Failure to Permit Resident Return After Hospitalization
Penalty
Summary
The facility failed to permit a resident to return after a hospitalization, in violation of federal requirements for permitting residents to return to the facility following a hospital stay or therapeutic leave. The resident, who had been admitted with multiple diagnoses including stroke, depression, and muscle weakness, was described as friendly but disoriented, requiring staff assistance for personal care, eating, transfer, and ambulation. After admission, the resident eloped from the facility and was found at another facility across the street. Upon return, the resident was placed on one-on-one supervision and later sent to the emergency room for evaluation. Despite repeated requests from the hospital, the facility refused to readmit the resident, citing concerns about the resident's safety due to confusion, agitation, and a tendency to attempt to leave the facility. Interviews with facility staff, including the Administrator and DON, revealed that the decision to refuse readmission was based on the belief that the resident was not safe at the facility, particularly given its proximity to a busy street. However, staff interviews and documentation indicated that the resident did not exhibit physical aggression, agitation, or behaviors that endangered herself or others. The resident was described as confused, talking about wanting new slippers, and attempting to get up from her wheelchair, but not combative or aggressive. The facility's own policies required that discharges or refusals to readmit be based on documented evidence that the resident's needs could not be met or that the resident posed a danger to themselves or others, with physician documentation supporting such decisions. In this case, there was no documentation from a physician indicating that the resident's needs could not be met or that transfer was necessary. The DON acknowledged the lack of clinical records supporting the decision and agreed that interventions such as a wander guard and adequate supervision might have prevented the elopement and subsequent transfer. The failure to permit the resident's return resulted in the resident remaining unnecessarily in the hospital while awaiting placement.