HospitalInspections.org

Based on staff interviews and medical record review, the facility failed to ensure that patients needing home health care were provided a list of home health agencies. Also, the facility failed to document in medical records that the list was presented to patients or patients' family members.

This failure limited the choices for patients needing post-hospital extended care services.

Findings:

1. The facility did not provide a list of home health agencies or document that a list was given to patients and/or family members.

a) On 01/05/13 a review of, "Memorial Health System Policy/Guideline" titled, "Patient Discharge Planning", revealed the following: "The discharge planning process will include documentation that a list of Skilled Nursing facilities (SNF) Home Health Agencies (HHA) post hospital extended care services to allow personal choice was presented to the patient or to the individual acting on the patient's behalf. The goal is that the patient's and families' wishes drive the direction of discharge discussions and planning."
b) On 01/06/13 a review of Sample Patient's #14, #18 and #20 medical records revealed that there was no documentation that a list of home health agencies had been provided to the patient's and/or family members.
c) On 01/06/13 at 1:31 p.m. review of medical record for Sample Patient #10 revealed that documentation by the Registered Nurse (RN) Case Manager stated the following: "Returned to room to follow up with Patient after some confusion was reported. I initially spoke with patient yesterday after therapy's recommendation changed from SNF to HHA. I explained the process of HHA and asked the patient if s/he had a preference for HHA companies s/he said no and that s/he wasn't sure where s/he was going home or to a skilled nursing facility. I explained that therapy evaluates patient for safe discharge and recommended HHA. When I was speaking to Patient today bedside RN was in the room. Patient stated that s/he didn't remember our conversation yesterday. As I continued talking about what we went over yesterday s/he said s/he does remember but s/he doesn't recall a choice and s/he wanted to know about prices from different HHA. I stated that the individual HHA would have to tell her/him about co pays. I offered to call in a few different agencies for her/him to interview and price compare. Patient wanted to call her/himself. S/he was provided a list and a copy of her/ his insurance card."
d) On 02/06/13 at 8:25 a.m., an interview with the RN Case Manager for Sample Patient #10 was conducted. S/he stated that the Patient's original recommendation was for sub acute care, and that s/he made good progress and her/his status changed to home health care. The Case Manager stated that s/he asked the Patient if s/he knew what home health agency s/he wanted and the Patient told her/him that s/he did not have a preference. S/he stated that s/he gave him a verbal list and that s/he based his/her referral by location and insurance. The Case Manager stated that when the home health agency staff member came in to see the Patient that s/he was not happy with that person. The Patient told the Case Manager that s/he wanted a list of home health agencies and s/he wanted to call her/himself. The Case Manager stated that s/he gave her/him a list and a copy of her/his insurance card.