Failure to Provide Complete Bed Hold Notices
Penalty
Summary
The facility failed to provide residents and their representatives with a written bed hold notice that included the cost per day information, which is necessary for informed consent. This deficiency was identified for nine residents who were transferred to a hospital for various medical reasons, such as severe lethargy, low blood sugar, altered mental status, and respiratory distress. The bed hold notices issued to these residents or their representatives only indicated the length of the bed hold but omitted the daily cost, which is a requirement under Medicaid guidelines. The facility's policy on temporary discharge and bed hold did not specify the daily rate or cost per day for holding a resident's bed during their absence. This omission was consistent across multiple documents, including the facility's Temporary Discharge (Bed-Hold) policy and the Admission Agreement. The lack of this critical information in the bed hold notices and facility policies meant that residents and their representatives were not fully informed about the financial implications of holding a bed during a hospital transfer. During an interview, the facility's Administrator and President of Operations acknowledged that the bed hold notices did not include the reserve bed payment policy. They believed that since residents were given the bed hold policy upon admission and were always allowed to return to the facility, the omission was justified. However, this belief did not align with the regulatory requirements, which mandate that the cost per day must be clearly communicated to ensure informed consent.
Plan Of Correction
Bed hold letter was revised reflecting cost for services for future issued bed hold letters. No corrective measures were done for residents R21, R27, R75, R9, R60, R69, R71, R91, and R86 as residents were issued bed hold letters and have already returned to the facility from their acute care stay. All residents issued bed hold letters have the potential to be affected. U.S. FOIA (b) (6) was in serviced by Administrator on the revised bed hold letter that now includes the bed hold cost. Director of Admission will present all future acute discharged residents and/or responsible parties with the revised bed hold letter. The Administrator will audit 5 residents weekly to ensure the revised letter reflecting bed hold cost was issued. Director of Admissions or designee will review all issued bed hold letters weekly for 3 months then monthly. Results of these audits will be provided to the Administrator on a monthly basis. All findings will be reported and reviewed monthly and reported quarterly during the QAPI meeting for the next 2 quarters by Director of Admission or designee to the QAPI committee. Evaluation by the committee to determine continuing frequency of audits.