Failure to Provide Timely Behavioral Health Services for Resident With Schizoaffective Disorder
Penalty
Summary
The deficiency involves the facility’s failure to ensure that a resident with known behavioral health needs received necessary behavioral health care and services when she began refusing medications, meals, and care. The resident was admitted with schizoaffective disorder and depression, had a documented history of schizophrenia, and was assessed as cognitively intact with decision-making capacity. Physician orders included psychotropic medications (aripiprazole and Lexapro) for schizoaffective disorder and depression. Beginning in early January, the resident progressively refused multiple medications, including psychotropic, pain, cardiovascular, gastrointestinal, and supplement medications, as well as blood sugar checks. Progress notes and interdisciplinary team documentation showed that from early January the resident exhibited behavioral changes and delusional thoughts, including repeatedly refusing medications and meals, calling law enforcement to report she had not eaten in several days, and refusing care such as changing, repositioning, and showers. Staff documented that she yelled at staff, shouted at CNAs, refused dinner and blood sugar checks, and declined to return to bed after being in her wheelchair. CNAs reported that the resident frequently refused showers and hygiene care, refused to have her incontinence brief changed, remained in her wheelchair in front of the nurse’s station, and at times had noticeable odor while continuing to refuse bathing despite repeated offers. Despite these ongoing refusals and documented behavioral changes related to her schizoaffective disorder, the resident did not receive timely psychiatric or psychological evaluation. A psychiatric consult was ordered several days after the onset of significant refusals and behavioral changes, but the evaluation was postponed and not completed before the resident was sent to the hospital for continued refusal of food, medications, and basic care. The facility’s own policies required comprehensive assessment and behavioral health services when there was a significant change in a resident’s physical, emotional, or mental condition, including refusal of treatment or medications and signs of emotional or psychosocial distress, but the necessary behavioral health services were not provided during the period of escalating refusals and behavioral symptoms.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.