Failure to Document Justification for Refusing Resident Readmission After Hospital Transfer
Penalty
Summary
The deficiency involves the facility’s failure to allow a resident to return from the hospital without a documented reason in the medical record explaining why the resident’s needs could not be met. Facility policy stated that when a resident is sent to an acute care setting, it is considered a transfer with an expected return, and that if the facility does not permit a resident’s return based on inability to meet needs, the facility must notify the resident/representative in writing and document the reason in the record. The policy also required that discharge decisions after an emergency transfer be based on the resident’s status at the time of attempted return, and that nursing notes include documentation of appropriate orientation and preparation prior to transfer or discharge. The resident involved had a PASRR dated several years prior showing manic and depressive episodes, serious functional problems, a history of intense psychiatric treatment, frequent crisis hotline calls with threats of self-harm, difficulty getting along with others, and a need for redirection. The preadmission packet and care plan identified diagnoses of anxiety, diabetes, schizophrenia, bipolar disorder, depression, obesity, and behaviors including becoming angry quickly, making threats, suicidal thoughts without a specific plan, risk for aggression, anxiety, irritability, difficulty getting along with others, and a need for two staff for care due to size and behaviors. The facility’s DON reviewed the preadmission packet and deemed the resident appropriate for admission, and the resident was admitted with the Public Administrator as guardian. Nursing notes documented that after admission the resident was very anxious, repeatedly approached the nurses’ station, requested hospice be called, used the call light frequently for minor issues, attempted to pull staff into bed, and required care in pairs. On the day of transfer, the resident returned from a smoke break, again requested hospice, reported having a mental and physical crisis, complained of chest pain radiating down the left arm, and stated an intention to harm self and everyone around. EMS was called, the resident began throwing things, EMS de-escalated the situation, and the resident was transferred to a hospital. Subsequently, the hospital social worker and the Public Administrator reported that facility social services stated the resident would not be accepted back and delivered a letter declining readmission, while the Administrator stated the facility would not allow return because the resident needed psychiatric evaluation and she felt other residents would not be safe. There was no documented reason in the resident’s medical record at the facility explaining why the resident’s needs could not be met upon attempted return, despite the facility’s decision not to readmit the resident.
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