Failure to Notify Resident Representative of Insurance Coverage Change
Penalty
Summary
The facility failed to honor a resident's right to have their appointed representative notified of changes affecting their care and finances when it changed the resident's health insurance coverage without informing the resident's power of attorney (POA). The resident had diagnoses including Alzheimer's disease and dementia, conditions that affect memory, thinking, and social abilities. The resident's profile and POA documents identified the resident's son as both financial and healthcare POA. The facility received a notification from the resident's insurance company indicating that the resident's current insurance plan was no longer offered, and subsequently enrolled the resident in a new health insurance plan. The Business Manager reported that the facility made the insurance change to ensure the resident would continue to have coverage, and confirmed that the new insurance coverage began on January 26, 2026, though the exact date of the change was not known. The Business Manager also stated that the resident's son, as POA, was notified of the change by the insurance company and then questioned the facility about why he had not been informed. The Nursing Home Administrator confirmed that the facility enrolled the resident in a different health insurance plan without notifying the POA. This sequence of actions and omissions resulted in the facility failing to ensure the resident's appointed representative was notified of the insurance coverage change.
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