HospitalInspections.org

Based upon record review and interview, the facility failed to ensure 1 of 1 (#1) patient's legal guardian was provided written information related to patient's rights for patient #1.

Record review of the physician's progress notes for patient #1 revealed that she was a 91-year-old female admitted on 09/30/2019 with diagnosis of: Acute Cerebral Vascular Accident (CVA), Aphasia, Hypokalemia, Anemia, Compression fracture of vertebra, Chronic Hypertension, Osteoporosis, Neuropathy, Left leg contracture, Incontinence, and Anxiety. Further review revealed that she was discharged from the facility on 10/04/2019 to a Skilled Nursing Facility (SNF).

Record review of patient #1's facility medical record revealed that her son and daughter had a shared Power of Attorney (POA) for the patient. Further review revealed no evidence that the patient or her POA's were given the Important Message from Medicare (IMM) upon her admission to the facility on 09/30/2019 or within 2 days of her discharge on 10/04/2019.

Record review of the facility grievance logs dated for the time period of 09/30/2019 to 10/06/2019 revealed that patient#1's POA (son) had filed a grievance with the facility stating that his mother was discharged inappropriately, late on a Friday evening, and that the patient and POA were not given the chance to challenge the patient's discharge from the facility.

Record review of the Social Workers notes revealed the following information:
-10/02/2019@ 04:15 pm: Pt lives at a Assisted Living (AL). She has a walker and WC. MD recommending (ARU) Acute Rehab Unit and per pt request referral sent to rehab facility.
- 10/03/2019@ 02:25 pm: Per staff from rehab facility BCBS states they are still reviewing request.
-10/04/2019@ 02:50 pm (Friday): Patient was denied ARU based on the fact that she is too weak for that level of care; they recommended SNF (Skilled Nursing Facility). Per Pt request referral sent to SNF.
-10/04/2019@ 02:56 pm (Friday): Phone Call to BCBS auth dept to try and expedite SNF referral. Spoke with representative who stated that he would work on expediting auth.

Record review of the of the facility's Patient Rights and Responsibilities policy, revised 04/17, revealed the patient or the patient's surrogate decision-maker will be informed of the "Patient's Rights & Responsibilities" at the time of admission by the Patient Access Representative (PAR). If requested, the PAR will provide the patient a copy of the Patient's Rights & Responsibility.

In an interview conducted on 02/26/2020 at 10:55 am, the facility Social Worker (SW) revealed that she was the primary Case Manager for Patient#1 and was responsible for overseeing her Case Management and discharge planning from the facility. The SW further stated that she was not present at the time of Patient #1's discharge from the facility on 10/04/2019, because she left early that day at about 3:30 pm, and that the nursing staff had handled her discharge paperwork. The SW stated that she had however spoken with the patient's daughter (POA) who was at the bedside before she left but did not give the daughter the IMM. When asked by the surveyor why she did not give the patient or her POA the IMM prior to the patient's discharge, the SW stated, "I didn't give the Medicare letter because it was 04:00 pm on Friday when we got the authorization to transfer from the insurance company. I did not think that she would be discharged until Monday."

In an interview conducted on 02/26/2019 at 11:20 am, the facility Quality Director confirmed the above findings.

Based on record review and interview, the facility failed to inform the patient and/or their legal representative of their freedom to choose among participating Medicare providers for 1of 1 patient's (#1) transferred.

Findings included:

Record review of the physician's progress notes for patient #1 revealed that she was a 91-year-old female admitted on 09/30/2019 with diagnosis of: Acute Cerebral Vascular Accident (CVA), Aphasia, Hypokalemia, Anemia, Compression fracture of vertebra, Chronic Hypertension, Osteoporosis, Neuropathy, Left leg contracture, Incontinence, and Anxiety. Further review revealed that she was discharged from the facility on 10/04/2019 to a Skilled Nursing Facility (SNF).

Record review of patient #1's facility medical record revealed that her son and daughter had a shared Power of Attorney (POA) for the patient. Further review revealed that the memorandum of transfer, dated 10/04/2019, did not contain a signature from the patient and/or her legal Power of Attorney (POA).

Record review of the facility grievance logs dated for the time period of 09/30/2019 to 10/06/2019 revealed that patient#1's POA (son) had filed a grievance with the facility stating that his mother was discharged inappropriately, late on a Friday evening, and that the patient and POA were not given the chance to challenge the patient's discharge from the facility.

Record review of the Social Workers (SW) notes, dated 10/02/2019 to 10/04/2019, revealed no evidence that the SW spoke with or gave the patient and/or her POA's information regarding placement options.

In an interview conducted on 02/26/2019 at 2:10 pm, the facility Quality Director confirmed the above findings.