Is this legal?

[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?!

[Neats, BSN]

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.

[Kooky Korky, BSN, RN]

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.

State why there was no transfer, who notified the writer, be specific, name names.

[NurseBlaq]

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.

Unless the facility knew the wife couldn't care for him and let him leave on pass just to pacify her and now that something is wrong they're looking to cover their ASSets. I wouldn't fall on that sword for them

[amoLucia]

Unless the facility knew the wife couldn't care for him and let him leave on pass just to pacify her and now that something is wrong they're looking to cover their ASSets. I wouldn't fall on that sword for them

Am also thinking that the familiy may be PO'd and starting to raise a ruckus. They may have been under the impression that SNF would continue to provide the emerg services. (Am curious if someone rec'd a bill.)

Yeah, maybe the ADON should have been notified, but that's a technicality.

I'm more guessing that there's family, money, and contined occupancy involved.

Anybody want to venture a guess what the monthly charges are for that familiy to have placed their seniors as they did?

[kbrn2002, ADN, RN]

I work in a SNF and we have had residents fall when out on leave with their families, it happens. We are not responsible for anything related to the fall when it occurs, but we still have a boatload of paperwork when they return. We still do an incident report, there's even a drop down option in the form we use for a "fall off facility grounds." We still initiate our standard post-fall protocol including updating the DON and the MD of the fall when the resident returns. What we don't do is leave the facility to care for the resident, family is instructed prior to leaving with the resident that if anything adverse happens while they are out they need to call 911. Rarely we get a family that panics a little because their family member fell at home and they need help getting them up, they are instructed again to call 911 and follow the instructions of the first responders.

[Alex_RN, BSN]

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.

Seriously, this is such a regular thing it should be covered in orientation.

[FolksBtrippin, BSN, RN]

I can understand the ADON wanting to be notified about the fall. I understand the purpose of assessing the pt once he returns, writing a note based on his report. Info should be requested from ems also.

Of course you should not have left your pts to go to assisted living. But that doesn't mean you can't address what happened.