HospitalInspections.org

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 and failed to respect the patient's representative goals of care and treatment preferences 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 68-year-old female admitted on 01/25/2021 with diagnosis of: Metastatic Breast Cancer, Uterine Cancer, Septic Shock, and Acute Kidney Injury. Further review revealed that she was discharged from the facility on 02/01/2021 to patient's daughter and son-in law's family home for hospice care.

Record review of the Case Manager/ Social Worker's Notes revealed in part the following information:

- 01/27/2021: HCM Discharge Planning User Fields:
Discharge Barriers: Medical Condition-Significant
Patient Goals and Preferences after discharge: Home vs SNF
Date/ Time: 01/27/2021 5:50 pm
Evaluated By: Registered Nurse (RN) Case Manager (CM)

-01/28/2021: HCM Support Services User Fields:
Comments:
Discharge Disposition: Hospice-Home
Score: 0.64042946
Level: Readmit Risk- High
Date/ Time: 01/28/2021 06:08 am

-01/29/2021@ 11:19 am: (RN Case Manager) received inbound call from CM at Health Texas who states patient is on service with hospice. States has arranged 24-hour caregiving services through them as well. She offers contact info for hospice at 210-421-1433.

-01/29/2021 @ 01:53 pm (RN Case Manager) (Late Entry for 11:30 am): Spoke with representative at hospice, states hospital bed and home oxygen are not yet delivered. She is to email me signed out of hospital DNR. Not yet received at current time 1453.

- 01/29/2021 @ 02:17 pm (RN Case Manager) Called Hospice Representative but reached voice mail. CM at Health Texas advising that no email yet received. She states that son-in-law is now refusing to take patient home stating she needs to return to Skilled Nursing Facility (SNF). She states son-in-law is not answering phone calls and when last spoken to, he refuses to pay out of pocket for days at SNF patient came from.

- 01/29/2021 @ 05:08 pm (RN Case Manager): Social Worker and Case Manager called Patient's daughter/ MPOA and she requested we speak with her spouse (son-in-law). Advised son-in-law that patient is being discharged from hospital with the services of hospice. Son-in-law states that they never agreed to hospice and was under the impression that patient would return to skilled nursing facility before going home with hospice. Advised him that CM has been in contact with his insurance CM and SNF is no longer an option. They attempted rehab at SNF and patient did not progress. Her condition worsened and she was transferred to hospital for treatment, now at her baseline and ready to discharge home. Son-in-law confirms he spoke with physician this afternoon and maintains refusal to take patient home with services. SW offered him phone number to call Medicare and appeal discharge.

-01/29/2021 @ 5:10 pm (Social Worker): received call from Son-in-Law. He offers appeal reference number 20210129-519-HF.

Record review of patient #1's facility medical record revealed that her daughter had a Power of Attorney (POA) for the patient. Further review revealed no evidence that the patient or her POA were contacted by the Case Manager or Social Worker regarding the patient's change in status and possible need for hospice care prior to attempted discharge on 01/29/2021.

Record review of the of the facility's Discharge Planning: Assessment, Implementation and Coordination policy, revised 05/2020, revealed in part the following information:

-Discharge Planning: Is a systemic, coordinated process that is designed to bring about a timely discharge of a patient from a hospital to the next appropriate level of care or return to their normal living situation .... The assessment not only includes interviews with the patient and family, but also interdisciplinary involvement with medical and nursing staff, ancillary staff, insurance representatives, and others deemed appropriate. The discharge plan should be developed with the patient and family and will be continually reinforced and updated as continuing care needs are identified.

-Patient's will be given choices in services available shall be discussed with patient/family, with the patient/family making the ultimate decision about what resources they want to utilize.

In an interview conducted on 04/28/2021 at 11:55 am, the facility RN Case Manager 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. She further confirmed that she had not spoken directly with the patient's daughter (MPOA) or Son-in-Law regarding her change in care status or need for hospice care prior to attempted discharge on 01/29/2021. The CM stated that she had been in contact with the Son-In-Law's insurance company representative who was handling the patient's case, so she (CM) thought they were updating the family on the patient's discharge needs. Therefore, she had not contacted them herself as she was busy with her patient caseload in the hospital.


In an interview conducted on 04/28/2021 at 12:15 pm, the facility Director of Case Management confirmed the above findings.