Hospice Compassus-Central Missouri

“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 17 (12%) clinical records reviewed of patients who received Hospice Aide (HA) services, the agency did not ensure that the Hospice Aide care plan included written patient care instructions to meet the patient’s needs. Clinical Record 11: The patient elected the hospice benefit on 11/06/2024. The plan of care dated 11/06/2024 through 02/03/2025 ordered “HA 2x per week.” On 01/30/2025, the physician ordered wound care with dressings to wounds on the patient’s right heel and coccyx. The HA care plan dated 11/06/2024 assigned the HA the relevant task of a “Shower at every visit.” The HA care plan was not updated to include instructions on what the HA should do should the dressings on the right heel and coccyx become dislodged or wet during the shower. Clinical Record 13: The patient elected the hospice benefit on 12/19/2024. The plan of care dated 12/19/2024 through 03/18/2025 ordered “HA 2x per week.” On 01/29/2025, the physician ordered wound care with a dressing to the patient’s coccyx wound. The HA care plan dated 01/30/2025 assigned the HA the relevant task of a “Bed bath at every visit.” The HA care plan did not document instructions on what the HA should do should the dressings on the coccyx wound become dislodged or wet during the bed bath. During a joint record review on 04/24/2025, the Area Executive of Clinical Operations confirmed that the wound dressing instructions were not included on the HA care plans.”

“It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide; and ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 8 of 17 (47%) clinical records reviewed of patients who received Hospice Aide (HA) services, the agency did not ensure the Registered Nurse (RN) made an on-site supervisory visit to the patient’s home no less frequently than every 14 days. Clinical Record 2: The patient elected the hospice benefit on 01/18/2025. The plan of care dated 01/18/2025 through 04/17/2025 ordered “HA 2x per week.” A clinical record review revealed HA supervisory visits dated 03/12/2025 and 03/27/2025, with 15 days outstanding. Clinical Record 3: The patient elected the hospice benefit on 09/29/2023. The plan of care dated 09/29/2023 through 12/27/2023 ordered “HA 2x per week.” A clinical record review revealed HA supervisory visits dated 10/12/2023,10/31/2023, and 11/15/2023, with 19 and 15 days outstanding, respectively. Clinical Record 11: The patient elected the hospice benefit on 11/06/2024. The plans of care dated 11/06/2024 through 02/03/2025 and 02/04/2025 through 04/04/2025 ordered “HA 2x per week.” A clinical record review revealed HA supervisory visits dated 11/22/2024 and 12/10/2024, with 18 days outstanding. HA supervisory visits were completed on 12/23/2024, 01/08/2025, and 01/24/2025, with 16 days outstanding between each of the HA supervisory visits. Additionally, HA supervisory visits were completed on 02/24/2025, 03/11/2025, and 04/01/2025, with 15 and 22 days outstanding, respectively. Clinical Record 13: The patient elected the hospice benefit on 12/19/2024. The plan of care dated 12/19/2024 through 03/18/2025 ordered “HA 2x per week.” A clinical record review revealed HA supervisory visits dated 02/25/2025 and 03/12/2025, with 15 days outstanding. Clinical Record 15: The patient elected the hospice benefit on 09/12/2024. The plan of care dated 09/12/2024 through 12/10/2024 ordered “HA 1x per week.” The first HA visit note was dated 09/17/2024. The first HA supervisory visit was dated 10/03/2024, with 16 days outstanding. Clinical Record 16: The patient elected the hospice benefit on 03/13/2025. The plan of care dated 03/13/2025 through 05/11/2025 ordered “HA 2x per week.” A clinical record review revealed HA supervisory visits dated 03/24/2025 and 04/17/2025, with 24 days outstanding. Clinical Record 18: The patient elected the hospice benefit on 10/16/2024. The plan of care dated 01/14/2025 through 04/13/2025 ordered “HA 2x per week.” A clinical record review revealed HA supervisory visits dated 02/06/2025 and 02/22/2025, with 16 days outstanding. Clinical Record 23: The patient elected the hospice benefit on 11/15/2024. The plan of care dated 11/15/2024 through 01/08/2025 ordered “HA 2x per week.” A clinical record review revealed HA supervisory visits dated 11/21/2024 and 12/06/2024, with 15 days outstanding. During joint record reviews on 04/23/2025 and 04/24/2025, the Area Executive of Clinical Operations confirmed that HA supervisory visits were completed less frequently than every 14 days.”

“It is required that the designated IDG member provides the SNF/NF or ICF/IID with the following information for each patient/resident: The most recent hospice plan of care; hospice election form and any advance directives; physician certification and recertification of the terminal illness; names and contact information for hospice staff involved in the patient’s care; instructions on how to access the hospice’s 24-hour on-call system; hospice medication information; and hospice physician and attending physician (if any) orders. This standard was not met as evidenced by observation, clinical record review, and interview. In 1 of 3 (33%) home visits to a patient/resident residing at a skilled nursing facility (SNF), the agency did not ensure that the SNF was provided with the patient’s most recent plan of care (POC). Home Visit 1/Clinical Record 1: The patient elected the hospice benefit on 01/14/2025 and resided in a SNF. During the home visit with the Registered Nurse (RN) [Personnel Record 9] on 04/22/2025, the hospice information binder at the SNF nurses’ station was reviewed with the RN [Personnel Record 9]. The patient’s POC in the hospice information binder at the SNF was dated 01/14/2025 through 03/14/2025. The RN [Personnel Record 9] confirmed that the plan of care at the SNF was not the most recent POC dated 03/15/2025 through 05/13/2025. During an interview on 04/22/2025, the Director of Clinical Services confirmed the finding, stating, “The most recent plan of care should be 03/15/2025 through 05/13/2025.””