Delayed and Insufficient PT Services for Two Rehab Admissions
Penalty
Summary
The deficiency involves the facility’s failure to provide specialized rehabilitative services, specifically PT, in a timely manner for two residents admitted for rehabilitation. Facility policy states that therapy evaluations and services are to be scheduled and conducted in accordance with the resident’s treatment plan and Medicare guidelines, with therapy coordinated with nursing and documented in the medical record. Despite this, both residents experienced delays between admission and initiation of PT services, and therapy recommendations to nursing were not made until several days after admission for one resident. One resident was admitted with multiple serious diagnoses, including intracerebral hemorrhage, dysphagia, morbid obesity, atrial fibrillation, heart disease, neurogenic bowel and bladder dysfunction, chronic kidney disease, edema, TIA, and cognitive impairment. The admission MDS documented the resident used a walker and manual wheelchair and required substantial to maximal assistance with ADLs and was dependent for toileting hygiene, while remaining cognitively intact. The resident’s CAA noted that the resident was working with therapy for increased independence with ADLs, and staff were to provide assistance and monitor for changes. However, the EMR shows that therapy-to-nursing recommendations were not completed until four days after admission, and PT did not evaluate the resident until that date. In interview, the resident reported not being evaluated for multiple days, remaining in bed over a weekend until therapy was available, and lacking a bariatric walker and wheelchair for several days, resulting in use of a urinal and bowel movements in bed because staff did not know how the resident ambulated or transferred until PT evaluated. The second resident was admitted for rehabilitation with hepatic encephalopathy, alcohol cirrhosis with ascites, and pancreatic cancer, and the admission MDS documented the resident was cognitively intact and needed moderate assistance with bathing, dressing, and bed mobility. PT screened the resident two days after admission and identified the need for a standard wheelchair and two-wheeled walker with assistance of one staff for transfers. The PT evaluation and plan of treatment, completed three days after admission, ordered PT five times per week for four weeks, including therapeutic exercises, neuromuscular reeducation, gait training, group procedures, therapeutic activities, and wheelchair management training. Documentation shows the resident received only two PT sessions on consecutive days, with no further PT provided before the resident was discharged to the hospital. In interviews, the Director of Rehab stated there was a gap in PT staffing, that the facility did not have a full-time PT, and that she could not get a PT to come in, contributing to the delay and limited provision of PT services for this resident.
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