HospitalInspections.org

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Based on review of the Hospital policies and procedures, clinical records and interviews with staff, patients and families, the Hospital failed to respect a patient's and family's expressed preferences for short term rehabilitation for one of seven (7) patients (Patient #2) in a total sample of ten (10) patients.

The Hospital Policy titled Discharge Planning indicates the the patients/family are to be active participants in the discharge planning process.

The Hospital Healthcare System owns both Hospital #1 and the Community Access Hospital (Hospital #2) with a Skilled Nursing Facility (SNF) located in another town.

The Surveyor reviewed Patient #2's clinical record on 9/16/14. The Case Management note, dated 7/23/14 at 9:30 A.M., indicated Patient #2 requested Case Manager #3 to speak with the family regarding short term rehabilitation. The Case Management note indicated Patient #2's family's first choice was given as two towns, neither town was the location of Hospital #2's SNF.

The Social Worker note, dated 7/23/14 at 1:19 P.M., indicated the family's first choice for short term rehabilitation was a facility other than the related swing bed program. The Social Worker note, dated 7/24/14 at 8:38 A.M., indicated Patient #2 had been screened and offered a bed at the first choice location. The Social Worker note, dated 7/24/14 at 1:19 P.M., indicated the family later made a decision to go to Hospital #2's SNF.


The Surveyor interviewed Case Manager #3 at 12:50 P.M. on 9/15/14. Case Manager #3 said Patient #2 requested that Case Manager #3 work with the family for discharge planning because Patient #2 felt so ill. Case Manager #3 said she offered choices to the family including the related swing bed program. Case Manager #3 said Patient #2's family immediately declined Hospital #2's SNF placement because of the geographic location.


The Surveyor interviewed Social Worker #3 at 9:20 A.M. on 9/17/14. Social Worker #3 said Patient #2 requested that Social Worker #3 work with the family to plan for Patient #2's discharge. Social Worker #3 said the family originally declined the related swing bed program because of the geographic location of the program. Social Worker #3 said Patient #2's family accepted a short term rehabilitation bed. Social Worker #3 said on the day of discharge she was summoned to Patient #2's room by the Chief Nursing Officer (CNO). Social Worker #3 said Patient #2's family said they were not aware of how wonderful of Hospital #2's SNF was until speaking with the CNO.

The Surveyor interviewed Patient #2's family member (Family Member #1) at 9:50 A.M. on 9/17/14. Family Member #1 said she was involved in the discharge planning for Patient #2. Family Member #1 said she had been given a list of after-care choices for Patient #2 and chose a short term rehabilitation program. Family Member #1 said on the day of discharge they were approached by the CNO who came to Patient #2's room and said something to the effect of she checked on patients. Family Member #1 said when she told the CNO of the choice for short term rehabilitation, she was asked why she chose that particular placement and why didn't Patient #2's family choose Hospital #2's SNF. Family Member #1 said the CNO raved about Hospital #2's program and included information about a private room and flat screen television and made Hospital #2's SNF sound like a resort. Family Member #1 said the care at Hospital #2's SNF was satisfactory, but she felt "steered and railroaded" to the program.