Athena Home Health & Hospice

“Based on review of the clinical record, agency documentation and staff interview, for one of one patient (Patient #15) who revoked their hospice benefit, the hospice nurse failed to provide the patient with accurate information concerning the patients rights to the Medicare Hospice Benefit. The findings include: Patient #15 elected the Hospice benefit on 12/27/23. Patient #15s diagnoses included Alzheimers disease, neurocognitive disorder with Lewy bodies, type II diabetes mellitus and chronic kidney disease. The physicians orders for the certification period from 10/22/24 to 12/20/24 included nursing services three times a week for assessments, wound care to the right medial calf ulcer and symptom management, hospice aide services, social work services, chaplain services and accepted volunteer services. The patient resided in an Assisted Living Facility/ALF. On 11/03/24 at 3:20 PM, RN #3 documented receiving a call from the ALF nurse that the patient fell, was experiencing pain in his/her leg and was going to the Emergency Department/ED and subsequently admitted with a fractured femur. A subsequent note dated 11/04/24 at 3:55 PM by the Supervisor of Clinical Services/SCS identified receiving a call from the spouse that surgery was planned, the family decided to revoke hospice services so that the patient could have surgery for the fractured femur and educated the spouse that the patient is eligible to re-elect hospice care. Interview and review of the nursing documentation with the Administrator on 11/14/24 at 10:45 AM failed to identify nursing explanation to the patient of the hospice benefit, including the right to seek treatment under the traditional Medicare benefit, for conditions unrelated to the terminal diagnosis (reference: the Center for Medicare & Medicaid Services, Medicare Hospice benefits booklet, p. 9: “Care for a condition other than your terminal illness. You should continue to use Original Medicare to get care for any health needs that aren’t related to your terminal illness. You may be able to get this care from the hospice team doctor or your own doctor. The hospice team determines whether any medical care you need is or isn’t related to your terminal illness, so it won’t affect your care under the hospice benefit.”). On 11/08/24, the SCS documented receiving a call from the spouse that the patient was on General Inpatient level/GIP level of care with another Hospice Agency at the hospital. Review of agency policy for Revocation of the Medicare Hospice Benefit directed in part that the reasons a patient may choose to revoke the Medicare Hospice Benefit when s/he elects active treatment, inconsistent with the role of palliative hospice care, moves beyond the geographical service area and chooses to withdraw from the program with or without cause.”

“L 644 Based on clinical record reviews, review of agency documentation and interview with agency personnel, for eight of nineteen patients (Patients #1, 4, 5, 7, 11, 13, 15 &16) in the survey sample, the agency failed to ensure the availability of volunteer services to the patient and family. The findings include: Patient # 5 elected the Hospice benefit on 7/17/23. Patient #5s diagnoses included chronic right heart failure, chronic obstructive pulmonary disease, and dementia. The physicians orders for the certification period from 9/10/24 through 11/8/24 included nursing services two times a week for nine weeks, hospice aide services, social work services, chaplain services, and accepted volunteer services. The patient resident in an Assisted Living Facility. Patient #11 elected the Hospice benefit on 6/26/24. Patient #11s diagnoses included senile degeneration of brain and unspecified dementia. The physicians orders for the certification period from 8/25/24 through 10/23/24 included nursing services two times a week for nine weeks, hospice aide services, social work services, chaplain services, and accepted volunteer services. The patient resided in a skilled nursing facility. Patient #13 elected the Hospice benefit on 10/5/23. Patient #13s diagnoses included senile degeneration of brain, unspecified dementia, and cognitive communication deficits. The physicians orders for the certification period from 9/29/24 through 11/27/24 included nursing services two times a week for nine weeks, hospice aide services, social work services, chaplain services, and accepted volunteer services. The patient resident in a skilled nursing facility. Interview and review with the Volunteer Coordinator on 11/14/24 at 12:30 PM failed to identify the provision of volunteer services in accordance with the physician ’ s orders and in response to the patient ’ s needs. The Volunteer Coordinator indicated volunteer services were requested by Patients #5, #11 and #13, but failed to identify volunteer services had been provided to the patient due to volunteer staff not being available in the patients service area. Patient #1 elected the Hospice benefit on 8/26/24. Patient #1s diagnoses included chronic obstructive pulmonary disease, acute respiratory failure with hypoxia and congestive heart failure. The physicians orders for the certification period from 10/25/24 to 12/23/24 included nursing services two times a week for assessments and symptom management, hospice aide services, social work services, chaplain services and accepted volunteer services. The patient resided in a Skilled Nursing Facility/SNF. Patient #4 elected the Hospice benefit on 11/09/23. Patient #4s diagnoses included senile degeneration of the brain, dementia and dysphagia. The physicians orders for the certification period from 9/04/24 to 11/02/24 included nursing services two times a week for assessments and symptom management, hospice aide services, social work services, chaplain services and accepted volunteer services. The patient resided in a SNF. Patient #7 elected the Hospice benefit on 9/23/22. Patient #7s diagnoses included Alzheimers disease and dementia. The physicians orders for the certification period from 9/12/24 to 10/31/24 included nursing services two times a week for thirteen weeks for assessments and symptom management, social work services, chaplain services and accepted volunteer services. The patient resided in an Assisted Living Facility/ALF. Patient #15 elected the Hospice benefit on 12/27/23. Patient #15s diagnoses included Alzheimers disease, neurocognitive disorder with Lewy bodies, type II diabetes mellitus and chronic kidney disease. The physicians orders for the certification period from 10/22/24 to 12/20/24 included nursing services three times a week for assessments, wound care to the right medial calf ulcer and symptom management, hospice aide services, social work services, chaplain services and accepted volunteer services. The patient resided in an ALF. Patient #16 elected the Hospice benefit on 4/25/24. Patient #16s diagnoses included chronic obstructive pulmonary disease, chronic respiratory failure, senile degeneration of the brain and heart failure. The physicians orders dated 4/25/24 included nursing services two times a week for assessments and symptom management, hospice aide services, social work services, chaplain services and accepted volunteer services. The patient resided in a SNF. Interview and review of Patients #1, 4, 5, 7, 11, 13, 15 &16 clinical records with the Volunteer Coordinator on 11/14/24 at 12:30 PM failed to identify the provision of volunteer services in accordance with the physician ’ s orders and in response to the patient ’ s needs. The Volunteer Coordinator indicated volunteer services were requested by Patients #1, 4, 5, 7, 11, 13, 15 & 16 but failed to identify volunteer services had been provided to the patient due to volunteer staff not being available in the patients service areas.”

“Based on review of the clinical records, review of agency policies and interview with hospice personnel, for five of nineteen patients (Patients #3, 5, 7, 8 & 15) in the survey sample, the hospice agency failed to develop and implement policies for the safe management of controlled substances within the patient home and the agency nurses failed to follow policies and procedures for the management and disposal of controlled drugs to prevent misuse or discrepancies. The findings include: Patient # 5 elected the Hospice benefit on 7/17/23. Patient #5s diagnoses included chronic right heart failure, chronic obstructive pulmonary disease, and dementia. The physicians orders for the certification period from 9/10/24 through 11/8/24 included nursing services two times a week for nine weeks for assessment and skilled observation, hospice aide services, social work services, chaplain services, and accepted volunteer services. The patient resided in an Assisted Living Facility (ALF). Physician orders included Morphine 20 milligrams/milliliter concentrate, give 0.25 milliliters orally every three hours as needed for pain or shortness of breath and Lorazepam 0.5 milligrams tablets, give one tablet orally every six hours as needed for anxiety or agitation. Interview and review of the clinical record from 9/10/24 through 11/8/24 with the Administrator on 11/14/24 failed to identify a Controlled Substance count every visit for the Morphine concentrate and Lorazepam tablets in accordance with agency expectations. Patient #8 elected the Hospice benefit on 6/19/24. Patient #8s diagnoses included senile degeneration of brain and unspecified dementia. The physicians orders for the certification period from 10/17/24 to 12/15/24 included nursing services two times a week for nine weeks, hospice aide services, social work services, chaplain services. The patient resided at home. Physician orders included Lorazepam 0.5 milligrams tablets, give one tablet orally every six hours as needed for anxiety or agitation and Morphine 20 milligrams/milliliter concentrate, give 0.25 milliliters orally every three hours as needed for pain or shortness of breath. Interview and review of the clinical record from 10/17/24 to 12/15/24 with the Administrator on 11:14 AM identified the Controlled Substance count for the Lorazepam tablets and Morphine concentrate were not completed by nursing every visit in accordance with agency expectations. Patient #7 elected the Hospice benefit on 9/23/22. Patient #7s diagnoses included Alzheimers disease and dementia. The physicians orders for the certification period from 9/12/24 to 10/31/24 included nursing services two times a week for thirteen weeks for assessments and symptom management, social work services, chaplain services and accepted volunteer services. The patient resided in an Assisted Living Facility/ALF. On 10/30/24 at 6 AM, Registered Nurse/RN #1 documented receiving a call from the ALF Manager for a change in the patients condition, RN #1 conducted an as needed visit and indicated the patient was having labored breathing, increased secretions and was actively dying. The physician was notified and a change in level of care to Continuous Care was documented for symptom management. On 10/31/24 at 6:50 AM, RN #2 indicated that the patient passed peacefully. Interview and review of the clinical record with the Administrator on 11/14/24 at 10 AM identified the completion of a Narcotic Waste and Destruction log completed by RN #2, identified that the Morphine and Ativan solutions were flushed down the toilet and failed to follow agency policies on the proper disposal of controlled substances. Review of agency policy on Home Use and Disposal of Controlled Substances directed to provide a copy of the written policies and procedures on the disposal of controlled substances and to follow the Environmental Protection Agency/EPA guidelines. Patient #15 elected the Hospice benefit on 12/27/23. Patient #15s diagnoses included Alzheimers disease, neurocognitive disorder with Lewy bodies, type II diabetes mellitus and chronic kidney disease. The physicians orders for the certification period from 10/22/24 to 12/20/24 included nursing services three times a week for assessments, wound care to the right medial calf ulcer and symptom management, hospice aide services, social work services, chaplain services and accepted volunteer services. The patient resided in an Assisted Living Facility/ALF. Physicians orders included Morphine Sulfate oral solution 20 mg/ml (milligrams/milliliter), give 0.25 ml sublingually every three hours as needed for pain or shortness of breath and Lorazepam 0.5 mg by mouth every six hours as needed for anxiety. Interview and review of the clinical record from 10/22/24 to 11/01/24 with the Administrator on 11/14/24 at 10:15 AM failed to identify a Controlled Substance count every visit for the Morphine solution and Lorazepam tablets in accordance with agency expectations.”