Failure to Allow Hospitalized Resident to Return Under Bed-Hold and Return Policy
Penalty
Summary
The deficiency involves the facility’s failure to allow a resident to return following a hospitalization, contrary to the facility’s bed-hold and return policy and the resident’s right to return. The resident had psychotic disorder with hallucinations due to a physiological condition and dementia, with a BIMS score of 6 indicating severe cognitive impairment, and was dependent on staff for all ADLs and bed mobility. She had been on 1:1 monitoring and required two staff for all ADLs. During toileting assistance, the resident swung her fist and struck a CNA in the face, then continued to come toward staff while yelling for them to get out of the room. Staff did not leave because of the 1:1 monitoring requirement. Facility staff, including the DON and SSD, reported this was the resident’s first known incident of physical assault, although she had a history of confusion, impulsive behavior, yelling at staff, and attempting to stand unassisted. Following this incident, the resident was sent to the hospital for physically aggressive behavior. The DON stated that on the day after transfer, the facility refused to accept the resident back because they believed her behaviors had not been stabilized, and the DON provided her cell phone number to the hospital with the statement that once the resident was stable, the facility would take her back. The DON also stated that after that date, she did not know of any attempts by facility staff to contact the hospital for updates on the resident’s status. The Administrator confirmed that the transfer was for stabilization and not considered a discharge, acknowledged the facility did not allow the resident to return because of the assaultive behavior, and stated there were no documented attempts to contact the hospital to determine if the resident had been stabilized or was ready to return. The facility’s “Bed-Holds and Returns” policy indicated that following hospitalization, residents whose return is in question due to clinical or behavioral concerns are to be evaluated based on their current condition, not their condition at the time of transfer, which was not followed in this case.
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