Harmony Hospice

“It is required that counseling services include an organized program for providing bereavement services delivered by or under the supervision of a qualified professional with experience or education in grief or loss counseling. Bereavement services are available to the family and other individuals up to one (1) year following the death of the patient. Bereavement counseling extends to residents of a SNF/NF (skilled nursing facility/nursing facility) or ICF/IDF (intermediate care facility/intellectual disability facility) when appropriate and identified in the bereavement plan of care. The bereavement services reflect the needs of the bereaved per a bereavement plan of care that includes the types of bereavement services to be offered and the frequency of service delivery. This standard was not met as evidenced by clinical record review, document review and interview. In 7 of 9 (78%) Clinical Records of patients who died, and accepted bereavement services, revealed that the agency did not ensure the development of a bereavement plan of care that included the type of bereavement services to be offered and the frequency of service delivery. Document 3: Policy No. 9-023 (revised November 2021) stated in part, “Procedure 2. After the bereavement risk assessment is completed, a plan will be developed to address bereavement/grief issues and will be implemented as needed. 6. Bereavement interventions will be reflective of the family/caregiver’s choice to participate in the bereavement program. 13. A bereavement file will be maintained on each family/caregiver unit of care. Each file will contain the following information: 13. D. A bereavement plan of care.” Clinical Record 4: The post death bereavement assessment dated 8/7/2023 indicated the need for bereavement services. No bereavement plan of care was documented with the type of service or frequency of services. Clinical Record 5: The post death bereavement assessment dated 3/27/2023 indicated the need for bereavement services. No bereavement plan of care was documented with the type of service or frequency of services. Bereavement services were provided 3 times a month. Clinical Record 6: The post death bereavement assessment dated 7/29/2023 indicated the need for bereavement services. No bereavement plan of care was documented with the type of service or frequency of services. Bereavement services were provided 2 to 3 times a month. Clinical Record 7: The RN (registered nurse) progress note dated 9/21/2023 stated “ MSW (medical social worker) notified to follow up for bereavement.” No bereavement plan of care was documented with the type of service or frequency of services. Clinical Record 8: The post death bereavement assessment dated 7/11/2023 indicated the need for bereavement services. No bereavement plan of care was documented with the type of service or frequency of services. Bereavement services were provided 2 to 3 times a month. Clinical Record 9: The post death bereavement assessment dated 11/19/2023 indicated the need for bereavement services. No bereavement plan of care was documented with the type of service or frequency of services. Clinical Record 11: The post death bereavement assessment dated 9/8/2023 indicated the need for bereavement services. No bereavement plan of care was documented with the type of service or frequency of services. An interview with the Administrator (personnel record 6) and Bereavement Coordinator (personnel record 3) on 11/28/2023 it was confirmed that the bereavement program needed to develop a plan of care to define the type and frequency of the bereavement services being provided.”

“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 2 of 8 (25%) clinical records reviewed of patient’s receiving hospice aide services it was revealed that the hospice agency did not ensure that the hospice aide care plan provided specific instructions to the aide. Clinical Record 1: The aide plan created 6/28/2023 for aide services to be provided 2 times a week with the assigned tasks, “Bath (Tub) every visit, Bath (shower) every visit.” The care plan did not provide clear instructions to the hospice aide regarding which type of bath was to be provided. Furthermore, the aide care plan assigned tasks for “mobility with walker, change bed linens, make bed, and straighten room” but did not provide clear instructions to the hospice aide as to the frequency of the assigned tasks allowing the aide to make decisions outside of the aide’s scope of practice. Clinical Record 2: The aide plan was created 6/16/2023 and updated on 7/6/2023, and 11/27/2023 for aide services 2 times a week and assigned the hospice aide the tasks, “Bathing (Bed) every visit, bathing Partial Sponge Bath every visit, bathing (shower) every visit, bathing (tub) every visit.” The care plan did not provide clear instructions to the hospice aide regarding the type of bath, allowing the aide to make decisions outside of the aide’s scope of practice. The Administrator stated in an interview on 11/29/2023 that the aide plan of care needed clear instructions for the aide to follow.”