Failure to Ensure Safe Discharge with Home Health Services Established
Penalty
Summary
A deficiency occurred when a resident was discharged home without ensuring that home health agency (HHA) services were established, despite orders and recommendations for such services. The resident, who was admitted for rehabilitation following a displaced left femur fracture and had generalized muscle weakness and legal blindness, was discharged home at her own request. The discharge orders included the need for physical therapy, occupational therapy, registered nurse services, and durable medical equipment, with the expectation that these would be provided through HHA. However, the facility failed to confirm that the HHA could initiate services prior to discharge. Interviews and record reviews revealed that the social services department sent referrals for HHA and necessary equipment, but only learned after discharge that the HHA could not accept the resident due to her not being established with a primary care physician. Multiple staff members, including the case manager, assistant director of nursing, and director of therapy, confirmed that HHA services should have been verified and established before discharge, especially given the resident's high risk factors such as living alone, impaired mobility, and vision loss. The resident's emergency contact also expressed concerns about her safety at home without adequate support. Documentation showed that the discharge was marked as being per the resident's preference, but therapy and nursing staff indicated that the discharge was against medical advice due to the resident's ongoing need for supervision and therapy. The lack of established HHA services resulted in a gap in care and placed the resident at risk, as confirmed by staff interviews and progress notes. The facility did not document the discharge as being against medical advice, nor did it ensure that the interdisciplinary team was fully informed of the lack of HHA services prior to discharge.