For our next “Ftag of the Week” on the CMSCG Blog, we will be reviewing a regulation from the Laboratory, Radiology, and Other Diagnostic Services regulatory group, F744. This regulation is not lengthy, nor is it frequently cited, but given the logistic and transportation issues that the country is experiencing, a little reminder about providing assistance to residents can be useful. F774 states that a nursing home must assist the resident in making transportation arrangements to and from the source of a service, if the resident needs assistance.
F774 on Survey
During survey, the surveyors will investigate whether residents were offered and assisted in making transportation arrangements for services. The “assistance” portion of this requirement requires that the provider considers the resident’s clinical, physical, mental and financial conditions when determining what help the resident requires. The surveyor will conduct record review and interviews with the resident/ representative/ family members to determine if transportation assistance was required or requested, and if the resident received transportation assistance to and from the source of service. The surveyor will also look to see if a delay in assisting the resident with transportation led to an adverse care outcome. Surveyors are instructed to also refer to Quality of Care or Quality of Life requirements which could result in additional deficiencies.
Surveyors are instructed to also refer to Quality of Care or Quality of Life requirements which could result in additional deficiencies.
What’s interesting to note is that next, we will be reviewing actual survey citations cited under F774 – Assist with Transport Arrangements to Lab Services, but none of them actually reference a missed lab appointment, but instead reflect facility failure to assist with transportation to multiple types of appointments. Let’s take a look as you might be mislead by assuming that you could only be cited with a deficiency related transportation to lab services based on the “title” of the regulation without looking at the content of it.
Standard Survey F744 – S/S: D
A resident’s record was reviewed for transportation assistance to scheduled appointments, and the review showed that the resident failed to show up for multiple podiatry appointments, as well as a consult with an orthopedic surgeon. On interview, the resident’s family member stated she was unable to attend the appointments and mentioned that there had been issues with taking the resident to his doctor’s appointments and had been told there was not enough staff to accompany the resident, and there were multiple other resident appointments on the same day. Per the facility’s policy, a member of the Nursing staff or Social Services staff was expected to accompany the resident when the resident’s family member was unavailable.
Standard Survey F744 S/S: D
A facility was cited for failure to provide a resident with transportation arrangements to and from a cardiac follow-up appointment, resulting in the resident missing the appointment and experiencing a delay in treatment. The resident was a new admission from the hospital, and the facility stated it was not aware the resident needed transportation assistance, despite the information being on the hospital discharge documentation.
Standard Survey F744 S/S: D
A facility was cited for failure to provide transportation to an eye appointment for a resident who was unable to walk and in a wheelchair. The resident’s spouse was interviewed and stated that the facility told him that he would have to transport her, but he cannot lift her. The facility Social Worker was interviewed and told the surveyor that she had contacted the family and the spouse stated the appointment center was too far away. She stated that she informed the spouse that if there was a problem transporting the resident, then she would make other transportation arrangements using a transportation company contracted with the facility. Upon further review, there was no documentation regarding any arrangements made for the resident.
These citations provide some common scenarios where systems can fail, so it’s worth taking a look at how your facility is ensuring all residents with transportation needs – whether it’s to the lab or elsewhere – are assisted in getting to a scheduled appointment. As mentioned earlier, there are multiple accounts of a lack of drivers for different transport companies, including ambulettes, so if your residents will be going out to appointments, ensure they have the help they need to get to and from the facility. Maybe consideration should have been given to citing these concerns related to relating to transportation to an office for a professional consult under a more appropriate regulatory tag.