HospitalInspections.org

Based on policy review, medical record review, and interviews, the facility failed to provide safe and appropriate discharge planning for 1 patient (Patient #1) of 29 patients reviewed.

The findings included:

Review of the facility's policy titled Case Management-Discharge Planning Documentation Guidelines revised date 7/10 revealed, "...All patients admitted to the hospital will be screened as soon as possible for recognition of those who may have complex post-hospital care needs...This screening assessment and documentation may include...Environmental limitations and resources...Financial ability to meet medical needs...Identified discharge needs..."

Review of the medical record revealed Patient #1 was admitted to the facility on 9/10/15 with diagnoses which included Dementia with Behavioral Disturbances. Review of the medical history revealed the patient is 74 years old with a known history of dementia and prior to admission the patient was found wandering in the street.

Review of the Discharge Summary revealed the patient was discharged on 10/15/15. Further review of the discharge summary revealed the patient was, "...homeless on admission...patient did not qualify for skilled nursing...the patient is confused and needs consistent with redirection and reorientation to the surroundings...no group home due to his limited income...He was discharged to Homeless Healthcare...Homeless Healthcare has been notified that the patient is coming and needs housing...Thought processes is disorganized...Thought content is delusional...His memory is impaired long term and impaired short term...intellect impaired..."

Review of Case Management notes from admission on 9/10/15 until discharge on 10/15/15 revealed no documentation the facility's case manager contacted Homeless Healthcare regarding the patient's referral. The first documentation of contact with Homeless Healthcare was dated 10/14/15 at 1:42 PM, in the discharge summary, which stated, "...pt [patient] is confused and needs consistent redirection and reorientation to his surroundings...No group home would take him due to his limited income...discharged to Homeless Healthcare as they assured the pt would see a case manager and assessed for needed services...Homeless Healthcare has been notified that patient is coming and needs housing..." There was no documentation of who the hospital staff spoke to at Homeless Healthcare. There was no documentation of the patient's family member being notified or involved in this discharge plan.

Review of the Discharge Instruction Form completed 10/15/15 revealed the patient was discharged at 5:20 AM and sent by cab to Homeless Healthcare. There was no documentation of the patient being accompanied by any staff or family members. The discharge form stated, "...Accompanied By: Cab..." Continued review of the discharge instructions revealed there were no follow-up appointments, no medication management referrals, no case management referrals, and no referrals or follow-up appointments of any type.

Interview with the Director of Behavioral Health Services on 1/21/16 at 2:00 PM, in a consultation room, confirmed Patient #1 was confused when discharged on 10/15/15, and that he was put in a taxi/cab on 10/15/15 with instructions to transport the patient to Homeless Healthcare Services. Further interview confirmed there was no documentation of the family being involved in this discharge plan or notified of this discharge. Further interview with the Director revealed the Case Manager that worked on the patient's referral to Homeless Healthcare was no longer working at the facility.

Telephone interview with the Medical Director at Homeless Healthcare, on 2/23/16 at 10:00 AM, revealed, "...I was the person who the hospital staff would have spoken to and they did not speak to me...he [Patient #1] just arrived at our facility...we were not called before he was sent to us...This facility does not have any inpatient services and does not have any housing resources...This facility is an outpatient clinic for homeless people...I do not know how he got here, he just showed up in the lobby..."