Little Neck Nursing Home, located in the Bronx, was cited in January for violating 42 CFR 483.10(b)(4). This provision of the Code of Federal Regulations gives nursing home residents, among other things, the right to form an advance directive plan.
For the resident in question, advance directives were discussed on several occasions. He made it clear that he would trust his daughter and son-in-law to make decisions for him should the occasion arise that he were unable to make decisions for himself. Despite these conversations with the nursing home staff, advance directives paperwork was not completed. The resident's son-in-law, when interviewed, also indicated that he would be willing to sign such paperwork, however no one at the facility had discussed the process with him or his wife. The nursing home's own policy states that "Information will be given to the resident and family/representative at the time of admission that will explain the nature of recognized Advance Health Care Directives and how such directives may be executed. Designated staff will assist the resident and/or representative in formulating and recording an Advanced Health Care Directive desired, and will assure that such directives are executed voluntarily." According to the DOH report, this was not done.
An underlying theme of the sections of the Code of Federal Regulations discussed frequently on this blog is that of maintaining dignity for nursing home residents. Allowing a patient to determine how to spend the remainder of his or her life is an important aspect of fulfilling a resident's dignity. Designating a health care proxy, executing a Do Not Resuscitate if desired, and other end of life measures ensure that the elderly resident spends his or her final days in the manner in which he or she desires. Failure to comply with the steps necessary to implement these measures could preclude the resident from this comfort and peace of mind in the final moments of life.
The full Department of Health findings can be found here.