Inappropriate Discharge of Resident Without Prosthesis and Adequate Support
Penalty
Summary
The deficiency involves the facility’s failure to permit a resident to remain in the facility and not transfer or discharge the resident unless the transfer or discharge was appropriate based on the resident’s health status. Facility policy stated that discharge planning must ensure a safe transition to a post-discharge setting that meets the resident’s health and safety needs and preferences. The resident had diagnoses including hypertension, diabetes, and a need for care following a surgical amputation, and the care plan identified discharge home with family support and home health services. However, multiple progress notes documented that the resident lived alone in an apartment and planned to discharge home after rehab, with no indication of consistent in-home supervision. Care conference documentation showed that a care conference was held, but the resident and family declined the invitation, and the plan of care was reviewed only with the IDT. Progress notes repeatedly recorded that the resident lived alone, and one note indicated the resident expressed a desire to extend the rehab stay with a new prosthesis, while staff lacked updated insurance information. Another note documented that the resident lost an insurance appeal and that the family chose to take the resident home that day, with arrangements for transportation and some DME (wheelchair cushion and sliding board) to be borrowed until ordered items were delivered. Interviews and hospital records further described that the resident was discharged home without his prosthetic leg and was instead provided a sliding board intended for use with supervision/assistance, despite documentation that he would be alone at home. The DON acknowledged that it was thought the resident’s son would help, but could not explain this expectation in light of the record showing the resident lived alone. The resident’s family member reported that the appeal for continued care was denied, that the resident was discharged only hours before a major snowstorm, that the resident was sent home without his prosthesis despite pleas not to discharge him without it, and that he lacked funds to pay out of pocket. Hospital documentation indicated the resident presented requesting placement, reporting inability to ambulate and care for himself at home without his prosthesis, and that the facility still had the prosthetic leg. The DON confirmed that the facility failed to permit the resident to remain in the facility and not transfer or discharge him unless the transfer or discharge was appropriate because his health had improved sufficiently so he no longer needed facility services.
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