Failure to Ensure Home Health Services Were Secured Prior to Discharge for Resident Requiring Wound Vac Care
Penalty
Summary
The deficiency involves the facility’s failure to have an effective discharge planning process to ensure that home health services were arranged prior to discharge for a resident who required ongoing wound vac therapy. The resident was admitted with a history of sleeve gastrectomy, surgical wound dehiscence, small bowel perforation, and a present surgical abdominal wound requiring a wound vac with physician orders for dressing changes three times weekly. The admission MDS showed the resident was cognitively intact, had functional limitations requiring assistance with several ADLs, and had an active goal to discharge to the community with discharge planning in process. On the day of discharge, the Discharge Planner sent a home health referral late in the morning to a home health agency and reported to the family that the agency had agreed to see the resident at home. The resident was discharged home with their spouse in the mid-afternoon while still requiring wound vac care. Later that same afternoon, the home health agency informed the Discharge Planner they could not accept the resident due to the resident’s geographic location. The Discharge Planner then contacted several additional home health agencies, all of which also declined for geographic reasons, but this occurred after the resident had already left the facility. Family interviews revealed that after discharge, no home health agency contacted the resident for two days, prompting the family to call the initially referred agency, which confirmed it had denied the referral and had notified the facility prior to discharge. The family stated the Discharge Planner continued to insist that the agency had accepted the referral. During this period, the resident remained at home with an abdominal wound vac and no home health services in place, and the family, including a registered nurse family member, provided the wound care themselves until other arrangements were eventually made. The Administrator later stated he expected his team to be aware of all plans for care and services at home before a resident was discharged.
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