MDS Alert

Question: If a resident dies while being transported to the hospital, does the death count as being in the facility, even though the resident was physically outside the facility and not under our direct care?

Answer: According to the Resident Assessment Instrument (RAI) Manual, on page 2-10, a death in facility occurs when a resident dies in a facility or while on a leave of absence (LOA). On page 2-13, the RAI Manual defines a LOA as:

• “Temporary home visit of at least one night; or
• “Therapeutic leave of at least one night; or
• “Hospital observation stay less than 24 hours and the hospital does not admit the resident.”

On pages 2-10 and 2-11, the RAI Manual says a resident who has left the facility has not “formally” left the facility, aka been discharged, unless:

• “Resident is discharged from the facility to a private residence (as opposed to going on an LOA);
• “Resident is admitted to a hospital or other care setting (regardless of whether the nursing home discharges or formally closes the record);
• “Resident has a hospital observation stay greater than 24 hours, regardless of whether the hospital admits the resident.
• “Resident is transferred from a Medicare- and/or Medicaid-certified bed to a noncertified bed; or
• “Resident’s Medicare Part A stay ends, but the resident remains in the facility.”

All of this information taken together would point you toward counting death in an ambulance (or however the resident was being conveyed) as a death in facility, even though the resident wasn’t physically in the facility at the time.