Hospice of Holland

“Based on interview and record review the agency failed to conduct an initial bereavement assessment for all the patient’s family members that focused on the spiritual and cultural factors that may impact their ability to cope with the patient’s illness and to ensure grief needs are continually monitored and updated as needed throughout the course of care and death of the patient for 15 (P-1, 2, 3, 4, 5, 7, 8, 9, 10, 11, 12, 13, 14, and 19)of a total of 19 records reviewed resulting in family members not receiving services and care plans thus impacting their ability to cope with the patient’s illness and death. Findings included: P-5: The patient is a 91-year-old woman admitted to hospice on 7/17/2024 with diagnoses of Congestive Heart Failure and history of Hypertension, Coronary Artery Disease and Chronic Obstructive Pulmonary Disease. The patient is dependent on 2 Liters of continuous Oxygen. Upon review of the record, it was noted the Social Worker had completed a bereavement assessment for the patient’s son, who was the patients Durable Power of Attorney (DPOA). However, the patient also had a daughter. There was no evidence found in the record that the Social Worker had completed a bereavement assessment for the daughter. The agency failed to complete a bereavement assessment for all living family members who may have grief needs to cope with the patient’s terminal illness. P-7: This 84-year-old patient was admitted to Hospice on 12/28/23 with diagnoses of Hypertensive Heart Disease, and Congestive Heart Failure (CHF). The Social Work Care Plan dated 3/9/23 identified that the patient has a wife and 2 children (a boy and girl) and documented a low risk level of complications to normal grief process for all. There were no individual assessments for each family member, all were included in one assessment. It was noted during the Care Plan Problem Interventions for the patient and family, the following Interventions defined outcome and engagement as “No Response” to all as follows: Acceptance of Disease Status and progression; Assessment of current awareness/acceptance of prognosis; Assess current level of coping; Assess current levels of sadness and anxiety; Assess, support and educate regarding ways grief may manifest; collaborate with bereavement staff regarding family coping; encourage and assist patient/family in life review; encourage expression of emotion; explore current losses; explore past losses and coping style; explore patient/family beliefs about death and dying; identify effective coping methods; identify support system; Journey’s end resource reviewed; normalize grief reactions; Provide education regarding the dying process; provide grief resources; provide information on available bereavement services; reinforce and explore strengths of patient/family. There was no individualized bereavement assessment for each family member to determine their bereavement needs. MR-8: The Start of Care was dated 1/26/2023 with diagnoses of Vascular Dementia with Behavioral Disturbance and Chronic Kidney Disease. The patient lives with her daughter, son-in-Law, and one of her sons. Another daughter and son live out of town. Upon review of the record, there was no evidence that the Social Worker completed a bereavement assessment for the daughter and son who lived in other locations. There was no individualized bereavement assessment for all immediate family members to determine their bereavement needs. These findings were reviewed and acknowledged during an interview on January 25, 2024, at 2:30 p.m. P-9: The Start of Care (SOC) was dated 12/13/23. The Plan of Care (POC) identified a terminal diagnosis of Anorexia. During record review on 1/24/24, it was noted that the bereavement risk assessment was completed by the Medical Social Worker (MSW) on 12/14/23 and noted one the patients daughters as the PCG (primary care giver). Under the section “;Other Family” it was noted that the patient had another child, 5 siblings and grandkids. The bereavement risk assessment failed to include the patients other child, 5 siblings and grandkids. P-10: The Start of Care (SOC) was dated 12/11/23. The Plan of Care (POC) identified a terminal diagnosis of Congestive Heart Failure. During record review on 1/24/24, it was noted that the bereavement risk assessment was completed by the MSW on 12/12/23 and noted the patients son as the PCG. Under the section “;Other Family” it was noted that the PCG had a spouse, and the patient had another child, and several close cousins. The bereavement risk assessment failed to include the patients other child and close cousins. P-11: The Start of Care (SOC) was dated 1/27/22. The Plan of Care (POC) identified a terminal diagnosis of Dysphagia. During record review on 1/23/24, it was noted that the bereavement risk assessment was completed by the MSW on 1/28/22 and noted one the patients daughters as the PCG. Under the section “;Other Family” it was noted that the patient had a son, 4 grandchildren and 2 greatgrandchildren. The bereavement risk assessment failed to include the patients son, grandchildren, and great-grandchildren. P-12: The Start of Care (SOC) was dated 12/8/22. The Plan of Care (POC) identified a terminal diagnosis of Colon Cancer. During record review on 1/23/24, it was noted that the bereavement risk assessment was completed by the MSW on 12/8/22 and noted one the patients daughters as the PCG. Under the section “;Other Family” it was noted that the patient additionally had 2 adult children. The bereavement risk assessment failed to include the patients other 2 adult children. P-13: The Start of Care (SOC) was dated 10/21/23. The Plan of Care (POC) identified a terminal diagnosis of Congestive Heart Failure. During record review on 1/23/24, it was noted that the bereavement risk assessment was completed by the MSW on 10/24/23 and noted one the patients daughters as the PCG. Under the section “;Other Family” it was noted that the patient had a spouse, 5 adult sons and grandchildren. The bereavement risk assessment failed to include the patients spouse, 5 adult sons and grandchildren. P-14: The Start of Care (SOC) was dated 12/28/23. The Plan of Care (POC) identified a terminal diagnosis of Congestive Heart Failure. During record review on 1/24/24, it was noted that the bereavement risk assessment was completed by the MSW on 12/29/23 and noted one the patients sons as the PCG. Under the section “;Other Family” it was noted that the patient had three additional children and “;Many grands and greats”. The bereavement risk assessment failed to include the patients other children, grandchildren, and great-grandchildren. P-19: The Start of Care (SOC) was dated 12/29/23. The Plan of Care (POC) identified a terminal diagnosis of Alzheimers. During record review on 1/25/24, it was noted that the bereavement risk assessment was completed by the MSW on 1/2/24 and noted one the patients sons as the PCG. Under the section “;Other Family” it was noted that the patient had two additional children, 3 grandchildren and 4 great-grandchildren. The bereavement risk assessment failed to include the patients other children, grandchildren, and great-grandchildren. These findings were reviewed with and acknowledged by the CCM-1 (Clinical Care Manager) during an interview on 1/25/24 at 11:45 am. CSM-1 (Counseling Service Manager) was contacted during the interview and stated, “;We are primarily doing the bereavement assessment on just the primary care giver.” P-1: The Start of Care (SOC) was dated 8/16/23. The Plan of Care (POC) identified a terminal diagnosis of malignant neoplasm of large intestine. During record review on 1/22/24, it was noted that the bereavement risk assessment was completed by the MSW on 8/17/23 and noted two of the patients daughters as the primary care givers (PCG). Under the section “;Other Significant Family Members” it was noted that the patient had “Siblings, spouse, children, grands” documented. The bereavement risk assessment failed to include the patients other siblings, spouse, children, and grandchildren. P-2: The SOC was dated 6/21/22. The POC identified a terminal diagnosis of Parkinson’s Disease. During record review on 1/23/24, it was noted that the bereavement risk assessment was completed by the MSW on 6/22/22 and noted a PCG. Under the section “;Other Significant Family Members” it was noted that the patient had “Son across the street and grandchildren” documented. The bereavement risk assessment failed to include the patients other son, and grandchildren. P-3: The SOC was dated 2/9/23. The POC identified a terminal diagnosis of hypertensive heart and kidney failure. During record review on 1/24/24, it was noted that the bereavement risk assessment was completed by the MSW on 3/10/23 and noted the son as the PCG. Under the section “;Other Significant Family Members” it was noted that the patient had “Partner Susan and sister Mary” documented. The bereavement risk assessment failed to include the partner and sister. P-4: The SOC was dated 3/9/23. The POC identified a terminal diagnosis of Leukemia. During record review on 1/24/24, it was noted that the bereavement risk assessment was completed by the MSW on 2/10/23 and noted Kate as PCG. Under the section “;Other Significant Family Members” it was noted that the patient had “Spouse and many friends” documented. The bereavement risk assessment failed to include the spouse or friends. During an interview on 1/25/24 at 12:40 p.m., the administrator (Adm#1) acknowledged the findings.”