Failure to Readmit Hospitalized Resident Despite Available Bed
Penalty
Summary
A resident with diagnoses including metabolic encephalopathy, spinal stenosis, type 2 diabetes, and COPD was admitted to the facility and was noted to have intact cognitive skills but required substantial assistance with activities of daily living. The resident was transferred to a general acute care hospital due to increased confusion and at the family's request. Following the hospitalization, the facility failed to readmit the resident, despite available female beds during the relevant period, resulting in the resident remaining in the hospital for 30 days. The admissions coordinator, responsible for facilitating returns after hospitalization, stated that the resident was denied readmission due to a change in insurance, a decision made by the regional marketer. The director of nursing was not informed of the denial and indicated that the regional marketer did not have the authority to deny readmission. Facility policy required that previously admitted residents be allowed to return, but this was not followed in this case.