Failure to Follow Discharge Follow-Up Policy for Discharged Resident
Penalty
Summary
The facility failed to follow its discharge policy for ensuring follow-up with discharged residents, as evidenced by the case of one resident who was discharged home after insurance discontinued payment for skilled services. The resident had multiple complex medical diagnoses, including sepsis, acute respiratory failure with hypoxia, type 2 diabetes with ketoacidosis and hyperglycemia, morbid obesity, and recent surgical aftercare. The case manager arranged for home health care through the resident's insurance company, which provided a reference number for services. However, it was later discovered that home health services had not been set up due to limitations in the resident's insurance plan. Despite the facility's policy requiring a follow-up call within 24 to 48 hours after discharge to verify that community services were in place, the case manager did not contact the resident post-discharge to confirm that home health services were being provided. The omission was acknowledged by the case manager, who stated that the follow-up call was simply forgotten. The Director of Nursing and Administrator both confirmed that the expectation was for follow-up contact to be made with discharged residents, but this did not occur in this instance.