A 34-year-old paraplegic resident in an Oklahoma nursing home claims he was not allowed back into the nursing home after he returned from a short stay in the hospital on New Year’s Eve. The nursing home asserted that the discharge was necessary due to the resident’s having committed assault against other residents and posing a danger to self and others.
The man denies the allegations made by the facility’s chief operating officer (COO) that he was a danger to himself and to other residents.
The police were called, and in a police report one of the police officers indicated that “the staff on the scene did not have any issues with the resident and did not agree with the decision” to discharge him. The police also reported that the COO admitted she had previously advised the resident that he had until Jan. 27 to gather his belongings and leave the facility. She claims the facility, however, was forced to discharge him under an emergency provision due to his escalating misconduct and criminal behavior.
The facility’s attorney gave this statement based upon what the COO had told him: “The resident has committed assault on persons at the facility. He’s aware of his actions. He knows they’re wrong. He can physically hit people. He’s thrown things at people.”
Authorities informed the facility that a court order was needed to evict the resident. However, the COO responded that the nursing home was not held to that eviction process and should that be considered a violation of a state statute, the facility would “bear the deficit.”
Here are the six justifications for involuntary transfer/discharge of a resident based on 42 CFR § 483.15(c) (F-Tag 622):
- The discharge or transfer is necessary for the resident’s welfare and the facility cannot meet the resident’s needs.
- The resident’s health has improved sufficiently so that the resident no longer needs the care and/or services of the facility.
- The resident’s clinical or behavioral status (or condition) endangers the safety of individuals in the facility.
- The resident’s clinical or behavioral status (or condition) otherwise endangers the health of individuals in the facility.
- The resident has failed, after reasonable and appropriate notice to pay, or have paid under Medicare or Medicaid, for his or her stay at the facility.
- The facility ceases to operate.
Compliance Perspective
Involuntarily discharging a resident without providing supporting documentation that the discharge or transfer is based on one of the six allowable reasons, and failure to ensure the discharge is to a safe location, may be considered provision of substandard quality of care, in violation of state and federal regulations.
Discussion Points
- Review policies and procedures regarding admission, transfer, and discharge of residents, including the protocols for involuntary discharge.
- Train staff to carefully document and report a resident’s behavior involving incidents where the safety and health of other residents may be endangered.
- Periodically audit instances where the facility transferred or discharged a resident to ensure compliance with F622 Transfer and Discharge, in the State Operations Manual, Appendix PP.
FOR MORE INFORMATION ON THIS TOPIC: INVOLUNTARY TRANSFER AND DISCHARGE
