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Date ArticleType
7/24/2018 Regulatory
Important things to remember when a resident misses a non-emergency medical service or appointment

Our seniors rely on transportation to get to non-emergency, yet vital, services and are also experiencing frustrations with the new transportation broker because of missed appointments and missed or delayed return trips to the facility.  Frustrations are also felt by facility staff as the responsibility and requirements of CMS to up-hold resident right’s and Quality of Care are taken seriously.  Some of the rights are, but not limited to the following:

  • The resident has a right to care in an environment that promotes maintenance or enhancement of each resident’s quality of life.  The resident has the right to a safe, clean, comfortable, and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
  • The resident has the right to know when there is a need to alter treatment significantly (that is, a need to discontinue or change an existing form of treatment due to adverse consequences, or to commence a new from of treatment. 
  • The resident has the right to voice grievances to the facility or other agency or entity that hears grievances without discrimination or reprisal.  Such grievances include those with respect to care and treatment which has been furnished as well as that which has not been furnished, the behavior of staff and other residents; and other concerns regarding the Long-Term Care facility stay.
  • The resident has the right to be informed in advance, by the physician or other practitioner or professional, of risks and benefits of proposed care, of treatment and treatment options, as well as changes, and the right to receive the services and/or items included in the plan of care. 
  • The resident has the right to be free from neglect.

Until issues surrounding missed appointments and return trips are improved and solved, nursing facilities and assisted living communities serving Medicaid and RCAP enrollees across the state will need to ensure the safety of each resident.  Always remember that a non-emergency appointment can lead to a new change of condition requiring emergency response. 

For nursing facilities, following should be reviewed and reinforced with the interdisciplinary team:

- Review your current policy and procedure for missed appointments.  To include communication with the attending physician, resident representative and nursing staff. 

  1. Assess the resident by taking vital signs as well as appropriate assessments to determine if the resident’s condition remains stable or requires intervention.  
  2. Alternatives for rescheduling missed appointments including an appropriate time frame to reschedule the appointment should be discussed with the resident, resident responsible party and interdisciplinary team. 
  3. Consider placing the resident in a 72-hour follow-up charting where assessment and documentation is required by each shift for 3 days.  Documentation should be focused on the resident unstable or stable conditions as well as the status of rescheduling the missed appointment.
  4. Review policy and procedures for change of condition to ensure compliance.  This will be extremely important when the health of the resident is compromised in association with the missed non-emergency appointment. 
  5. Review the Grievance policy and procedure to ensure resident/resident representative concerns are documented and addressed. 

For Assisted Living facilities serving Medicaid and RCAP enrollees, following should be reviewed and reinforced with the interdisciplinary team to ensure compliance with promptly arranging for or assisting with the provision of medical, dental, podiatry, or nursing care or other health care services as requested by the resident or resident’s legal representative:

- Review current policy and procedures for missed appointments to ensure access to persons and services inside and outside the facility is occurring related to transportation to medical appointments.

  • Establish protocols for evaluation of the resident, include vital signs and any significant alteration of treatment, that is a need to discontinue an existing form of treatment or commence a new form of treatment.
  • Establish a system to track missed appointments and the rescheduling of appointments and updating services plans accordingly. 
  • Review protocol to identify, document and manage a change of condition or significant decline in a resident’s physical, mental, or psychosocial status. Monitor management of identified symptoms and communication with the resident’s physician and legal representative. When active symptoms exist, consider placing the resident in a 72-hour follow-up charting where documentation is required by each shift for 3 days.  Documentation should be focused on the status of the rescheduled appointment and the resident’s response.  Example:  A resident misses a dental appointment and later develops unmanageable oral pain.

- Delayed trips in returning to the facility require a proactive approach in planning the transportation.  Each facility is encouraged to develop action plans to ensure there are processes in place to address the following questions: 

  • Does the resident require an escort because of a physical, or memory deficit?
  • Will the resident need any special items such as food, medication, oxygen and/or device?
  • Does the resident have proper identification on their person?
  • Is there a system to ensure compliance with requirements of participation related to information to be sent with the resident for each transfer?
  • Does the resident and escort have instructions to follow if there is a delay in returning to the facility once the appointment has ended?
  • Is there a system in place to track residents safe return from appointments?

In conclusion, an assessment of the resident to determine changes of condition to identify bruises, or clinical conditions is recommended upon a resident return from a scheduled appointment.  Minimum assessment should include vital signs, mobility, and skin assessment as well as the resident’s response to the appointment/transportation. 

If you have questions or require assistance, email ldavenport@ihca.org