Failure to Re-Admit Resident After Psychiatric Hospitalization Due to Safety Concerns and Incomplete Pre-Admission Assessment
Penalty
Summary
The facility failed to re-admit a resident following an inpatient psychiatric hospital stay, despite documentation from the psychiatric hospital indicating the resident was stable enough to return. The resident had a complex medical and psychiatric history, including high blood pressure, colostomy, vascular dementia, bipolar disorder, schizophrenia, and mood disorder. The facility issued an emergency discharge notice, citing concerns for the safety of other residents and staff due to the resident's medication noncompliance, aggressive behaviors, and continued agitation both prior to and during the hospital stay. The discharge notice was sent to the resident, their guardian, and the Ombudsman, and stated that the discharge was necessary for the safety of all residents, with the right to appeal outlined, but the discharge was already effectuated. Interviews with facility staff revealed that there were significant concerns and a lack of adequate information at the time of the resident's initial admission. The Admissions/Marketing Coordinator and DON noted that the referral was flagged as requiring further evaluation due to behavioral history, but they were unable to obtain the resident's PASRR or sufficient medical records from the hospital. Despite their concerns and an unsuccessful on-site evaluation, the regional admissions staff accepted the resident for admission. The facility administrator acknowledged that the facility was not equipped to provide the necessary care for the resident and that the initial admission should not have occurred. The Ombudsman confirmed involvement with the resident and expressed surprise that the facility had accepted the resident initially, given the behavioral and mental health history. The Ombudsman also noted the lack of a recent PASRR and believed the facility did not have accurate information prior to admission. The facility's decision to refuse re-admission after the psychiatric hospitalization was based on ongoing concerns for the safety of other residents and staff, as well as the resident's continued noncompliance and behavioral issues.