Failure to Provide Medically Related Social Services and Discharge Planning Support
Penalty
Summary
The facility failed to provide medically related social services to a resident when the Case Manager (CM) did not meet with the resident despite multiple requests. The resident was admitted with a right tibia fracture, diabetes mellitus, and hypotension, and had HMO insurance. The resident’s History and Physical and MDS documented that the resident had intact cognitive skills for decision-making and required substantial/maximal assistance for most ADLs. During a phone interview, the resident reported making many requests through nursing staff to see the CM and stated being told that the CM, not the facility social workers, was responsible for coordinating care and discharge for HMO residents. RN 1 confirmed remembering the resident’s request and stated that the CM was informed but RN 1 did not follow up. Review of the electronic medical record showed no CM notes indicating any meeting or discussion with the resident until 14 days after admission, although the CM acknowledged they should have seen the resident earlier and did not. The DON reviewed the CM’s job description, which stated that the CM is responsible for monitoring all HMO/managed care residents for care needs and orders, and for discussing discharge plans with residents to ensure the plan and level of care meet their needs and ability to participate. The facility’s Social Services policy stated that medically related social services are provided to help residents attain or maintain their highest practicable physical, mental, or psychosocial well-being, including informing and educating residents about health care options and assisting with factors negatively affecting psychosocial functioning, such as helping residents voice and resolve grievances. The failure of the CM to meet with the resident from 2/10/2026 to 2/23/2026 resulted in the resident being unaware of the discharge plan and experiencing mental stress.
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