Optimal Care Hospice

“It is required that each patient’s individualized written plan of care reflects patient and family goals and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 5 of 19 (26%) clinical records reviewed, the agency did not ensure the individualized written plan of care reflected patient and family goals and identified planned interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 3: The patient elected hospice services on 04/05/2024 with a terminal illness of unspecified malignant neoplasm of the esophagus. The initial nursing assessment dated 04/05/2024 included documentation that the patient had dysphagia, required precautions to avoid aspiration, and was a high fall risk. The written plan of care dated 04/05/2024 did not reflect patient and family goals and planned interventions associated with the patient’s aspiration and fall risks identified in the comprehensive assessment. Clinical Record 5: The patient elected hospice services on 10/03/2023 with a terminal illness of hypertensive heart and chronic kidney disease with heart failure and unspecified stage 1-4 chronic kidney disease. The initial nursing assessment dated 10/03/2023 included documentation that the patient had abdominal tenderness, abdominal distention, constipation, and was a high fall risk. The written plan of care dated 10/03/2023 did not reflect patient and family goals and planned interventions associated with the patient’s constipation and fall risk identified in the comprehensive assessment. Clinical Record 6: The patient elected hospice services on 06/01/2024 with a terminal illness of unspecified severe protein-calorie malnutrition. The initial nursing assessment dated 06/01/2024 included documentation that the patient had dysphagia, required precautions to avoid aspiration, and would not be started on a bowel protocol due to frequent loose stools. The written plan of care dated 06/01/2024 did not reflect patient and family goals and planned interventions associated with the patient’s aspiration risk and diarrhea identified in the comprehensive assessment. Clinical Record 12: The patient elected hospice services on 01/11/2024 with a terminal illness of Huntington’s disease. The initial nursing assessment dated 01/11/2024 included documentation that the patient had dysphagia leading to recurrent aspiration and a Percutaneous Endoscopic Gastrostomy (PEG) tube in place which was flushed twice a day by the assisted living facility staff. The written plan of care dated 01/11/2024 and updated 07/09/2024 did not reflect patient and family goals and planned interventions associated with the patient’s aspiration risk identified in the comprehensive assessment. Clinical Record 14: The patient elected hospice services on 10/04/2023 with a terminal illness of unspecified Alzheimer’s disease. The initial nursing assessment dated 10/04/2023 included documentation that the patient had a history of seizures, was incontinent of bowel and bladder, and was at a high risk for falls. The written plan of care dated 10/04/203 and updated on 01/01/2024 did not reflect patient and family goals and planned interventions associated with the patient’s fall risk identified in the comprehensive assessment. During joint clinical record reviews and interviews on 08/23/2023, the Administrator, Regional Clinical Director, and Vice President of Hospice confirmed, for the clinical records identified, the individualized plans of care did not reflect patient and family goals, and planned interventions associated with problems, including aspiration and fall risks, diarrhea, and constipation, identified during the initial comprehensive assessment.”

“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 an 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 2 of 16 (12%) clinical records reviewed with hospice aide services provided, the agency did not ensure the Registered Nurse prepared specific written patient care instructions for the aide to follow. Clinical Record 7: The patient elected the hospice benefit on 02/16/2024 with a terminal illness of secondary malignant neoplasm of the bone. The initial nursing assessment dated 02/16/2024 included documentation that the patient had contractures of the right upper and lower extremities and paralysis of the left upper extremity. The hospice aide care plan dated 02/16/2024 and updated on 02/19/2024 did not alert the aide to the patient’s contractures and paralysis. Clinical Record 10: The patient elected the hospice benefit on 04/18/2024 with a terminal illness of Atherosclerotic heart disease of the native coronary artery with unspecified angina. The initial nursing assessment dated 04/18/2024 included documentation that the patient was at a high fall risk and required two persons to assist with stand-pivot transfers. The plan of care dated 04/18/2024 included orders for two-person assistance with transfers. The hospice aide care plan dated 04/18/2024 included instructions for the aide to place the patient on the bedside commode for showering using one-person assistance. The plan did not alert the aide to the required two persons for stand-pivot transfers. During joint clinical record reviews and interviews on 08/22/2023, the Administrator, Regional Clinical Director, and Vice President of Hospice confirmed that the hospice aide care plans identified did not alert the aide to patient conditions that could affect the safety of the care provided.”

“It is required that volunteers be used in day-to-day administrative and direct patient care roles. Volunteer services provided to patients/families are in a defined role and supervised by a designated hospice employee. Volunteer services are noted in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 3 of 3 (100%) clinical records reviewed with volunteer services provided, the agency did not ensure volunteer services were noted in the plan of care. Clinical Record 6: The patient elected hospice services on 06/01/2024 with a terminal illness of unspecified severe protein-calorie malnutrition. The volunteer care plan dated 06/21/2024 included plans for volunteer services to be provided to the patient once per month for pet therapy companionship. The clinical record contained no evidence that the plan of care that was reviewed and updated no less frequently than every 15 days since 06/01/2024 noted the volunteer services provided. Clinical Record 12: The patient elected hospice services on 01/11/2024 with a terminal illness of Huntington’s disease. The volunteer care plan dated 02/21/2024 included plans for volunteer services to be provided to the patient once per month for pet therapy companionship. The clinical record contained no evidence that the plan of care that was reviewed and updated no less frequently than every 15 days since 01/11/2024 noted the volunteer services provided. Clinical Record 16: The patient elected hospice services on 09/14/2023 with a terminal illness of Hypertensive heart disease with heart failure. The patient revoked the hospice benefit on 06/09/2024 to seek aggressive treatment. The volunteer care plan dated 10/17/2023 included plans for volunteer services to be provided to the patient once a week for companionship and emotional support. The clinical record contained no evidence that the plan of care that was reviewed and updated no less frequently than every 15 days from 09/14/2023 through 06/09/2024 noted the volunteer services provided. During joint clinical record reviews and interviews on 08/23/2024, the Administrator, Regional Clinical Director, and Vice President of Hospice confirmed that the clinical records contained no evidence that the plans of care were updated to include the volunteer services provided.”