Failure to Readmit a Hospitalized Resident to First Available Semi-Private Bed
Penalty
Summary
The facility failed to permit a resident to be readmitted to the first available bed in a semi-private room following hospitalization and transfer to a long-term acute care hospital (LTACH), as required by its own bed-hold and return policy. The resident had a history of hemiplegia and hemiparesis following cerebral infarction and dementia, with documentation showing severe cognitive impairment and a lack of capacity to make decisions. The resident was originally admitted and later readmitted to the facility, then transferred to a general acute care hospital (GACH) via 911 for altered mental status, increased respirations, and oxygen desaturation, and subsequently admitted to an LTACH for further evaluation and therapy. At the LTACH, documentation indicated that the resident’s discharge goal/plan included transfer back to a SNF, and a psychiatric consultation noted that the resident was calm, quiet, and manageable with the current treatment plan. The LTACH case manager reported that a psychiatric consultation report addressing behavioral issues was completed and sent to the facility. Despite this, when the LTACH inquired about readmission, the facility’s Admission Coordinator Director and DON stated that the facility refused to readmit the resident, initially citing that behavioral issues had not been addressed or evaluated in the LTACH records. Further review showed that the facility had multiple available female beds in semi-private rooms on the dates in question. The DON acknowledged that the facility received the psychiatric consultation report from the LTACH and still refused readmission, and also stated that the resident should be accepted for readmission if there were no behaviors that would endanger the health or safety of the resident or others, and that the facility could provide the care and meet the resident’s needs. The facility’s written policy on bed-holds and returns required that residents be allowed to return to their previous room if available, or to the first available semi-private bed, provided they still required facility services and were eligible for Medicare or Medicaid services, and that residents be evaluated based on their current condition following hospitalization. The facility did not follow this policy in the resident’s case.
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