Failure to Permit Resident Return After Hospitalization
Penalty
Summary
The facility failed to permit a resident to return after hospitalization, in violation of its own policy and federal regulations regarding resident rights to remain in the facility unless specific criteria for discharge are met. The resident in question had a complex medical history, including osteomyelitis, paraplegia, anxiety disorder, and an ileostomy, and was admitted and readmitted to the facility prior to the incident. Documentation showed that the resident experienced an acute episode of confusion, agitation, and combative behavior, which coincided with a urinary tract infection, sepsis, and metabolic encephalopathy. Staff documented that the resident was resistant to care, removed his colostomy bag, and swung a trapeze bar, but interviews with staff indicated that he had not been physically aggressive toward other residents and that his behavior was likely related to his acute medical condition. On the day of the incident, the resident was sent to the hospital for evaluation due to increased confusion and agitation. The facility completed an involuntary discharge notice, citing safety concerns and an inability to meet the resident's needs. The administrator delivered the resident's belongings and attempted to have the resident sign discharge paperwork at the hospital, despite being informed by hospital staff that the resident was not cognitively able to understand or sign the documents. Hospital case management notes and interviews confirmed that the administrator stated the resident would not be allowed to return to the facility, and this was communicated to both the hospital and the resident's family member. Multiple interviews with facility staff, hospital staff, the ombudsman, and the resident himself revealed that the resident was not offered the opportunity to return to the facility after his medical condition stabilized. The administrator maintained that the resident refused to return, but both the resident and his family member stated they were not given the option. The facility's actions were not consistent with its policy or regulatory requirements, as the resident's acute behavioral episode was related to a treatable medical condition, and there was no evidence that the facility could not meet his needs after stabilization.