Failure to Provide Medicare/Medicaid Benefit Information at Admission
Penalty
Summary
The facility failed to consistently provide residents and/or their representatives with both oral and written information on how to apply for and use Medicare and Medicaid benefits at the time of admission. This deficiency was identified for four out of five sampled residents, each of whom had varying medical conditions such as muscle weakness, bacterial blood infection, dementia, failure to thrive, weakness, wound infection, and hip fracture. Some residents were cognitively intact and able to verbalize their needs, while others had severe cognitive impairment, necessitating communication with their representatives. Record reviews revealed that there was no documentation indicating that the admission agreement, which should include information on Medicare and Medicaid benefits, was reviewed or discussed with the residents or their representatives upon admission. Nursing progress notes and admission packets lacked evidence that this required information was provided. Interviews with residents confirmed that they did not recall receiving or discussing this information at the time of their admission. Further investigation showed that out of 36 admissions in the past 30 days, only two admission packets contained the necessary information regarding Medicare and Medicaid benefits. Staff interviews indicated a lack of clarity about the timeframe for completing admission packets and acknowledged that the process had been delayed due to staffing vacancies, particularly in the admissions director/coordinator position. Staff confirmed that without timely review of admission paperwork, residents and their representatives would not be fully informed about their Medicare and Medicaid options.