Failure to Provide Bed-Hold Notices and Notify Ombudsman of Facility-Initiated Discharges
Penalty
Summary
The deficiency involves the facility’s failure to provide required written notification of its bed-hold policy to residents and/or their representatives prior to transfer to the hospital, and failure to notify the State Long-Term Care Ombudsman of facility-initiated discharges. For one resident (R1), who had moderately impaired cognition with a BIMS score of 11/15, the EMR showed an unplanned transfer to an acute hospital after staff noted a cut, bruise, and bleeding on the right eyelid and sent the resident for evaluation. Progress notes documented that the POA was notified of the transfer and later contacted about whether the bed should be held, with the POA declining. However, there was no documentation that the bed-hold process, including cost per day and appeal rights, was explained, no completed bed-hold form, and no documentation that the Ombudsman was notified of the facility-initiated discharge. For a second resident (R9), who had no cognitive impairment with a BIMS score of 15/15, the admission and discharge-return-anticipated MDS assessments showed an unplanned discharge to an acute hospital from which the resident did not return. Review of the EMR revealed no documentation that a bed hold was discussed with the resident or representative at the time of transfer, no record of the daily cost of services, and no indication of whether a bed hold was chosen. There was also no documentation that the Ombudsman was notified of this facility-initiated discharge to the hospital. During interview, the Social Services Director confirmed that a bed-hold form was not completed for this resident. For a third resident (R10), the records showed an unplanned discharge to the hospital for abnormal vital signs, with no return to the facility. EMR review again showed no documentation that a bed hold was discussed with the resident or representative, no record of the cost per day, and no indication of a decision regarding bed hold. There was also no documentation that the Ombudsman was notified of this discharge. The Social Services Director described a practice of faxing a monthly admissions/discharge report to the Ombudsman and then discarding the fax documentation, and the Ombudsman’s office reported not having received the facility’s monthly discharge lists since a specified prior date and stated the facility was told to maintain documentation of these notifications. Facility policies required that residents/representatives be informed and receive a copy of the bed-hold procedure upon transfer, that responses be documented, and that the appropriate Ombudsman be notified of all facility-initiated discharges, including hospitalizations, but these requirements were not met for the three reviewed residents.
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