Is this legal?

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.

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

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?

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.

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.

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.