Resident Not Permitted to Return After Hospitalization Due to Behavioral Concerns and Documentation Failures
Penalty
Summary
A resident with a history of pneumothorax and mild intellectual disabilities was admitted to the facility and later transferred to a local hospital due to difficulty breathing and self-injurious behavior. While hospitalized, the facility's Social Services Manager requested a psychiatric evaluation for the resident before his return. The resident was deemed medically ready for discharge by the hospital, and the therapy department recommended sub-acute rehab. However, the facility declined to permit the resident's return, citing inappropriate behaviors and placing him on a 'do not admit' list, despite the absence of documentation supporting this decision in the medical record. Communication records between the hospital and facility admissions staff revealed that the facility informed the hospital that the resident was on a 'do not admit' list and that there was no bed available, although the hospital staff indicated the resident wished to return. The facility's Business Development Manager and Admission Director both referenced the resident's behaviors as the reason for refusal, but there was confusion and lack of clarity regarding who authorized the placement on the 'do not admit' list. The Nursing Home Administrator later reported that the decision was made without her knowledge and that the facility could have met the resident's needs. Documentation related to the resident's bed hold policy was incomplete and improperly executed, with missing signatures, dates, and unclear resident consent. The resident himself reported not understanding the bed hold refusal he signed. Facility policy required that residents be permitted to return after hospitalization unless a formal discharge process, including proper notification to the resident and the State Long-Term Care Ombudsman, was followed. In this case, there was no documentation of such a process, and the resident was not allowed to return to the next available bed.