Failure to Verify and Honor Resident’s Choice of Representative
Penalty
Summary
The deficiency involves the facility’s failure to establish and honor the resident’s choice of representative/responsible party. A male resident with a terminal diagnosis of senile degeneration of the brain was admitted from a hospital with hospice orders and documentation listing one family member (Family Member #2) as the responsible party. The face sheet and hospice paperwork identified Family Member #2 as the responsible party and signatory for hospice services, while the PASRR Level I screening listed a different family member (Family Member #3) as next of kin. The resident’s history and physical documented that he was alert and oriented to person, place, and situation, though with significant forgetfulness and impaired insight. A BIMS assessment later showed a score of 8, indicating moderate cognitive impairment, but the entry MDS initially had no BIMS score. Family Member #3 reported that the resident had been placed on hospice by Family Member #2 prior to transfer and that she was notified only after the fact. She stated that at the current facility the resident told staff he did not want Family Member #2 as his responsible party because she did not treat him well, and that he did not have a power of attorney. She further stated that the facility did not consult the resident or family about who he wanted as his representative and simply continued the same responsible party designation from the hospital, based on the fact that the resident had lived with Family Member #2 before admission. During a care plan meeting, Family Member #3 voiced that she believed the resident did not need hospice, but was told that Family Member #2 was the next of kin and remained the designated representative. The Administrator stated that the facility relied on the hospice paperwork and information from the hospice agency, both of which identified Family Member #2 as the representative, and that the facility did not review the PASRR documentation or ask the resident whom he wanted as his representative. The Social Worker stated she relied on the facility system, which listed Family Member #2 as the responsible party, and was not aware of a different next of kin. She also reported that a BIMS assessment had been requested to better gauge cognition, but therapy did not complete it because the resident was on hospice. The resident himself stated he did not know how he ended up at the facility under hospice, reported that Family Member #2 left him there and did not want him back home, and clearly expressed that he did not want hospice services and wanted Family Member #3 to be his responsible party. The facility’s resident rights policy stated that residents have the right to identify individuals or roles to be included in the planning process, but the facility did not obtain or act on the resident’s expressed preference for his representative.
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