Failure to Allow Hospitalized Resident to Return and Inadequate Discharge Process
Penalty
Summary
The deficiency involves the facility’s failure to allow a resident, who had been transferred to a hospital, to return to their previous room or to the facility upon bed availability, contrary to the facility’s transfer and discharge rights policy and regulatory requirements. The resident had diagnoses including Parkinson’s disease with dyskinesia, unspecified dementia with anxiety, and atherosclerotic heart disease, and was assessed as significantly cognitively impaired but usually able to understand others and make themselves understood. The resident’s comprehensive care plan included a behavior focus with interventions such as diversion, redirection, 1:1 supervision, television, and 15‑minute checks. According to progress notes, the resident was transported to a hospital after being found in another resident’s room. The Medical Director documented that, although they had previously told the family that the facility could manage the resident’s behaviors, the events leading to the hospital transfer changed the situation, and the facility informed the family that they could not meet the resident’s needs for discharge back from the hospital. The Social Worker documented informing the family that the facility would need to discharge the resident because it was unable to meet the resident’s needs at that time, and directed the family to the hospital social worker/discharge planner for assistance with alternative placement. The Social Worker also discussed packing the resident’s belongings and provided contact information for the facility biller when the family inquired about redirecting the resident’s benefits. In interviews, the DON stated that after the resident was found in another resident’s room, the resident was placed on consistent 15‑minute checks and that the resident had to be on a locked unit due to known exit‑seeking behaviors. The DON further stated the facility chose not to take the resident back when they were cleared for discharge because the facility had not concluded its investigation and believed it could not continue 1:1 supervision after 15‑minute checks had failed. The family member reported being told by the emergency room physician, based on information from the facility, that the resident would not be welcomed back, and stated that facility staff never met with them regarding discharge, did not provide options for alternative placements, and that the resident was instead sent to another hospital unit designed to hold residents with behaviors while awaiting nursing home placement. The Administrator confirmed that this other hospital unit was used for residents who were hard to place, usually due to behaviors.
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