Failure to Assist Dependent Hospice Resident With Meals and Offer Alternatives
Penalty
Summary
The deficiency involves the facility’s failure to provide required assistance with eating to a dependent resident. The resident had diagnoses including Alzheimer’s disease, dementia, moderate protein calorie malnutrition, mixed incontinence, osteoarthritis, and cerebral ischemia, and was admitted to hospice with cerebral atherosclerosis. The nursing and nutritional plans of care, MDS, and functional abilities assessment all documented that the resident had severe cognitive impairment, was rarely/never understood, was dependent on staff for all ADLs including eating, received a mechanically altered therapeutic diet, and was on physician-ordered supplements and a weight gain regimen due to being underweight with a BMI of 11.8. Care plan interventions included assisting with feeding, providing and serving supplements and diet as ordered, and monitoring and recording intake at every meal. On the morning of the observed deficiency, a CNA delivered the resident’s breakfast tray, elevated the head of the bed, uncovered the plate and hot cereal, cut up the food, added sugar to the cereal, placed a spoon in the bowl, opened the milk carton, and then left the room. Over the next several minutes, the resident was observed looking toward the television, then with eyes closed, and made no attempts to feed herself. The food remained uncovered and untouched. The resident later attempted only to drink from the milk carton, with no attempts to eat the food. During this time, the CNA was observed seated at a computer in the lounge and did not return to assist with feeding until nearly an hour later, at which point the CNA removed the tray with the food still untouched. The CNA confirmed in interview that the resident had not eaten any of the breakfast meal and that no assistance with breakfast had been provided. At lunchtime the same day, the CNA again delivered the meal tray, repositioned the resident in bed, uncovered and set up the meal, and this time sat next to the resident and provided spoon-fed bites, instructing the resident to take a bite of each item before refusing the meal. The CNA later reported to an RN that the resident consumed only half a portion of ice cream and a bite of beans, and then removed the tray, leaving the remaining ice cream on the overbed table. No alternative food choices were offered after the resident’s limited intake at lunch. In interviews, both the CNA and the RN verified that the resident was dependent on staff for eating, had not been assisted with breakfast, and had not been offered alternative food choices when refusing most of the lunch meal. The deficiency was cited as continued non-compliance from prior surveys.
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