Failure to Ensure Safe and Supported Discharge for Cognitively Impaired Resident
Penalty
Summary
The facility failed to ensure that a resident was discharged to a location that met her needs and provided the necessary support and resources. The resident had multiple diagnoses, including severe cognitive impairment, dementia with psychotic and mood disturbances, memory deficits, speech and language deficits, dysphagia, pain, anxiety disorder, and difficulty walking. Clinical documentation indicated that the resident required a mechanically ground diet, supervision and assistance with medication management, and was not considered safe to use the stove. She also needed assistance with activities of daily living such as bathing, dressing, and mobility, and was noted to have poor nutritional status and significant recent weight loss. Despite these needs, the resident was discharged to live alone with no verified support system or caregivers. The facility did not document any assessment of the resident's ability to prepare her prescribed diet or safely manage her medications and activities of daily living. Discharge education and instructions were provided only to the resident, who had severe cognitive impairment, and not to any family member or caregiver. The facility relied on statements from the resident and her brother regarding the existence of a support network, but did not verify the availability, capacity, or willingness of any caregivers. There was no documentation of offers to assist with Medicaid applications or to help the brother obtain power of attorney, despite financial concerns being a barrier to alternative discharge options. After discharge, the resident was found to be unable to manage her medications, nutrition, or hygiene, and lacked any support at home. Home health assessment documented that she required 24-hour supervision, which was not available, and she was not eating or taking her medications. The resident was subsequently admitted to the hospital with further weight loss, confusion, and a new injury. The facility's discharge planning process did not include adequate assessment or documentation of the resident's needs, the capabilities of any support persons, or the provision of necessary education to those responsible for her care after discharge.