Failure to Arrange Home Health Services Prior to Discharge
Penalty
Summary
The facility failed to ensure that home health services were arranged prior to the discharge of a resident with significant medical needs. The resident, who had diagnoses including cerebral infarction, hemiplegia, hemiparesis, vascular dementia, dysphagia, impulse disorder, major depression, and intermittent explosive disorder, required assistance with most activities of daily living and was incontinent. Although the social worker faxed information to a home health agency before discharge, the agency later confirmed they did not have the resident as a client and did not serve individuals under the age of 60. The resident reported not receiving any home health services after discharge. Interviews with facility staff, including the Social Service Designee, Administrator, and DON, revealed they believed home health services had been arranged, but were unaware that the resident was not receiving them. Review of facility policy indicated that discharge planning should include arranging for home health and follow-up calls post-discharge, but there was no documented evidence that follow-up calls were made to the resident after discharge. This deficiency was identified during a complaint investigation and affected one resident out of three records reviewed.