24/7 Apollo Hospice and Palliative Care

“It is required that each patient’s individualized written plan of care 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, interview and observation. In 2 of 14 (14%) clinical records reviewed it was revealed that the agency did not ensure the plans of care included interventions based on the problems identified in the comprehensive assessments. CLINICAL RECORD 1: In the initial comprehensive nursing assessment, dated 07/11/2025, the RN documented that the patient had a Foley catheter 16 French in place. During the home visit (Home Visit 1) on 07/15/2025, conducted with the Chaplain (Personnel Record 6), the patient was observed with a Foley catheter in place. The plan of care (POC), dated 07/11/2025, did not include any problems, goals, or interventions related to the Foley catheter. The POC included the following statements for the genitourinary system problem; “Potential for altered bladder elimination related to disease process incontinence.” The following interventions were listed; “Instruct patient/family/caregiver on proper incontinence care; on-going assessment of urinary eliminations status discomfort, complications and alterations; instruct patient/family/caregiver regarding new medication/treatment order and side effects; monitor/assess effectiveness of current and new medication/treatment.” On 07/16/2025 during an interview the Director of Patient Care Services (DPCS) reported that this was a new admission, and the Foley catheter interventions were missed on the initial plan of care. CLINICAL RECORD 3: In the initial spiritual assessment, dated 05/02/2025, the Chaplain documented “source of distress/concern included anticipatory grief.” On the visit note dated 06/21/2025 the Chaplain documented, “Chaplain to remain supportive and provide ongoing spiritual care and emotional encouragement for the duration of hospice services to ensure spiritual needs are met and addressed.” The plan of care dated 04/30/2025 to 07/28/2025, did not include any problems, goals, or interventions related to anticipatory grief or spiritual issues. During an interview with the Administrator and DPCS on 07/16/2025 they confirmed the POC did not include any goals or interventions to address the spiritual issues. The Administrator said that the Chaplain discussed the patient needs during the interdisciplinary team meetings and because of that she didn’t realize they weren’t documented on the POC.”

“It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. Each patient’s record includes, at a minimum signed copies of the notice of patient rights and the hospice election statement. This standard was not met as evidenced by clinical record review, document review and interview. In 3 of 14 (21%) clinical records reviewed it was revealed that the agency did not ensure the record included election of benefit forms that were completed and signed in accordance with regulation. Per the Code of Federal Regulations: § 418.24 Election of hospice care. (b) Content of election statement. The election statement must include the following: (4) The effective date of the election, which may be the first day of hospice care or a later date but may be no earlier than the date of the election statement. CLINICAL RECORD 2: The ‘Election of Hospice Benefit’ document was signed by the patient’s power of attorney (POA) on 07/08/2025. The document included the hospice election statement, “I (patient name) choose to elect the Medicare hospice benefit and receive Hospice services from (Agency) to begin on (effective date).” The effective date of election was left blank. CLINICAL RECORD 5: The ‘Election of Hospice Benefit’ document was signed by the patient’s spouse on 01/21/2025. The document included the hospice election statement, “I (patient name) choose to elect the Medicare hospice benefit and receive Hospice services from (Agency) to begin on (effective date).” The effective date of election was left blank. CLINICAL RECORD 6: The ‘Election of Hospice Benefit’ document was signed by the patient’s power of attorney (POA) on 05/15/2025. The document included the hospice election statement, “I (patient name) choose to elect the Medicare hospice benefit and receive Hospice services from (Agency) to begin on (effective date).” The effective date of election was left blank. Personnel Record 1: During the interview on 07/16/2025 the Administrator and Director of Patient Care Services reviewed the election of benefit forms and reported that “somehow we missed the (effective) date on those forms.” The Administrator also confirmed that all three were Medicare patients. Per the Code of Federal Regulations: § 418.24 Election of hospice care. (b) Content of election statement. The election statement must include the following: (4) The effective date of the election, which may be the first day of hospice care or a later date, but may be no earlier than the date of the election statement.”