Advanced Home Health and Hospice, Inc.

“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, 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, 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 measurements 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 and interview. In 1 of 3 (33%) home visit observations, the organization did not ensure a medication review was completed, and the medication profile was updated. Home Visit 3: The patient elected the hospice benefit on 09/16/2024. During the home visit observation with the Hospice Aide (HA) (Personnel Record 9), a medication review was completed by comparing the patient’s home medications to the hospice medication profile. The patient’s home medications included Aripiprazole 2mg po [by mouth] daily started on 09/03/2024 per the facility’s administrator. The hospice medication profile did not include Aripiprazole. During a joint record review and interview on 10/10/2024, the Regional Director/ Registered Nurse/ Bereavement Coordinator/ Volunteer Coordinator confirmed the medication review had not included Aripiprazole, and the medication was not included in the patient’s medication profile.”

“It is required that hospice care and services provided to patients and families follow the individualized plan of care established by, the hospice IDG [interdisciplinary group] in collaboration with the attending physician (if any), the patient or patient representative if any of them so desire, the primary caregiver in accordance with the patient’s needs if any of them so desire. This standard was not met as evidenced by clinical record review and interview. In 1 of 10 (10%) clinical records reviewed with spiritual counseling services provided, the agency did not ensure the spiritual counselor provided services as ordered on the plan of care. Clinical Record 2: The patient elected the hospice benefit on 05/06/2024. The plans of care dated 05/06/2024 to 08/03/2024 and 08/04/2024 to 11/01/2024 included an order for “Chaplain frequency 1/month duration 90/day 3 PRN [as needed] spiritual needs.” The clinical record contained documentation of a missed visit in June that stated, “Scheduled visit rescheduled chaplain’s unavailability.” The missed visit in August stated, “Please assign to Chaplain [name]” and the missed visit in September stated, “No answer to phone call. Rescheduled.” There was no documented evidence in the clinical record that the Chaplain attempted to reschedule the spiritual counseling visits ordered once a month. During a joint clinical record review and an interview on 10/10/2024, the Regional Director/ Registered Nurse/ Bereavement Coordinator/ Volunteer Coordinator confirmed that there was no documented evidence that spiritual counseling services were provided during the times identified.”

“It is required that the hospice documents the cost savings achieved through volunteers. Documentation includes the identification of each position that is occupied by a volunteer, the work time spent by volunteers occupying those positions, and estimates of the dollar costs that the hospice would have incurred if paid employees occupied the positions noted in Item 1 and for the durations noted in Item 2. This standard was not met as evidenced by document review and interview. The hospice did not ensure cost savings achieved through volunteers was documented. Review of the agency’s volunteer program revealed the agency did not document the number of volunteer hours and the cost savings the hospice would have incurred if paid employees occupied the positions from January 2024 through September 2024. During an interview on 10/10/2024, the Regional Director/ Registered Nurse/ Bereavement Coordinator/ Volunteer Coordinator confirmed the agency did not have documentation of volunteer hours from January 2024 through September 2024. Upon reviewing the volunteer program, the documentation lacked evidence of the number of volunteer hours, the volunteer percentage, and the cost savings the hospice would have incurred if paid employees occupied the positions from January 2024 through September 2024. There were no documented volunteer hours for 2024.”

“It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician a copy of the hospice discharge summary and the patient’s record, if requested. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed for patients with live discharge, the agency did not ensure the discharge summary was forwarded to the patient’s attending physician. Clinical Record 11: The patient elected the hospice benefit on 12/12/2023 and was discharged for no longer terminally ill on 06/08/2024. The clinical record contained no documented evidence that the discharge summary was forwarded to the patient’s attending physician. During a joint record review and interview on 10/10/2024, the Regional Director/ Registered Nurse/ Bereavement Coordinator/ Volunteer Coordinator confirmed that the record did not include documentation that the discharge summary was forwarded to the patient’s attending physician.”

“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; the patient’s current plan of care; the patient’s latest physician orders; and any other documentation that will assist in the post-discharge continuity of care or that is requested by the receiving facility or the attending physician. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed for patients with live discharge, the agency did not ensure the discharge summary included required elements. Clinical Record 11: The patient elected the hospice benefit on 12/12/2023 and was discharged for no longer terminally ill on 06/08/2024. The clinical record contained no documented evidence of a completed discharge summary that included a summary of the patient’s hospice stay, including treatments, symptoms, and pain management, the patient’s current plan of care, the patient’s latest physician orders, and any other documentation that will assist in the post-discharge continuity of care or that is requested by the receiving facility or the attending physician. During a joint record review and interview on 10/10/2024, the Regional Director/ Registered Nurse/ Bereavement Coordinator/ Volunteer Coordinator confirmed that the record lacked evidence of a completed discharge summary that included a summary of the patient’s hospice stay, including treatments, symptoms, and pain management; the patient’s current plan of care; the patient’s latest physician orders; and any other documentation that will assist in the post-discharge continuity of care or that is requested by the receiving facility or the attending physician.”