Failure to Allow Resident to Return After Hospitalization Due to Family Behavior
Penalty
Summary
The deficiency involves the facility’s failure to ensure a safe and appropriate discharge/transfer by refusing to allow a resident to return from the hospital, despite being able to meet the resident’s medical needs and in the absence of problematic resident behaviors. The resident, over age 65, had dementia, respiratory failure, diabetes, and asthma, and was dependent on staff for eating, personal hygiene, dressing, and transferring. The resident was transferred to the hospital at the family’s request and was hospitalized with pneumonia and hyponatremia. While the facility later issued an Expedited Notice of Transfer citing that the safety of individuals in the facility would otherwise be endangered, the record did not show that the resident had exhibited behaviors that endangered others, nor did it show that the facility reassessed the resident once she returned to baseline at the hospital prior to issuing the immediate discharge notice. Interviews with facility staff confirmed that the decision not to readmit the resident was based on the behavior of a family member, not on the resident’s condition or conduct. The admissions director stated the resident was not permitted to return and that the situation required an immediate discharge, but could not specify the reason beyond family dynamics. The DON reported there had been no issues with the resident’s care or behavior and acknowledged that a facility could not refuse readmission based on a family member’s behavior, further stating the resident should have been allowed to return. The NHA described the resident as a great resident with no mistreatment of staff or other residents, and admitted the decision to deny readmission was made quickly due to concerns about the abusive behavior of a family member and its impact on staff. The NHA also acknowledged that the resident had the right to return, that the facility could manage the resident’s medical needs, and that the Expedited Notice of Transfer was not completed or provided to the resident or family prior to discharge from the hospital. A RN corroborated that the resident had no significant behavior issues and was friendly toward staff, while noting that a family member often directed care decisions in conflict with the resident’s wishes.
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