MDS Alert

Make sure staff aren’t talking to residents this way.

With a growing number of citations, F-241 “Dignity” is clearly an area that surveyors are cracking down on. Heed these expert insights and actual surveyor notes to avoid the most common problems leading to F-241 deficiencies.

Expect Differing Interpretations among Surveyors

For F-241, §483.15(a) states: “The facility must promote care for residents in a manner and in an environment that maintains or enhances each resident’s dignity and respect in full recognition of his or her individuality.”

The State Operations Manual (SOM) regulations are interpretive, “so that might mean you could get cited differently for the same or similar situations depending on who the surveyor is and variations even occur from state to state,” cautioned Kaile Hilliard, LCSW, Regulatory Compliance Manager, West Division, at Genesis HealthCare LLC, in a recent posting.

And F241 is “one of those tags that can get interpreted differently and does not have an all-inclusive definitive list of what deficient practice is,” Hilliard points out.

Rule of thumb: “The focus of F-241 requirements is to ensure caregivers provide services in a manner which enhances/maintains a dignified existence for residents,” notes Dave Walker, BS, LNHA, Leadership Coach for the Quality Improvement Program for Missouri’s Long-Term Care Facilities (QIPMO). “If all facility staff keep in mind the basic principle of caring for residents in the manner in which s/he would expect to be treated, or would expect a loved one to be treated, the facility staff will have made great strides toward compliance.”

Don’t Make These Mistakes

F-241 recently made the top-10 citations list nationwide, and it ranked among the top deficiencies in many states including Missouri, with 21 citations from July to September 2015 in that state alone. Walker highlights areas of noncompliance that surveyors cited in some of those nursing homes:

1. Lack of assistance. Notes included the following:

• “Wheelchair in disrepair and wasn’t a good fit for the resident.”
• “No foot rests on wheelchair.”
• “Failed to respond to calls for assistance timely.”
• “Failed to provide showers.”
• “Failed to clean a bedside commode which caused distress to the resident.”
• “Call lights not within reach,” and “call lights not answered promptly.”

2. Substandard dining experience. Some notes included:

• “Staff standing while assisting resident with dining.”
• “Failed to serve meals on time and residents sitting in dining room for long periods of time without being served drinks.”
• Assisting residents to eat without talking to them.”
• “Residents lined up outside dining room.”
• “Meals served on trays.”
• “Used disposable dining ware.”
• “Obtained a resident’s blood glucose level while in the dining room.”

3. Not respecting care needs. Surveyors noted:

• “Failed to cover exposed residents.”
• “Signs posted about care needs.”
• “Labeled incontinence briefs and name left in view.”
• “Pulling wheelchairs backwards.”
• “Staff calling residents ‘Momma,’” and “staff verbally snapping at residents (i.e., ‘Go crazy, Grandma!)’”
• “Staff speaking to residents in an undignified manner (‘You’re a pain in my butt but I still love you’).”
• “Staff ignored resident’s request for assistance.”
• “Night shift dressed residents and left in bed.”

Avoid These Red Flags, Too

And in addition to these types of problems, Walker advises that you look out for other areas of noncompliance that could earn you an F-241 citation, including:

• Failing to knock on the resident’s door before entering the room, or failing to wait for a reply or permission to enter after knocking;
• Not grooming residents as they wish to be groomed, including not shaving male and female residents and allowing dirty fingernails or uncombed hair;
• Labeling each resident’s clothing in a way that disrespects his or her dignity;
• Transporting residents through public areas without appropriate clothing;
• Allowing a resident’s care equipment (i.e., catheter bags) to be in obvious sight of other persons;
• Using clothing protectors (bibs) for all residents, regardless of individual preference;
• Dressing residents in wrinkled, torn, or mismatched clothing; and
• Displaying signs or posters showing residents’ care needs.

According to survey results and noted citations, the most common concerns tend to involve maintaining resident privacy while transporting throughout the facility, the use of bibs, staff not interacting with the resident while assisting them, staff not speaking to residents in a respectful manner, and signage.

Take 4 Actions Now

But keep in mind that these regulatory areas are not all-inclusive, Walker says. “Respecting individual care needs is essential to ensuring resident satisfaction and compliance with regulations.”

Walker also advises that your facility:

1. Develop a pleasant, relaxing dining environment;
2. Train and observe your staff to see how they interact and don’t interact with the residents;
3. Ensure staff members consistently treat residents with respect and consideration; and
4. Ensure facility managers promote and develop an organizational culture of caring that is reinforced through ongoing staff education and sensitivity training.