Incomplete Hospital Transfer Documentation and Missing Bed-Hold Notices
Penalty
Summary
The deficiency involves the facility’s failure to complete required hospital transfer documentation and provide proper written notices regarding transfer, appeal rights, and bed-hold policies for residents sent to the hospital. Facility policy on Admission, Transfer & Discharge – Bed Hold Policy required written information to residents or representatives specifying the duration of the state bed-hold policy, with two notices: one in advance of transfer and a second at the time of transfer or within 24 hours for emergencies, and documentation of attempts to reach the representative if contact was not made. A separate Bed Hold Policy Notification required the resident or representative to return a signed notification to the business office within 24 hours of transfer or discharge if they chose to retain the bed, and specified the amount to be charged for retaining the bed. For one resident, the Nursing Home Transfer or Discharge Notices for two separate hospitalizations were incomplete. The notices, dated for each transfer, stated that the transfer was necessary for the resident’s welfare and that their needs could not be met at the facility, but did not include the resident representative’s information, the address of the receiving facility, or a brief explanation of why the resident was sent to the ER. Progress notes showed that social services staff left a voicemail regarding bed hold and later documented that a family member verbally consented to hold the bed, and Bed Hold Policy Notification forms reflected verbal consent to hold the bed for each hospitalization. However, there was no documentation in the medical record that a written discharge/transfer notice and bed-hold information were actually provided to the resident or representative at the time of either hospital transfer. For another resident, a progress note documented that the resident was sent to the hospital via stretcher, and a later Nursing Home Transfer or Discharge Notice again stated that the transfer was necessary for the resident’s welfare and that their needs could not be met at the facility. This notice was also incomplete, lacking the resident representative’s information, the address of the receiving facility, and a brief explanation of the reason for ER transfer. Progress notes showed that social services attempted to contact the resident’s family member but were unable to leave a voicemail, and later documented the resident’s readmission. There was no documentation that a written discharge/transfer notice or bed-hold information was provided to the resident or representative at the time of transfer, and no Bed Hold Policy Notification was found in the chart for this hospitalization. Staff interviews confirmed that both floor nurses and social services were responsible for completing and providing transfer/discharge and bed-hold notices, and that these were expected to be given to residents and/or representatives as soon as possible, including after weekend transfers.
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