Failure to Ensure Resident Discharge Rights During Unauthorized Leave
Penalty
Summary
The facility failed to ensure appropriate discharge rights for a resident who was discharged following a leave of absence (LOA) despite having her LOA privileges revoked by physician order. The resident, who had diagnoses including diabetes mellitus type II, infection of the left hip, pain, weakness, and gait abnormalities, was identified as low risk for elopement but had a history of substance abuse and dependence. Her care plan and physician orders specifically indicated that LOA privileges were revoked due to substance use, and she was not allowed to leave the facility. On the day of the incident, the resident left the facility with her family against medical advice (AMA), despite being aware that her LOA privileges had been revoked. Facility staff documented that the resident and her family were informed of the revoked privileges and that leaving under these circumstances was considered an AMA discharge. The resident later contacted the facility and was told she had violated the physician's order and was officially considered to have left AMA. When staff attempted to have the resident and her daughter sign the AMA form, both refused, and staff signed the form with a witness instead. Interviews with facility staff, including the RN, social services designee, administrator, DON, and social worker, confirmed that the resident's LOA privileges were revoked due to substance use and that the decision to proceed with an AMA discharge was based on her leaving the facility without authorization. The administrator and staff indicated that the resident had previously left the facility without permission and had been re-educated, but the final decision to discharge her AMA was made after she left despite the revoked LOA order. Facility policy requires a 30-day advance notice for discharge except in specific circumstances, but in this case, the discharge was processed as AMA due to the resident's actions.