Enhabit Hospice

“It is required that the hospice registered nurse completes an initial assessment within 48 hours of the patient’s election of hospice care, in accordance with CMS §418.24 (the elements of the hospice care election statement). This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (11%) clinical records reviewed, the agency did not ensure the hospice registered nurse completed an initial assessment within 48 hours of the patient’s election of hospice care that included the assessment of the patient’s immediate physical status related to the terminal illness and related conditions. CLINICAL RECORD 6: The patient elected the hospice benefit on 08/04/2026 with a terminal diagnosis of liver carcinoma. The patient had a PleurX drain in place at the time of admission; however, the RN initial comprehensive assessment dated 8/04/2026 did not document the presence of the PleurX drain. The Skilled Nurse (SN) visit note dated 08/06/2026, documented that the patient’s abdomen was distended and tender, and a PleurX drain was noted in the right upper quadrant with the dressing clean, dry, and intact. During joint clinical record review and interview on 08/12/2026, the Administrator confirmed the finding.”

“It is required that each patient’s individualized written plan of care: includes all services necessary for the palliation and management of the terminal illness, including the following: drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 2 of 19 (11%) clinical records reviewed, the agency did not ensure that the patient’s plan of care included drugs and treatments to meet the needs of the patient. CLINICAL RECORD 2: The patient elected the hospice benefit on 07/13/2026 with a terminal diagnosis of malignant neoplasm of the colon and diabetes. The RN initial comprehensive assessment dated 07/13/2026 documented that the patient’s blood glucose was being monitored three times daily. The patient was receiving insulin Glargine (U-100)/ml 15 units administered subcutaneously twice a day. The hospice plan of care dated 07/13/2026 through 0812/2026 did not include documented interventions, monitoring parameters, or other instructions addressing the management of the patient’s diabetes, including the identified need for blood glucose monitoring and insulin administration. CLINICAL RECORD 6: The patient elected the hospice benefit on 08/04/2026 with a terminal diagnosis of liver carcinoma. The Skilled Nurse (SN) visit note dated 08/06/2026, documented that the patient’s abdomen was distended and tender, and a PleurX drain was noted in the right upper quadrant with the dressing clean, dry, and intact. The plan of care did not include instructions, interventions, or other direction regarding management of the PleurX drain. During joint clinical record review and interview on 08/12/2026, the Administrator confirmed that the plans of care did not reflect the patient’s identified needs for care.”

“It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review, interview, and observation. In 3 of 18 (17%) clinical records reviewed in which Hospice Aide (HA) services were provided, the agency did not ensure that the Hospice Aide received written patient care instructions to meet the patient’s needs. CLINICAL RECORD 1: The patient elected the hospice benefit on 10/18/2024 with a terminal diagnosis of Parkinson’s Disease. The hospice plans of care (POC) for 10/18/2024 through 08/10/2026 ordered Hospice Aide (HA) visits 2XW. The face-to-face encounter dated 10/17/2024 documented that the patient was experiencing difficulty swallowing and difficulty clearing secretions when coughing. Additionally, the face-to-face encounter dated 07/16/2026 documented that the patient’s swallowing had declined since the previous benefit period. A review of the HA care plan for the dates of 10/18/2024 through 08/10/2026 revealed no instructions for the HA addressing aspiration precautions or swallowing-related safety measures. CLINICAL RECORD 2: The patient elected the hospice benefit on 07/13/2026 with a terminal diagnosis of malignant neoplasm of the colon. The hospice POC dated 07/13/2026 through 08/11/2026 ordered HA visits 2XW. The Registered Nurse (RN) initial comprehensive assessment dated 07/13/2026 documented that the patient had a colostomy and risk for aspiration. A review of the HA care plan for 07/13/2026 through 08/11/2026 revealed no instructions for the HA on colostomy care during personal care or precautions to address the patient’s identified risk for aspiration. CLINICAL RECORD 7: The patient elected the hospice benefit on 07/13/2026 with a terminal diagnosis of syringomyelia and syringobulbia. The hospice POC dated 07/13/2026 through 08/11/2026 ordered HA visits 2XW. The RN initial comprehensive assessment dated 07/13/2026 documented that the patient had a colostomy. A review of the HA care plan for 07/13/2026 through 08/11/2026 revealed no instructions for the HA on caring for the colostomy during personal care. During joint record reviews and interviews on 08/12/2026, the Administrator confirmed the findings and stated that the HA care plans needed to be more complete to include individualized instructions related to patient safety and colostomy care. The Administrator further stated that the RNs would receive re-education on developing hospice aide care plans.”

“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 hospice did not ensure that hospice volunteers provided day-to-day administrative or direct patient care services equal to five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. During an interview and review of the Volunteer Services Annual reports for calendar years 2024 and 2025 with the Volunteer Coordinator on 08/13/2026, it was revealed that hospice volunteers provided day-to-day administrative or direct patient care services in an amount equal to 2.46% for calendar year 2024 and 1.95% for calendar year 2025. During an interview with the Volunteer Coordinator on 08/13/2026, and review of the Volunteer Services Annual reports for calendar years 2024 and 2025, it was revealed that the agency did not ensure hospice 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. The Volunteer Services Annual Reports documented volunteer hours of 2.46% for 2024 and 1.95% for 2025.”

“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. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed for patients with a live discharge, the agency did not ensure the patient’s attending physician received a copy of the hospice discharge summary. CLINICAL RECORD 15: This patient elected the hospice benefit on 05/20/2026 with a terminal diagnosis of cirrhosis of the liver and revoked hospice services on 07/15/2026. A clinical record review revealed that the agency did not send a copy of the discharge summary to the attending physician. During a joint clinical record review and interview, the RN Team Leader confirmed that the attending physician did not receive the discharge summary. The RN Team Leader explained that the referring physician’s name had been removed from the electronic medical record (EMR), which caused the discharge summary to be automatically directed to the hospice physician rather than the attending physician.”

“It is required that the designated IDG member provides the SNF/NF or ICF/IID with the following information for each patient/resident: the most recent hospice plan of care; hospice election form and any advance directives; physician certification and recertification of the terminal illness; names and contact information for hospice staff involved in the patient’s care; instructions on how to access the hospice’s 24-hour on-call system; hospice medication information; [and] hospice physician and attending physician (if any) orders. This standard was not met as evidenced by clinical record review, interview and observation. In 1 of 2 (50%) home visits observed at a skilled nursing facility (SNF), the agency did not provide the SNF with the hospice election form and the advance directives. In 1 of 2 (50%) home visits observed at a skilled nursing facility (SNF), the agency did not provide the SNF with the with the physician certification and recertification of the terminal illness. HOME VISIT 2: The patient elected the hospice benefit on 07/13/2026 with a diagnosis of malignant neoplasm of the colon. The patient resided in a skilled nursing facility (SNF). During a home visit with the Licensed Medical Social Worker (LMSW) [Personnel Record 2] on 08/11/2026, a review of the hospice binder provided to the SNF revealed no advance directives or physician certification of the terminal illness. During an interview on 08/11/2026, the Administrator confirmed the findings and stated that the agency generally provides the advance directives and the physician certification of the terminal illness to the facility”

“It is required that the designated IDG member provides the SNF/NF or ICF/IID with the following information for each patient/resident: the most recent hospice plan of care; hospice election form and any advance directives; physician certification and recertification of the terminal illness; names and contact information for hospice staff involved in the patient’s care; instructions on how to access the hospice’s 24-hour on-call system; hospice medication information; [and] hospice physician and attending physician (if any) orders. This standard was not met as evidenced by clinical record review, interview and observation. In 1 of 2 (50%) home visits observed at a skilled nursing facility (SNF), the agency did not provide the SNF with the hospice election form and the advance directives. In 1 of 2 (50%) home visits observed at a skilled nursing facility (SNF), the agency did not provide the SNF with the with the physician certification and recertification of the terminal illness. HOME VISIT 2: The patient elected the hospice benefit on 07/13/2026 with a diagnosis of malignant neoplasm of the colon. The patient resided in a skilled nursing facility (SNF). During a home visit with the Licensed Medical Social Worker (LMSW) [Personnel Record 2] on 08/11/2026, a review of the hospice binder provided to the SNF revealed no advance directives or physician certification of the terminal illness. During an interview on 08/11/2026, the Administrator confirmed the findings and stated that the agency generally provides the advance directives and the physician certification of the terminal illness to the facility”