Failure to Inform Family of Transfer Denial and Provide Discharge Planning Resources
Penalty
Summary
The facility failed to provide required referrals to local agencies and support services for discharge planning and failed to notify a resident’s representative of a denial of admission from a preferred receiving facility. One resident was admitted with malignant neoplasm of the ribs, sternum, and clavicle, along with muscle weakness and difficulty walking. An MDS assessment showed the resident had intact cognition, required setup or clean-up assistance with eating, and was dependent on staff for oral hygiene, toileting hygiene, and personal hygiene. An IDT discharge planning note documented that the resident preferred to return to the community, with a plan to locate an assisted living facility or board and care. During discharge planning, the resident’s family member informed social services staff that she wanted the resident discharged to a facility closer to her home, which was more than three hours away, and she provided the name of a specific facility. The Social Services Director acknowledged receiving this request and documented in the IDT discharge planning record that the plan was to discharge the resident to a facility near the family member. The Social Services Director faxed the resident’s clinical information to the requested facility and received a response the next day indicating that the facility was unable to admit the resident. Despite receiving the denial, the Social Services Director did not inform the family member that the preferred facility had declined admission and did not provide names of other facilities or community resources to assist with identifying alternative placement closer to the family member. The Social Services Director stated that she did not provide additional resources or support for discharge planning and acknowledged that it was her responsibility to do so. The Administrator stated that IDT meetings are used to coordinate necessary services for safe discharge and that the Social Services Director should have assisted the family in finding an appropriate facility closer to them and informed the family of the denial, consistent with the facility’s discharge policy requiring involvement of the resident/representative and referrals to local agencies when there is interest in returning to the community.
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