Failure to Provide Appropriate Self-Feeding Assistance for Resident With Prosthetic Arms
Penalty
Summary
The facility failed to provide appropriate assistance and accommodation for self-feeding to a resident with bilateral upper arm amputations who used prosthetic arms. The resident, admitted with diagnoses including dementia, traumatic amputation at both elbows, and COPD, was cognitively intact with a BIMS score of 14 and required staff setup assistance for eating per the MDS. Physician orders directed that bilateral upper arm prosthetic devices be applied before breakfast and removed after dinner, with skin checks each shift. OT notes from 12/03/25 to 02/06/26 documented discharge recommendations for self-feeding that included stand-by assist from staff and use of a scoop plate. During breakfast observations on two separate days, the resident was seen eating without appropriate use of utensils or assistive devices, despite the documented needs and therapy recommendations. On one morning, the resident sat in the dining room with bilateral prostheses and grabber hooks in place; red and white plastic utensils were loosely strapped to the prostheses. The resident pushed the utensils up out of the way and bent over the plate, scooping French toast into his mouth without using utensils, despite an activities assistant encouraging him to use the utensils. On another morning, the resident initially used a regular spoon to eat cereal but then put the spoon down and bent over the plate to eat scrambled eggs with his mouth, without staff coming to assist or encourage utensil use. The therapy director later clarified that the red and white utensils were intended for use when the prostheses were not on, and that the resident preferred thin-handled utensils that could be held with the grabber hooks. A CNA confirmed that the resident typically did not use utensils, preferred to scoop food with his mouth, and required daily encouragement to use a spoon or fork. The facility’s routine care policy included assisting residents with eating and hydration, but staff actions did not consistently reflect this for the resident.
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