Failure to Follow Involuntary Discharge Procedures for Resident Returning from Therapeutic Leave
Penalty
Summary
The facility failed to ensure that a resident was not involuntarily discharged without a valid reason and without following required procedures. The resident, who had diagnoses including congestive heart disease and muscle weakness, was admitted for long-term care and had a physician order allowing therapeutic leave for up to four hours at a time. On the date of the incident, the resident left the facility on a pass and returned late, after which staff, under the direction of the Assistant Director of Nursing (ADON), did not allow the resident to reenter the facility. The resident was given their belongings and told they could not stay due to repeated violations of the four-hour pass rule, despite the resident expressing a desire to remain at the facility. Documentation showed that the discharge was recorded as 'against medical advice' (AMA), but the resident did not sign the AMA form, and the form itself lacked a diagnosis. Staff notes indicated that the resident was unhappy with being discharged and did not want to leave. Interviews with facility staff, including the ADON, DON, and Case Manager, revealed that the facility had an ongoing issue with the resident returning late from passes, but there was no written policy supporting automatic AMA discharge for exceeding the pass time. The DON and Administrator acknowledged that the required 30-day written notice of involuntary discharge and notification to the Long-Term Care Ombudsman were not provided to the resident. The facility's actions were based on verbal warnings and frustration with the resident's non-compliance, rather than adherence to established discharge procedures. The resident was not provided with the opportunity to appeal the discharge or receive proper notification, and the discharge was not supported by a physician order or a documented safe discharge plan. The facility's failure to follow its own policies and regulatory requirements resulted in the resident being involuntarily discharged without due process.