A recent article published in the New York Times claims that nursing homes throughout the US have at times used minor outbursts of residents who are poor, require extra care, and are covered by the less lucrative paying Medicaid program as a way of removing them from their facilities. They allege that facilities send those residents to emergency rooms or hospitals for psychiatric evaluations. Then, according to court findings and government watchdogs in 16 states, including over 60 lawyers and numerous nursing home employees and doctors, when the residents are discharged, they are not allowed to return to the facilities.
The article cited these three cases as examples: a New York nursing home where a resident threw a bingo chip, a Georgia care home where a 46-year-old paralyzed resident repeatedly complained that no one had changed her disposable brief, and a California facility where a patient threw tableware.
Reimbursement rates paid to facilities for residents covered by Medicaid are much lower than rates paid by Medicare and private insurers. Consequently, this may trigger a financial incentive for some facilities to prefer Medicare/privately insured, or private pay residents over Medicaid covered residents.
Federal regulations have strict transfer and discharge requirements. All facilities must have policies that address holding a resident’s bed during periods of absence, such as during hospitalization or therapeutic leave, and the process for ensuring a safe discharge is achieved. Additionally, facilities must provide written information about these policies to residents prior to and upon transfer for such absences. This information must be provided to all facility residents, regardless of their payment source. For more information see the State Operations Manual Appendix PP for the F-Tags listed below.
Compliance Perspective
Issue
Facilities that fail to adhere to federal and state regulations regarding transfer and discharge, with the intent of removing residents covered by Medicaid in favor of admitting residents covered by better paying sources, may be considered a breach of residents rights under regulations requiring equal practices regardless of payment source (F621), transfer and discharge requirements (F622), notice requirements before transfer/discharge (F623), notice of bed-hold policy before/upon transfer (F625), and permitting residents to return to the facility (F626), all of which could result in surveyor citations and related sanctions.
Discussion Points
- Review policies and procedures to ensure that all policies regarding admission, transfer, and discharge are in writing and in effect.
- Train staff regarding regulations covering the transfer and discharge of residents.
- Periodically audit incidents involving residents being sent to emergency rooms and hospitals for psychiatric evaluation to determine if there are inequities regarding their payment sources, e.g., Medicare over Medicaid.
FOR MORE INFORMATION ON THIS TOPIC view: INVOLUNTARY TRANSFER AND DISCHARGE.
