Failure to Follow Bed-Hold Policy Resulting in Loss of Resident’s Room
Penalty
Summary
The deficiency involves the facility’s failure to follow its bed-hold policy and ensure an appropriate transfer/discharge process for a resident who was hospitalized. The facility’s policy for the Subacute Unit (SAU) required that at the time of transfer or discharge, the resident and representative receive written notice of the bed-hold policy, including the duration of the bed hold and readmission criteria, and that residents whose hospitalization exceeds the bed-hold period be allowed to return upon the first availability of a semi-private bed if they still require SAU services and are Medicaid-eligible. The policy also required that if a resident transferred with an expectation of return could not come back, the facility must provide written notice of transfer/discharge, including reasons for the move, effective date, new location, appeal rights, and contact information for the state LTC ombudsman and protection and advocacy agencies, and send a copy to the ombudsman. The resident was admitted to the facility and later transferred to an acute care hospital, with a Notice of Transfer/Discharge indicating the transfer was necessary for the resident’s welfare and that the resident’s needs could not be met in the facility. A SAU Form–Notice of Bedhold documented that the resident left for hospitalization and elected to hold the bed for a specified seven-day period. Hospital progress notes showed that within that period the resident’s condition stabilized and improved, and that the resident could begin planning to return to the facility and remained stable for return. The hospital case manager reported that hospital staff informed the facility that the resident was ready to return, but the facility stated there was no available bed on the unit where the resident had previously resided. The Administrator reported that, based on a telephone conversation with a hospital discharge coordinator indicating the resident would not be returning to the facility “any time soon” and would be in the hospital a few more days, he cancelled the resident’s bed hold, discharged the resident from the room, and reassigned the room to another resident before the end of the elected bed-hold period. The Administrator did not further clarify with hospital staff what was meant by the statement that the resident would not be returning “any time soon” and did not obtain a more specific anticipated return date. The Administrator also stated that only 14 rooms on the unit were covered by the resident’s insurance and that the resident was placed on a waiting list for a covered room. A Contracts Unit Chief later confirmed that the facility could have held the resident’s room for two weeks from the date of transfer if the resident was expected to return and acknowledged that the Administrator should not have cancelled the bed hold.
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