Transcript Let Me Return Home Curriculum PowerPoint - Long

“Let Me Return Home”
NURSING HOME REFUSAL TO
ALLOW RESIDENTS TO RETURN
POST-HOSPITALIZATION
Training for Hospital Discharge Planners
Office of Ombudsman for Long-Term Care
Minnesota Board on Aging
2016
Ms. Simpson’s First Day of Work
2
June Simpson– Hospital
Discharge Planner
Mr. Milton – wants to
return to his home at
Harbor View NH after a
one week hospital stay
Mr. Milton’s Story
3
Before Hospital
Admission
During Hospital Stay
 Mr. Milton had raised
 Physicians made
his cane and threatened
roommate to a “beat
down”
 History of “behaviors”
at Harbor View (HV)
including pinching and
grabbing staff and
residents
adjustments to
medications
 Treated for bladder
infection
 Mr. Milton is tolerating
medication changes and
bladder infection resolved
 He is ready to return to
HV
So Ms. Simpson Calls Harbor View…
4
Mr. Milton
Ready To
Return Home
to Harbor View
Harbor View’s Social
Worker Says
“No” Citing Concerns About
Resident and Staff Safety
To Ms. Simpson’s Surprise…
?
?
?
• Social Worker says
Harbor View “discharged
Mr. Milton to hospital”
• Harbor View will not be
“readmitting” Mr. Milton
• Social Worker says June
is to call other NHs to find
alternative placement
5
What Do You Call This Situation?
?
?
?
Involuntary Discharge
6
This Is A Serious Problem
7
NH Residents &
Families
Admitting Hospital
 Violates residents’ rights
 Expends hospital time
 Isolates residents and
and resources
 Compels hospital staff to
quickly find alternative
placement for patients
being involuntarily
discharged
families from their homes
and communities
 Creates resident anxiety
due to uncertainty about
being able to go home
 Risk of transfer trauma due
to multiple placements
Today’s Training Objectives
8
Understand
Mr. Milton’s
rights about
involuntary
discharge
Suggest
advocacy
strategies
for Mr.
Milton & his
family
Identify
resources to
help Mr.
Milton
return to
HV
9
So, Ms. Simpson –
What’s Next For Mr. Milton?
How Does Ms. Simpson Advocate For Mr. Milton?
10
 Ask Mr. Milton if
he wants to return
to Harbor View?*
Yes
• Inform of right
to appeal and
• Right to return
to Harbor View
No
• Help Mr. Milton
find another
home
LTC Ombudsman Office is here to help!
*If appropriate, contact Mr. Milton’s surrogate decision-maker
Office of Ombudsman
for Long-Term Care
Minnesota Board On Aging
11
Phone:
651-431-2555
Toll-Free:
1-800-657-3591
Fax:
651-431-7452
Empowers consumers to advocate
for themselves and their rights
Provides advocacy services and
education to LTC consumers
With consent, works to resolve
problems about care and rights
LTC Ombudsman Viewpoint
12
Regulations require that Mr. Milton be
issued a “Bed Hold Notice”
HV has a legal obligation to follow federal
regulations if it intends to involuntarily
discharge Mr. Milton
HV should allow Mr. Milton to return to HV
once he is ready to discharge from the
hospital
Absent extraordinary circumstances,
residents have a right to return to their
nursing homes and the right to due process,
even if a notice of discharge has been issued
Types of Transfers & Discharges
13
Voluntary
Involuntary
 When a resident
 When a facility initiates
initiates a request for
transfer or discharge
the transfer or
discharge
 Regardless of the
resident’s choice or
preference
 Even if the resident
does not object to it
The “Voluntary Discharge” Dialogue
“We can’t meet
your husband’s
needs.”
“You need to
find another
place.”
“This isn’t the
best place for
your father.”
These Situations are NOT Voluntary Discharges
Because NH Initiates These Dialogues
14
Why Not “Voluntary Discharge?”
“We can’t meet
your husband’s
needs.”
“You need to
find another
place.”
Discuss Each Scenario
15
“This isn’t the
best place for
your father.”
Involuntary Discharge Regulations
16
Resident must receive a written
involuntary discharge notice
Notice must contain specific and detailed
legal requirements, including reason for
discharge and location of discharge
Must provide 30 day* timeframe to
exercise right to appeal (see exceptions on
slide 19)
Right to remain in or return to NH
pending appeal to an administrative law
judge, absent extraordinary circumstances
Grounds for NH Discharges
17
Common
Less
Common
• Needs (welfare) cannot be
met at NH
• Safety of individuals in the
facility is endangered
• Health of individuals in the
facility is endangered
• NH ceases to operate
• Nonpayment, after
appropriate notice
• Improved health - no longer
requires NH level care
*Exceptions To 30 Day Notice Period
18
* Needs cannot be met at NH
* No longer requires NH level of care
* Health or safety of individuals in the
facility is endangered
* Has resided in NH for fewer than 30 days
Required Documentation
19
“Can’t Meet Needs”
 Clinical documentation
from resident’s
physician stating
resident’s health care
needs cannot be met at
NH
“Danger To Self or
Others”
 Clinical documentation
from a physician stating
health of other
individuals at NH is
endangered by the
resident - and the basis
for the endangerment
Resident has right to review documentation, with rare exceptions
Bed Hold Notice
20
 “Bed Hold Notice” defines
 Must be in writing
under what circumstances
MA will pay to hold the
bed
 Bed hold notice also
contains HV’s bed-hold
policies
 Harbor View must give
Mr. Milton option to pay
to “hold” his bed
regardless of NH current
occupancy
 Should be provided to Mr.
Milton and/or his
representative before
transfer to hospital
 Obtaining resident signature
on the bed hold notice is not
required, but best practice
 If unable to provide bed hold
notice at time of transfer to
the hospital, bed hold notice
should be provided within 24
hours
Does Mr. Milton Have a Signed BED HOLD?
21
Request to Hold • Proceed with discharge
Bed at Harbor View planning for return to HV
Elected Not to
Hold His Bed at
Harbor View
No Bed Hold On
File At Hospital
• Discuss with Mr. Milton why
he decided not to hold his
bed
• Assist Mr. Milton in
requesting copy of notice
from NH; call LTC
Ombudsman immediately if
NH refuses to issue one
22
 Medical Assistance (MA) pays to
Bed
Hold
Notice,
continued
hold bed for 18 days in
Minnesota
 Includes NH’s policy if Mr.
Milton’s hospital stay exceeds 18
days
 If >18 days, Mr. Milton’s right to
return to the first available semiprivate NH bed as long as he
requires skilled nursing care
Why Does a Bed Hold Notice Matter?
23
 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!
Additional Protections as “Prohibited
Practice” Under Medical Assistance Rules
24
MN Statute 256B.48 CONDITIONS FOR PARTICIPATION
Subdivision 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.”
25
 On Day of Hospital Admission
 Confirm
General
Advocacy
Strategies
Be
Proactive!
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
staff
26
 Questions to ask if NH refuses to
BE
PROACTIVE
Suggested
Advocacy
Strategies
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 30day notice period*
 If Yes – inform the resident of the
right to appeal the discharge notice;
contact the OOLTC
 If No – advise resident to request a
written notice of discharge; contact
OOLTC
 *subject to exceptions stated in slide
19
Advocacy Steps for Mr. Milton
27
1
2
3
• Ask Mr. Milton if he wants to return to Harbor
View NH.
• Review Bed Hold Notice from Harbor View
sent with Mr. Milton to hospital ASAP.
Identify any problems now to avoid crisis later.
• Contact OOLTC, assist Mr. Milton in speaking
to the NH Administrator about his desire to
return Harbor View.
Suggested Advocacy Steps
28
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.
Suggested Advocacy Steps
29
• MN Department of Health’s Office of Health
Facility Complaints (OHFC): 1-800-369-7994
• Website:
http://www.health.state.mn.us/divs/fpc/oh
fcinfo/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.
Suggested Advocacy Steps
30
• Refer Mr. Milton to the Office Of
Ombudsman for Long-Term
Care for appeal assistance:
• 1-800-657-3591 or
• 651-431-2555
Suggested Advocacy Steps
31
8
• Mr. Milton and/or his family may benefit
from legal advice.
• Some elder law attorneys specialize in
nursing home law.
• To 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.
32
Back To
Mr.
Milton
Suggested
Advocacy
Strategies
 Facilitate Mr. Milton’s
communication with staff at HV
 Try to understand Harbor View’s
point of view; clarify facility
concerns about Mr. Milton’s return
 Work with HV social worker to
provide seamless care coordination
in Mr. Milton’s best interest
 Continue progress achieved at
Hospital
 Develop proper discharge plan
33
 Share possible resources for facility
Back To
Milton
Suggested
Advocacy
Strategies
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.org
 Office of Ombudsman for Mental
Health and Developmental
Disabilities: (651) 757-1800 or 1800-657-3506;
http://mn.gov/omhdd/ if
resident has MI diagnosis.
Goals with Advocacy Strategies
34
 Mr. Milton is informed
of his right to appeal
an involuntary
discharge.
an
or
 Mr. Milton has the
right to return to
Harbor View.
 Mr. Milton - and every resident - has the right to
proper notification and due process.
Assisted Living & Housing with Services
35
 Not 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 agreement
 MN Stat. 144D (housing with services) and 144G
(assisted living establishments)
 Fair Housing Act protects consumers from
disability-related discrimination
 Americans with Disabilities Act (ADA)
“Housing With Services”
36
 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
holder
 Or the housing provider contracts with a licensed
home health care agency (HCA)
 Must register with the Minnesota Department of
Health (MDH)
 MN Statutes 144D apply
 Eviction Process under Landlord Tenant Laws apply
“Assisted Living” in Plain Language
37
 Package of health-related services provided in a
housing with services (HWS) setting
 Must be provided under appropriate licensure and
quality of care standards
 Generally have a Comprehensive Home Care License
 Licensed 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
38
Landlord
Home Care Provider
Landlord – Tenant Lease
Contract
Service Agreement Between
Provider and Tenant
For HWS/AL: Ask These Questions
39
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.

40
Additional
Training
Available
Let Me Return Home:
Assisted Living Edition
Eviction and Service Termination
in Housing with Services/Assisted
Living Establishments
Training Objectives:
o Strategies to resolve/address an
Assisted Living provider’s statement
that a tenant cannot return to the
establishment post-hospitalization
o Understand consumer rights
o Understand current laws and
regulations regarding HWS/AL settings
Office of Ombudsman
for Long-Term Care
Minnesota Board On Aging
41
Phone Intake Line:
1-800-657-3591 or 651-431-2555
Mailing: PO Box 64971, St. Paul,
MN, 55164-0971
Site: 540 Cedar St., St. Paul
Website:
mnaging.org\advocate\ooltc.htm
QUESTIONS?
42
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