Failure to Honor Resident’s Right to Return After Hospital Transfer
Penalty
Summary
The deficiency involves the facility’s failure to protect a resident’s right to return to the facility following a hospital transfer, despite documentation that a return was anticipated and a bed was available. The resident was a long-term resident with no discharge plan in place and considered the facility to be their home. The resident had multiple diagnoses, including non-ST elevation myocardial infarction, type 2 diabetes mellitus, Alzheimer’s disease, hypothyroidism, difficulty in walking, muscle weakness, hypertension, and anxiety disorder. The resident’s MDS Nursing Home Discharge Item Set indicated a discharge with return anticipated, and general notes documented that the resident’s representative wanted the resident to return to the facility after being sent to the hospital for an unwitnessed fall. While the resident was hospitalized, the facility’s Director of Marketing sent a referral communication to the hospital stating that the resident required a higher level of care and that the facility could not provide the needed level of care. The DON reported that the facility had a bed capacity of 99, a census of 94, and one bed hold, confirming that a bed was available. Nonetheless, the DON stated the facility would not accept the resident back due to perceived safety concerns, including aggressiveness, wandering, and fall risk. The DON also stated that a non-clinical staff member checked on the resident’s status at the hospital and that there was no nurse-to-nurse communication or nursing assessment between the hospital and the facility regarding the resident’s condition. Record review showed that the resident’s care plans, initiated prior to the hospital transfer, already identified risks for unavoidable falls related to confusion and poor safety awareness, episodes of aggressive behaviors, and wandering behaviors. The DON acknowledged that these behaviors were present before the transfer and stated that if the facility had known about them, the resident would not have been admitted, despite the resident being a long-term resident. The SSD confirmed there was no discharge plan and that the resident was considered long term with no plans for discharge. Hospital documentation, including a physician progress note and a psychiatric follow-up visit, indicated the resident remained confused due to Alzheimer’s disease but did not exhibit physical or verbal aggression, hallucinations, homicidal or suicidal ideation, and had only low to moderate anxiety managed with buspirone and non-pharmacological interventions. A PASRR notice indicated no serious mental illness requiring specialized mental health services. The facility’s own bed-hold and returns policy stated that residents must be permitted to return following hospitalization if they still require services provided by the facility and are eligible for Medicare or Medicaid services, but the resident was not allowed to return.
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