Failure to Inform Resident of Financial Obligations Prior to Discharge
Penalty
Summary
The facility failed to inform a resident that their insurance would not cover the cost of a board and care facility prior to discharge. The resident, who was admitted with diagnoses including hypertension and repeated falls and required supervision or assistance with hygiene, was able to make their own decisions. Prior to discharge, the resident specifically asked the social service staff if their insurance would pay for the board and care facility, and was incorrectly told that it would. Upon arrival at the new facility, the resident learned that their social security check would be used to pay for their stay, resulting in a share of cost that the resident was not prepared for. The Social Service Director acknowledged that she did not explain the financial obligations to the resident before discharge and recognized that the resident had the right to be informed. The Director of Nursing confirmed that residents should be informed in writing about payment expectations before discharge or transfer. The resident reported experiencing stress and anxiety due to the unexpected financial burden and stated that they would have preferred to be informed beforehand to make an informed decision. The facility's policy requires that appropriate information be communicated to the receiving provider, but this was not followed in this case.