Failure to Provide Written Transfer, Bed-Hold, and Appeal Notices for Hospitalized Residents
Penalty
Summary
Surveyors identified that the facility failed to provide required written notices of transfer, bed-hold practices, and appeal rights to residents’ responsible parties for two residents who were transferred to the hospital. Facility policy on Transfer and Discharge required that, once admitted, residents and their representatives receive a written transfer/discharge notice in a language and manner they can understand, including the specific reason for transfer, effective date, transfer location, explanation of the right to appeal, and the name, address, and telephone number of the State entity that receives appeal requests, as well as information on how to obtain an appeal form. The facility’s Bed Hold Notice policy required that, at the time of transfer to the hospital, written information be provided to the resident and/or representative specifying the reserve bed payment policy and facility bed-hold policies, and that a signed and dated copy of this notice be kept in the resident’s record. Record review showed that one resident with severe cognitive impairment, dependent for all tasks and diagnosed with non-traumatic intracerebral hemorrhage, cerebral edema, pneumonia, osteoarthritis, right-sided hemiplegia/hemiparesis, aphasia, and seizures was transferred to the hospital after the daughter requested transfer due to worsening condition and breathing concerns; the progress note documented that the responsible party was notified, but there was no written transfer or bed-hold notice in the EMR. Another resident, also severely cognitively impaired and dependent for all tasks, with diagnoses including non-traumatic subacute subdural hemorrhage, seizures, cerebral infarction, atrial fibrillation, unspecified dementia, malnutrition, and type II diabetes, was transferred to the hospital after family reported cyanosis of the fingernail beds and the physician ordered oxygen and transfer for further diagnosis and treatment; again, the record only reflected that the responsible party was notified, with no written transfer or bed-hold documentation retained. In interviews, the National Director of Risk Management stated that staff always called the responsible party when a resident was discharged but did not send written notification, and that while a bed-hold notification form was sent with the resident to the hospital, a copy was not kept in the EMR. The Administrator reported he was not aware that the responsible party needed to receive written notice of transfer and bed-hold information upon any hospital transfer.
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