Failure to Provide Bed-Hold Notice and Discharge Communication
Penalty
Summary
The facility failed to provide a required bed-hold notice to a resident and their representative when the resident went out on therapeutic leave, as required for Medicaid beneficiaries. The facility did not have a policy for issuing bed-hold notifications for therapeutic leave, and staff interviews confirmed that such notices were only given when a resident was admitted to a hospital for more than 24 hours, not for therapeutic leave with family. The Executive Director, Business Office Manager, and other staff acknowledged that bed-hold notifications were not provided in these circumstances, and the Executive Director later recognized this as an oversight. The resident involved had a history of schizophrenia and wandering, with a severely impaired cognitive status as indicated by a BIMS score of 03. The resident frequently went on therapeutic leave with family, as documented in progress notes and facility records. On the date in question, the resident left with family for therapeutic leave and did not return. The family and resident representative were not informed of a discharge at the time of departure, nor were they provided with information about bed-hold policies, appeal rights, or the resident's ability to return to the facility. Interviews with the resident's representative and family revealed confusion and lack of communication regarding the resident's discharge status, medication supply, and the process for returning to the facility. The representative reported not understanding the appeal process and not receiving timely or adequate notification about the resident's discharge or bed-hold rights. Additionally, the facility did not remove the resident's wander guard upon discharge, and there was no follow-up from the social worker regarding the resident's care after leaving the facility.