Failure to Honor Resident Representative's Request for Hospice Care
Penalty
Summary
The facility failed to honor the wishes of a resident's representative by not allowing the resident to remain at the facility while receiving hospice services. The resident's representative was informed by the Social Services Director (SSD) that the facility would discharge the resident because they could not provide hospice care on-site, despite the representative's request for the resident to stay and receive hospice care. The representative appealed the discharge twice and attempted to find another facility, but was denied due to the resident's wound care needs. Ultimately, the representative felt pressured by staff to take the resident home. Medical record review showed that the SSD attempted to issue a Notice of Medicare Non-Coverage (NOMNC), but the family did not sign it, and the SSD reiterated that hospice care could not be provided at the facility. A review of the facility's contract with a hospice provider revealed that the facility did have an agreement in place to provide hospice services to residents. Interviews with the SSD, DON, and Nursing Home Administrator confirmed that the facility preferred to discharge residents who required hospice or long-term care, even though they were capable of providing hospice services. The DON and NHA both stated that residents were discharged when they needed hospice care, and the NHA confirmed that the facility would only provide hospice care for a few days before discharging the resident to another setting. The facility was dually certified for rehabilitation and long-term care, but did not honor the resident representative's request for continued care with hospice services.