Improper Discharge and Refusal to Readmit Resident After Hospital Transfer
Penalty
Summary
The deficiency involves the facility’s failure to ensure a resident’s right and ability to return following a hospital evaluation, and the improper treatment of a hospital transfer as a voluntary discharge. The resident, admitted in April 2024 with dementia, history of UTIs, anxiety, repeated falls, and anemia, had a care plan indicating long-term care placement. The resident’s MassHealth Eligibility Form showed Medicaid as the primary payor on the day of transfer, meaning a bed hold should have been in place under facility policy, which states that residents must be permitted to return following hospitalization or therapeutic leave regardless of payor source. On the day of the incident, the resident was in the bathroom with a nurse when the resident’s legs buckled while being assisted off the toilet, and the nurse lowered the resident to the floor. A family member, who heard a loud bang and believed the resident had fallen, called the local police and EMS to have the resident evaluated in the ED, noting that the resident had recently fallen and been hospitalized two days earlier for chronic vertebral fractures. The nurse reported telling EMS there was no physician’s order for transfer and that the facility was not transferring the resident, and did not know which hospital EMS would use. EMS documentation indicated that the family requested ED evaluation and that facility staff requested the resident not be sent back and stated they would not accept the resident back. Following the transfer, the nursing supervisor, DON, and administrator treated the resident’s departure as a discharge initiated by the family and as having left against medical advice, despite there being no physician’s order for discharge or transfer and no discharge paperwork provided. The supervisor stated she was told by administration that the resident was considered discharged and not allowed to return. The DON and administrator both stated that the family had discharged the resident by calling police and EMS and initiating the ED transfer, and the administrator stated that because the family initiated the discharge, the facility did not have to readmit the resident despite the resident’s payor source. A police report documented that when the resident returned from the ED a few hours later, facility staff stated the resident had been transferred AMA and was discharged from the facility, and the facility would not accept the resident back, contrary to the facility’s bed-hold and return policy and the requirement to permit return after hospitalization.
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