered or declined or that the POAHC was invited. A third resident with vascular dementia, history of stroke, and type 2 diabetes, also with a BIMS score of 10 and an activated POAHC, had only one care conference documented in the last year. The POAHC for this resident reported not being invited to a care conference for almost a year, had never refused a care conference, and wanted a conference to discuss the resident’s care. The Social Worker stated that care conference timing is personalized and acknowledged not consistently using the Care Conference UDA per policy, and the Nursing Home Administrator confirmed that care conferences should be attempted at least quarterly and upon request, and that the Social Worker should be using the Care Conference UDA as required by facility policy.
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