Failure to Ensure Equal Access and Discharge Planning Regardless of Payment Source
Penalty
Summary
The facility failed to ensure equal access to services and assistance with alternative placement for a resident whose payor source changed from Medicare Part A to private pay. The resident was admitted for skilled nursing services and, after Medicare coverage ended, continued to reside at the facility as a private pay resident. Assessments indicated that the resident no longer met the medical eligibility for nursing home level of care and was appropriate for a lower level of care, such as assisted living. Despite this, there was no active discharge plan documented in the clinical record for several months, and the facility did not provide evidence of consistent discharge planning or assistance with alternative placement. Documentation showed that the resident and their POA were informed about the need to move to a lower level of care, and a bed was available at an assisted living facility, but the resident refused to move. The resident's cognitive status declined over time, as indicated by BIMS scores, but the facility continued to allow the resident to remain without a documented discharge plan. The POA reported that the facility staff threatened to contact Adult Protective Services (APS) if attempts were made to move the resident, and staff confirmed that APS was contacted due to concerns about the resident's mental health and threats of self-harm during discussions about transfer. Interviews with facility leadership revealed a lack of communication with the POA regarding discharge planning and an absence of proactive steps to prepare for the resident's discharge, despite the resident being assessed as appropriate for a lower level of care months earlier. The facility indicated that if the resident's funds were depleted, they would be considered "days awaiting placement" pending Mainecare, and would need to accept an available assisted living facility within a certain distance. However, there was no evidence that the facility had actively assisted with alternative placement or ensured equal access to services regardless of payment source.