Failure to Ensure Resident Discharge Location Met Needs and Preferences
Penalty
Summary
The facility failed to ensure that a resident's discharge location met the resident's needs for family support and resources. The resident, who had a history of pneumonia and falls, required partial to moderate assistance with activities of daily living and mobility, as documented in the Minimum Data Set and Physical Therapy Discharge Summary. Despite these needs, the discharge planning process did not provide the resident or their family member with choices regarding potential discharge locations. The family member reported that no options were offered and that the only assisted living facility (ALF) presented was provided on the day of discharge, leaving insufficient time to evaluate alternatives or appeal the decision due to external circumstances. Interviews with facility staff, including the case manager, social services director, and director of nursing, confirmed that the resident and family were not given a list of ALFs to consider and that there was no documentation of other options being discussed. The case manager indicated that the ALF was found within 48 hours before discharge, and the family was informed that if they did not agree to the transfer, they would need to pay for additional days until a safe placement was found. The facility's policy required assisting residents in selecting a post-acute care provider relevant to their goals and preferences, but this was not followed in this case.