Failure to Provide Required Notice and Discharge Planning Before Involuntary Discharge
Penalty
Summary
The deficiency involves the facility’s failure to provide required written notice with appeal rights and discharge planning prior to an involuntary discharge for one resident. The resident had persistent atrial fibrillation, diabetes, and required assistance with ADLs including toileting hygiene, dressing, personal hygiene, and bed mobility, and was receiving PT. He had no cognitive impairment and had previously been homeless, living in his car, and was admitted for continued medical management, therapy, and safe discharge planning. His care plan documented his wish to discharge to the community and the need for community referral, with interventions to establish and evaluate a pre-discharge plan. During the stay, the resident expressed interest in obtaining Medicaid and in moving to assisted living or a pay-by-the-week motel. A discharge planning meeting documented that his managed insurance would no longer pay for his care as of a specified date, and staff discussed discharge versus remaining and paying privately. The resident wanted to appeal the insurance decision and was informed he would be responsible for costs if he remained after coverage ended. However, at that time he was not provided a written discharge notice, and the documentation did not indicate that he was physically able to be safely discharged or that assistance with a Medicaid application was offered, despite his earlier expressed interest. Subsequent discharge planning notes recorded that a family member’s payment temporarily covered his room and board and that staff and the resident discussed discharge locations, payment, transportation, and using therapy time to get stronger, with a planned discharge date. Again, the notes did not document that he was physically able to be safely discharged, that he was offered help applying for Medicaid, or that he received a written discharge notice with appeal rights, even though he was told he would be discharged on a specific date. Later, when a family check failed to clear, the resident was informed he owed the facility and was told he needed to leave that day, despite his report that he could not get out of bed due to pain. There was no physician documentation that he was safe for discharge, no discharge plan put in place, and no written discharge notice with appeal rights or Medicaid assistance documented prior to his involuntary discharge attempt, leading him to call 911 for transfer to the hospital.
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