Failure to Provide Adequate Discharge Planning and Education for Resident Leaving AMA
Penalty
Summary
The facility failed to ensure that a resident was adequately educated on potential discharge options and prepared for a safe transfer/discharge after the resident signed an Against Medical Advice (AMA) form. The resident, who was cognitively intact and had multiple medical diagnoses including heart failure, neurogenic bladder, diabetes mellitus, and persistent mood disorders, required assistance with several activities of daily living and was on a complex medication regimen. Despite these needs, there was no documentation that alternative discharge plans were discussed with the resident on the day of discharge, nor was there evidence that the resident was provided with sufficient information or support to ensure a safe transition. The incident began after an altercation between the resident and another resident, which resulted in both being sent to the hospital for evaluation. Upon return, the resident was presented with the AMA paperwork by the Business Office Manager (BOM) and Director of Nursing (DON), which he signed. Interviews revealed that the resident did not fully understand the AMA form and felt pressured to leave due to concerns about the incident and possible police involvement. Staff interviews confirmed that the resident needed facility-level care for his mental health and diabetes management, and that he was not offered other suitable discharge alternatives within the next 30 days. The resident ultimately left the facility for a homeless shelter, arranged by the social worker, without his medications and without a clear plan for ongoing care. He subsequently experienced a significant health issue related to his diabetes and required hospitalization. The facility did not have a policy regarding discharge against medical advice, and staff acknowledged that no comprehensive discharge planning or education was provided to the resident prior to his departure.