Centracare Hospice

“Based on interview and document review, the agency failed to identify the order or visit frequency for volunteer services for 3 of 3 patients (P1, P5, P6) who received volunteer services. P1’s plan of care (POC) dated 10/15/23 through 1/12/24, identified a start of care (SOC) date 7/17/23, with diagnoses of heart failure and kidney disease. The POC identified planned visits for services with visit sets, which included chaplain visits one to four visits for 13 weeks, hospice aide (HA) one visit weekly for 13 weeks, music therapy five to six visits in 13 weeks, medical social work (SW) visits six visits in 13 weeks and 4 visits as needed (prn), and skilled nursing visits one weekly for 13 weeks and eight visits prn. Interventions for volunteer services were identified on P1’s POC under ongoing hospice services, as well as noted changes with volunteer services when they occurred; however, planned visits for volunteer services were not identified on P1’s POC visit sets. P1’s volunteer coordinator note dated 7/19/23, identified volunteer services would be provided two to four times per month through P6’s current benefit period. P1’s Hospice Volunteer Visit Reports identified P1 had volunteer visits 10/2/23, 10/3/23, 10/12/23, 10/24/23, and 10/30/23. P1’s medical record lacked physician orders to initiate volunteer services and/or orders for changes to the frequency and duration of volunteer visits when they occurred. P5’s POC dated 9/14/23 through 12/12/23, identified a SOC 9/14/23, with diagnoses of chronic obstructive pulmonary disease (COPD) and heart failure. The POC identified planned visits for services with visit sets, which included HA one visit weekly for 12 weeks, SW visits six times in 13 weeks and 6 visits prn, occupational therapy (OT) visits two times a week for four weeks and skilled nursing visits two times weekly for 12 weeks and ten visits prn. Interventions for volunteer services were identified on P5’s POC under ongoing hospice services, as well as noted changes with volunteer services when they occurred; however, planned visits for volunteer services were not identified on P5’s POC visit sets. P5’s Volunteer Coordinator note dated 9/18/23, identified volunteer services would be provided two to four times per month through P5’s current benefit period. P5’s Hospice Volunteer Visit Reports identified P5 received volunteer visits on 9/27/23, 10/3/23, 10/13/23, and 10/20/23. P5’s medical record lacked physician orders to initiate volunteer services and/or orders for changes to the frequency and duration of volunteer visits when they occurred. P6’s POC dated 10/31/23 through 12/29/23, identified a SOC 5/4/23, with diagnoses of heart disease and pulmonary fibrosis. The POC identified planned visits for services with visit sets, which included chaplain one to two times every two weeks for nine weeks, HA one visit weekly for 9 weeks, massage therapy one to two visits every week for nine weeks, music therapy visits seven to nine visits in nine weeks, SW visits four visits in nine weeks and four visits prn, and skilled nursing visits two times weekly for 9 weeks and eight visits prn. Interventions for volunteer services were identified on P6’s POC under ongoing hospice services, as well as noted changes with volunteer services when they occurred; however, planned visits for volunteer services were not identified on P6’s POC visit sets. P6’s Volunteer Coordinator note dated 10/9/23, identified volunteer services would be provided one time weekly through P6’s current benefit period. P6’s Hospice Volunteer Visit Reports identified P5 received volunteer visits on 10/12/23, 10/17/23, 10/20/23, 10/26/23, and 11/7/23. P6’s medical record lacked physician orders to initiate volunteer services and/or orders for changes to the frequency and duration of volunteer visits when they occurred. When interviewed on 11/13/23, at 2:00 p.m. the volunteer coordinator (VC) stated she added volunteer services to a patient’s POC as an intervention. VC did not obtain physician orders for volunteer services and so did not document the frequency or duration of visit sets on the patient’s POC. Volunteer services were discussed at the patient’s interdisciplinary group meeting (IDG) and the hospice physician attended the IDG meetings and so would be made aware at that time if volunteer services were initiated or changed. During interview on 11/14/23, at 2:30 p.m. the administrator stated it was the agency’s practice to document volunteer interventions on a patient’s POC; however, the agency did not treat the service as a physician-ordered service. It would be difficult to enter visit sets, frequency, and duration into a patient’s POC as it would be classified as physician-ordered services and would then follow all tracking criteria for visits such as flagging for physician notification for missed visits. The physician was notified when a volunteer was initiated or changed with volunteer services at the patient’s IDG meetings. The agency policy Care Planning Process dated 5/2021, identified an individualized plan of care was initiated after completion of the comprehensive assessment. The care plan would be based on assessment findings, the patient’s desires for care, patient needs, problems, and goals and in collaboration with other professionals. The care plan would be modified as indicated by patient choice, changes in condition, psychosocial status, home environment, care or service needs. The policy identified sixteen documentation requirements including type of services, supplies and equipment required and frequency and duration of visits.”