Inaccurate Intimate-Relations Care Plans for Cognitively Impaired Residents
Penalty
Summary
The deficiency involves the facility’s failure to develop accurate, individualized comprehensive care plans for several cognitively impaired residents, specifically related to intimate relationships and sexual activity. Record review showed that four residents with diagnoses including Alzheimer’s disease, unspecified dementia, and neurocognitive disorder with Lewy bodies were all assessed as severely cognitively impaired on their quarterly MDS assessments. Some of these residents also exhibited behaviors such as verbal aggression, rejection of care, and wandering. Despite this, each of these residents had an active care plan focus area indicating a desire for an intimate relationship with a consenting resident partner, with documentation that responsible parties or family had given consent for such relationships. The care plans for these residents included goals stating that the residents would have their psychosocial needs and sexual choices/preferences met with dignity and privacy. Interventions listed in the care plans directed nursing staff to provide education in safe sex practices, including sexually transmitted infection prevention and hygiene, to ensure signage on doors to private areas used for intimate activity to maintain privacy and dignity, and to provide private areas for consensual intimate activities upon request. These interventions were written as if the residents were engaging in or planning to engage in sexual activity and were able to consent to such activity, despite their severe cognitive impairment documented on the MDS. Staff interviews further clarified that the actual resident behaviors did not match the written care plans. The Memory Care Unit Coordinator stated that residents on the secured memory care unit held hands, hugged, and danced, but that no residents engaged in sexual contact. The MDS Nurse reported that she completed the intimate relations care plan focus areas based on corporate instruction and understood that the residents only held hands or danced together, not that they engaged in sexual behaviors; she also stated she did not question whether these care plans were appropriate for the residents involved. The DON and Administrator both acknowledged that care plans should be individualized, accurate, appropriate, and up to date, and the DON explained that the care plans were implemented because responsible parties had given consent for residents to hold hands, hug, and dance, while confirming that no sexual activity occurred between residents. This mismatch between documented care plan goals/interventions and the residents’ actual conditions and behaviors led to the cited deficiency.
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