Encompass Hospice of Eastern Idaho

“It is required that the written Patient Bill of Rights includes the right to: be involved in the development of his or her plan of care. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy #0-125 “Discharge from Hospice Program” (11/2021) stated in the relevant part “Procedure: 1. All necessary paperwork will be completed, including a signed discharge form. 5. The organization will inform the family both verbally and in writing, including a timeline for discontinuing services.” In 1 of 2 (50%) clinical records reviewed of patients with a live discharge, the agency did not ensure the patient signed discharge forms per agency policy. Clinical Record 15: The patient elected hospice care on 02/06/2024 and was discharged from hospice care for an extended prognosis on 05/06/2024. The clinical record did not contain evidence that the patient received both verbal and written notification of the discharge. There was no evidence that the Notification of Medicare Non-Coverage Form was given to the patient or family. During an interview and a joint record review on 11/06/2024, the Branch Director agreed the Notification of Medicare Non-Coverage had not been scanned into the clinical record.”

“It is required that each patient’s individualized written plan of care includes measurable outcomes anticipated from implementing and coordinating the plan of care. This standard was not met as evidenced by clinical record review and interview. In 3 of 19 (16%) clinical records reviewed, the agency did not ensure the individualized written plan of care included measurable outcomes anticipated from implementing and coordinating the plan of care (POC). Clinical Record 5: The patient elected the hospice benefit on 03/25/2024 with a diagnosis of atherosclerotic heart disease. The POC dated 03/25/2024 documented the patient’s goal: “Patient will have optimal cardiac function.” “Optimal” cardiac function is not measurable. Clinical Record 16: The patient elected the hospice benefit on 08/31/2023 with a diagnosis of mesothelioma. The POC dated 08/31/2023 documented the patient’s goal: “Patient will have decreased edema and SOB (shortness of breath) within constraints of disease.” This goal did not include measurable parameters for the edema or shortness of breath. The POC did not include the patient’s current level of edema, how to decrease it, or how to measure the decrease of the edema or shortness of breath. Clinical Record 18: The patient elected the hospice benefit on 04/25/2024 with a diagnosis of malignant neoplasm, unspecified. The POC dated 04/25/2024 documented the patient’s goal: “Patient’s pain will remain at an acceptable level of (blank) to patient/caregiver.” This POC did not specify the patient’s acceptable/measurable pain level as described by the patient or family. During an interview and joint clinical record review on 11/06/2024, the Branch Director agreed the goals were not measurable as written.”

“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 and the patient’s record, if requested. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed in which the patient was live discharged, the agency did not ensure the discharge summary was forwarded to the attending physician. Clinical Record 15: The patient elected hospice care on 02/06/2024 and was discharged from hospice care for an extended prognosis on 05/06/2024. The clinical record did not contain evidence of the discharge summary being forwarded to the patient’s attending physician. During a joint clinical record review and interview on 11/06/2024, the Branch Director agreed the discharge summary had not been forwarded to the attending physician for the live discharge.”

“It is required that Hospice care of the patient/resident is stated in a written plan of care established and maintained in consultation with SNF/NF or ICF/IID representatives. The hospice plan of care identifies the care and services that are needed and specifies which provider is responsible for performing the functions that are agreed upon and included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 2 of 3 (67%) clinical records reviewed of patients residing in a SNF/NF (skilled nursing facility/nursing facility), the agency did not ensure that the plan of care identified the care and services that were needed, specifying which provider was responsible for performing the functions that were agreed upon and included in the plan of care. Clinical Record 1/Home Visit 1: The patient elected hospice care on 11/10/2023 and resided in a SNF. During the home visit with the Hospice Aide (HA) [Personnel Record 7] on 11/05/2024, the patient was observed to have a wound to his right forearm. The hospice plan of care (POC) dated 10/22/2024 did not identify which provider was responsible for providing services or discuss how the coordination of care would occur between the providers. Clinical Record 2/Home Visit 2: The patient elected hospice care on 10/15/2024 and resided in a SNF. During the home visit with the Registered Nurse (RN) [Personnel Record 4] on 11/05/2024, the patient was observed to have a Foley catheter and wounds to bilateral heels. The hospice plan of care (POC) dated 10/22/2024 did not identify which provider was responsible for providing services or discuss how the coordination of care would occur between the providers. During an interview on 11/05/2024, the Branch Director described a “form” that was placed in the binder at the SNF that discussed some aspects of the care coordination. The form was to be scanned into the clinical record. The forms were not located in the documentation. The Branch Director agreed that the current plans of care did not include a delineation of responsibilities.”