MECKLENBURG COUNTY, N.C. — A rehab facility put a 71-year-old man with dementia in a taxi, sent him to a locked and empty home, where he then wandered off and got lost, following a dispute over payment, according to the man’s family.
“They shouldn’t have did me like that. I didn’t know where I was at,” said Alexander Rose. “I was frightened. I could have had a heart attack.”
Voicemails from Rose to his son Tarance show he was disoriented on the day he was discharged.
“I’m at the airport,” he said in one voicemail. “I mean, I’m at the doctor’s office.”
“I’m at the bus station waiting on you,” Rose said in another call.
“I’m in the courtroom. I’m outside the courtroom,” he said in another call.
“I’m over here in Brooklyn with my cousin,” Rose said. “Call me right now.”
The frantic phone calls were made inside the Mecklenburg Health and Rehabilitation Center in Charlotte. After Rose suffered a stroke, his son, Tarance said he was unable to provide the round-the-clock care needed. Rose was admitted to Atrium Health in July and transferred to the private facility for long-term treatment.
Less than a month into his stay at the Mecklenburg rehab center, Tarance says he was told his father’s Medicare wasn’t enough. He needed Medicaid as well. The process would take 45 days but the facility wouldn’t wait for the paperwork to process, said Tarance.
“Whatever I got to do, I’ll do it,” said Tarance. He says the facility told him: “No, no, we just don’t have the time. We’re going to send your dad home. You’ve got to come get him.”
“I’m not in a position to come get him,” said Tarance. “That’s when it led back to saying, ‘If you don’t come get your dad, we’ll put him in a cab and send him to the shelter.’”
But Rose wasn’t sent to a shelter. According to a voicemail, which FOX 46 was unable to independently authenticate, the facility said Rose was “discharging” by taxi and would arrive at Tarance’s home “shortly.”
Rose signed his own discharge papers, was put in a taxi, and sent to his son’s locked and empty home.
“I’m like what?,” said Tarance, who was more than two hours away in South Carolina when he got listened to the voicemail. “I’m not even around.”
A friend found his father.
“If they put him in a cab 10 in the morning, I found him around 2 pm… wandering, lost,” he said. “He was out of breath. He couldn’t even breathe.”
Rose says he didn’t know what he was signing or where he was going.
“Did they tell you where you were going?,” asked FOX 46 investigative reporter Matt Grant. “Did they say, ‘We’re sending you to your son’s house?”
“No,” said Rose.
“Did you know what you were signing?” asked Grant.
“No,” replied Rose.
“They just said, ‘Here sign this and you did it?” asked Grant.
“Yeah,” said Rose.
Facilities that accept Medicare and Medicaid have to follow state and federal rules, which in this case, may have been violated.
In most cases, a 30-day notice must be given when discharging a patient, which Tarance says was not done, and a transfer needs to be arranged in consultation with the patient or guardian to “develop a discharge plan of care to facilitate the safe and orderly transfer of the resident to a location capable of meeting the resident’s individual needs,” according to the Centers for Medicare and Medicaid Services (CMS).
After learning about what happened to Rose from FOX 46, CMS officials forwarded the complaint to the State Survey Agency, which conducts inspections, “to review.”
Off-camera, the administrator of the facility, Cassandra Dority, laughed when Grant told her about the Rose’s complaint. She accused Tarance of being “inaccurate” but would not elaborate.
FOX 46 asked if Rose was in the right frame of mind to sign his own discharge papers especially since Tarance is his guardian and has power of attorney to make medical decisions. Dority says she can’t comment on the specifics of this case due to patient privacy laws but provided the following statement:
“As a trusted healthcare provider, we arrange safe and appropriate discharges according to the guidance of an interdisciplinary team of physicians and other trained clinicians, and federal and state regulations. When a patient is competent and capable of returning to his or her prior home setting, we have a responsibility to honor his or her wishes. To accommodate the patient’s wishes, we help arrange appropriate transport and provide the family with ample notice to plan accordingly.
Although privacy laws prohibit us from commenting about particular patients without their permission, we can say that a family member’s opinion and healthcare provider’s assessment may differ in regards to a patient. We remain committed to our patients and take great pride in the care that we provide.”
The issue of improper patient discharges are a “great concern,” according to a 2017 CMS memo, which listed that as the “most frequent complaint” the agency receives. A common reason for “non-compliant discharges” are “payment concerns” regarding Medicaid.
CMS officials say improper discharges are “unsafe” and “traumatic” to patients.
Tarance says his father, who is also diabetic, was sent home with a plastic bag without any of his needed medication.
“Smells like urine,” he said, pulling a pair of pants out of the bag.
After rescuing his father, Tarance says he was hit with a bill for more than $1700.
“I’m doing everything the system says do,” he said. “Now, we get him in the system and the system say we don’t want him. Kick him out. And if you don’t come get him, we shipping him anyway.”
Tarance says he has now placed his father in a nursing home, that is working with the family on obtaining Medicaid payments.
When we receive complaints regarding quality of care issues, we refer such complaints to the State Survey Agency to investigate to determine if federal requirements regarding patient quality of care, safety and rights are being adhere to. It’s important to keep in mind that the outcomes of an investigation are needed before any conclusions can be drawn regarding the discharge and transfer of a resident.
Federal requirements specified at 42 CFR 483.15 state, for facility initiated discharges, the facility must provide notice of discharge to the resident and resident representative along with a copy to the Office of the State Long Term Care Ombudsman at least 30 days prior to discharge or as soon as possible. Federal requirements also permit the discharge and transfer of a resident when it is necessary for the resident’s welfare and the resident’s needs cannot be met in the facility; or the safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident.
Prior to the discharge and transfer of a resident, the facility is required to develop a discharge plan of care to facilitate the safe and orderly transfer of the resident to a location capable of meeting the resident’s individual needs. This plan of care is developed by the interdisciplinary team in consultation with the attending physician, resident and/or legal guardian.
Click here to read the rules facilities have to follow.
Click here to read the 2017 CMS memo.
If you would like to file a complaint against a nursing home or other care facility you can call 1-800-Medicare or contact the North Carolina Division of Health Service Regulation here: https://info.ncdhhs.gov/dhsr/ciu/filecomplaint.html.
You can search inspection records here: https://info.ncdhhs.gov/dhsr/facilities/search.asp
You can find the rules, regulations and federal protocols and guidance that apply to nursing facilities here: https://info.ncdhhs.gov/dhsr/nhlcs/rules.html.