Failure to Readmit Hospitalized Resident and Provide Required Transfer/Discharge Protections
Penalty
Summary
The deficiency involves the facility’s failure to allow a severely cognitively impaired resident to return following a hospital transfer and its decision to treat the resident as discharged at the time of transfer, contrary to its own transfer/discharge policy and resident rights. The facility’s written policy stated that residents sent to an acute care setting, such as a hospital, must be permitted to return, and that a determination that needs could not be met must be based on an assessment at the time of proposed return, with documentation of unmet needs, attempts to meet those needs, and any danger posed to others. The policy also required written notice to the resident and representative of the transfer or discharge and the reasons for the move, as well as application of bed-hold and return policies to all residents regardless of payor source. The resident had diagnoses including encephalopathy, vascular dementia with behavioral disturbance, TIA, alcohol abuse, and wandering, and was assessed as severely cognitively impaired, requiring supervision for basic ADLs. After the resident hit a CNA on the head and neck, management and a nurse decided to send the resident to the ED for evaluation and possible referral to a different facility, and the resident was transferred to the hospital. The business office manager reported that the resident, whose primary payor was Medicaid and who was eligible for a 20‑day bed hold, was initially placed on a hospital leave bed hold but was then changed to discharged effective the date of transfer. Bed availability records showed that a gender‑specific bed appropriate for the resident was available on multiple days following the transfer. The hospital case manager reported that the resident remained hospitalized for an extended period and that the hospital contacted the facility multiple times regarding the resident’s return once medically ready, but the facility either refused readmission or did not respond, despite the resident being medically stable and cooperative with care. The ombudsman and family members reported being told by the facility or hospital that the facility would not readmit the resident, and both family members stated they did not receive any written notification of transfer or discharge or an explanation of why the facility could not meet the resident’s needs. The director of social services and the administrator were unable to provide documentation showing which of the resident’s needs could not be met, what attempts had been made to meet those needs, or any written notice to the resident’s health care agents, despite the administrator stating that the interdisciplinary team had decided the resident could not return.
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