Absolute Hospice Agency LLC

“It is required that the written Patient Bill of Rights includes the right to choose his or her attending physician. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed, the agency did not ensure documentation that the patient chose his/her attending physician. Clinical Record 2: The patient elected the hospice benefit on 01/21/2024. The hospice election statement was signed by the patient on 01/21/2024. The “Right to choose an attending physician” section of the hospice election statement included a check mark for “I acknowledged that my choice for an attending physician is” but the “Physician Name, NPI (if known), and Office Address” were left blank. The Owner, Administrator, and Director of Patient Care Services stated in an interview on 10/24/2024 the record did not include documentation of the patient’s choice of attending physician.”

“It is required that each patient’s individualized written plan of care reflects patient, and family goals and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 3 of 14 (21%) clinical records reviewed, the agency did not ensure the individualized plan of care included patient and family goals and interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 3: The patient elected the hospice benefit on 10/18/2024. The initial psychosocial assessment dated 10/19/2024 included documentation that the Medical Social Worker (MSW) would see the patient once per month and 2 as needed visits for psychosocial crises. There was no documented evidence of interventions for the MSW on the plan of care dated 10/19/2024. Clinical Record 5: The patient elected the hospice benefit on 07/10/2024. The nursing assessment dated 10/08/2024 included documentation that “The patient also is non-compliant in taking his/her medications despite the family explaining the importance of medication. Instructed family to mix it with apple sauce or in Ensure.” There was no documented evidence that the plan of care dated 10/17/2024 included patient specific goal(s) and intervention(s) for medication management. Clinical Record 7: The patient elected the hospice benefit on 12/28/2023. The nursing assessment dated 06/25/2024 included documentation that the patient had a stage 4 pressure injury to the left elbow. The physician order for wound care stated, “Cleanse with wound cleanser. Apply collagen dry form, xeroform. Cover with ABD pad and wrap with kerlix roll. Secure with tape. Repeat dressing change every 2 days and as needed for any soiling or loss of dressing integrity. Wound care can be provided by hospice SNs [skilled nurses] and patient caregivers.” There was no documented evidence that the plan of care dated 06/27/2024 included patient specific goal(s) and intervention(s) for the patient’s left elbow wound. The Owner, Administrator, and Director of Patient Care Services stated in an interview on 10/24/2024 the plans of care did not reflect patient and family goals and interventions based on problems identified in the initial and updated comprehensive assessments.”

“It is required that hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. This standard was not met as evidenced by document review and interview. The agency did not ensure hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. Review of the agency’s 2024 Volunteer Saving Report revealed the volunteer percentage of hours worked for January 2024 through September 2024 was 0%. The Administrator/Volunteer Coordinator (VC) stated in an interview on 10/24/2024, all patients have been offered volunteer services but have refused volunteer services up to this point. The VC stated recruitment of more volunteers was in process and he reports at the quarterly QAPI meetings regarding status of volunteer program and cost savings. The VC also stated, on 10/23/2024 one of the patient’s family members has decided the patient would like to have a volunteer once a week for 2 hours and they are in the process of setting up a volunteer. The review of the “Volunteer Savings Report” revealed the agency did not ensure that volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equaled five percent (5%) of the total patient care hours of all paid hospice employees and contract staff.”

“It is required that if the care of a hospice patient is transferred to a Medicare/Medicaid certified facility, the hospice forwards to the receiving facility a copy of the hospice discharge summary described in HCDT 40.I and the patient’s record, if requested. This standard was not met as evidenced by clinical record review and interview. In 2 of 2 (100%) clinical records reviewed for patients that transferred to a Medicare/Medicaid certified facility, the agency did not ensure a copy of the discharge summary was forwarded to the receiving facility. Clinical Record 8: The patient elected the hospice benefit on 01/19/2024. The patient revoked hospice care on 01/29/2024 and was transferred to the hospital. There was no documented evidence in the clinical record that a transfer summary was sent to the receiving facility. Clinical Record 9: The patient elected the hospice benefit on 07/12/2024. The patient was transferred to another hospice agency on 08/23/2024. There was no documented evidence in the clinical record that a transfer summary was sent to the receiving facility. The Owner, Administrator, and Director of Patient Care Services stated in an interview on 10/24/2024 the records did not include documentation that the discharge summaries were sent to the receiving facilities.”

“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 1 (100%) clinical record reviewed for a patient that revoked the hospice benefit, the agency did not ensure a copy of the hospice discharge summary was forwarded to the patient’s attending physician. Clinical Record 8: The patient elected the hospice benefit on 01/19/2024 and revoked hospice care on 01/29/2024 to pursue aggressive treatment. There was no documented evidence in the clinical record that the discharge summary was sent to the patient’s attending physician. The Owner, Administrator, and Director of Patient Care Services stated in an interview on 10/24/2024 the record did not include documentation that the discharge summary was sent to the patient’s attending physician.”