Compassus - Greater Maine

“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 and interview. In 5 of 19 (26%) clinical records reviewed of patients who received Hospice Aide (HHA) services, the agency did not ensure that the HA received written patient care instructions to meet the patient’s needs. Clinical Record 1: The patient elected hospice care on 06/30/2023 with a diagnosis of cerebrovascular disease. The patient resided in a skilled nursing facility (SNF). The plan of care (POC) dated 08/22/2024 through 10/21/2024 ordered, “HHA two (2) times per week.” On 10/15/2024, the physician ordered wound care with a dressing to the patient’s left leg. The HHA care plan dated 10/18/2024 assigned the HHA the relevant task: “Partial bed bath every visit.” The HHA care plan did not provide the HHA with instructions related to the wound dressing during the bed bath should the dressing become dislodged or wet. Clinical Record 3: The patient elected hospice care on 07/29/2024 with a diagnosis of cerebrovascular disease. The patient resided in an assisted living facility (ALF). The POC dated 07/29/2024 through 10/26/2024 ordered, “HHA (2) two times per week.” On 09/10/2024, the physician ordered wound care with a dressing to the patient’s right wrist. The HHA care plan dated 09/03/2024 assigned the HHA the relevant tasks: “Shower on the first visit of the week and bed bath on the second visit of the week.” The HHA care plan did not provide the HHA with instructions related to the right wrist wound dressing during the bed bath or shower should the dressing become dislodged or wet. Clinical Record 10: The patient elected hospice care on 06/19/2023 with a diagnosis of Parkinson’s Disease. The patient resided in a SNF. The POC dated 06/19/2023 through 09/16/2023 ordered, “HHA 2 times per week.” On 08/31/2023, the physician ordered wound care with a dressing to a wound on the patient’s coccyx. The HHA care plan dated 09/01/2023 assigned the HHA the relevant task: “Shower every visit.” The HHA care plan did not provide the HHA with instructions related to the coccyx wound dressing during the shower should the dressing become dislodged or wet. Clinical Record 12: The patient elected hospice care on 07/18/2024 with a diagnosis of gastrointestinal hemorrhage. The patient resided in a SNF. The POC dated 07/18/2024 through 10/15/2024 ordered, “HHA 2 times per week.” On 08/12/2024, the physician ordered wound care with a dressing to a wound on the patient’s right calf. The HHA care plan dated 08/12/2024 assigned the HHA the relevant task: “Bed bath weekly.” The HHA care plan did not provide the HHA with instructions related to the right calf wound dressing during the bed bath should the dressing become dislodged or wet. Clinical Record 17: The patient elected hospice care on 02/22/2024 with a diagnosis of Parkinson’s Disease. The patient resided in an ALF. The POC dated 02/22/2024 through 05/20/2024 ordered, “HHA 2 times per week.” On 04/18/2024, the physician ordered wound care with a dressing to a wound on the patient’s right buttock. The HHA care plan dated 04/25/2024 assigned the HHA the relevant task: “Shower every visit.” The HHA care plan did not provide the HHA with instructions related to the right buttock wound dressing during the shower should the dressing become dislodged or wet. During a joint record review on 10/23/2024, the Director of Clinical Services confirmed that the aide care plans did not include wound dressing instructions. The agency currently has an active PIP that started last year involving the documentation of aide care plans to be specific for each patient. They have done extensive education with both their registered nurses and aides on aide care plans.”

“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 and interview. In 4 of 19 (21%) clinical records reviewed of patients who received Hospice Aide (HHA) services, the agency did not ensure that HHA supervisory visits were completed no less frequently than every 14 days. Clinical Record 1: The patient elected hospice care on 06/30/2023 with a diagnosis of cerebrovascular disease. The POC dated 06/30/2023 through 09/27/2023 ordered, “HHA 2 times per week.” A clinical record review revealed HHA supervisory visits dated 08/08/2023 and 08/30/2023, with 22 days outstanding. Clinical Record 11: The patient elected hospice care on 06/13/2023 with a diagnosis of malignant neoplasm of the endometrium. The patient resided in an assisted living facility (ALF). The POC dated 06/13/2023 through 09/10/2023 ordered, “HHA 2 times per week.” A clinical record review revealed HHA supervisory visits dated 06/27/2023 and 07/13/2023, with 16 days outstanding. Clinical Record 12: The patient elected hospice care on 07/18/2024 with a diagnosis of gastrointestinal hemorrhage. The patient resided in a skilled nursing facility (SNF). The POC dated 07/18/2024 through 10/15/2024 ordered, “HHA 2 times per week.” A clinical record review revealed HHA supervisory visits dated 08/26/2024 and 09/12/2024, with 17 days outstanding. Clinical Record 16: The patient elected hospice care on 10/01/2023 with a diagnosis of Alzheimer’s Disease. The patient resided in an assisted living facility (ALF). The POC dated 10/01/2023 through 12/30/2023 ordered, “HHA 2 times per week.” A clinical record review revealed HHA supervisory visits dated 10/10/2023 and 10/26/2023, with 16 days outstanding. During a joint record review on 10/23/2024, the Director of Clinical Services confirmed that the HHA supervisory visits were greater than every 14 days.”