Failure to Follow Up on Podiatry Referral for Resident with Diabetes and Renal Failure
Penalty
Summary
The facility failed to follow up on a podiatry consultation referral for one resident who was admitted with diagnoses including Type 2 diabetes mellitus and dependence on renal dialysis. The resident's admission orders included a consultation to podiatry for mycotic hypertrophic nails and/or keratotic lesions. Despite the referral being approved, the resident did not receive podiatry services due to insurance denials and a transition to new coverage. The facility did not offer private-pay podiatry services while awaiting authorization approval. Interviews with facility staff confirmed that proper nail care and hygiene were expected, especially for residents with long toenails, as ingrown toenails can lead to infection and skin breakdown. The Social Service Director acknowledged the delay in podiatry services and the lack of alternative arrangements during the insurance transition. Review of facility policy indicated that the Social Services Director was responsible for assisting in obtaining necessary health services, including podiatry, to meet resident needs.