Failure to Ensure Timely Provision of DME and Home Health Services After Discharge
Penalty
Summary
Facility staff failed to ensure timely provision of ordered durable medical equipment (DME) and home health (HH) services for one resident who was discharged home. The resident, cognitively intact per a discharge MDS BIMS score of 15, had diagnoses including atherosclerotic heart disease of native coronary artery without angina pectoris, morbid obesity due to excess calories, end stage renal disease, and muscle weakness. Upon discharge home, physician orders were in place for a bedside commode and a front‑wheeled walker to be delivered to the resident’s home, as well as HH services including nursing and physical therapy. The resident reported that these DME items were not delivered until several days after discharge and that HH services did not begin until approximately one week after arrival home. During this period, the resident stated she had to use a bedpan for four days and, due to limited mobility, this was very difficult on her body and mental state, and she reported that her body became weaker and one leg became flaccid. Interviews with facility staff corroborated the delays in DME and HH service initiation. The Director of Social Services confirmed that the resident was discharged home and that the bedside commode and front‑wheeled walker were not delivered until several days later, and that HH services did not begin until about a week after discharge, acknowledging this was an issue and not typical. The Director of Rehabilitation stated she had provided a bedpan prior to discharge because the bedside commode would not be at the home when the resident arrived and later went to the resident’s home to set up the bedside commode after the DME provider did not do so. The Administrator stated it was not acceptable that the DME was delivered and HH services started after such delays. Discharge planning notes documented the resident’s calls reporting that DME had not been delivered and that a personal care aide company could not cover services, as well as subsequent contacts with the DME provider and multiple HH agencies, confirming that the ordered equipment and HH services were not in place in a timely manner following discharge.
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