Mille Lacs Health System Hospice

“Based on interview and document review the agency failed to consistently ensure the required interdisciplinary group meetings (IDG) members were present for each IDG meeting for 7 of 10 patients (P5, P6, P8, P10, P3, P4, P9) reviewed for comprehensive assessments. P3: P3’s POC 4/28/24 to 6/26/24, identified a start of care date (SOC) 10/31/22. Diagnosis included neurocognitive disorder with Lewy bodies. P3 received skilled nurse (SNV), nursing aide (NA) and volunteer services. The Interdisciplinary Group (IDG) Meetings dated 1/10/24, 2/7/24, 2/21/24, 3/6/24, 3/20/24, 4/3/24, 4/17/24, and 5/1/24, identified the IDG team met to discuss P3’s hospice care and treatment, however, team participants were not identified. The IDG team participation lists for 1/10/25, 2/7/24, 2/21/24, and 3/20/24, identified P3’s registered nurse (RN), the hospice physician and licensed social worker (LSW) did attend the meeting, however the hospice chaplain did not. The IDG team participation lists for 4/3/24, 4/17/24, and 5/1/24, identified P3’s RN and the hospice physician did attend the meeting, however, the hospice LSW and chaplain did not. P4: P4’s POC 12/30/23 to 2/27/24, identified a SOC date of 1/14/21 and included a diagnosis of Alzheimer’s disease. P4 received SNV, NA and LSW visits. The IDG meeting dated 1/10/24, identified the IDG team met to discuss P4’s hospice care and treatment, however, team participants were not identified. The IDG team participation list for 1/10/25, identified P4’s registered nurse (RN), the hospice physician, and the licensed social worker (LSW) did attend the meeting, however, the hospice chaplain did not. P9: P9’s POC 7/30/24 to 9/27/24, identified a SOC 2/1/24. Diagnosis included diabetes mellitus with chronic kidney disease. P9 received SNV and NA visits. P9’s IDG meetings dated 5/29/24, 6/13/24, 6/26/24, 7/11/24, 7/24/24, and 8/7/24, identified the IDG team met to discuss P9’s hospice care and treatment. Team participants in attendance included two of P9’s RN’s and the hospice physician. P9’s LSW and the hospice chaplain did not attend the meetings. A joint interview was conducted with the director of nursing (DON) and nurse manager (NM) on 8/12/24 at 1:15 p.m. The DON stated the agency did not currently have a chaplain and tried to incorporate the patient’s own chaplain when needed. The NM stated the agency had lost its LSW in March 2024, and were using an interim LSW until they hired someone. The interim LSW did not attend any of the IDG meetings. The agency had just recently hired another LSW and would be attending the meetings going forward. When interviewed on 8/14/24, at 9:15 a.m. the NM stated the agency had a chaplain until last month when he resigned, however, the chaplain had not attended any of the agency IDG meetings. They had tried to talk to a couple of local chaplains, but none were interested in taking the volunteer position. The NM was aware a spiritual team member and LSW should be present at the agency IDG meetings to provide input regarding patient care related to their areas of practice. They had just hired a LSW and she would be attending every two-week meetings in the future. The agency was still working on finding a spiritual counselor or chaplain. The agency’s undated policy Interdisciplinary Group identified the interdisciplinary group would work together to meet the physical, medical, psychosocial, emotional, and spiritual needs of their clients and families. The IDG group included a doctor of medicine who was an employee or under contract with the hospice agency, a registered nurse, licensed social worker and a pastoral or other counselor. P8 P8’s POC 6/13/24 to 9/10/24, identified the start of care (SOC) date was 6/13/24. Diagnosis included malignant neoplasm of lower lobe left bronchus with secondary malignant neoplasm of brain and other parts of the nervous system. P8 received skilled nurse, nursing aide and medical social worker. The Interdisciplinary Group (IDG) Meeting dated 6/26/24, 7/11/24, 7/24/24, and 8/7/24, identified the IDG team met to discuss P8’s hospice care and treatment. The IDG team participation list for 6/26/24, 7/11/24, and 7/24/24 Identified P8’s registered nurse (RN) and the hospice physician attended the meeting, however, the licensed social worker (LSW) and chaplain did not. The IDG team participation list for 8/7/24, identified P8’s RN and the LSW attended the meeting, however, the hospice physician and chaplain did not. P10 P10’s POC 7/31/24 to 10/28/24, identified the start of care (SOC) date as 5/2/24. Diagnosis included malignant neoplasm of the colon. The IDG meetings dated 5/15/24, 5/29/24, 6/13/24, 6/26/24, 7/11/24, 7/24/24, and 8/7/24, identified the IDG team met to discuss P10’s hospice care and treatment. The IDG team participation list for 5/15/24 and 6/13/24 identified P10’s RN, the physician, and P10’s nurse aide attended the meeting, however the LSW and chaplain did not. The IDG team participation list for 5/29/24, 6/26/24, 7/11/24, and 7/24/24, identified P10’s RN and the physician attended the meeting, however, the LSW and chaplain did not. The IDG team participation list for 8/7/24 identified P10’s RN and the LSW attended, however the chaplain and the physician did not. P5 P5’s plan of care (POC) 2/14/24 to 5/13/24, identified a start of care date (SOC) 11/16/23. Diagnosis included Alzheimer’s disease. P5 received skilled nurse, nursing aide and volunteer services. The Interdisciplinary Group (IDG) Meeting(s) dated 1/10/24, 2/7/24, 2/21/24, 3/6/24, 3/20/24, 4/3/24, 4/17/24, and 5/1/24, identified the IDG team met to discuss P5’s hospice care and treatment. The IDG team participation list for 1/10/25, 2/7/24, 2/21/24, and 3/20/24, identified P5’s registered nurse (RN), the hospice physician and licensed social worker (LSW) did attend the meeting; however, the hospice chaplain did not attend. The IDG team participation list for 4/3/24, 4/17/24, and 5/1/24, identified P5’s RN, and the hospice physician did attend the meeting; however, the hospice LSW and chaplain did not. P6 P6’s POC 2/25/24 to 5/25/24, identified a start of care date (SOC) 2/26/24. Diagnosis included Mesothelioma of pleura (cancer of the linings around the lungs). P6 received skilled nurse, nursing aide, and physical therapy. The Interdisciplinary Group (IDG) Meeting dated 3/6/24, 3/20/24, 4/3/24, and 4/17/24, identified the IDG team met to discuss P6’s hospice care and treatment. The IDG team participation list for 3/20/24, identified P6’s registered nurse (RN), the hospice physician and licensed social worker (LSW) did attend the meeting; however, the hospice chaplain did not. The IDG team participation list for 4/3/24, and 4/17/24, identified P6’s RN, and the hospice physician did attend the meeting; however, the hospice LSW and chaplain did not.”