HospitalInspections.org

Based on review of swing bed patient rights and staff interviews, the Acute Care Hospital staff failed to ensure all swing bed patients received the required Swing Bed Patient Rights to include the right to:

a. share a room with his or her spouse when married patients live in the same facility and both spouses consent to the arrangement,

b. inform each Medicaid-eligible resident, in writing, at the time of admission to the facility and when the resident becomes eligible for Medicaid of the items and services that are included in nursing facility services under the State plan and for which the resident may not be charged, those items and services that the facility offers and for which the resident may be charged, and the amount of charges for those services, and inform each Medicaid-eligible resident when changes are made to the items and services.

The CAH administrative staff identified a census of 4 swing bed patients at the beginning of the survey and admitted 46 swing bed patients in 2018. Failure to present all of the required rights to the patients admitted to swing bed patients and/or their legal representative could result in the patients and/or their legal representatives being unaware of all their rights as swing bed patients while they are continuing to receive skilled level of care, potentially resulting in the patients failing to exercise their rights if they so desired.

Findings include:

1. Review of the "Skilled Nursing Care Admission Agreement," revised 7/2018, revealed it lacked the following swing bed patient rights:

a. to share a room with his or her spouse when married patients live in the same facility and both spouses consent to the arrangement,

b. inform each Medicaid-eligible resident, in writing, at the time of admission to the facility and when the resident becomes eligible for Medicaid of the items and services that are included in nursing facility services under the State plan and for which the resident may not be charged, those items and services that the facility offers and for which the resident may be charged, and the amount of charges for those services, and inform each Medicaid-eligible resident when changes are made to the items and services.

2. During an interview on 3/27/2019 at approximately 4:00 PM, the Director of Med/Surg Nursing confirmed the hospital staff failed to inform the swing bed patients of the above listed swing bed patient's rights.

Based on document review and staff interview, the acute care hospital failed to maintain a dental services contract for skilled patients in swing beds. The administrative staff identified a census of 4 skilled patients at the time of the entrance. Failure to ensure the hospital offered dental services to swing bed patients could potentially result in the swing bed patients needing dental services and the hospital staff failing to ensure the patients received dental care.

Findings include:

1. During an interview on 3/27/19, 10:05 AM, the Director of Med/Surg reported skilled patients in swing beds could receive dental services from either their personal dentist or another local dentist. The Director of Med/Surg lacked knowledge of a written agreement or contract with a dentist to provide dental services to swing bed patients.

2. Review of a list of Contracted Services provided by hospital administrative staff revealed the list lacked a contract with a dentist for dental services.

3. Review of the "DENTAL SERVICES POLICY FOR SWING BED," provided on 3/27/19 by the Director of Med/Surg, revealed in part, "Whenever possible, the patients own dentist... arrangements made for care to be received by him/her,...if not possible with own dentist...contact another local dentist to provide the care.." The policy lacks identification of a dentist for the provision of routine or emergency dental services to the hospital's swing bed patients, if the patient lacked a local dentist.

3. During an interview on 3/27/19 at 3:00 PM, the Vice President of Patient Care Services, acknowledged the hospital lacked a written agreement or contract with a dentist to provide routine and emergency dental services for its swing bed patients, or a dentist on the hospital's medical staff which could provide dental services to the hospital's swing bed patients.