Unsafe Discharge to Homeless Shelter Without Adequate Planning
Penalty
Summary
A deficiency occurred when a resident with multiple complex medical and mental health diagnoses, including diabetes, COPD, hypertension, depression, anxiety, and cocaine dependence, was discharged from the facility to a homeless shelter without adequate discharge planning or ensuring a safe and appropriate transition. The resident required assistance with medication administration, supervision for activities of daily living, and ongoing medical and mental health management. Despite these needs, there was no evidence that the facility developed or implemented a comprehensive care plan to address the resident's discharge needs, nor did they ensure the resident's representative was involved in the discharge planning process or aware of the discharge destination. The facility issued a 30-day discharge notice to the resident, citing non-payment and improvement in condition, with the proposed discharge location being a local homeless shelter. Documentation revealed that the resident was discharged with her medications but without any referrals for follow-up care, access to transportation, or arrangements for ongoing medical oversight. The homeless shelter staff determined upon arrival that the resident was not appropriate for their facility due to her inability to ambulate independently and manage stairs, and the shelter did not provide medical, social, or transportation services. The resident expressed a desire to return to the facility, but the facility refused re-admission, citing non-payment and a policy against accepting discharged residents. Interviews and record reviews indicated that the facility did not follow up on the resident's stated preference to obtain her own housing or assist with the Home Choice program until prompted by the ombudsman. There was no documentation of communication with the resident's emergency contact regarding the discharge, and the facility did not attempt to place the resident in any other setting besides the homeless shelter. The lack of a comprehensive discharge plan, failure to ensure the resident's needs and preferences were met, and inadequate communication with both the resident's representative and the receiving shelter led to the resident being discharged to an unsafe and inappropriate environment.