NEW JERSEY VETERANS MEMORIAL HOMES
POLICY STATEMENT.
The Division of Veterans Healthcare Services (DVHS) requires that each of the New Jersey Veterans Memorial Homes (VMH) handle all discharges in accordance with the regulatory codes set forth by the New Jersey Department of Health and Senior Services, the U.S. Department of Veterans Affairs, and the New Jersey Department of Military and Veterans Affairs, at the same time enforcing the Resident’s Bill of Rights.
PURPOSE.
To facilitate a resident’s discharge from a New Jersey Veterans Memorial Home in a manner that assures that the rights of the individual to be discharged are protected, in accordance with licensing standards.
DEFININTION.
DISCHARGE - the permanent removal from a New Jersey Veterans Memorial Home, which will absolve the resident or representative payor from further financial obligation, and will permit the facility to admit another resident. Involves placements made outside of the Department.
INTERDISCIPLIANRY TEAM (IDT) - a group of staff members, both professional and ancillary, representative of each service, coordinated by a Registered Nurse (RN), and responsible for the development of individual resident care and treatment plans, in accordance with the New Jersey Department of Health and Senior Services’ licensing standards. For the purpose of this procedure,
the Interdisciplinary Team assumes the responsibility for discharge planning.
CAUSE OF DISCHARGE - shall apply to the following:
1. In an emergency, with notification of the resident’s physician or advanced practice nurse and next of kin/guardian, designated representative; or
2. For medical reasons or to protect the resident’s welfare or the welfare of others; or
3. To comply with clearly expressed and documented resident choice, or in conformance with the New Jersey Advance Directives for Health Care Act, as specified in N.J.A.C. 8:39.6(d); or
4. For nonpayment of fees, in situations not prohibited by law; or
5. Being restored to a state of being able to promote self-care and support within the community; or
6. Abusive/disruptive behavior(s), refusal to abide by the rules, regulations, and/or policies and procedures guiding the conduct and behavior of residents as a condition of stay; or
7. Fraud or willful misrepresentation; or
8. Expiration
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PROCEDURE.
A. New Jersey Veterans Memorial Homes
1. The New Jersey Veterans Memorial Homes will ensure that licensing and regulatory standards guiding the resident discharge process will be followed and enforced. Discharges will be handled in accordance with the Resident’s Bill of Rights
a. Medical and/or Psychological Discharge:
(1) When a resident’s condition changes in a way that the facility is no longer able to meet the resident’s medical and/or psychological needs, as determined through the medical examination and Interdisciplinary Team assessment(s), the discharge procedure may be implemented.
(2) The Interdisciplinary Team will review the appropriateness of the discharge, per New Jersey Department of Health and Senior Services’ standards.
a) Upon recommendation for discharge, the Interdisciplinary Team will formulate plans for the resident and recommend alternate placements.
b) The assigned Social Services Case Manager will assist the resident and/or designated representative in implementing the discharge plan.
c) The Resident Accounts/Business Office is responsible for the reconciliation and closeout of the resident’s account with the facility.
b. Voluntary Discharge:
(1) The voluntary request for discharge must be made through the assigned Social Services Case Manager.
(2) The Interdisciplinary Team will meet and formulate a discharge plan.
(3) The Social Services Case Manager will assist the resident and/or designated representative in implementing the discharge plan.
(4) The Resident Accounts/Business Office will be responsible for the reconciliation and closeout of the resident’s account with the facility.
(5) Following release of the bed, a resident may apply for readmission to any of the Veterans Memorial Homes after a period of six (6) months has elapsed and must follow the normal admissions process.
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(6) Residents can discharge themselves from the facility upon presentation of a written release. If the resident is adjudicated mentally incompetent, then upon the written consent of a guardian/designated representative, the resident may be discharged.
c. Involuntary Discharge:
(1) The New Jersey Department of Health and Senior Services’ evaluation will serve as a guideline for the Interdisciplinary Team in dealing with behaviorally difficult residents.
a) Resident may be transferred/discharged on the basis of the Interdisciplinary Team’s evaluation. All steps to implement transfer/discharge will comply with the NJ Department of Health and Senior Services’ standards, the NJ State Office of the Ombudsman for the Institutionalized Elderly guidelines, and VMH procedures.
b) Social Services staff will act as a liaison and provider of information to facilitate the transfer/discharge. The attending physician/designee will be responsible for implementing the transfer/discharge.
(2) Criteria for Involuntary Discharge is as follows to protect the resident’s welfare and the welfare of others:
a) Substance abuse
b) Alcohol abuse
c) Suicidal tendencies
d) Elopement
e) Physical abuse of staff/peers
f) Intentional or accidental setting of fire
g) Self-abuse
h) Facility unable to meet the medical, psychiatric, psychosocial and safety needs of the resident.
(3) Identifying the Problems:
a) A Department Head will refer the above problems to Social Services
b) Documentation must include the following;
i. The problem
ii. Intervention attempts
iii. Results produced by intervention
iv. Other relevant information
v. Situation preceding and following the behavior
vi. Supporting explanation for discharge
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c) Social Services will review problems with the resident/designated representative.
d) When no change occurs, the Social Worker will request a meeting of the Interdisciplinary Team.
(4) Intervention Process:
a) The Social Services Case Manager will assess the problem and present the concerns for Interdisciplinary Team review and/or intervention.
b) The Interdisciplinary Team will develop the intervention process that will be implemented.
(5) Discharge Recommendation:
a) If intervention does not change the targeted behavior, the Interdisciplinary Team will request the resident’s discharge from the facility.
b) Upon recommendation for discharge, the Interdisciplinary Team will formulate a discharge plan.
c) The Social Services Case Manager will forward, in writing, the VMH’s decision to discharge the resident to the resident/designated representative.
i. The Social Services Case Manager will assist the resident/designated representative in implementing the discharge plan.
ii. The Business Office will be responsible for the reconciliation and closeout of the resident’s account with the facility.
d. Appeals Process:
(1) The appeals process is used as an internal control mechanism to allow the resident/ designated representative the opportunity to exercise rights as a resident of the NJ Veterans Memorial Home.
a) The appeals process will be used when a resident does not want to be discharged.
(2) The Interdisciplinary Team will hear the resident’s appeal against discharge.
a) After the Interdisciplinary Team determines the appropriateness of the request, the Chairperson will present the fact-finding information to the Chief Executive Officer.
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b) The Chief Executive Officer will approve or deny the Discharge
c) The Social Services Case Manager will have ten (10) business days to inform the resident/designated representative of the decision.
(3) If the appeal is denied the resident and/or designated representative may appeal, in writing, to the Division Director within ten (10) days of the decision of the Chief Executive Officer.
a) All pertinent information will be sent to the Division Director within ten (10) days of the notification of appeal.
b) The Division Director will respond to the resident and/or designated representative within thirty (30) days of receipt of the appeal.
c) The Division Director’s decision will be final.
Revised: July 2007