Share the Care Hospice, Inc.

“It is required that hospice care and services provided to patients and families follow the individualized plan of care established by the hospice IDG in collaboration with the attending physician (if any), the patient or patient representative if any of them so desire, and 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 3 of 14 (21%) clinical records reviewed, the agency did not ensure hospice care and services followed the individualized plan of care. Clinical Record 5: The patient elected the hospice benefit on 08/07/2024. The plan of care for the certification period dated 02/03/2025 to 04/03/2025 included an order for nursing services as follows: “Registered Nurse (RN) 1 visit every two weeks with one as-needed visit.” Clinical record review revealed the RN documented a nursing visit note dated 02/02/2025 and the next nursing visit note was dated 03/02/2025, a total of four weeks between nursing visits. The RN did not provide nursing visits every two weeks as ordered in the plan of care. Clinical Record 10: The patient elected the hospice benefit on 12/05/2023. The plan of care for the certification period dated 06/02/2024 to 07/31/2024 included an order for nursing services as follows: “Registered Nurse (RN) 1 visit every 14 days.” Clinical record review revealed the RN documented a nursing visit note dated 06/29/2024 and the next nursing visit note was dated 07/20/2024, a total of 21 days between nursing visits. The RN did not provide nursing visits every 14 days as ordered in the plan of care. Clinical Record 11: The patient elected the hospice benefit on 09/03/2024. The plan of care for the certification period dated 12/02/2024 to 03/01/2025 included an order for nursing services as follows: “Registered Nurse (RN) 1 visit every two weeks with one as-needed visit.” Clinical record review revealed the RN documented a nursing visit note dated 12/19/2024 and the next nursing visit note was dated 01/16/2025, a total of four weeks between nursing visits. The RN did not provide nursing visits every two weeks as ordered in the plan of care. During an interview and review of records on 04/03/2025, the Administrator stated “[Clinical Record 5] received RN visits once every two weeks when the patient had hospice aide services at the beginning of care. The patient stopped the aide visits, so the nursing frequency was changed to monthly. The order was not updated, and the RN should have visited as ordered in the plan of care for [Clinical Records 10 and 11].”

“It is required that counseling services include an organized program for providing bereavement services delivered by or under the supervision of a qualified professional with experience or education in grief or loss counseling. Bereavement services are available to the family and other individuals up to one (1) year following the death of the patient. Bereavement counseling extends to residents of a SNF/NF (skilled nursing facility/nursing facility) or ICF/IID (intermediate care facility/Individuals with Intellectual Disabilities) when appropriate and identified in the bereavement plan of care. 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 1 of 1 (100%) clinical record reviewed with patient death, the agency did not ensure a post bereavement risk assessment was completed and a bereavement plan of care was developed. Agency policy No. 1.021 Bereavement Assessment, dated November 2023, required 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.” Clinical Record 7: The patient elected the hospice benefit on 02/22/2023. The patient’s death occurred on 06/09/2024. The initial bereavement assessment dated 02/25/2023 included documentation that the patient’s nephew was identified as the bereaved with a low bereavement risk at the time of the assessment. Clinical record review revealed no documented evidence that the Interdisciplinary Team completed a post-death bereavement risk assessment, and there was no documented evidence of a bereavement plan of care developed by the Bereavement Coordinator per the agency’s policy. The clinical record did not include communication or follow-up with the bereaved after the patient’s death. During an interview on 04/02/2025, the Administrator stated, “The nephew declined any bereavement services, but the Bereavement Coordinator should have added documentation in the medical record.””

“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. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 3 of 7 (43%) clinical records reviewed with hospice aide services provided, the agency did not ensure the Registered Nurse documented an aide supervisory visit no less frequently than every 14 days. Clinical Record 10: The patient elected the hospice benefit on 12/05/2023. The plan of care for the certification period dated 06/02/2024 to 07/31/2024 included an order for Hospice Aide services with an ordered frequency of two visits each week. The RN documented an aide supervisory visit on 06/29/2024 and the next aide supervisory visit was dated 07/20/2024, a total of 21 days and 7 days outstanding. Clinical Record 11: The patient elected the hospice benefit on 09/03/2024. The plan of care for the certification period dated 12/02/2024 to 03/01/2025 included an order for Hospice Aide services with an ordered frequency of two visits each week. The RN documented an aide supervisory visit on 12/19/2024 and the next aide supervisory visit was dated 01/16/2025, a total of 18 days and 4 days outstanding. The RN also documented an aide supervisory visit on 02/13/2025 and the next aide supervisory visit was dated 02/28/2025, a total of 15 days and 1 day outstanding. Clinical Record 14: The patient elected the hospice benefit on 03/05/2024. The plan of care dated 03/05/2024 included an order for Hospice Aide services with an ordered frequency of two visits each week. The RN documented an aide supervisory visit on 03/19/2024. Clinical record review revealed HA services continued through 04/16/2024, but the clinical record contained no documented evidence of aide supervisory visits after 03/19/2024, as of the date of record review on 04/02/2025. During an interview and record review on 04/02/2025, the Administrator stated, “The RN missed the aide supervision visits.””

“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 4 of 4 (100%) clinical records reviewed with patient transfer to a facility, the agency did not ensure the discharge summary was forwarded to the receiving facility. Clinical Record 8: The patient elected the hospice benefit on 02/06/2025. The patient was discharged and transferred to the hospital on 02/17/2025. The Registered Nurse documented a discharge summary of the patient’s hospice care in the record. However, there was no documentation in the record that a copy of the discharge summary was sent to the receiving facility. Clinical Record 10: The patient elected the hospice benefit on 12/05/2023. The patient was discharged and transferred to the hospital on 07/26/2024. The Registered Nurse documented a discharge summary of the patient’s hospice care in the clinical record. However, there was no documentation in the record that a copy of the discharge summary was sent to the receiving facility. Clinical Record 13: The patient elected the hospice benefit on 06/06/2023. The patient was discharged and transferred to the hospital on 04/21/2024. The Registered Nurse documented a discharge summary of the patient’s hospice care in the clinical record. However, there was no documentation in the record that a copy of the discharge summary was sent to the receiving facility. Clinical Record 14: The patient elected the hospice benefit on 03/05/2024. The patient was discharged and transferred to the hospital on 04/17/2024. The Registered Nurse documented a discharge summary of the patient’s hospice care in the clinical record. However, there was no documentation in the record that a copy of the discharge summary was sent to the receiving facility. During an interview on 04/02/2025, the Administrator stated, “We haven’t sent the discharge summary to the hospital when a patient was transferred.””