Failure to Assess and Coordinate Safe Discharge to Homeless Shelter
Penalty
Summary
The deficiency involves the facility’s failure to consider the availability, capacity, and capability of a caregiver/support setting to meet a resident’s care needs prior to discharge. The facility’s policy required that information necessary to meet a resident’s needs be provided upon transfer, but for one resident with chronic kidney disease, morbid obesity (BMI >70), muscle weakness, difficulty walking, anxiety/adjustment disorders, and multiple active wound care orders, this did not occur. A Discharge MDS documented the resident was cognitively intact but required supervision/touching assistance for eating, hygiene, dressing, toileting, and footwear, and substantial/maximal assistance for bathing. The TAR and wound care note showed ongoing wound care needs, including a chronic ulcer with exposed subcutaneous tissue and MASD requiring topical treatment, and documented that refusal of care and garments could lead to unhealable wounds, sepsis, and death. The discharge evaluation noted a follow-up medical appointment but the record lacked a referral to a wound care clinic, documentation that the receiving setting could meet ADL or wound care needs, and a signed discharge plan. The resident was discharged to a homeless shelter without prior contact from the facility to verify the shelter’s ability to meet her care needs. The homeless shelter’s case manager reported their cots could not support individuals over 400 lbs and that they could not provide wound care or mobility assistance, and confirmed the facility had not contacted them before dropping off the resident. The shelter’s medically fragile program requirements specified that individuals must be independent with ADLs, that LTC facilities must provide advance notification to verify bed availability and care capability, and that an in-person assessment is required prior to acceptance. Transportation records showed the resident was offloaded at the shelter, which then informed the driver they could not accept her; the transport company left a message for the facility and later informed the facility that the shelter could not accept the resident, but the facility did not request the resident be returned. The resident remained outside the shelter until transported to the ER. The Social Services Director stated she did not notify the shelter because it was a homeless shelter and did not refer the resident to a wound clinic because she believed the resident could perform her own care, while the DON stated the resident could not apply cream to bilateral buttocks without assistance. Cross-references were made to F656 and F657.
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