| 77 |
BANGOR NURSING & REHABILITATION |
205020 |
103 TEXAS AVE |
BANGOR |
ME |
4401 |
2019-08-21 |
550 |
G |
1 |
0 |
QVUV11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record reviews, interviews, and observation, it was determined the Facility has violated Resident #253's right to be free from discrimination, coercion, and interference as evidenced by the facility's refusal to readmit him/her because of the resident's known [MEDICAL CONDITION], attempts to transfer Resident #253 to another nursing facility without the resident's consent, and by not honoring a Hearing Officer's decision to re-admit, for 1 of 1 resident's reviewed (Resident #253). Finding: A review of the Facility Assessment, dated [DATE], indicated the Facility cared for individuals with a [DIAGNOSES REDACTED]. Resident #253 was admitted to the Facility in (MONTH) of (YEAR) with a [DIAGNOSES REDACTED]. The resident's Minimum Data Sets (MDS) 3.0 assessments, dated [DATE] and [DATE], indicated the following: -He/she required extensive assistance with the support of two or more persons providing physical assistance for bed mobility, toilet use, and personal hygiene; -He/she was totally dependent with the support of two or more persons providing physical assistance with bathing; -He/she was occasionally incontinent of urine (less than 7 episodes of incontinence over a 7-day period) per the [DATE] MDS and was always continent of urine per the [DATE] MDS -He/she was always continent of bowel -He/she did not require a toileting program to manage his/her continence. -His/her weight was 473 pounds and 481 pounds respectively. -He/she was at risk for pressure ulcers but did not have pressure ulcers. -There was no active discharge plans and the resident did not want to talk to anyone about the possibility of leaving this Facility and returning to live and receive services in the community. On [DATE], the primary care provider (PCP) assessed the resident's leg and decided the resident needed intravenous (IV) antibiotics at the hospital; therefore, the patient was transferred to the hospital and was admitted . The MDS 3.0 assessment, dated [DATE], indicated the following: -This discharge was unplanned and it was anticipated the resident would return to the Facility. -He/she required extensive assistance with bed mobility, toilet use, and personal hygiene. -He/she was totally dependent on staff for transfer and bathing. -He/she was always continent of urine and bowel. -His/her weight was 578 pounds. -He/she did not have any pressure ulcers. -There was not an active discharge in place for the resident to return to the community. Between admission in (MONTH) (YEAR) through [DATE], there was no evidence that the Facility was unable to meet this resident's needs despite his/her [DIAGNOSES REDACTED]. Written communication between the hospital and the Facility, dated [DATE] and [DATE], was reviewed and indicated the following: -The resident was concerned about losing his/bed at the Facility ([DATE]). -The Facility was notified that the resident was ready for discharge ([DATE]). -The Facility representative informed the hospital that the resident's readmission status was changed to declined; No appropriate bed; and Patient too complex ([DATE]). -The Facility representative wrote Our facility can no longer meet (Resident #253) needs due to (Resident #253) bariatric status. On [DATE], the Facility sent a letter to Resident #253 indicating your bed hold has expired, and you have been discharged from our facility. We will not be able to accept you to Bangor Nursing & Rehabilitation Center on the basis that your current needs cannot be met by our facility. The letter provided information on how the resident could appeal this decision, and further informed the resident .a nursing facility may not transfer or discharge a resident until a decision is rendered if that resident has requested a hearing within 10 days of receipt of notice. Unless the health or safety individuals is in immediate risk or immediate transfer or discharge is necessitated by the resident's urgent medical need. On [DATE], four days after the discharge letter, Resident #253 appealed the notice of Facility-initiated discharge and requested a hearing. On [DATE], an appeal hearing was held. The appeal decision was as follows: Bangor Nursing & Rehabilitation Center did not meet the regulatory requirements for an involuntary discharge of (Resident #253). Bangor Nursing & Rehabilitation Center shall readmit (Resident #253) to (his/her) previous room if available or immediately upon the first availability of a bed in a semi-private room . On [DATE] at 1:09 p.m., during the Facility's most recent Federal survey, the Director of Nursing (DON) was interviewed. It was confirmed, with the DON, that Resident #253 had not been readmitted to the Facility pending the appeal process, had not been readmitted after the appeal hearing decision, and that there was no documentation, by a Physician, that indicated any specific need that the resident required that the Facility could not meet. The Facility was issued a statement of deficiencies, dated [DATE], for regulatory violations (F622 and F6262) regarding this Facility-initiated discharge and the refusal to comply with the resident's right to return to the Facility. On [DATE], 206 days after the patient was transferred to the hospital, the Medical Director wrote a document that indicated, (Facility) does not have the staff, expertise, equipment, or infrastructure in place to care for (Resident #253) in (his/ her) current condition in a manner consistent with applicable standards of care. This opinion is based upon the following: -(Facility) does not have a wall suction unit. Without this unit, (Resident #253) would be consistently exposed to urine and this would lead to skin breakdown, pressure sores and possible infections. -Moving (Resident #253) in bed to provide skin care and hygiene support requires assistance from 3 to 4 CNAs. The staffing ratios in nursing homes generally and at (Facility) specifically make this not feasible. If (Facility) was required to support this level of staffing, it would negatively impact care of other patients at (Facility). -(Facility)cannot institute [MEDICAL CONDITION] treatment. It does not have access to specialized staff or equipment. In fact, there is none available in the greater Bangor area. -(Facility) is not permitted to restrict (Resident #253) diet in any way as this violates her rights per applicable nursing home regulations. This includes not being able to prohibit third parties from bringing in outside food that exacerbates (his/her) obesity and heart failure, and BNRC cannot prevent (Resident #253) from ordering fast food to be delivered to the facility. -Applicable nursing home regulations require that (Facility) care for (Resident #253's) overall wellbeing including (his/her) psychosocial needs. To meet this standard in the context for (Resident #253) (Facility) may be in a position to have to modify its physical infrastructure and hire additional CNAs and medical staff with specific expertise, among other possible operational impacts. On [DATE] between 9:30 a.m. and 10:00 a.m., the Administrator and DON were interviewed, and they indicated the following: -The Facility could not readmit Resident #253 related to his/her need for [MEDICAL CONDITION] treatment and currently there was no clinic in the greater Bangor area. -The Facility could not evacuate Resident #253 out of his/her room in an emergency. -The amount of staff required to take care of Resident #253 would take away from the care of other residents at the Facility. This investigation through a review of the resident's medical records from the Facility and the hospital, interviews, and/or an observation determined the following: -At the hospital, Resident #253's is utilizing a PureWick female catheter attached to wall suction. However, there was no indication that this treatment would be required upon readmission to the Facility. -Resident #253's [MEDICAL CONDITION] was not a new [DIAGNOSES REDACTED]. In addition, [MEDICAL CONDITION] treatment is available in the Bangor area. -Resident #253 required the assistance of 2 or more staff prior to being admitted to the hospital on [DATE]; therefore, the number of staff to care for this resident was not a new issue impeding the resident's return to the Facility. -Resident #253 has not experienced a significant weight gain while in the hospital. The resident's weight was 578 pounds when he/she was transferred to the hospital on [DATE] and his/her weight was 587 pounds on [DATE]. -The resident's wheelchair was too wide to fit through the doorway and staff had been instructed on ways to transfer the resident to his/her wheelchair outside of his/her room. On [DATE] at 9:30 a.m., the current Administrator indicated a mock evacuation had been conducted (prior to hospitalization ) with three firemen from the Bangor Fire Department and they were able to evacuate Resident #253 from his/her room. On [DATE] at 3:00 p.m., the Assistant State Fire Marshall, confirmed that the expectation for Long-Term Care Facilities was to protect residents in place and evacuation is considered a last resort. He stated that he had a conversation with the Bangor Fire Chief to verify the fire departments ability to evacuate Resident #253 in the event of an emergency and the Bangor Fire Chief stated, Bangor Fire would be able to remove the resident in an emergency. -On [DATE] at 10:10 a.m., the following equipment, which is owned by Resident #253 and stored in the Facility's garage, was observed: an electric bariatric transfer lift rated to lift [PHONE NUMBER] pounds; an electric-hand cranked bed that is rated for 650 pound capacity; one electric-hand crank bed that is rated for 1000 pound capacity; a bariatric commode; and a bariatric wheelchair. During a further review of Resident #253's clinical record, the following was noted: -Resident #253 was receiving counseling services between (MONTH) (YEAR) to (MONTH) (YEAR). Resident #253 discussed his/her concerns about remaining in the Bangor area to be close to his/her family; his/her concerns about his/her family members' health and wellbeing; his/her feelings about food, food and fluid restriction, and obesity; his/her fear and concern about the Facility trying to force him/her out of the nursing home and send him/her to another facility. -A Social Services Note, dated [DATE], indicated the resident was informed of his/her Medicare 100th day was [DATE] and the resident asked about remaining at this facility as LTC (Long-Term Care) because (he/she) has nowhere else to go. (He/She) states the staff here knows (him/her) and (he/she) is very comfortable with our staff. Informed (him/her) that (he/she) could remain here. -A Social Service Note, dated [DATE], indicated the following: the Licensed Social Worker (LSW) discussed with the resident the possibility of perhaps moving to a different facility to better accommodate (his/her) needs; the resident indicated that he/she did not want to move from the Facility as he/she waited two years to be able to be admitted to the Facility; and that a meeting would be held on [DATE] to discuss concerns from staff. -Social Service Notes, between [DATE] and [DATE], indicated the Facility was attempting to find a facility to transfer the resident to and several facilities were contacted regarding the potential transfer. These attempts were made without the resident's consent and after he/she had expressed on [DATE] that he/she did not want to move. - A plan of care meeting was held on [DATE] with Resident #253, Resident #253's family members, the Assistant DON, the Rehabilitation Services Manager, and the Social Service Director present. The meeting note indicated there was discussion about the resident's weight gain; the resident's poor choices with food; that he/she had ordered out often; and he/she frequently stayed up at night requesting sandwiches and snacks. The resident indicated that he/she was not getting what he/she ordered from the kitchen. The note indicated the dietary department had worked very closely with Resident #253 multiple times to help him/her lose the weight. Resident #253 stated that he/she was addicted to food. The notes also indicated that the resident stated that he/she was worried that he/she would be kicked out of BNRC, despite being told that he/she was the key to his/her well-being, and that he/she needed to make better choices and get himself/herself back on that losing track again. There was no documentation to indicate that the Interdisciplinary Team identified the reasons and causes for the resident's deviation from the care plan related to the resident's weight and implemented necessary changes for resident success. - On [DATE], the resident was seen by his/her counselor. The counselor documented the following: Patient was in bed resting. Patient was in a sad mood, and (he/she) was upset. Patient stated, 'I had a meeting today. The social worker came in and told me that I would have to go somewhere else where I was safe, and she wanted me to sign papers. I didn't sign them and I'm tired of them moving me all around this state because I'm obese and they don't want to lift me.' Patient was crying and feeling hopeless, helpless, and judged. Patient was able to talk about feeling that (he/she) was being treated this way because of (his/her) weight. Patient feels they are trying to get rid of (him/her) because it takes 3 people to move (him/her). Patient feels that they'd rather have (him/her) in bed than to get someone to move (him/her). On [DATE] at 12:25 p.m., the Facility's DON, confirmed Resident #253 had not wanted to leave the Facility and that resident's greatest concern was being near his/her family in Bangor. On [DATE] at 12:50 p.m., the LSW stated that prior to the resident's hospitalization , on [DATE], the Facility care team, nursing, therapy, dietary, and social services had concerns about being able to meet the resident's needs at the Facility. She confirmed that she had a talk with the resident about this concern and she confirmed the resident indicated that he/she did not want to leave the Facility. On [DATE] at 11:15 a.m., Resident #253 was interviewed in his/her room at the hospital. When asked how he/she would feel about returning to BNRC, the resident stated, I am reluctant, in a way. They had the fire department come to see if they would be able to get me out of the room, and the nurse said, while the fire department was there, that they would never be able to get me out the door. I don't want them to misuse me at the nursing home. I don't think they want me there. I want to stay close to my (family) in Bangor. My (family) can't travel, and (my family) has been through so much. I worry about (my family) and want to be able to see (my family). On [DATE] at 11:47 a.m., the Facility's Medical Director was interviewed. When asked if she could reference any provider progress notes for Resident #253 that supported that the Facility was providing poor quality of care or if she could provide any notes to support that the Facility was unable to meet Resident #253's care needs, she stated, There are no provider notes to support that we could not meet that resident's needs. She further stated, (Resident #253) was sent to the hospital on [DATE]. I sent (him/her) for treatment at the hospital and I expected (him/her) to come back to the nursing home. I had no knowledge that the Facility was going to discharge the resident. If the Facility accepted this resident back for care now, I would have to care for (him/her). The failure of the Facility to protect the resident's rights for a dignified existence and access to quality of care regardless of his/her [DIAGNOSES REDACTED].#253's fear of isolation from his/her family, and the Facility's refusal to allow Resident #253 to return to his/her home has resulted in increased sadness and feelings of being judged and not valued as a human being because of his/her weight. |
2020-09-01 |