Vitas Healthcare Corporation of Illinois

“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, document review, and interview. Agency policy “Supervision, Delegation and Coordination” (updated 07/15/2019) read in part, “The RN should provide direction and guidance to the HA … The RN must complete a HA Supervisory visit during the nursing visit to the patient at least every 14 days when hospice aide services are on the plan of care … Hospice Aide supervisory visits will be documented on the Visit Summary that accompanies the RN visit...” In 2 of 19 (11%) clinical records reviewed in which Hospice Aide (HA) services were provided, the agency did not ensure that the Registered Nurse supervised the HA at least every fourteen days. Clinical Record 2: The patient elected the hospice benefit on 06/12/2023. The plan of care (POC) ordered, and the patient’s frequency grid included HA visits three times a week for the weeks of 02/29/2024, 03/07/2024, and 03/14/2024. For the week of 03/21/2024, the POC ordered HA visits twice weekly. The Registered Nurse documented a HA supervisory visit on 02/29/2024. The next HA supervisory visit was documented on 03/18/2024, with eighteen (18) days outstanding. Clinical Record 15: The patient elected the hospice benefit on 11/30/2023. The plan of care ordered, and the patient’s frequency grid included one HA visit weekly for the weeks of 02/21/2024, 02/28/2024, 03/06/2024, and 03/13/2024. The Registered Nurse documented a HA supervisory visit on 02/21/2024. The next HA supervisory visit was documented on 03/13/2024, with twenty (20) days outstanding. During a joint clinical record review and an interview on 05/10/2024, the Senior Patient Care Administrator and the National Patient Care Administrator confirmed that there were gaps in the supervision of the hospice aides of more than fourteen days for clinical records #2 and #15.”

“It is required that volunteers are used in day-to-day administrative and/or direct patient care roles. Volunteer services provided to patients/families are in a defined role and under the supervision of a designated hospice employee. Volunteer services are: noted in the plan of care; [and] documented in the patient record, including the time spent. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy “Care Planning” stated in part, “Care Plan Components...Scope is the discipline that will perform the interventions. Each intervention must have an assigned scope. Ensure the intervention is within the scope of practice of the assigned discipline... VOL = Volunteer... The frequency of each intervention is to be at each visit by the assigned discipline unless otherwise indicated in the intervention... Best Practice: Collaboration and Communication...Collaboration and Communication Examples by role ..Volunteer...changes in POC, frequency, interventions, etc. … “ In 3 of 3 (100%) clinical records reviewed, the agency did not ensure that the volunteer visit frequency was noted in the patient’s plan of care. Clinical Record 5: The patient elected the hospice benefit on 01/11/2024. The patient’s plan of care ordered, and the patient’s frequency grid for the weeks of 03/22/2024 and 04/19/2024 included no hospice volunteer visits. Volunteer visits were documented as completed on 03/26/2024 and 04/19/2024. The POC did not include orders for volunteer services. Clinical Record 9: The patient elected the hospice benefit on 07/02/2022. The patient’s plan of care ordered, and the patient’s frequency grid for the weeks of 02/21/2024, 03/13/2024, 03/27/2024, 04/17/2024, and 04/24/2024 included no hospice volunteer visits. Volunteer visits were documented as completed on 02/22/2024, 03/14/2024, 03/30/2024, 04/18/2024, and 04/29/2024. The POC did not include orders for volunteer services. Clinical Record 10: The patient elected the hospice benefit on 11/28/2023. The patient’s plan of care ordered, and the patient’s frequency grid for the weeks of 02/08/2024, 02/15/2024, and 04/03/2024 included no hospice volunteer visits. Volunteer visits were documented as completed on 02/08/2024, 02/15/2024, and 04/08/2024. The POC did not include orders for volunteer services. During a joint clinical record review and interview on 05/10/2024, the Senior Patient Care Administrator and the National Patient Care Administrator confirmed there were no volunteer frequency orders for the volunteer visits for clinical records #5, #9, and #10.”