Syringa General Hospital Hospice

“Based on review of patient medical records, policies, State Operations Manual Chapter 2, and staff interview it was determined the hospice failed to properly document a discharge for 3 of 3 patients (Patient #1, #2, and #3) who were documented as revocations or live discharges and whose records were reviewed. This caused patients to be improperly documented as revoked when an assessment should have been completed and a determination if a revocation or discharge was needed. Findings include: State Operation Manual Chapter 2 §2081 defined a revocation as, “a voluntary action taken by the patient or representative. The election of the hospice benefit is the beneficiary’s choice rather than the hospice’s choice, and the hospice cannot revoke the beneficiary’s election.” Additionally, the State Operations Manual Chapter 2 2081 - Revoking Election of Hospice Care stated, “The hospice patient or representative may revoke the patient’s election of hospice care at any time during the election period according to 42 CFR 418.28. Revocation is a voluntary action taken by the patient or representative. The election of the hospice benefit is the beneficiary’s choice rather than the hospice’s choice, and the hospice cannot revoke the beneficiary’s election.” These guidelines were not followed.An undated hospice policy titled “Discharge from Hospice Services” stated, “Hospice may discharge a patient if: •The patient and or family caregiver requests services to be discontinued (see revocation) • The patient dies • The patient moves out of the hospice services area or transfers to another hospice (see revocation) • Hospice determines that the patient is no longer terminally ill •The patient seeks curative treatment/care (See revocation).” This policy was not followed. An undated hospice policy titled “Revocation” stated, “Revocation is the decision by the patient receiving Hospice care to discontinue hospice care. … IT is always the choice of the beneficiary rather than the Hospice’s choice.” This policy was not followed. Examples included:1. Patient #1 was an 82-year-old male, readmitted to hospice on 4/16/25 with terminal diagnosis of Senile degeneration of the brain. Patient #1 received SN, hospice aide and LSW services. His hospice record for this certification period 4/16/25 – 6/15/25 as well as certification period 12/9/24 – 3/13/25 were reviewed.The Hospice record included a SN note dated 3/13/25, which stated Patient #1’s wife called hospice and requested a visit as the patient was unresponsive at a restaurant and the server had called the ambulance. The hospice note documented LSW called patient back and “advised no staff in area. … Life Flight had been dispatched. … [LSW] explained to spouse that seeking treatment for pt, we would revoke pt. from Hospice. Spouse voiced understanding.”Hospice record included a medical director note dated 4/9/25, which stated, “He’s had a complicated course over the last month with an episode of altered consciousness and alertness that led to EMS involvement and ultimately his wife feeling forced to revoke hospice services for him as Life Flight had been dispatched to take him for a stroke workup at [out of area hospital] on 03/13/2025. This episode had occurred in a restaurant and wife felt external pressure from those involved. … EMS called Life Flight and his wife revoked hospice for him. Life Flight took him to [out of area hospital] for evaluation; despite being told he was on hospice. … he was discharged home from the ED that evening.”Patient #1’s medical record also included a document titled “Inpatient Care” which stated, “If you select another hospital for inpatient care, you need to revoke hospice services.” This automatic revocation would constitute a choice of revocation by the hospice, not the patient.An interview with the Hospice Manager was conducted 4/22/25 beginning at 3:30pm. The Hospice Manager confirmed when patients go outside of their local hospital for care, they are told they must revoke services as the hospice does not have contracts with outside facilities, which is not in line with the Hospice’s Revocation policy which stated, “It is always the choice of the beneficiary rather than the Hospice’s choice.”2. Patient #2 was an 86-year-old male, admitted to hospice 2/24/24 with a terminal diagnosis of dysphagia with concurrent aspiration. Patient #2 had secondary diagnosis of dementia, coronary artery disease and COPD. Patient #2 received SN, Hospice Aide and LCPC services. Patient #2’s hospice record for the certification period 5/28/24 -6/1/24 was reviewed.Patient#2’s hospice record included a note dated 6/1/24, which documented, “Spouse calls to report patient jtube just fell out. States “he just stood up and the whole thing fell out.” … [RN] informed spouse [local hospital] could take him but they may not be able to replace tube if surgery is required. Family prefers to take patient to [out of area] ER. Spouse and dtr [daughter] understand a revocation from hospice has to be signed when they arrive at the ER.”Patient #2’s hospice record included a document titled “Discharge Summary” dated 6/1/24. “Patient/Family revoked Hospice [marked with an] X Revocation Notice complete & signed.”Patient #2’s hospice medical record had no documentation the family requested a revocation.An interview with the Hospice Manager was conducted 4/22/25 beginning at 3:30pm. The Hospice Manager confirmed when patients go outside of their hospital for care they are told they must revoke services as the hospice does not have contracts with outside facilities.3. Patient #3 was an 89-year-old male admitted to hospice on 5/16/24 with the terminal diagnosis of high-grade adenocarcinoma of the prostate. Patient #2 had secondary diagnoses of atrial fibrillation and hypertension and received SN, LSW, and Hospice Aide services. Patient #3’s hospice record for the certification period of 3/12/25 to present was reviewed.Patient #3’s hospice record included the SN note from 5/14/25 which documented the patient called hospice as he was unable to void and was constipated. The RN documented she attempted to place a foley catheter and was unsuccessful. Patient #3’s hospice record documented the patient was referred to the local hospital where he was seen by the ED physician who was also unable to place a catheter.Patient #3 was then referred to an outside hospital. A SN nurse note dated 5/14/24 recorded, “Plan for pt to be referred to urology for further eval. He is agreeable to revoke off hospice today since he will be going out of our service area for further urological treatment.” Patient #3 was seen at another hospital, catheter placed, and the patient was discharged home the same day. There was no documentation Patient #3 or family requested revocation from hospice or to receive a higher level of care.An interview with the Hospice Manager was conducted 4/22/25 beginning at 3:30pm. The Hospice Manager confirmed when patients go outside of their hospital for care, they are told they must revoke services as the hospice does not have contracts with outside facilities.”