FACILITY INITIATED DISCHARGE NOTIFICATION EXPECTATIONS. Penny Clark State Long-Term Care Ombudsman

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1 FACILITY INITIATED DISCHARGE NOTIFICATION EXPECTATIONS Penny Clark State Long-Term Care Ombudsman

2 42 CFR PART 483 REQUIREMENTS FOR STATE AND LONG TERM CARE FACILITIES (c)(3) Transfer and discharge Facility requirements Notice before transfer The facility must send a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman.

3 SURVEY & CERTIFICATION NH Notice of Transfer or Discharge The facility must also send a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman. Sending a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman provides added protection to residents and ensures the Office of the State Long-Term Care Ombudsman is aware of facility practices and activities related to transfers and discharges.

4 SURVEY & CERTIFICATION NH A. Facility-Initiated Transfers and Discharges If the facility has decided to discharge the resident while the resident is still hospitalized, the facility must send a notice of discharge to the resident and resident representative, and must also send a copy to the State Long-Term Care Ombudsman. For any other types of facility-initiated discharges, the facility must provide the notice of discharge to the resident and resident representative along with a copy to the State Long-Term Care Ombudsman at least 30 days prior to the discharge or as soon as possible. When a resident is temporarily transferred on an emergency basis to an acute care facility, notice of the transfer may be provided to the resident and resident representative as soon as practicable. Copies of notices for emergency transfers must still be sent to the ombudsman, but they may be sent as a list on a monthly basis.

5 SURVEY & CERTIFICATION NH B. Resident Initiated Transfers and Discharges A resident initiated transfer or discharge means the resident or the resident representative has provided verbal or written notice of intent to leave the facility. For resident initiated transfers or discharges, sending a copy of the notice to the ombudsman is not required.

6 FACILITY INITIATED TRANSFER AND DISCHARGE NOTICE CHECKLIST A notice of a facility initiated transfer/discharge should contain: The reason for the transfer or discharge. The effective date of the transfer or discharge. Where the resident will be transferred or discharged. A copy of the following state is required by state statute; A health care facility or health care service shall not discriminate or retaliate against a person residing in, served by or employed at such facility or service who has initiated or participated in any proceeding authorized by the Health Care Facility Lecensure Act or who has presented a complaint or provided information to the administrator of such facility or service, or to the Department of Health & Human Services. Such person may maintain an action for any type of relief, including injunctive and declaratory relief, permitted by law.

7 FACILITY INITIATED TRANSFER AND DISCHARGE NOTICE CHECKLIST A statement that the resident has the right to appeal the decision to transfer or discharge. The facility may not transfer or discharge the resident while the appeal is pending, unless the failure to discharge or transfer would endanger the health or safety of the resident or other individuals in the facility. The facility must document the danger that failure to transfer or discharge would pose. A statement that the resident has the right to contact: The State Long-Term Care Ombudsman; Disability Rights Nebraska

8 TRANSFER AND DISCHARGE FACILITY REQUIREMENTS The facility must permit each resident to remain in the facility and not transfer or discharge the resident from the facility unless: The transfer or discharge is necessary for the resident s welfare and the resident s needs cannot be met in the facility; The transfer or discharge is appropriate because the resident s health has improved sufficiently so the resident no longer needs the services provided by the facility; The safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident; The health of individuals in the facility would otherwise be endangered; The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay in the facility. For a resident who becomes eligible for Medicaid after admission to a facility, the facility may charge a resident only allowable charges under Medicaid; or The facility ceases to operate.

9 DOCUMENTATION When a facility transfers or discharges a resident under any of these circumstances, the facility must ensure the transfer or discharge is documented in the resident s medical record and appropriate information is communicated to the receiving provider. The documentation must include: The basis for the transfer; In the case of transfer or discharge of needs cannot be met, documentation must include the specific need that cannot be met, facility attempts to meet the need, and the service available at the receiving facility to meet the need. The documentation must be made by a physician.

10 BED HOLD POLICY At the time of transfer of a resident for hospitalization or therapeutic leave, a nursing facility must provide to the resident and the resident representative, written notice which specifies the duration of the bed hold policy.

11 PERMITTING RESIDENTS TO RETURN TO FACILITY A facility must establish and follow a written policy on permitting residents to return to the facility after they are hospitalized or placed on therapeutic leave. The policy must provide for the following: A resident whose hospitalization or therapeutic leave exceeds the bed hold period returns to the facility to their previous room if available or immediately upon the first availability of a bed. If the facility determines that a resident was hospitalized with the expectation of returning to the facility cannot return to the facility, the facility must comply with requirements under facility initiated transfer and discharge.

12 QUESTIONS Penny Clark State Long-Term Care Ombudsman