Failure to Allow Resident Return After Hospitalization
Penalty
Summary
The facility failed to ensure that a resident with Alzheimer's disease and severe cognitive impairment, who was transferred to a General Acute Care Hospital (GACH) for evaluation and treatment of uncontrollable singing and refusal of activities of daily living, was allowed to return to the facility after being cleared for discharge by the hospital. The resident's records indicated that she was admitted to the facility with significant cognitive decline and behavioral disturbances. Upon transfer to the GACH, the facility provided a bed hold notice and a Notice of Proposed Transfer and Discharge, but the discharge notice was not properly signed by the resident or her family member, and did not specify the required advance notice period. After the resident was stabilized and ready for discharge from the GACH, the hospital's social worker contacted the facility to arrange for her return. The facility's Admissions Coordinator, following direction from the facility's psychiatrist and Administrator, declined to readmit the resident, stating that she required placement in a facility better equipped to handle behavioral issues. This decision was made without giving the resident an opportunity to demonstrate improvement. Despite available beds at the facility, the resident remained in the hospital for 21 days while alternative placement was sought. Facility policy indicated that residents seeking to return after hospitalization should be allowed to return to their previous room or the first available bed, provided they still required the facility's services and met eligibility criteria. However, the facility did not follow this policy in the resident's case, as documented in interviews with facility staff and the GACH social worker. The resident was ultimately transferred to another skilled nursing facility after an extended hospital stay.