Delayed Therapy Evaluation Due to Missed Orders and Miscommunication
Penalty
Summary
Facility staff failed to provide a timely specialized therapy evaluation for a resident who was admitted with significant neurological impairments, including cerebral infarction and hemiplegia. The resident was dependent in multiple activities of daily living and had a physician's order for Occupational Therapy (OT), Physical Therapy (PT), and Speech Therapy (ST) evaluations upon admission. Despite this standing order, the initial therapy evaluations were not initiated until several weeks after admission, contrary to facility policy which required evaluations to be completed within two days of a referral. Interviews with staff revealed confusion and miscommunication regarding the resident's therapy orders and insurance status. The Director of Rehabilitation stated that no therapy orders were present initially, and therapy evaluations did not begin until nearly a month after admission. The Business Office Manager clarified that the resident had Medicare Part B as a therapy payor source, but there was a misunderstanding at admission regarding insurance coverage, which contributed to the delay in therapy services. The resident and her spouse reported that therapy services were not provided as expected, with the spouse stating that the facility social worker informed them that therapy could not be initiated due to insurance issues. The resident experienced significant pain and required assistance with mobility, as observed during the survey. Facility policy and staff interviews confirmed that the therapy evaluation order was missed, resulting in delayed treatment and placing the resident at higher risk for decline.