Failure to Readmit Resident After Reversed Discharge Decision
Penalty
Summary
The facility failed to readmit a resident after a hearing officer determined that the discharge was inappropriate and ordered the facility to reverse its decision. Despite the appeal ruling, the facility refused to allow the resident to return from the hospital, where she had been transferred for evaluation and treatment. The facility also did not permit the resident to remain for the full 30 days after issuing a 30-day discharge notice, as required by regulation. There was no documentation from a physician indicating that the resident had needs that could not be met in the facility, nor was there documentation of the transfer or discharge in the resident's medical records. The resident involved was an older adult with multiple medical conditions, including overactive bladder, right leg below knee amputation, stroke, pressure ulcers, hemiplegia, and hemiparesis. She was cognitively intact and required substantial to maximal assistance with most activities of daily living. The resident was transferred to the hospital for evaluation and treatment after a fall, and was ready for discharge back to the facility, but the facility refused to readmit her, citing non-payment and lack of Medicaid paperwork. The family had filed an appeal with the state, which resulted in a decision that the facility must readmit the resident, but the facility did not comply. Interviews with facility staff, including the Business Office Manager and DON, confirmed that the resident was not allowed to return due to non-payment and alleged non-compliance with Medicaid application requirements. The staff were not aware of the appeal decision until informed by the surveyor. The facility's written policy on admission, transfer, and discharge requires compliance with federal regulations, including not discharging residents while an appeal is pending, unless health or safety is endangered. However, the facility failed to follow this policy and did not document the required information in the resident's records.