Failure to Assist Resident With Requested Transfer and Insurance Coordination
Penalty
Summary
The deficiency involves the facility’s failure to honor a resident’s right to self-determination and choice regarding transfer to another skilled nursing facility closer to family. A resident with diagnoses including hemiplegia, hemiparesis, type 2 diabetes mellitus, and essential primary hypertension, and with documented moderate cognitive impairment and dependence on staff for several ADLs, expressed a desire to transfer to a facility in Bakersfield to be closer to his sons. The resident reported wanting this for some time and stated he was not informed about the transfer process and was unaware of what was happening, indicating reliance on his responsible party to handle the transfer. The responsible party stated that it had been almost three months since the resident’s desire and request to transfer were communicated to the facility, but they were not provided with a list of available facilities in Bakersfield and did not receive consistent information about why the transfer could not occur. The responsible party further reported not being able to speak with the administrator despite requests and not receiving assistance from the facility in changing the resident’s insurance so that Bakersfield facilities could accept the resident. The social services director confirmed that the family had requested a transfer to Bakersfield for at least one to three months and acknowledged that a contacted Bakersfield facility did not accept the resident’s insurance, stating that changing insurance was the responsibility of the resident or responsible party. Progress notes showed that social services spoke with an admissions director at a Bakersfield facility and learned they did not take the resident’s insurance, but records did not show referrals or transfer plans prior to the complaint investigation date. The resident’s discharge care plan, which included interventions to discuss placement options as requested and review insurance verification and authorization as needed, did not reflect that these interventions were implemented before the complaint, resulting in an unreasonable delay and impediment to the resident’s requested transfer.
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