Is this legal?

  1. I had a patient that was signed out of the facility to stay with his spouse in an independent living facility/apartment for the weekend, connected to the skilled nursing facility I work at. Keep in mind these are 2 different buildings/connected by a hallway. She was advised to call 911 in case of an emergency and took his meds with her. 9 hours later he fell while his wife slept and set off his life alert and the front desk called me and informed me of his fall. No injuries and he refused to go with EMS. However on Monday I get a nasty call from the Adon asking me why she wasn't notified of the fall. Well 1st it wasn't in our facility. 2nd he was in the care of his wife and 3rd I didn't see ****. I didn't go assess him bc EMS already did. So what she's telling me now is that I should have gone to assess the fall leaving my other 14 residents behind and play paramedic. And that I'm responsible for the resident even when they leave our facility. I don't get it. He isn't where I can keep an eye on him. He's a 1000 yards away signed out to his wife. What I'm asking here is am I responsible for the care of this patient if he is no longer in my facility. He wasn't discharged, just taken out on pass for the weekend. Had he stayed in his room the fall wouldn't have happened. When she signed him out she took full responsibility of him knowing she cldnt care for him by herself and admin knew this too. So Adon is asking me to write a statement about what happened and fill out events and fall scene investigations when I didn't see what happened. I told her I don't feel comfortable doing that bc I wld be writing a legal document speculating what happened or on he said she said. I hope I explained this well. If one of ur patients went home for the weekend and had a accident are u required to run over there and provide care?! Bc that's what she's telling me. What if he had fallen at McDonald's. Or at the mall. I can't be held accountable for accidents that happen outside our facility. I asked her to show me an official policy and procedures for our company on this or perhaps something from the BON staying this is legal. Any advice?!
  2. Visit Gabbym441 profile page

    About Gabbym441

    Joined: Jun '18; Posts: 1; Likes: 5
    from TX , US

    18 Comments

  3. by   Davey Do
    Quote from Gabbym441
    I can't be held accountable for accidents that happen outside our facility. I asked her to show me an official policy and procedures for our company on this or perhaps something from the BON staying this is legal. Any advice?!
    Unless I'm missing something or are mistaken, I'd say it sounds like you've got it covered, Gabbym.

    Welcome to AN.com!
  4. by   Here.I.Stand
    I'm not a legal expert but I can't see how you could be held responsible...the family CHOSE to bring him to their private home -- where they know full well they don't have a nursing staff. My parents/their siblings used to bring my grandparents to family gatherings on a weekly basis, and the only time they involved LTC staff was if they felt my grandparent needed to go back earlier than expected, they called to give the nurse a heads up.

    As for leaving the facility to assess him, there is no way in hades I would be comfortable with that. What about the res's in your facility that you ARE responsible for?? I believe the term the BON uses for this is "abandonment." And anyway, nurses are NOT trained as first responders! You have no business going into someone else's home and deciding what to do.... even in your facility, if someone falls and sustains an injury you call 911 while monitoring the pt's CABs. In this case, appropriate action is for his wife to call 911, and the dispatcher walking her through monitoring his CABs until EMS arrives.

    I probably would have written an incident report that included the info from the call from Life Alert, and that the family had been instructed to call 911 in case of emergency -- IF you had given that instruction yourself (either in person or over the phone.) I would think it appropriate to give the ADON a heads up too, as 1) risk management might need to get involved and 2) if injuries happened, that would impact his nursing care upon his return to the facility.

    But actually *handling* the fall situation, or documenting the actions taken outside of your facility (e.g. immediate post-fall assessment, or res's words to EMS) -- absolutely not.
  5. by   JKL33
    Your understanding makes sense; hopefully there aren't tons of gaps in your SNF's policies that will cause trouble.

    One thing did stick out in what you wrote, though:

    Quote from Gabbym441
    I didn't go assess him bc EMS already did.
    Either you're responsible for him while he's off in the assisted living or you're not. If you're not, then your reason for not assessing him isn't that EMS already did, it's that he is not presently under your care and is not on the premises.

    Hopefully there isn't something hinky like poor policies and procedures that don't support your actions.

    If forced to write a report it would be:

    "Notifed by [Person/role] @ [time] on [date] that patient experienced a fall while on LOA @ [official name of ALF] and was evaluated by EMS personnel. [Person] reports that patient declined further medical evaluation for fall. Patient did not return to [SNF] for evaluation of or assistance with this matter. "

    Stay calm when interacting even though you find this nonsensical.

    Time to learn the details of the related policies, forms and procedures as well.

    Good luck
  6. by   sallyrnrrt
    *moderator edit - unnecessary input*
    Last edit by AN Admin Team on Jun 22
  7. by   RNNPICU
    I think you could write a response...
    Pt and family on LOA, educated on ...... Educated and reminded to call 911 for any and all emergencies. On 00/00/00 was notfied of an EMS en route to location ..... It was reported to me that X had fallen. EMS was reported on scene, and reported that there was no transfer at this time.
  8. by   Nascar nurse
    As someone with 30+ years experience in LTC/assisted living, I've seen plenty of inexperienced management nurses get their knickers twisted about some insane idea of what they think should have happened even tho they were totally misinformed in the law, or just lacking plain common sense. When they go off in a crazy tangent they then make their nurses nuts.

    OP, you absolutely can not abandon your skilled nursing patients to go assess someone that is signed out (doesn't matter if they are next door or 2 states away). The only thing you can document is "Was informed by XYZ that ABC happened. XYZ reported resident has no injuries". Put it on whatever form the boss is telling you and be done with it.
    Last edit by AN Admin Team on Jun 22 : Reason: Quoted edited post
  9. by   psu_213
    What is the normal procedure for responding to emergencies in the ILF? Does staff at the SNF usually have any responsibility in this? This is purely from a hospital point of view--the hospital is required to assess/stabilize anyone on hospital property--visitor, staff, etc. who experiences a medical problem. I'm not saying the OP did anything wrong--just curious if there is any obligation given that the ILF is physically attached to the SNF.
  10. by   brownbook
    Quote from Gabbym441
    I had a patient that was signed out of the facility to stay with his spouse in an independent living facility/apartment for the weekend, connected to the skilled nursing facility I work at. Keep in mind these are 2 different buildings/connected by a hallway.

    She was advised to call 911 in case of an emergency and took his meds with her. 9 hours later he fell while his wife slept and set off his life alert and the front desk called me and informed me of his fall. No injuries and he refused to go with EMS. However on Monday I get a nasty call from the Adon asking me why she wasn't notified of the fall.

    Well 1st it wasn't in our facility. 2nd he was in the care of his wife and 3rd I didn't see ****. I didn't go assess him bc EMS already did. So what she's telling me now is that I should have gone to assess the fall leaving my other 14 residents behind and play paramedic. And that I'm responsible for the resident even when they leave our facility.

    I don't get it. He isn't where I can keep an eye on him. He's a 1000 yards away signed out to his wife. What I'm asking here is am I responsible for the care of this patient if he is no longer in my facility. He wasn't discharged, just taken out on pass for the weekend. Had he stayed in his room the fall wouldn't have happened.

    When she signed him out she took full responsibility of him knowing she cldnt care for him by herself and admin knew this too. So Adon is asking me to write a statement about what happened and fill out events and fall scene investigations when I didn't see what happened. I told her I don't feel comfortable doing that bc I wld be writing a legal document speculating what happened or on he said she said. I hope I explained this well.

    If one of ur patients went home for the weekend and had a accident are u required to run over there and provide care?! Bc that's what she's telling me. What if he had fallen at McDonald's. Or at the mall. I can't be held accountable for accidents that happen outside our facility. I asked her to show me an official policy and procedures for our company on this or perhaps something from the BON staying this is legal. Any advice?!

    Please use paragraphs, pauses, when you post. Reading your one long paragraph is like listening to someone with pressured speech, (to use a psych term), or a drunk with verbal diarrhea, (to use a common term).

    I understand you're upset, it does sound crazy. Your ADON wants you to write a statement. So do it. Make it short, sweet, simple, state the facts, no excuses, no extra explanations. Keep it very short...patient was signed out to his wife, patient's life alert sent out an alarm, EMS assessed patient, patient refused treatment.

    Don't add any more that just plain simple facts.
  11. by   JKL33
    Quote from psu_213
    What is the normal procedure for responding to emergencies in the ILF? Does staff at the SNF usually have any responsibility in this? This is purely from a hospital point of view--the hospital is required to assess/stabilize anyone on hospital property--visitor, staff, etc. who experiences a medical problem. I'm not saying the OP did anything wrong--just curious if there is any obligation given that the ILF is physically attached to the SNF.
    That is an EMTALA obligation; it applies to hospitals that participate with M'care and have a dedicated emergency department.

    Relevant EMTALA-related CMS info:

    However, the following are not considered parts of the hospital and are not to be included in the evaluation of the hospital's compliance:

    Components appropriately certified as other kinds of providers or suppliers. i.e., a distinct part Skilled Nursing Facility and/or distinct part Nursing Facility, Home Health Agency, Rural Health Clinic, or Hospice; Excluded residential, custodial, and non-service units not meeting certain definitions in the Social Security Act; and,

    Physician offices located in space owned by the hospital but not functioning as hospital outpatient services departments
    And, an unofficial site - section 2B

    Rare as it may be, I think the commonsense answer is probably also the correct answer this time.

    .....unless someone here can shed other light

    PS - another clue would be whether or not the OP is regularly expected to assess emergencies over in the ALF/ILF.
  12. by   Have Nurse
    Quote from Nascar nurse
    As someone with 30+ years experience in LTC/assisted living, I've seen plenty of inexperienced management nurses get their knickers twisted about some insane idea of what they think should have happened even tho they were totally misinformed in the law, or just lacking plain common sense. When they go off in a crazy tangent they then make their nurses nuts.

    OP, you absolutely can not abandon your skilled nursing patients to go assess someone that is signed out (doesn't matter if they are next door or 2 states away). The only thing you can document is "Was informed by XYZ that ABC happened. XYZ reported resident has no injuries". Put it on whatever form the boss is telling you and be done with it.

    I agree. Sounds like it might be a good idea though to have a quiet respectful meeting to clear the air on this. I would be curious to know why your boss seems to think you or for that matter, your facility might be responsible? It makes no sense. He was signed out and off premises.
  13. by   Ruby Vee
    Quote from Gabbym441
    I had a patient that was signed out of the facility to stay with his spouse in an independent living facility/apartment for the weekend, connected to the skilled nursing facility I work at. Keep in mind these are 2 different buildings/connected by a hallway. She was advised to call 911 in case of an emergency and took his meds with her. 9 hours later he fell while his wife slept and set off his life alert and the front desk called me and informed me of his fall. No injuries and he refused to go with EMS. However on Monday I get a nasty call from the Adon asking me why she wasn't notified of the fall. Well 1st it wasn't in our facility. 2nd he was in the care of his wife and 3rd I didn't see ****. I didn't go assess him bc EMS already did. So what she's telling me now is that I should have gone to assess the fall leaving my other 14 residents behind and play paramedic. And that I'm responsible for the resident even when they leave our facility. I don't get it. He isn't where I can keep an eye on him. He's a 1000 yards away signed out to his wife. What I'm asking here is am I responsible for the care of this patient if he is no longer in my facility. He wasn't discharged, just taken out on pass for the weekend. Had he stayed in his room the fall wouldn't have happened. When she signed him out she took full responsibility of him knowing she cldnt care for him by herself and admin knew this too. So Adon is asking me to write a statement about what happened and fill out events and fall scene investigations when I didn't see what happened. I told her I don't feel comfortable doing that bc I wld be writing a legal document speculating what happened or on he said she said. I hope I explained this well. If one of ur patients went home for the weekend and had a accident are u required to run over there and provide care?! Bc that's what she's telling me. What if he had fallen at McDonald's. Or at the mall. I can't be held accountable for accidents that happen outside our facility. I asked her to show me an official policy and procedures for our company on this or perhaps something from the BON staying this is legal. Any advice?!
    Even though the patient was out on pass and not under your care at the time of the fall, I think it would have been prudent to have informed your ADON. Management hates when they find these things out from others rather than hearing about it from their employee. Other than that, I think you were correct.
  14. by   Neats
    It depends on the situation. There are a lot of continuity care facilities that start with independent apartment, then move to assisted living and finally SNF care. The nursing staff can go to all in an emergency. Most of the time they have their own separate staff. Some are set up for responsibility for all level of cares. Some only in emergencies should staff respond to the ALF or Apartments. If they have the responsibility to respond then you should do so. This does not sound like it is the case. It sounds like each level of care is independent of each other and more than likely have their own NPI numbers designated each a different business.


    Chapter 6 of the Medicare Claims Processing Manual provides that the facility cannot bill a beneficiary during a leave of absence, this is one of the reasons why we make them sign out and release responsibility back to the family.

    If your ADON is wanting you to write a statement I would write something like arrived for shift and report says Mr C was signed out by family member for week end. At approximately XXX I received a call from XXX regarding a possible fall. I was informed EMS was called but patient refused to go to emergency depart and I was informed patient was not harmed. No other action was made for this patient as this patient was under the care custody and control of family member.

    I think I would have written a little note in patient chart, and in handoff report, not in 24 hour report, just to notify nursing staff in the event this patient returned with bruising/injury this way the paper trial has already been started even though the patient was not in house.
    Last edit by Neats on Jun 22

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