HospitalInspections.org

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Based on interview and review of hospital policies and procedures, the Critical Access Hospital failed to develop a written policy and procedure to prevent abuse and neglect of long-term care ("swing bed") residents.

Failure to prevent such a policy and to educate staff regarding this policy risks abuse of vulnerable long-term care residents.

Findings included:

1. Review of the hospital's policy and procedure titled "Adult/Child Suspected Abuse, Social Services," Policy #6094914 dated 03/19, showed the policy identified how to identify and report suspected abuse of adults and children. The policy did not include specific procedures for prevention, and investigation of abuse, neglect, and exploitation of long-term care residents being cared for in the hospital.

2. On 11/14/19 at 4:00 PM during an interview with the investigator, the hospital's Chief Executive Officer (Staff #1) and Chief Nursing Officer (Staff #2) confirmed that the hospital did not have a abuse and neglect prevention and investigation policy and procedure for long-term care residents.
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Based on interview, record review, and review of hospital policies and procedures, the Critical Access Hospital failed to ensure that staff members developed and implemented an individualized, ongoing activity program in accordance with interests identified in the resident's activities assessment for 2 of 3 long-term care ("swing bed") residents reviewed (Patients #1, #2).

Failure to develop and implement an individualized activities plan for long-term care residents risks impairment of physical, mental, and psychosocial well-being.

Findings included:

1. Review of the hospital's policy and procedure titled "Activities and Activity Program, SB," Policy #5820295 approved 01/19, showed the hospital would provide for an ongoing program of activities designed to meet the interests and physical, mental, and psychosocial well-being of each swing bed resident in accordance with their comprehensive assessment. A variety of activities would be offered to facilitate the resident's physical, social, and mental well-being.

2. Review of the medical records of three swing bed residents currently hospitalized under the hospital's long-term care "swing bed" program showed that a hospital staff member had performed an assessment of each resident's activity interests and developed activity plans. On 11/13/19 at 9:35 AM during an interview with the investigator, a staff nurse caring for Patients #1 and #2 (Staff #3) stated the residents had experienced a significant decline in health status and were currently on end-of-life care. The activity plans for these residents had not been revised to reflect their current needs.

3. On 11/13/19 at 1:50 PM during an interview with the investigator, the hospital's activities program director (Staff #4) stated that the hospital's activities coordinator (Staff #5) worked one day per week. The interview showed there were no structured activities on the days that the coordinator was not present.

4. On 11/14/19 at 8:10 AM during an interview with the investigator, the hospital's activities coordinator (Staff #5) confirmed there were no structured activities on the days she was not present. The coordinator stated she had not been trained to provide activities for residents with significantly limited abilities related to ongoing health problems.
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Based on interview, record review, and review of hospital policies and procedures, the Critical Access Hospital failed to ensure that hospital staff 1) developed and revised comprehensive care plans for long-term care ("swing bed") residents in accordance with the resident's comprehensive assessment, as demonstrated by 6 of 8 residents reviewed (Patients #1, #2, #3, #4, #5, #7); and 2) implemented a functional maintenance program in accordance with the resident's plan of care for 2 of 2 residents reviewed (Patient #1, #2).

Failure to develop and implement a comprehensive plan of care based on a comprehensive assessment of the long-term care resident's needs risks deterioration of the resident's health and adverse healthcare outcomes.

Findings included:

ITEM #1 - COMPREHENSIVE CARE PLANS

1. Review of the hospital's policy and procedure titled "Swingbed Assessment/Alert Charting," Policy #6434155 Approved 07/19, showed a team of hospital staff members including nursing, social services, activities, and dietary would perform a comprehensive assessment of a swing bed resident within 72 hours of admission. Nursing staff members would perform a physical reassessment of all swing bed residents monthly or when the resident's health condition changed.

2. Review of the hospital's policy and procedure titled "Swing Bed Care Plans and Care Conference," Policy #6434122 approved 08/19, showed a temporary plan for care would be developed for each swing bed resident within 24 hours of admission. A personalized comprehensive plan for care would be developed within 14 days of admission. The policy did not state the plan for care would be reviewed and revised according to changes in the resident's condition.

3. Review of three long-term care "swing bed" residents currently receiving care at the hospital showed the following:

a. Patient #1 was a 70 year old resident who had been admitted to the hospital's swing bed program on 12/12/18 for end-of-life care due to brain cancer. An entry in the resident's medical record dated 11/11/19 showed the resident was experiencing increasing pain and discomfort and was receiving pain management services through a local hospice care provider. The resident's care plan was dated 03/26/19 and read "Patient is on services through Assured Hospice" but did not identify what those services included. The plan did include goals, interventions, and time frames for pain management or other end of life needs. There was no evidence the plan had been reviewed and revised as the resident's health status declined.

b. Patient #2 was an 88 year-old resident who had been admitted to the hospital's swing bed program on 10/01/16. The resident's medical records showed the resident had experienced a progressive decline in her health status since admission. The resident developed a stage 4 pressure ulcer in August 2019, had recently lost weight, and was experiencing pain. End of life care was ordered on 11/07/19. The resident's care plan dated 05/01/19 did not include interventions for care of the resident's wound and prevention of other pressure ulcers nor interventions for pain management. There was no evidence the plan had been reviewed and revised when the resident's health status changed. During an interview with the investigator on 11/13/19 at 8:40 AM, a registered nurse providing care to the resident (Staff #3) confirmed the resident's comprehensive care plan had not been reviewed and revised since 05/01/19.

c. Patient #3 was an 83 year-old resident who had been admitted to the hospital's swing bed program on 08/02/19 for rehabilitative care due to weakness and severe deconditioning. During an interview with the investigator on 11/13/19 at 9:20 AM, a registered nurse providing care to the resident (Staff #3) stated that the resident experienced pain related to joint contractures. The nurse stated the resident did not want medication and preferred that staff apply warm towels to her joints. Review of the resident's care plan showed the plan did not include goals, interventions, and time frames for pain management.

4. Review of the medical records for five long-term care "swing bed" residents who had been hospitalized between 04/01/19 and 10/31/19 showed the following:

a. Patient #4 was an 81 year-old resident with breast cancer who had been admitted to the hospital's swing bed program on 08/17/18 for end-of-life care. The resident had a tracheostomy and pressure ulcers on her coccyx and buttocks on admission. The resident's care plan dated 08/17/18 did not include goals, interventions, and time frames for care of her tracheostomy nor time frames for achievement of other treatment goals. The resident's condition declined during her hospitalization, and the residient expired on 09/07/19.

b. Patient #5 was a 95 year-old resident who had been admitted to the hospital's swing bed program on 04/22/19 for care of pressure ulcers on her buttocks and heel. The resident's care plan dated 06/18/19 did not include goals, interventions, and time frames for pain management. The resident's condition declined during her hospitalization, and the resident expired on 08/06/19. There was no evidence the resident's plan for care had been reviewed and revised as the resident's health status declined.

c. Patient #7 was a 96 year-old resident who had been admitted to the hospital's swing bed program on 05/03/19 for end-of-life care following a myocardial infarction (heart attack). The resident's condition declined during her hospitalization, and the resident expired on 08/09/19. The resident's care plan was dated 05/23/19. There was no evidence the resident's plan for care had been reviewed and revised as the resident's health status declined.


ITEM #2 - FUNCTIONAL MAINTENANCE PROGRAM

1. Review of the comprehensive care plans for Patients #1 and #2 showed the resident's care would include the hospital's functional maintenance program to maintain functional mobility.

2. On 11/13/19 at 1:50 PM during an interview with the investigator, the hospital's occupational therapist (Staff #4) stated a functional maintenance program for residents who did not have physical or occupational therapy had been proposed in April 2018. The therapist stated the program had not been developed and implemented.
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