Failure to Allow Hospitalized Resident to Return Due to Financial Approval Issues
Penalty
Summary
The deficiency involves the facility’s failure to establish and follow a written policy permitting residents to return after hospitalization, resulting in a resident not being allowed to return and instead being effectively discharged while hospitalized. The resident was an older female admitted with a primary diagnosis of unspecified cerebral infarction (stroke) and secondary diagnoses including hemiplegia and hemiparesis affecting the right dominant side, unspecified dementia without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety. Admission records showed she was admitted on 02/23/2026, and the MDS entry tracking reflected that admission date. The following day, an MDS discharge record documented an unplanned discharge to a short-term general hospital, and the discharge summary stated she was sent to the hospital for evaluation due to G-tube issues and possible aspiration with slightly coarse sounds in the upper right lobe, though she denied cyanosis or respiratory distress. Interviews with facility staff revealed that the resident was clinically approved for admission but not financially approved. The DON stated the resident did not return from the hospital because she was not financially approved. The Marketer/Admissions staff reported that the resident was not funded and lacked an identification card, having only a green card, and therefore was not approved for admission based on funding. The ADON and BOM both confirmed that the resident was clinically but not financially approved, and that she was admitted by confusion while management was not in the building, as the facility had been expecting two other new admissions. The BOM indicated transportation had been set up for the wrong person, leading to this resident’s arrival, and that once the discrepancy was recognized, the plan was to transfer her back to the sending facility; however, she was instead sent to the hospital for treatment and not allowed to return. The facility’s discharge planning policy referenced completing discharge planning when anticipating discharge to another setting, but the report did not show that this policy was followed to permit the resident’s return after hospitalization.
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