Providence at Home With Compassus Hospice Care, Anchorage

“It is required that the documented comprehensive assessment includes a drug profile that contains the patient’s current prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; [and] other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following: the effectiveness of drug therapy; drug side effects; actual or potential drug interactions; duplicate drug therapy; [and] drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and, as appropriate, preventive measures are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added or changes are made to existing medication. This standard was not met as evidenced by clinical record review, observation, and interview. In 3 of 4 (75%) home visits and clinical records reviewed, the agency did not ensure that the comprehensive assessment included a drug profile listing the patient’s current medications. Home Visit 1/Clinical Record 1: The patient elected the hospice benefit on 02/06/2026 with a diagnosis of amyotrophic lateral sclerosis (ALS). The patient resided in a skilled nursing facility (SNF). During the home visit with the Hospice Aide [Personnel Record 7] on 06/16/2026, the hospice medication profile (printed on 06/15/2026) was compared to the SNF medication profile (printed on 06/16/2026). The following medications were listed on the SNF medication profile and were not listed on the hospice medication profile: “Artificial saliva mouth/throat gel, give 1 unit by mouth as needed (ordered 02/07/2026), loperamide 2 mg, give 1 via G-Tube every 24 hours as needed (ordered 02/08/2026), and lubricating eye drops, 1 drop both eyes as needed (ordered 02/07/2026).” The last comprehensive hospice nursing visit was dated 06/09/2026. Home Visit 2/Clinical Record 2: The patient elected the hospice benefit on 01/17/2026 with a diagnosis of chronic kidney disease. The patient resided in a SNF. During the home visit with the Social Worker [Personnel Record 5] on 06/16/2026, the hospice medication profile (printed on 06/15/2026) was compared to the SNF medication profile (printed on 06/16/2026). The following medications were listed on the SNF medication profile and were not listed on the hospice medication profile: “Milk of Magnesia 400 mg/5ml, give 30 ml as needed if no bowel movement in 3 days (ordered 01/16/2026), Senna 8.6 mg, give 2 tablets daily (ordered 02/26/2026), Tums 500 mg, give 2 tablets as needed (ordered 04/10/2026), and Dulcolax 10 mg, daily as needed (ordered 01/16/2026), Fleet enema, daily as needed if no results from Dulcolax (ordered 01/16/2026), and lidocaine patch, apply daily for 12 hours. (ordered 01/16/2026).” The hospice medication profile contained the following medications not listed on the SNF profile: “Seroquel 25 mg, give 1 tablet at bedtime (ordered 03/23/2026), and polyethylene glycol, 1 packet daily as needed (ordered 01/17/2026).” The last comprehensive hospice nursing visit was dated 06/10/2026. Home Visit 3/Clinical Record 3: The patient elected the hospice benefit on 12/05/2025 with a diagnosis of primary lateral sclerosis. The patient resided in an assisted living facility (ALF). During the home visit with the Registered Nurse (Personnel Record 4) on 06/16/2026, the hospice medication profile (printed on 06/15/2026) was compared with the ALF medication profile (printed on 06/16/2026). The following medications were listed on the ALF medication profile and were not listed on the hospice medication profile: “Clotrimazole !% cream, apply to ears as needed (ordered 02/20/2026), polyethylene glycol, 1 packet daily as needed (ordered 02/20/2026), ventolin 90 mcg, every 6 hours as needed ordered 02/20/2026), Vitamin AD Topical Ointment, daily as needed (ordered 02/20/2026), and Deep Sea Nasal Spray 0.65%, daily as needed (ordered 02/20/2026). The ALF medication profile documented Bisacodyl 10 mg, 1 every 3 days as needed (ordered 02/20/2026), and lorazepam 0.5 mg, one (1) tablet every 6 hours as needed. The hospice medication profile documented Bisacodyl 10 mg, daily as needed (ordered 12/05/2025), and lorazepam 0.5 mg, one (1) tablet every 4 hours as needed (ordered 12/05/2025). The last comprehensive hospice nursing visit was dated 06/09/2026. During an interview and joint clinical record review on 06/18/2026, the Administrator and Director of Clinical Services stated the nurses are expected to reconcile the medications “at least every 2 weeks, but it is preferred that it is completed every visit.””

“It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met, as evidenced by observation, clinical record review, and interview. In 1 of 3 (33%) home visits observed and clinical records reviewed of patients receiving Hospice Aide (HA) services, the agency did not ensure that the Hospice Aide received written patient care instructions to meet the patient’s needs. HOME VISIT 1/CLINICAL RECORD 1: The patient elected the hospice benefit on 02/06/2026 with a diagnosis of amyotrophic lateral sclerosis. The patient resided in a skilled nursing facility (SNF). The plan of care ordered Hospice Aide services twice weekly. The Hospice Aide care plan dated 06/15/2026 assigned the HA the relevant tasks: “Bathing (bed); shampoo (shower cap); hair care; skin care (apply lotion to body after bed bath); foot care; shaving; oral care; nail care-file nails weekly at first visit of week; ear care; dressing (clothing per patient choice); position for comfort; empty trash; change linens if wet or soiled; call light in reach; provide comfort and support; Registered Nurse (RN) communication for any incomplete tasks.” All tasks were to be completed every visit unless otherwise specified. During the home visit with the Hospice Aide (HA) [Personnel Record 7] on 06/16/2026, the Hospice Aide asked the SNF RN if the patient’s feeding tube “had been disconnected so she was able to give the bath.” The RN replied that the patient knew “she (HA) would be there this morning so he had disconnected it already.” The HA care plan did not contain specific instructions for the HA regarding the feeding tube or asking the SNF staff to disconnect it. The HA care plan documented “Aspiration precautions with tube feeding.” As the HA began bathing the patient, the HA stated that the patient was “nonverbal, but he liked watching Disney movies on the television.” The HA reported cleaning “under his arms and inside his hands due to his contractures” Contractures were observed in the patient’s arms and right leg.” The contractures were not addressed on the HA care plan and the task of “file nails” would need specific instructions considering the patient’s severe contractures. The task: dressing in clothes “per patient’s choice” did not specify if the patient should be dressed in clothes and the patient cannot make decisions due to confusion. During a review of the observed HA visit and the care plan on 06/16/2026, the Administrator and the Director of Clinical Services agreed that the feeding tube instructions, the contractures, and a clarification to “assist with dressing” should be added to the aide care plan.”

“It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s community attending physician upon hospice discharge—includes at least the following: a summary of the patient’s hospice stay, including treatments, symptoms, and pain management. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy #HOS-C_04B “Discharge/Transfer/Revocation” (effective 01/01/2023, revised 04/05/2026) stated in part, “4. A complete discharge summary must include the discharge summary from the EMR (electronic medical record), most recent plan of care, most recent medication list, any physician’s orders provided in the 2 weeks prior to discharge, including any for post-discharge planning.” In 1 of 2 (50%) clinical records reviewed of discharged patients, the organization did not ensure the discharge summary provided to the patient’s attending physician included a summary of the patient’s hospice stay including treatments, symptoms, and pain management. CLINICAL RECORD 16: The patient elected the hospice benefit on 03/08/2026 with a diagnosis of alcoholic cirrhosis. The patient elected to revoke the hospice benefit on 05/20/2026. The discharge summary completed on 05/20/2026 noted the following: “Patient reports she would like to revoke hospice services so she can get her dental work/teeth pulled and dentures. She is also interested in seeking full therapy from ..... Dr. (name) aware he is now responsible for cares.” The discharge summary did not include documentation of the summary of the patient’s stay, including treatments, symptoms, and pain management. During an interview and a joint clinical record review on 06/18/2026, the Administrator and Director of Clinical Services agreed the discharge summary written by the nurse did not “include all the pertinent information required.””