Nursing Home Refusal to allow residents to return post-hospitalization - PowerPoint Presentation

Nursing Home Refusal to allow residents to return post-hospitalization “Let Me Return Home” Training for Hospital Discharge Planners Office of Ombudsman for Long-Term Care Minnesota Board on Aging 2016

Ms. Simpson’s First Day of WorkJune Simpson– Hospital Discharge Planner Mr. Milton – wants to return to his home at Harbor View NH after a one week hospital stay 2

Before Hospital AdmissionDuring Hospital Stay Mr. Milton had raised his cane and threatened roommate to a “beat down”History of “behaviors” at Harbor View (HV) including pinching and grabbing staff and residentsPhysicians made adjustments to medicationsTreated for bladder infection Mr. Milton is tolerating medication changes and bladder infection resolved He is ready to return to HV Mr. Milton’s Story 3

So Ms. Simpson Calls Harbor View… 4

To Ms. Simpson’s Surprise… 5

What Do You Call This Situation? 6

NH Residents & FamiliesAdmitting HospitalExpends hospital time and resources Compels hospital staff to quickly find alternative placement for patients being involuntarily dischargedThis Is A Serious Problem Violates residents’ rightsIsolates residents and families from their homes and communitiesCreates resident anxiety due to uncertainty about being able to go homeRisk of transfer trauma due to multiple placements 7

Today’s Training Objectives 8

So, Ms. Simpson – What’s Next For Mr. Milton? 9

How Does Ms. Simpson Advocate For Mr. Milton? Ask Mr. Milton if he wants to return to Harbor View?* LTC Ombudsman Office is here to help! *If appropriate, contact Mr. Milton’s surrogate decision-maker 10

Office of Ombudsman for Long-Term Care Minnesota Board On Aging 11 Phone: 651-431-2555 Toll-Free:1-800-657-3591Fax: 651-431-7452

LTC Ombudsman Viewpoint 12

VoluntaryInvoluntaryWhen a resident initiates a request for transfer or discharge When a facility initiates the transfer or dischargeRegardless of the resident’s choice or preferenceEven if the resident does not object to itTypes of Transfers & Discharges 13

The “Voluntary Discharge” Dialogue These Situations are NOT Voluntary Discharges Because NH Initiates These Dialogues14

Why Not “Voluntary Discharge?” Discuss Each Scenario 15

Involuntary Discharge Regulations 16

Grounds for NH Discharges 17

*Exceptions To 30 Day Notice Period 18

“Can’t Meet Needs”“Danger To S elf or Others”Clinical documentation from resident’s physician stating resident’s health care needs cannot be met at NH Clinical documentation from a physician stating health of other individuals at NH is endangered by the resident - and the basis for the endangermentRequired Documentation Resident has right to review documentation, with rare exceptions 19

Bed Hold Notice“Bed Hold Notice” defines under what circumstances MA will pay to hold the bed Bed hold notice also contains HV’s bed-hold policiesHarbor View must give Mr. Milton option to pay to “hold” his bed regardless of NH current occupancy Must be in writingShould be provided to Mr. Milton and/or his representative before transfer to hospitalObtaining resident signature on the bed hold notice is not required, but best practiceIf unable to provide bed hold notice at time of transfer to the hospital, bed hold notice should be provided within 24 hours 20

Does Mr. Milton Have a Signed BED HOLD? 21

Bed Hold Notice,continued Medical Assistance (MA) pays to hold bed for 18 days in MinnesotaIncludes NH’s policy if Mr. Milton’s hospital stay exceeds 18 daysIf >18 days, Mr. Milton’s right to return to the first available semi-private NH bed as long as he requires skilled nursing care22

Why Does a Bed Hold Notice Matter?Explains Mr. Milton’s rights Lack of Bed Hold Notice identifies potential transfer/discharge issues Understanding the policy and regulations prepares you to advocate for Mr. Milton’s rights If the NH refuses to provide a Bed Hold Notice to your patient, consult with LTC Ombudsman office immediately!23

24Additional Protections as “Prohibited Practice” Under Medical Assistance Rules MN Statute 256B.48 CONDITIONS FOR PARTICIPATIONSubdivision 1. Prohibited Practices.“A nursing facility is not eligible to receive medical assistance payments unless it refrains from all of the following:(g) refusing, for more than 24 hours, to accept a resident returning to the same bed or a bed certified for the same level of care, in accordance with a physician’s order authorizing transfer, after receiving inpatient hospital services.”

General Advocacy Strategies Be Proactive! On Day of Hospital AdmissionConfirm resident’s desire to return to facility and facility’s preparation for return before the resident is medically ready for discharge from the hospital Ask resident or surrogate decision - maker if a bed hold notice was received If Yes – get a copy If N0 – assist resident in requesting a copy and discuss resident rights with facility staff25

BE PRO-ACTIVE Suggested Advocacy StrategiesQuestions to ask if NH refuses to accept resident back:Ask resident or representative if the facility has issued an Involuntary Discharge Notice If Yes – inform resident of the right to return to the NH during the 30-day notice period* If Yes – inform the resident of the right to appeal the discharge notice; contact the OOLTCIf No – advise resident to request a written notice of discharge; contact OOLTC*subject to exceptions stated in slide 1926

Advocacy Steps for Mr. Milton 27

Suggested Advocacy Steps 4 If Administrator refuses, ask if Mr. Milton has been issued a “Notice of Involuntary Discharge” and the effective date. 5 If No Notice : Refer Mr. Milton to advocacy agencies to begin appeal in absence of proper discharge notice. If Yes: Remind Administrator that HV is still legally responsible for Mr. Milton’s return until discharge date and of Mr. Milton’s right to appeal the involuntary discharge. 28

Suggested Advocacy Steps MN Department of Health’s Office of Health Facility Complaints (OHFC): 1-800-369-7994 Website: http://www.health.state.mn.us/divs/fpc/ohfcinfo/contohfc.htm OHFC investigates complaints about: quality of care violations of rights for NH residents including refusal to take back residents transferred to hospitals If OHFC substantiates a complaint, it has discretion to issue a deficiency, state licensing orders, and fines. 29

Suggested Advocacy Steps Refer Mr. Milton to the Office Of Ombudsman for Long-Term Care for appeal assistance: 1-800-657-3591 or 651-431-2555 30

Suggested Advocacy Steps Mr. Milton and/or his family may benefit from legal advice. Some elder law attorneys specialize in nursing home law. T o find an attorney, contact the Minnesota State Bar Association Lawyer Referral System at 1-800-292-4152 or visit its website: www. Mnfindalawyer. com. Minnesota Legal Services Coalition may be another resource: 1-651-228-9105. 8 31

Back To Mr. Milton Suggested Advocacy StrategiesFacilitate Mr. Milton’s communication with staff at HVTry to understand Harbor View’s point of view; clarify facility concerns about Mr. Milton’s returnWork with HV social worker to provide seamless care coordination in Mr. Milton’s best interest Continue progress achieved at HospitalDevelop proper discharge plan 32

Back To Milton Suggested Advocacy StrategiesShare possible resources for facility to address resident’s needs: MN/ND Alzheimer’s Association: 1-800-272-3900; www.alz.org National Alliance for Mental Illness (NAMI): 1-651-645-2948; www.namihelps.orgOffice of Ombudsman for Mental Health and Developmental Disabilities: (651) 757-1800 or 1-800-657-3506; http://mn.gov/omhdd/ if resident has MI diagnosis. 33

Goals with Advocacy Strategies Mr. Milton is informed of his right to appeal an an involuntary or discharge. Mr. Milton has the right to return to Harbor View.Mr. Milton - and every resident - has the right to proper notification and due process. 34

Assisted Living & Housing with ServicesNot subject to the same laws/rules as NHs In MN, these establishments are subject to: Landlord and Tenant Law - MN Stat. 504B et. Seq.Terms and conditions of the tenant’s lease and service agreementMN Stat. 144D (housing with services) and 144G (assisted living establishments)Fair Housing Act protects consumers from disability-related discrimination Americans with Disabilities Act (ADA)35

“Housing With Services” Residential setting (primarily for ages 55 and older) that arranges for health-related services on-site. The housing provider may also be the arranged home care provider/home health care agency license holderOr the housing provider contracts with a licensed home health care agency (HCA)Must register with the Minnesota Department of Health (MDH) MN Statutes 144D applyEviction Process under Landlord Tenant Laws apply 36

“Assisted Living” in Plain Language37 Package of health-related services provided in a housing with services (HWS) settingMust be provided under appropriate licensure and quality of care standards Generally have a Comprehensive Home Care LicenseLicensed by MN Dept. of Health (MDH)MN Statutes 144G apply Service Agreement termination under MDH scope – 30-day notice necessary *Ask About Additional OOLTC Training on Curriculum Available

Understanding AL/HWS Regulations Landlord Home Care Provider Landlord – Tenant Lease Contract Service Agreement Between Provider and Tenant 38

For HWS/AL: Ask These Questions Confirm provider’s status: comprehensive license and assisted living (AL) provider.Has AL provider appropriately re-assessed resident? Has AL provider given tenant a service agreement termination in writing with at least 30 day notice? Has HWS establishment given an eviction notice/lease termination in writing? Has AL provider reviewed options with tenant for alternate agencies to provide health-related services? Is consumer receiving EW/CADI/CAC/BI waivered services? If so, there may be additional protections to discuss with waiver case manager. 39

Additional Training Available Let Me Return Home: Assisted Living Edition Eviction and Service Termination in Housing with Services/Assisted Living Establishments Training Objectives: Strategies to resolve/address an Assisted Living provider’s statement that a tenant cannot return to the establishment post-hospitalizationUnderstand consumer rights Understand current laws and regulations regarding HWS/AL settings 40

Office of Ombudsman for Long-Term Care Minnesota Board On Aging 41

Thank you for your time and attention!Please take the time to provide feedback on the evaluation form.42 QUESTIONS?