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Based on interviews, record reviews, and LTAC (Long Term Acute Care) Governing Board Bylaws, the Governing Body failed to ensure the hospital had an effective discharge planning process in that 1 of 1 Patient (Patient #2) was discharged from the hospital in a wheelchair to a homeless shelter by an ambulance van. The homeless shelter was not able to meet Patient #2's discharge needs. Patient #2 was subsequently taken to a different hospital where he was admitted for medical treatment.

This practice posed an Immediate Jeopardy to the health and safety of Patient #2 and other patients discharged from the hospital with similar needs.

Findings Included:

Patient #2's History and Physical dated 02/26/15 6:08 PM indicated he was admitted for "debility secondary to recent periotoneal abscess, status post exploratory laparotomy and drainage of abscess...had stage II or III left buttock ulcer present on this admission...patient was transferred to...for further evaluation and physical therapy..."

Patient #2's Physical Therapy Initial Evaluation dated 02/26/15 at 4:06 PM included physical therapy "...to improve deficits of strength, ROM (range of motion), balance and endurance...expect slow progress due...morbidities and prolonged hospitalization." The plan was for daily "therapeutic exercises, therapeutic activities and gait training."

The Physician Progress Note dated 04/05/15 6:31 PM indicated Patient #2 had "...Extremities: Severe generalized muscle wasting. He has especially generalized muscle wasting in his lower extremities with debility and poor balance..."

The Discharge Summary dated 04/09/15 at 1:43 PM indicated Patient #2's discharge diagnoses included, "...Stage II to III left buttock ulcer present on admission, clean, and ...will continue wound care per wound care discharge instructions...chronic pain syndrome...improved from his rehab standpoint...discharge home tomorrow...stable...follow up...Clinic..."

The Physician Progress Note dated 04/13/15 12:23 PM for Patient #2 indicated, "...still working on discharge arrangements...apparently left over the weekend...people he was going to be discharged to decided not to taken (take)." Patient #2 was taken to the hospital and "subsequently had been forced to return...discharge planning has been difficult...will continue to follow the patient here until we are able to get a good discharge plan for him."

The Physician Progress Note dated 04/15/15 2:49 PM indicated, "...Able to move all 4 extremities, does have a left lower extremity weakness...debility with unsteady gait...Discharge planning. It has been difficult issue, try to find a place for him to be discharged to..."

The Case Management Notes dated 04/15/15 (unknown time) for Patient #2 included, "...continue local wound care..."

Physician Progress Note dated 04/18/15 9:08 PM for Patient #2 included, "... Extremities: Severe generalized muscle wasting is noted...Debility, progressive failure to thrive, for which they are waiting for placement...continued efforts to place the patient..."

The Case Management Notes dated 04/22/15 (unknown time) for Patient #2 included, "...ambulating 80 ft (feet) with FWW (front wheel walker)..."

The Discharge Summary dated 04/22/15 5:02 PM included, "...does not have any need for further hospitalization. He tells me his only problem is weakness in his left leg. He has had inconsistent examine in his left lower extremity...no place to go...friends have been concerned about his risk of falling due to his left leg weakness...not aware of any diagnosis that would have led to the weakness of his left leg..."

The Case Management Discharge Plan dated 04/23/15 10:45 AM included, "Anticipated discharge date: 4/23/15...to shelter...wheelchair van..."

The Wound Care Nurses Discharge Note of Current Condition dated 04/23/15 11:42 AM included, "Wound Care Discharge Instructions...cleanse sacral wound with NS (normal saline), apply...dressing, QOD (every other day)...offload sacral area to help heal pressure ulcer...understanding of repositioning q (every) 2 hours and offloading sacral area...follow up with wound care MD as ordered...."

The Case Management Notes dated 04/23/15 (unknown time) included Patient #2 was scheduled for discharge on 04/23/15...initially transported to...however unable to stay secondary...was in wheelchair...able to walk 75 ft (feet) with FWW (front wheel walker)...contacted...shelter...must go to...and be processed there and then would (be) transported..."

The authorization for Outside Services dated 04/23/15 (unknown time) indicated Patient #2 was scheduled to be discharged by wheelchair van.

During an interview on 06/18/15 at 1:15 PM, Personnel #5 stated that at the time of discharge Patient #2 could put his left foot brace on and off. Personnel #5 was asked if the patient needed a wheelchair and he said "for long distances only." He went on to say that Personnel #5 was transferring to and from a bedside commode at the time of discharge and added, "He was getting around in his room on his own."

During an interview on 06/18/15 at 1:31 PM, Personal #6 stated that prior to discharge Patient #2 was given a choice between a wheelchair or a walker and he chose the wheelchair. He went on to say case management had arranged for him to be discharged to a homeless shelter the second time. The ambulance took him there but the patient was declined because of his wheelchair and the ambulance service took him to Hospital C.

During a telephone interview on 06/22/15 at 2:00 PM, Personnel #7 in the presence of Personnel #1 said that she had contacted Homeless Shelter A and talked with a lady but did not know her name. The lady agreed that the shelter would take Patient #2. Personnel #7 was asked if she mentioned to the lady at the shelter that Patent #2 had a wheelchair. Her reply was "no." Personnel #7 added that Patient #2 did not need the wheelchair, the facility had provided him with the wheelchair for his comfort knowing he would be standing in a line to get registered at the shelter. Personnel #7 said that before the next discharge she talked to Homeless Shelter C and was told "they did accept wheelchairs" but the patient had to be processed at Homeless Shelter B first. She said when she returned to work on 04/26/15 she learned that Patient #2 was at another facility. She was asked what had happened and replied, "I don't know what happened." Personnel #7 was asked if Patient #2 had been given a choice between a walker, a wheelchair, or crutches. She said that she did not know if crutches were offered, but did know he had a choice between a walker or wheelchair.

During a telephone interview on 06/22/15 at 2:30 PM Personnel #1 was asked if she had any additional information to share and said she wanted to mention that the wheelchair Patient #2 used was for "comfort only," and he did not need to use a wheelchair.

The LTAC Governing Board Bylaws, H-ML F 01-005 A, dated 4/22/15 included: "...Recognizing that the Governing Board of...Kindred is responsible for...the evaluation and supervision of the conduct of the Hospital, including the care and treatment of patients..."

Cross refer to A0820.

Based on interviews, record reviews, and LTAC (Long Term Acute Care) policy and procedures, the hospital failed to have an effective discharge planning process in that 1 of 1 Patient (Patient #2) was discharged from the hospital in a wheelchair to a homeless shelter by an ambulance van. The homeless shelter was not able to meet Patient #2's discharge need requirements. On 04/23/15, the date of discharge, Patient #2 was subsequently taken to a different hospital where he was admitted for medical treatment.

This practice posed an Immediate Jeopardy to the health and safety of Patient #2 and other patients discharged from the hospital with similar needs.

Findings Included:

Patient #2's History and Physical dated 02/26/15 6:08 PM indicated he was admitted for "debility secondary to recent periotoneal abscess, status post exploratory laparotomy and drainage of abscess...had stage II or III left buttock ulcer present on this admission...patient was transferred to...for further evaluation and physical therapy..."

Patient #2's Physical Therapy Initial Evaluation dated 02/26/15 at 4:06 PM included physical therapy "...to improve deficits of strength, ROM (range of motion), balance and endurance...expect slow progress due...morbidities and prolonged hospitalization." The plan was for daily "therapeutic exercises, therapeutic activities and gait training."

The Physician Progress Note dated 04/05/15 6:31 PM indicated Patient #2 had "...Extremities: Severe generalized muscle wasting. He has especially generalized muscle wasting in his lower extremities with debility and poor balance..."

The Discharge Summary dated 04/09/15 at 1:43 PM indicated Patient #2's discharge diagnoses included, "...Stage II to III left buttock ulcer present on admission, clean, and ...will continue wound care per wound care discharge instructions...chronic pain syndrome...improved from his rehab standpoint...discharge home tomorrow...stable...follow up...Clinic..."

The Physician Progress Note dated 04/13/15 12:23 PM for Patient #2 indicated, "...still working on discharge arrangements...apparently left over the weekend ...people he was going to be discharged to decided not to taken (take)." Patient #2 was taken to the hospital and "subsequently had been forced to return...discharge planning has been difficult...will continue to follow the patient here until we are able to get a good discharge plan for him."

The Physician Progress Note dated 04/15/15 2:49 PM indicated, "...Able to move all 4 extremities, does have a left lower extremity weakness...debility with unsteady gait...Discharge planning. It has been difficult issue, try to find a place for him to be discharged to..."

The Case Management Notes dated 04/15/15 (unknown time) for Patient #2 included, "...continue local wound care..."

Physician Progress Note dated 04/18/15 9:08 PM for Patient #2 included, "... Extremities: Severe generalized muscle wasting is noted...Debility, progressive failure to thrive, for which they are waiting for placement...continued efforts to place the patient..."

The Case Management Notes dated 04/22/15 (unknown time) for Patient #2 included, "...ambulating 80 ft (feet) with FWW (front wheel walker)..."

The Discharge Summary dated 04/22/15 5:02 PM included, "...does not have any need for further hospitalization. He tells me his only problem is weakness in his left leg. He has had inconsistent examine in his left lower extremity...no place to go...friends have been concerned about his risk of falling due to his left leg weakness...not aware of any diagnosis that would have led to the weakness of his left leg..."

The Case Management Discharge Plan dated 04/23/15 10:45 AM included, "Anticipated discharge date: 4/23/15...to shelter...wheelchair van..."

The Wound Care Nurses Discharge Note of Current Condition dated 04/23/15 11:42 AM included, "Wound Care Discharge Instructions...cleanse sacral wound with NS (normal saline), apply...dressing, QOD (every other day)...offload sacral area to help heal pressure ulcer...understanding of repositioning q (every) 2 hours and offloading sacral area...follow up with wound care MD as ordered..."

The Case Management Notes dated 04/23/15 (unknown time) included Patient #2 was scheduled for discharge on 04/23/15...initially transported to...however unable to stay secondary...was in wheelchair...able to walk 75 ft (feet) with FWW (front wheel walker)...contacted...shelter...must go to...and be processed there and then would (be) transported..."

The authorization for Outside Services dated 04/23/15 (unknown time) indicated Patient #2 was scheduled to be discharged by wheelchair van.

During an interview on 06/18/15 at 1:15 PM, Personnel #5 stated that at the time of discharge Patient #2 could put his left foot brace on and off. Personnel #5 was asked if the patient needed a wheelchair and he said "for long distances only." He went on to say that Personnel #5 was transferring to and from a bedside commode at the time of discharge and added, "He was getting around in his room on his own."

During an interview on 06/18/15 at 1:31 PM, Personal #6 stated that prior to discharge Patient #2 was given a choice between a wheelchair or a walker and he chose the wheelchair. He went on to say case management had arranged for him to be discharged to a homeless shelter the second time. The ambulance took him there but the patient was declined because of his wheelchair and the ambulance service took him to Hospital C.

During a telephone interview on 06/22/15 at 2:00 PM, Personnel #7 in the presence of Personnel #1 said that she had contacted Homeless Shelter A and talked with a lady but did not know her name. The lady agreed that the shelter would take Patient #2. Personnel #7 was asked if she mentioned to the lady at the shelter that Patent #2 had a wheelchair. Her reply was "no." Personnel #7 added that Patient #2 did not need the wheelchair, the facility had provided him with the wheelchair for his comfort knowing he would be standing in a line to get registered at the shelter. Personnel #7 said that before the next discharge she talked to Homeless Shelter C and was told "they did accept wheelchairs" but the patient had to be processed at Homeless Shelter B first. She said when she returned to work on 04/26/15 she learned that Patient #2 was at another facility. She was asked what had happened and replied, "I don't know what happened." Personnel #7 was asked if Patient #2 had been given a choice between a walker, a wheelchair, or crutches. She said that she did not know if crutches were offered, but did know he had a choice between a walker or wheelchair.

During a telephone interview on 06/22/15 at 2:30 PM Personnel #1 was asked if she had any additional information to share and said she wanted to mention that the wheelchair Patient #2 used was for "comfort only," and he did not need to use a wheelchair.

The LTAC Discharge Planning Policy and Procedures, H-ML 10-013 PRO, Release Date 5/2015 included: "...Case Managers...will collaborate with patients...and community resources when determining the appropriate post-hospital discharge destination for the patient to ensure that patients have a smooth and safe transition from the LTAC...Initiate the implementation of the discharge plan prior to the patient's transition to the next level of care..."

Cross refer to A0820.

Based on interviews, record reviews, and LTAC (Long Term Acute Care) policy and procedures, the hospital failed to have an effective initial discharge plan in that 1 of 1 Patient (Patient #2) was discharged from the hospital in a wheelchair to a homeless shelter by an ambulance van. The homeless shelter was not able to meet Patient #2's initial implementation of discharge needs. On 04/23/15, the date of discharge, Patient #2 was subsequently taken to a different hospital where he was admitted for medical treatment.

This practice posed an Immediate Jeopardy to the health and safety of Patient #2 and other patients discharged from the hospital with similar needs.

Findings Included:

Patient #2's History and Physical dated 02/26/15 6:08 PM indicated he was admitted for "debility secondary to recent periotoneal abscess, status post exploratory laparotomy and drainage of abscess...had stage II or III left buttock ulcer present on this admission...patient was transferred to...for further evaluation and physical therapy..."

Patient #2's Physical Therapy Initial Evaluation dated 02/26/15 at 4:06 PM included physical therapy "...to improve deficits of strength, ROM (range of motion), balance and endurance...expect slow progress due...morbidities and prolonged hospitalization." The plan was for daily "therapeutic exercises, therapeutic activities and gait training."

The Physician Progress Note dated 04/05/15 6:31 PM indicated Patient #2 had "...Extremities: Severe generalized muscle wasting. He has especially generalized muscle wasting in his lower extremities with debility and poor balance..."

The Discharge Summary dated 04/09/15 at 1:43 PM indicated Patient #2's discharge diagnoses included, "...Stage II to III left buttock ulcer present on admission, clean, and ...will continue wound care per wound care discharge instructions...chronic pain syndrome...improved from his rehab standpoint...discharge home tomorrow...stable...follow up...Clinic..."

The Physician Progress Note dated 04/13/15 12:23 PM for Patient #2 indicated, "...still working on discharge arrangements...apparently left over the weekend...people he was going to be discharged to decided not to taken (take)." Patient #2 was taken to the hospital and "subsequently had been forced to return...discharge planning has been difficult...will continue to follow the patient here until we are able to get a good discharge plan for him."

The Physician Progress Note dated 04/15/15 2:49 PM indicated, "...Able to move all 4 extremities, does have a left lower extremity weakness...debility with unsteady gait...Discharge planning. It has been difficult issue, try to find a place for him to be discharged to..."

The Case Management Notes dated 04/15/15 (unknown time) for Patient #2 included, "...continue local wound care..."

Physician Progress Note dated 04/18/15 9:08 PM for Patient #2 included, "... Extremities: Severe generalized muscle wasting is noted...Debility, progressive failure to thrive, for which they are waiting for placement...continued efforts to place the patient..."

The Case Management Notes dated 04/22/15 (unknown time) for Patient #2 included, "...ambulating 80 ft (feet) with FWW (front wheel walker)..."

The Discharge Summary dated 04/22/15 5:02 PM included, "...does not have any need for further hospitalization. He tells me his only problem is weakness in his left leg. He has had inconsistent examine in his left lower extremity...no place to go...friends have been concerned about his risk of falling due to his left leg weakness...not aware of any diagnosis that would have led to the weakness of his left leg..."

The Case Management Discharge Plan dated 04/23/15 10:45 AM included, "Anticipated discharge date: 4/23/15...to shelter...wheelchair van..."

The Wound Care Nurses Discharge Note of Current Condition dated 04/23/15 11:42 AM included, "Wound Care Discharge Instructions...cleanse sacral wound with NS (normal saline), apply...dressing, QOD (every other day)...offload sacral area to help heal pressure ulcer...understanding of repositioning q (every) 2 hours and offloading sacral area...follow up with wound care MD as ordered...."

The Case Management Notes dated 04/23/15 (unknown time) included Patient #2 was scheduled for discharge on 04/23/15...initially transported to...however unable to stay secondary...was in wheelchair...able to walk 75 ft (feet) with FWW (front wheel walker)...contacted...shelter...must go to...and be processed there and then would (be) transported..."

The authorization for Outside Services dated 04/23/15 (unknown time) indicated Patient #2 was scheduled to be discharged by wheelchair van.

During an interview on 06/18/15 at 1:15 PM, Personnel #5 stated that at the time of discharge Patient #2 could put his left foot brace on and off. Personnel #5 was asked if the patient needed a wheelchair and he said "for long distances only." He went on to say that Personnel #5 was transferring to and from a bedside commode at the time of discharge and added, "He was getting around in his room on his own."

During an interview on 06/18/15 at 1:31 PM, Personal #6 stated that prior to discharge Patient #2 was given a choice between a wheelchair or a walker and he chose the wheelchair. He went on to say case management had arranged for him to be discharged to a homeless shelter the second time. The ambulance took him there but the patient was declined because of his wheelchair and the ambulance service took him to Hospital C.

During a telephone interview on 06/22/15 at 2:00 PM, Personnel #7 in the presence of Personnel #1 said that she had contacted Homeless Shelter A and talked with a lady but did not know her name. The lady agreed that the shelter would take Patient #2. Personnel #7 was asked if she mentioned to the lady at the shelter that Patent #2 had a wheelchair. Her reply was "no." Personnel #7 added that Patient #2 did not need the wheelchair, the facility had provided him with the wheelchair for his comfort knowing he would be standing in a line to get registered at the shelter. Personnel #7 said that before the next discharge she talked to Homeless Shelter C and was told "they did accept wheelchairs" but the patient had to be processed at Homeless Shelter B first. She said when she returned to work on 04/26/15 she learned that Patient #2 was at another facility. She was asked what had happened and replied, "I don't know what happened." Personnel #7 was asked if Patient #2 had been given a choice between a walker, a wheelchair, or crutches. She said that she did not know if crutches were offered, but did know he had a choice between a walker or wheelchair.

During a telephone interview on 06/22/15 at 2:30 PM Personnel #1 was asked if she had any additional information to share and said she wanted to mention that the wheelchair Patient #2 used was for "comfort only," and he did not need to use a wheelchair.

The LTAC Discharge Planning Policy and Procedures, H-ML 10-013 PRO, Release Date 5/2015 included: " ...Case Managers...will...Initiate the implementation of the discharge plan prior to the patient's transition to the next level of care..."