Better Choice Hospice Inc.

“It is required that the comprehensive assessment includes an initial bereavement assessment of the needs of the patient’s family and other individuals, focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and considered in the bereavement plan of care. This standard was not met as evidenced by document review, clinical record review, and interview. In 2 of 14 (14%) clinical records reviewed, the agency did not ensure that an initial bereavement assessment was completed as part of the comprehensive assessment. Agency policy Number: C: 13 Bereavement Assessment, effective 08/2020, stated in part, “On admission, the social worker or hospice registered nurse will complete a bereavement risk assessment that is given to the Bereavement Coordinator.” Agency policy Number: C: 14 Bereavement Services, effective 08/2020, stated in part, “A bereavement risk assessment will be completed by the hospice social worker at the time of admission to hospice.” Clinical Record 7: The patient elected the hospice benefit on 07/28/2023. Clinical record review revealed the initial bereavement assessment was completed on 10/27/2023. The clinical record contained no documented evidence that an initial bereavement assessment was completed as part of the comprehensive assessment at admission. Clinical Record 13: The patient elected the hospice benefit on 11/01/2023. Review of the clinical record revealed no documented evidence that an initial bereavement assessment was completed as part of the comprehensive assessment at the start of care. The Director of Patient Care Services confirmed findings in joint record review and interview on 03/27/2024 that the comprehensive assessments for clinical records 7 and 13 did not include an initial bereavement assessment completed as part of the comprehensive assessment.”

“It is required that the bereavement services reflect the needs of the bereaved per a bereavement plan of care that includes the types of bereavement services to be offered and the frequency of service delivery. This standard was not met as evidenced by document review, clinical record review, and interview. In 5 of 10 (50%) bereaved clinical records reviewed, the agency did not ensure documentation of the bereavement plan of care that reflected the types of bereavement services offered and the frequency of delivery. Agency policy Number: C:13 Bereavement Assessment, effective 08/2020, stated in part, “After the death occurs, the hospice social worker or Bereavement Coordinator will complete the bereavement follow-up assessment. The Bereavement Coordinator will develop a plan for intervention based on the findings of the bereavement follow-up assessment. The Bereavement Coordinator or Volunteer will document the family bereavement interventions. Upon completion all bereavement documentation will be filed.” Agency policy Number: C: 14 Bereavement Services, effective 08/2020, stated in part, “After a death has occurred, the bereavement assessment will be updated, and the family/caregiver needs will be discussed at the next interdisciplinary group meeting. Bereavement interventions will be reflective of the family/caregiver’s choices to participate in the bereavement program. A bereavement file will be maintained on each family/caregiver unit of care. Each file will contain the following information: all bereavement assessments made, a bereavement plan of care, and all bereavement clinical notes that have been written and/or letters sent to the bereaved.” Clinical Record 5: Date of death: 08/20/2023. The clinical record included documentation that a bereavement letter was sent on 08/20/2023, but there was no documented evidence that a bereavement plan of care was developed to include the types of bereavement services offered and the frequency of service delivery. Clinical Record 8: Date of death: 04/04/2023. The clinical record contained no documented evidence that a follow-up assessment was completed or that a bereavement plan of care was developed to include the types of bereavement services offered and the frequency of service delivery. Clinical Record 10: Date of death: 06/24/2023. The clinical record included documentation that a bereavement letter was sent on 06/24/2023, but there was no documented evidence that a bereavement plan of care was developed to include the types of bereavement services offered and the frequency of service delivery. Clinical Record 11: Date of death: 03/74/2023. The clinical record included documentation that a bereavement letter was sent on 03/74/2023, but there was no documented evidence that a bereavement plan of care was developed to include the types of bereavement services offered and the frequency of service delivery. Clinical Record 13: Date of death: 12/03/2023. The clinical record contained no documented evidence that a follow-up assessment was completed or that a bereavement plan of care was developed to include the types of bereavement services offered and the frequency of service delivery. In a joint record review and interview on 03/27/2024, the Director of Patient Care Services confirmed the findings that clinical records 5, 8, 10, 11, and 13 did not include a bereavement plan of care that reflected the types of bereavement services that were offered and the frequency of delivery. In an interview on 03/27/2023, the Bereavement Coordinator stated in part “I should have documented a plan of care for those patients I have sent letters to.””

“It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. This standard was not met as evidenced by document review, clinical record review, and interview. In 2 of 8 (25%) clinical records reviewed with hospice aide services provided, the agency did not ensure that a registered nurse made an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and ensure that services ordered by the hospice Interdisciplinary Group (IDG) met the patient’s need. Agency policy Number: P: 30 Hospice Aides Education/Supervision Policy, effective 08/2020, stated in part “HHA [Hospice Aide] services will be offered to all patients who require personal care assistance as determined in the Initial Plan of Care and as updated by the RN [Registered Nurse] case manager and as agreed upon by the IDG. These activities in accordance with the plan of care and physician’s (or other authorized independent practitioner’s) orders will be assigned and supervised by a hospice registered nurse, and documented in the plan of care, no less than every 2 weeks.” Clinical Record 1: The initial plan of care dated 12/09/2023 included an order for hospice aide visits two times a week. Hospice aide visits were provided two times a week beginning on 12/26/2023 through the date of review on 03/28/2024. Clinical record review revealed the RN completed a hospice aide supervisory visit on 02/16/2024. The next aide supervisory visit was completed by the RN on 03/08/2024, a total of 20 days after the 02/16/2024 visit and 6 days outstanding. The clinical record contained no documented evidence that hospice aide supervisory visits were completed no less frequently than every 14 days. Clinical Record 3: The initial plan of care dated 08/08/2023 included an order for hospice aide visits two times a week. Hospice aide visits were provided two times a week beginning on 08/13/2023 through the date of discharge on 08/31/2023. The clinical record lacked evidence that hospice aide supervisory visit was completed no less frequently than every 14 days. During a joint record review and interview on 03/28/2024, the Director of Patient Care Services confirmed that clinical records 1 and 3 did not contain evidence that an aide supervisory visit was performed by the Registered Nurse no less frequently than every 14 days.”

“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 document review, clinical record review, and interview. In 2 of 2 (100%) clinical records reviewed with live discharge, the agency did not ensure the discharge summary included a summary of the patient’s hospice stay, including treatments, symptoms, and pain management. Agency policy Number: C: 33 Discharge Summary, effective 08/2020, stated in part, “All patients discharged from a service and from hospice will have a discharge summary completed and filed in the clinical record. Hospice personnel who provide care will complete a discharge summary at the time the discipline is discontinued, which will include, as appropriate: The status of problems identified at admission and during provision of care, the resolution of identified problems, continuing symptom management needs, a summary of the care or services provided, the patient’s current plan of care, and the patient’s latest physician orders.” Clinical Record 3: Clinical record review revealed the patient revoked hospice care and was discharged from the hospice on 08/31/2023. The discharge summary did not include documentation of a summary of the patient’s hospice stay, including treatments, symptoms, and pain management as required by agency policy. Clinical Record 4: Clinical record review revealed the patient revoked hospice care and was discharged from the hospice on 08/09/2023. The discharge summary did not include documentation of a summary of the patient’s hospice stay, including treatments, symptoms, and pain management as required by agency policy. In a joint record review and interview on 03/28/2024, the Director of Patient Care Services confirmed the discharge summaries for clinical record 3 and clinical record 4 did not include a summary of the patient’s hospice stay, including treatments, symptoms, and pain management.”