Failure to Timely Readmit Resident Following Hospitalization
Penalty
Summary
The facility failed to allow a resident to return following a hospitalization, despite available beds, resulting in a delay of the resident's readmission. The resident, who had significant medical needs including hemiplegia, morbid obesity, type 2 diabetes, and functional quadriplegia, was transferred to a general acute care hospital and was ready for discharge back to the facility. Hospital discharge planners attempted to coordinate the resident's return, but facility staff repeatedly communicated that there were no available beds or mattresses, even though census records indicated open female beds during the relevant period. Interviews with facility staff revealed inconsistencies in communication and awareness regarding the resident's readiness for readmission. The admissions director stated that the first contact from the hospital was received several days after the hospital began attempting to arrange the resident's return, and cited a lack of a mattress as the reason for the delay, despite available beds. The director of social services and assistant director of nursing both indicated that the resident had a history of frequent hospitalizations and readmissions without prior issues, and acknowledged that the resident had the right to return to the facility after hospitalization. Facility policy required that Medicaid residents whose hospitalization exceeded the bed hold period be readmitted upon the first availability of a bed, provided certain criteria were met. Despite this policy, the resident's return was delayed due to the facility's failure to provide a necessary bariatric mattress and lack of timely communication between facility departments and with the hospital. This resulted in the resident not being readmitted as soon as a bed was available, contrary to facility policy and regulatory requirements.