Failure to Provide Specialized Wheelchair Due to Incomplete PASARR Coordination
Penalty
Summary
The facility failed to incorporate recommendations from the PASARR Level II determination and evaluation report into a resident's assessment, care planning, and transitions of care. Specifically, the facility did not submit a completed Nursing Facility Specialized Services (NFSS) application to ensure a resident with severe intellectual disabilities, muscle weakness, and dementia received a specialized motorized wheelchair (CMWC) as recommended by her rehabilitation assessment. The resident was dependent on staff for most activities of daily living and used a manual wheelchair, despite being assessed as needing a tilt-in-space wheelchair with custom support to improve posture and participation in daily activities. The deficiency was due to the facility's inability to obtain a current hospice plan of care signed by the physician, which was required for the NFSS application. The Director of Rehabilitation (DOR) stated he submitted the application, but it was denied for lack of the signed plan of care. Despite repeated requests to hospice staff, including the nurse manager, the required documentation was not provided for several months. The DOR discussed the issue in morning meetings but did not escalate the matter to the Administrator (ADM), his immediate supervisor, for further assistance. The PASARR representative confirmed that the facility was notified and reminded to submit the NFSS request but failed to follow up after the initial denial. Observations showed the resident continued to use a manual wheelchair and was unable to communicate or maintain proper posture. The ADM was unaware of the ongoing issue until much later and acknowledged that the delay in obtaining the necessary documentation resulted in the resident not receiving the recommended specialized equipment.