Ask Proactive – Our IDT was actively working on a discharge plan for a resident to be discharged home on Friday, but on the previous Saturday the family came and told the nurses they were taking the resident home that afternoon. We were able to obtain a discharge order from the MD for this and set up some expedited services for care in the home setting prior to the resident’s departure that afternoon. Would this discharge be considered a planned or unplanned discharge?

Q:

Our IDT was actively working on a discharge plan for a resident to be discharged home on Friday, but on the previous Saturday the family came and told the nurses they were taking the resident home that afternoon. We were able to obtain a discharge order from the MD for this and set up some expedited services for care in the home setting prior to the resident’s departure that afternoon. Would this discharge be considered a planned or unplanned discharge?

 

A:

The RAI MDS 3.0 User Manual provides the following examples of unplanned discharges:

• • An acute-care transfer of the resident to a hospital or emergency department in order to either stabilize a condition or determine if an acute-care admission is required based on emergency department evaluation, OR
  • Resident unexpectedly leaving the facility against medical advice, OR
  • Resident unexpectedly decides to go home or to another setting (e.g. due to the resident deciding to complete treatment in an alternate setting.

 

A planned discharge occurs when

• • Both the resident and facility expect the discharge
  • The discharge date is scheduled in advance
  • The resident is leaving for a non-emergent expected reason (e.g. transferring to a lower level of care such home, assisted living or independent living setting, or transfers to another SNF by arrangement.)

 

In your situation the discharge is considered unplanned because the discharge occurred prior to the planned discharge date and the facility was not anticipating the discharge to occur when it did.  Even though the facility was able to obtain discharge orders and set up some in-home services, the timing of the discharge was not expected.  This scenario is consistent with CMS’ definition of an unplanned discharge.

 

Documentation on the day of discharge should include the following:

• • The originally planned discharge date and discharge planning previously in place
  • The family unexpected arrival and decision to take the resident home at that time
  • The IDT’s coordination with the MD to obtain discharge order and establish in home service
  • Any education/training provided to the family and/or resident prior to discharge, including the provision of the reconciled medication list and any discharge instructions
  • The resident’s condition and the time of discharge

 

 

 

Written By:

 

Christine Twombly

Senior Consultant

Proactive LTC Consulting

 

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