Failure to Readmit Hospitalized Resident During Bed Hold Due to Candida auris Status
Penalty
Summary
The deficiency involves the facility’s failure to readmit a resident during an active seven-day bed hold period following a hospital transfer, resulting in a potential inappropriate discharge. The facility’s own Bed Hold Notice Upon Transfer policy, revised 12/2022, states that residents must be permitted to remain in the facility and not be transferred or discharged unless specific criteria are met, such as the resident’s needs not being met in the facility, sufficient improvement in health, safety concerns, non-payment, or facility closure. The resident had a Social Services Assessment indicating a preference to remain in LTC, no assistance available at home, and a need for extensive to total assistance with ADLs and transfers, supporting ongoing LTC appropriateness. The resident was transferred to an acute care hospital for slurred speech, with documentation showing an eINTERACT Transfer Form and a progress note describing the event and subsequent hospital transfer. The facility’s Daily Census documented a bed hold for the resident’s room from 11/18–11/20, with no other roommates assigned during that period. However, the Order Summary Report for November did not contain a physician’s order for the transfer or for a bed hold. During the hospitalization, the hospital case manager requested readmission the day after transfer, but the facility informed the hospital that the resident would not be readmitted, despite the active seven-day bed hold. The facility’s refusal to readmit was based on the resident’s hospital diagnosis of Candida auris, an MDRO fungal infection, and the need for enhanced standard or contact precautions. This decision conflicted with the facility’s Management of Candida Auris policy, which allows for placement on transmission-based precautions, use of PPE, and either a single room or cohorting with another resident with the same organism. Interviews with the DON and RN indicated that residents on isolation or enhanced barrier precautions, including those with Candida auris, could be accommodated, and that the resident’s room was unoccupied by other residents during the relevant days, meaning the resident could have been placed alone. The administrator acknowledged that the facility had not accepted residents with Candida auris in the past and confirmed that the resident was not readmitted during the bed hold period, leading to the appeal for readmission.
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