Failure to Timely Readmit Resident After Hospital Transfer
Penalty
Summary
The facility failed to ensure the timely readmission of a resident who was transferred to a general acute care hospital for further evaluation due to medical needs. The resident, who had severe cognitive impairment, hemiplegia, and bipolar disorder, was dependent on staff for all activities of daily living and lacked capacity to make decisions. After the transfer, the facility's records indicated a seven-day bed hold was in place, and the resident had the right to be readmitted to the first available bed even if the hospitalization exceeded the bed-hold period. Despite this, the facility did not readmit the resident for seven days after the resident was ready for discharge from the hospital. Documentation and interviews revealed that a bed was available during this period, but the facility's admission team delayed the readmission process due to concerns about verifying the resident's insurance eligibility, specifically related to a Medi-Cal M1 code. The admissions coordinator, DON, and administrator were all involved in the decision-making process, with instructions given to hold the readmission until insurance eligibility was confirmed, even though the resident was Medi-Cal eligible and the facility's policy did not require third-party payment guarantees for readmission. Observations confirmed that the bed previously occupied by the resident remained vacant and unassigned to any other resident during the delay. The facility's own policies and procedures indicated that residents should be readmitted to their previous room or the next available bed, regardless of insurance status, but this was not followed. The delay resulted in the resident remaining unnecessarily in the hospital, contrary to the facility's stated policies and the resident's rights.