Failure to Permit Safe Return and Proper Discharge After Hospitalization
Penalty
Summary
A deficiency occurred when the facility failed to permit a resident to return after a hospitalization, despite the resident requiring extensive assistance with all activities of daily living and having multiple complex medical conditions, including diabetes mellitus, chronic respiratory failure, COPD, major depressive disorder, end stage renal disease, morbid obesity, and a history of seizures. The resident was dependent on staff for care and had a care plan addressing resistance to care, dialysis needs, diabetes management, and congestive heart failure. The resident was sent to the hospital for shortness of breath and chest pain, received necessary treatment, and was cleared for return to the facility on two separate occasions. Upon both attempts to return from the hospital, emergency services and hospital staff reported that the facility refused to readmit the resident. The facility staff, including the Administrator, cited the resident's history of refusing care, medications, and dialysis, as well as being rude and abusive towards staff, as reasons for not allowing reentry. Despite these behavioral concerns, there was no documentation of a proper discharge process, and the resident was not provided with a safe alternative placement. Interviews with facility staff, emergency medical technicians, hospital staff, and the Ombudsman confirmed that the resident was denied reentry and that no discharge paperwork or safe discharge planning was completed. The facility's own policy on discharge planning did not address the process for allowing residents to return after a hospital visit. Multiple staff members, including the ADON and nurses, indicated they were unaware of any formal discharge and anticipated the resident's return. The Administrator acknowledged that the resident was not properly discharged and would not be allowed to return, despite understanding that this placed the resident at risk of not having a safe place to live and receive necessary care. The lack of proper discharge documentation and refusal to readmit the resident constituted a failure to ensure a safe and appropriate transfer or discharge.