Failure to Honor Resident Representative’s Discharge Wishes
Penalty
Summary
Facility staff failed to honor the wishes of a resident’s representative regarding discharge, despite the resident being determined unable to comprehend information and make decisions. The resident had been admitted from the hospital for rehabilitation, and two physician certifications documented the resident’s incapacity on two separate dates. A social services note recorded that the resident’s representative wanted the resident discharged earlier than the date set by the Director of Rehabilitation so the resident could be home, and the representative planned to follow up with Social Services about a discharge date. Subsequently, when the representative arranged transportation home and notified the facility, Social Services staff (Staff #6) informed the representative that discharge paperwork, including an Against Medical Advice (AMA) form, had to be signed and returned before the resident could leave on the requested date. Staff #6 acknowledged telling the representative that, because the resident could not sign, the representative needed to sign the AMA form for the resident to be discharged. The AMA form, later provided to the surveyor, contained a written statement by the representative that the facility had said the resident would not be allowed to leave unless the form was signed, and it was signed by both the representative and Staff #6. An email from Staff #6 to the representative stated that the facility could send discharge paperwork in advance but required the signed paperwork to discharge the resident on the requested day. The representative reported believing the facility could not hold the resident if the representative wanted the resident to go home, but signed and returned the AMA form after being told the resident could not be discharged without it. The corporate nurse later confirmed she had informed Staff #6 that the AMA form was not required, but this occurred after the representative had already signed the document.
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