Failure to Ensure Dignified and Respectful Communication With Residents
Penalty
Summary
The deficiency involves failures to honor residents’ rights to dignity, respectful communication, and self-determination. One resident with intact cognition, paraplegia, respiratory failure, seizure disorder, malnutrition, and significant psychosocial diagnoses (MDD, antisocial personality disorder, PTSD) reported that a respiratory therapist (Staff G) suctioned his tracheostomy in a way he perceived as rough and distressing. He stated that Staff G instilled a large amount of saline into his tracheostomy tube while he was talking, causing choking, coughing, and gagging, and that it felt as though she was trying to “shut him up” and “drown” him. After leaving his room, he reported hearing Staff G in the hallway, within his hearing distance, laughing and mocking his concern by repeating that he said she was going to drown him. Another respiratory therapist (Staff H) recalled the resident’s report that Staff G laughed with another staff member in the hallway about his concern, and an LPN (Staff A) confirmed that Staff G told her in the hallway that the resident had accused her of trying to drown or kill him, after which the resident began banging on the wall and yelling. A second resident with moderately impaired decision-making, myotonic muscular dystrophy, chronic respiratory failure with hypoxia, anxiety disorder, and MDD used a communication board but did not have this communication need or intervention identified in the care plan. When asked about concerns with Staff G, this resident nodded yes and spelled out “rude” on the communication board. A CNA (Staff J) reported witnessing Staff G enter this resident’s room and say, in a rude tone, “what do you want? As they were just in there,” which made the resident cry. The lack of care plan identification of the resident’s impaired communication and use of a communication board, combined with Staff G’s rude verbal interaction, demonstrated a failure to support and respect the resident’s communication needs and emotional well-being. A third resident with severe cognitive impairment (BIMS score of 4), traumatic brain injury, seizure disorder, and depression had a care plan noting impaired cognitive function and frustration when unable to express words, leading to cussing and yelling. During observation, this resident was seated in a wheelchair outside the shower room awaiting assistance for a bath and made a loud exhaling noise. A staff member at a nearby medication cart repeated the sound in a mocking manner and said to the resident, “life is so tough isn’t it, it’s so terrible.” The resident did not respond. These interactions, including mocking comments and conversations about residents within their hearing distance, were inconsistent with the facility’s policy requiring residents to be treated with dignity and respect and not to be laughed at or talked about within hearing distance.
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