Refusing to take a resident bac

[CapeCodMermaid, RN]

Maybe some one in Massachusetts can help me out. I was told years ago there was a regulation that stated we didn't have to readmit a resident if we were not able to care for them. I can't find the reg and I'm in the middle of a 'discussion' with a local hospital. The resident is in his 40s. He assaulted two CNAs. My administrator and I don't think we can take him back.

Any comments?

[MunoRN, RN]

I don't know the specific laws in MA, but the main problem will be Federal anti-patient-dumping statutes. If the patient is sent out to the hospital and at discharge will require a level of care that the facility cannot provide, then the facility is legally justified in refusing the patient back. In general though, if the facility has decided they don't want the patient back due to a problem that exist prior to the transfer to the hospital, they are legally required to take the patient at discharge from the hospital but are free to initiate the transfer/discharge process just as they would have done prior to hospital admission.

[heron, ASN, RN]

Would psych issues count as the level of care the facility can't provide? A long shot, but it might work. If not, I highly recommend informing the resident that he will be arrested and charged if he attacks any caregivers.

After all, he can't have it both ways. If psych issues mean he's not responsible for his behavior and the facility is unable to keep him from being a danger to himself and others, he needs a higher level of care. If he is capable of controlling his own behavior, then he needs to deal with the consequences of indulging himself.

Worked for us. What does risk management say?

[CapeCodMermaid, RN]

We don't have a risk management department. We have a corporate attorney whose legal opinion is we do not have to take him back since he presents as a danger to others.

[MunoRN, RN]

Is the danger he presents now significantly different compared to before going into the hospital? The basic purpose of anti-dumping statutes is to prevent facilities from using a hospitalization as a way of dumping a patient when there has been no change in circumstances from before the hospitalization. Your facility is free to initiate a transfer to another facility due to the patient's behaviors, but if the behaviors aren't new then having the hospital hold onto the patient while that process occurs isn't justified.