Always Present Hospice

“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. 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 and interview. In 3 of 19 (16%) clinical records reviewed, the agency did not ensure that the drug profiles included the patients’ current prescriptions. CLINICAL RECORD 8: The patient elected hospice on 12/09/2025 with a diagnosis of unspecified combined systolic (congestive) and diastolic (congestive) heart failure. The initial plan of care and physician orders dated 12/09/2025 documented the patient had oxygen 2 liters per nasal cannula as needed. The medication profile, reviewed on 01/13/2026, did not include oxygen. CLINICAL RECORD 13: The patient elected hospice on 12/11/2025 with a diagnosis of chronic obstructive pulmonary disease. The initial comprehensive nursing assessment, dated 12/11/2025, documented the patient was oxygen-dependent. The initial plan of care/physician order dated 12/11/2025 documented the patient had an oxygen concentrator. The medication profile, reviewed on 01/14/2025, did not include oxygen. CLINICAL RECORD 14: The patient elected hospice on 09/22/2025 with a diagnosis of chronic obstructive pulmonary disease. The initial comprehensive nursing assessment, dated 09/22/2025, documented the patient was using oxygen at 2 liters/minute and had become oxygen-dependent. The initial plan of care/physician order dated 12/11/2025 documented the patient had an oxygen concentrator. The medication profile, reviewed on 01/14/2025, did not include oxygen. During an interview on 01/14/2026, the Director of Nursing reviewed the records and verified the medication profiles did not include oxygen. She stated the “Nurses have been educated on how to enter the medications on the medication profiles when entering the physician’s order. This must have been overlooked during documentation review.””

“It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the drugs and treatments necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed, the agency did not ensure the patient’s individualized written plan of care included all services necessary for the palliation and management of the terminal illness including treatments necessary to meet the needs of the patient. CLINICAL RECORD 14: The patient elected hospice on 09/22/2025 with a diagnosis of chronic obstructive pulmonary disease. The registered nurse (RN) comprehensive assessment, dated 11/3/2025, stated the patient was using continuous positive air pressure (CPAP) at night. The initial plan of care, dated 10/6/2025, did not include respiratory goals and interventions related to the use of CPAP, frequency, and/or instruction to the patient/caregiver. During an interview on 01/14/2026, the Clinical Director reviewed the patient’s plan of care and verified there were no interventions or goals for the use of CPAP. She stated she “reviews documentation regularly and has been working with the nurses to improve the documentation in the plan of care and this was an oversight.””

“It is required that each patient’s individualized written plan of care includes medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed, the agency did not ensure that the written plan of care (POC) durable medical equipment (DME)/supplies included oxygen equipment and supplies. CLINICAL RECORD 8: The patient elected hospice on 12/09/2025 with a diagnosis of unspecified combined systolic (congestive) and diastolic (congestive) heart failure. The initial nursing assessment and physician orders dated 12/09/2025, documented oxygen 2 liters/minute per nasal cannula. The initial POC, dated 12/09/2025, DME list did not include oxygen equipment/supplies. During an interview on 01/13/2026, the Director of Nursing and Administrator reviewed the clinical record and verified the POC did not include oxygen/supplies in the DME/Supply list. She stated, “This is usually added at the time the order is written and was inadvertently not added.””

“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 clinical record review and interview. In 2 of 17 (12%) records reviewed of patients accepting hospice aide services, the agency did not ensure the hospice aide care plan included specific patient care instructions. CLINICAL RECORD 1: The patient elected hospice on 08/13/2025 with a diagnosis of multiple sclerosis. The registered nurse (RN) initial comprehensive assessment dated 08/13/2025, and subsequent RN comprehensive assessments dated 12/17/2025, 12/31/2025, 01/07/2026, documented a stage 4 pressure ulcer on the sacro-coccyx with a dressing. The hospice aide care plan dated 08/14/2025 did not include instructions for what to do with the dressing during bathing or if the dressing was dislodged. CLINICAL RECORD 9: The patient elected hospice on 10/07/2025 with a diagnosis of cerebral infarction. The initial RN comprehensive assessment documented a patient with dysphagia and at risk for aspiration secondary to stroke. The hospice aide care plan dated 01/12/2026 did not include aspiration precautions. During an interview on 01/13/2026 the Director of Nursing (DON) and Administrator reviewed the findings and confirmed that specific instructions were not included in the hospice aide care plans. The DON stated that she “reviews documentation when it is submitted but must have missed that the instructions were not entered” and that she has been “working with the nurses to improve documentation.””

“It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff, including physicians’ orders. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed, the agency did not ensure a physician order was written for all past and current identified patient needs. CLINICAL RECORD 13: The patient elected hospice on 12/11/2025 with a diagnosis of chronic obstructive pulmonary disease. The initial comprehensive nursing assessment, dated 12/11/2025, documented the patient was oxygen-dependent. The initial plan of care/physician order dated 12/11/2025 documented the patient had an oxygen concentrator. The clinical record did not contain evidence of a physician order for oxygen use, liter flow, frequency, and method of delivery. During an interview on 01/14/2026, the Director of Nursing reviewed the clinical records and was not able to provide evidence that a physician’s order was present in the record for oxygen. She stated, “The physician order is usually entered when the equipment is requested and must have been overlooked.””