Assisted Home Hospice

“Based on interview and record review, the facility failed to ensure the Interdisciplinary Group (IDG) maintained responsibility for directing, coordinating, and supervising the hospice services per policy, for two of 18 sampled patients (Patients 17 and 18), when missed visits by the Hospice Aide (HA) was without documentation to indicate communication, follow-up, or coordination of the missed visits. This failure had the potential to result in delays or interruptions in necessary personal care, unmet activities of daily living needs and lack of continuity of care for the patients. Findings:1. During a review of Patient 17’s “General Patient Details,” dated 8/16/2026, the general patient details indicated Patient 17 was admitted to hospice services with a terminal diagnosis of heart disease. Patient 17’s Plan of Care (POC) indicated a recertification period of 8/16/2026 to 11/13/2026 and identified HA (Hospice Aide) services two times weekly for assistance with personal care.During a review of Patient 17’s “Visit Schedule,” dated 8/16/2026 to 9/12/2026 indicated a missed HA visit for the weeks of 8/16/2026 and the week of 8/30/2026. Further review of the visit schedule indicated no communication notes, missed visit notes or other documentation that the missed HA visit was communicated to the Registered Nurse or other members of the IDG. There was no documentation to indicate whether arrangements were made to provide the missed visits.During a concurrent interview and record review on 9/10/2026 at 1:50 p.m. with the Registered Nurse (RN 2), Patient 17’s “Visit Schedule,” dated 8/16/2026 to 9/12/2026 was reviewed. RN 2 confirmed the missed HA visits did not have communication notes. RN 2 stated it was not done. 2. During a review of Patient 18’s “General Patient Details,” dated 3/17/2025, the general patient details indicated Patient 18 was admitted to hospice services with a terminal diagnosis of Multiple Sclerosis (a disease that affects the central nervous system including the brain and spinal cord). Patient 18’s Plan of Care (POC) indicated a recertification period of 7/10/2026 to 9/7/2026 and identified HA (Hospice Aide) services two times weekly for assistance with personal care.During a review of Patient 18’s “Visit Schedule,” dated 8/23/2026 to 9/7/2026 indicated a missed HA visit for the weeks of 8/23/2026 and the week of 8/30/2026. Further review of the visit schedule indicated no communication notes, missed visit notes or other documentation that the missed visit was communicated to the Registered Nurse or other members of the IDG. There was no documentation to indicate whether arrangements were made to provide the missed visits.During a concurrent interview and record review on 9/10/2026 at 10:50 a.m. with the Registered Nurse-Clinical Supervisor (RNCS), Patient 18’s “Visit Schedule,” dated 8/23/2026 to 9/7/2026 was reviewed. RNCS confirmed the missed HA visits did not have communication notes. RNCS stated there should have been communication notes done for the missed visits.During a review of the facility’s policy and procedure (P&P) titled, “Hospice Interdisciplinary Plan of Care,” revised April 2022, the P&P indicated, “Visit frequency is established/authorized by the IDG. In the event of a visit refusal or cancellation request by patient, family or facility staff will be documented as a missed visit in the EMR [Electronic Medical Record] under clinical charting or if appropriate a change in frequency will be documented.””

“Based on interview and record review, the facility failed to ensure a physician’s discharge order was written for one of 18 sampled patients (Patient 6), when Patient 6 revoked her hospice benefits (a patient’s choice to no longer receive Medicare covered hospice benefits). This failure resulted in an incomplete discharge process, and the potential to affect continuity of care. Findings:During a review of Patient 6’s “Revocation of the Medicare Hospice Benefit Form,” dated 3/27/2026, the form indicated the reason Patient 6 was revoking the hospice benefit was due to, “unresolved pain, nausea & vomiting despite medication and treatment.” The form was not signed by a Physician.During a concurrent interview and record review on 9/10/2026 at 9 a.m. with the Registered Nurse (RN 1), Patient 6’s “General Patient Details,” [undated], was reviewed. The General Patient Details indicated Patient 6 was admitted with a diagnosis that included unspecified cirrhosis of the liver (liver damage). RN 1 stated Patient 6’s start of care was on 10/29/2025, and the most recent recertification was dated, 1/27/2026 through 4/26/2026. RN 1 stated Patient 6 revoked the hospice benefit on 3/27/2026.During a concurrent interview and record review on 9/10/2026 at 1:52 p.m. with the Registered Nurse-Clinical Supervisor (RNCS), Patient 6’s “Physician Orders,” was reviewed. RNCS was unable to locate a physician’s discharge order for Patient 6. RNCS stated the physician was supposed to enter a discharge order when a patient revoked the hospice benefit.During a review of the facility’s policy and procedure (P&P) titled, “Discharge/Transfer from Hospice,” revised August 2023, the P&P indicated, “PURPOSE: To assure continuity of care, adequate communication, uniformity of care and completeness of the discharge/transfer process. Prior to discharging a patient who has not passed away, a written physician’s discharge order will be obtained from the hospice Medical Director or physician designee.””