Affiliated Dialysis of Joliet

“H-HOME PT PLAN OF CARE DEV/UPDATED CFR(s): 494.100(b)(1)(iii) Services include, but are not limited to, the following: (iii) Development and periodic review of the patient’s individualized comprehensive plan of care that specifies the services necessary to address the patient’s needs and meets the measurable and expected outcomes as specified in §494.90 of this part. This Standard is not met as evidenced by: 27125 Based on document review, interview, and observation, it was determined that for 1 of 4 (Pt. #1) patients reviewed for plan of care, the Facility failed to ensure the care plan was individualized to facilitate treatment for at home dialysis. Findings include: 1. The Facility’s policy titled, “Plan of care (1/2024)” was reviewed on 8/1/2024 and required, “The interdisciplinary team must develop and implement a written, individualized comprehensive plan of care that specifies the services necessary to address the patient’s needs.” 2. The clinical record of Pt. #1 was reviewed on 8/1/2024. Pt. #1 was admitted on 4/8/2024 with a diagnosis of end stage renal disease. The care plan dated 5/15/2024 included under the modality goal section, “Is patient candidate for home? Yes; Is patient comfortable with current modality? Yes; Is patient interested in another modality? No, Satisfied with current Modality. The care plan lacked documentation of training complications or reason for requiring treatment to be provided at the clinic instead of Pt #1’s home. 3. Upon entrance to the Facility on 8/1/2024 at 9:00 AM, the Registered Nurse/Director of Clinical Services (E#1) stated that Pt. #1 was in the training room receiving dialysis at the clinic. E#1 stated, “[Pt. #1] started training and the family member backed out [after 1 training session] so I have been doing dialysis treatments 5 times a week here since admission. The physician has been working on [Pt. #1] getting a technician that can do treatment at home. This should be happening soon.” E#1 stated that there have been multiple conversations with the physician about Pt. #1’s eligibility to continue the home program. 4. On 8/1/2024 at approximately 9:15 AM, Pt. #1 was observed in training room #2 receiving a dialysis treatment via a NxStage Home Dialysis Machine. Pt. #1 had a arteriovenous fistula (direct connection between an artery and vein) for dialysis access. 5. Pt. #1 was interviewed on 8/1/2024 at 9: 20 AM. Pt. #1 stated that he was originally dialyzed at an in center facility, but could not tolerate it and home dialysis was suggested. Pt. #1 stated, “My son was supposed to learn, but he just couldn’t handle it and my wife works. I have been coming here everyday for my treatment.” Pt. #1 stated that Pt. #1 was unsure what the plan was for home treatment or if Pt. #1 would continue coming to the clinic. 6. During an interview on 8/1/2024 at 9:30 AM via telephone, the Medical Director (MD#1) stated that Pt. #1 could not tolerate in center dialysis. Pt. #1 was admitted to the hospital multiple times with nausea/vomiting and not eating. MD#1 stated, “[Pt. #1] would get very sick, so I looked at alternatives for treatment. I decided that home dialysis would be the best option. The patient gets less fluids and shorter treatments, just more often. I have been looking for someone [other family or a dialysis technician] who can perform dialysis in the home setting for Pt #1. I felt that if we didn’t provide dialysis in the clinic, [Pt. #1] would die. I know we are not regulated to perform dialysis everyday in the clinic, but we are working on another option. Hopefully this will happen in the next couple of weeks.” 7. During an interview on 8/1/2024 at 12:45 PM via telephone, the Social Worker (E#2) stated that E#2 has not been asked to assist in finding a caregiver for Pt. #1 to perform dialysis in the home. E#2 stated, “I know that the family cannot help, but nobody has ever told me there was a need to find help for [Pt. #1].””