Quality of Life Hospice LLC

“It is required that the Interdisciplinary Group, in collaboration with the individual’s attending physician (if any), reviews, revises, and documents the individualized care plan as frequently as the patient’s condition requires. This standard was not met as evidenced by clinical record review and interview. In 4 of 6 (67%) clinical records reviewed revealed the agency did not ensure the individualized plan of care was updated as frequently as the patient’s condition required. Clinical Record 2: The patient elected the hospice benefit on 1/20/2024 for the diagnosis of Alzheimer’s disease. The Psychosocial plan of care (POC) dated 1/24/2024 reflected the interventions of “funeral planning and lack of coping skills.” Social worker visit on 3/6/2024 noted “Moved to new GH (group home) end of February due to husband stating he cannot pay for current GH costs. Husband owes prior GH 2 months’ worth of rent. Denied Medicaid. MSW will assist with other community resources.” During Home Visit 2 on 3/14/2024 with the social worker, the Site Visitor interviewed the social worker who advised she was assisting the husband regarding financial resources, Medicaid, community resources, and potential guardianship for the patient. No updates had been made to the psychosocial POC since admission. Clinical Record 3: The patient elected the hospice benefit on 1/29/2024 for the diagnosis of Parkinson’s disease. Nursing assessment dated 2/25/2024 noted “Patient uses wheelchair for mobility but with maximum assistance as he always attempts to stand up by himself. Per CG (caregiver) patient fell this morning after he attempted to get up from bed by himself, sustained a laceration to middle forehead.” During Home Visit 3 with RN site visitor noted a large scar, approximately 1 inch on his forehead. The RN The plan of care (POC) did not include a mobility POC or safety POC, nor did it include a skin integrity POC which addressed any of the issues noted in this assessment. Clinical Record 4: The patient elected the hospice benefit on 11/18/2023 for the diagnosis of Alzheimer’s disease. The plan of care (POC) dated 11/18/2023 Respiratory goal noted: optimum level of oxygen. The nursing assessment dated 12/5/2023 noted, “Patient transitioning at this time. Oxygen changed to continuous for shortness of breath. Comfort meds were given by caregivers.” The respiratory POC problem was not updated nor was an imminent death problem added to the POC. Clinical Record 6: The patient elected the hospice benefit on 12/22/2023 for the diagnosis of Alzheimer’s disease. A nursing visit was made on 1/18/2024 for “seizure-like activity” and the visit frequency was adjusted to daily as the patient was noted to be actively dying. The plan of care was not updated to include the seizures nor the imminent death problems and interventions. During an interview and joint record review with the Director of Nursing on 3/14/2024, the plans of care were reviewed, and it was confirmed they had not been updated as frequently as the patient condition required.”

“It is required that 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 4 of 6 (67%) clinical records reviewed in which aide services were accepted revealed the agency did not ensure the hospice registered nurse provided the aide with specific instructions. Clinical Record 1: The patient elected the hospice benefit on 11/18/2023 for the diagnosis of atherosclerotic heart disease. The hospice aide care plan dated 11/18/2023 included the relevant tasks of bathing the patient using a shower chair and assistance with dressing the patient. The revised aide care plan dated 2/7/2024 changed the bathing task from a shower chair to a bed bath. The initial nursing assessment dated 11/18/2023 listed the patient have oxygen at 2 liters per minute as needed. The oxygen was not listed on either aide care plan. Clinical Record 3: The patient elected the hospice benefit on 1/29/2024 for the diagnosis of Parkinson’s disease. The hospice aide care plan dated 1/29/2024 had relevant tasks of bathing via shower chair and shaving patient. The seizure disorder identified on the initial nursing assessment dated 1/29/2024 was not listed on the aide care plan. Clinical Record 4: The patient elected the hospice benefit on 11/18/2023 for the diagnosis of Alzheimer’s disease. The hospice aide care plan dated 11/18/2023 had the relevant tasks of bed bath and dressing. A nursing assessment dated 12/9/2023 noted patient was on oxygen 2 liters per minute continuously. The aide care plan did not notify the aide the patient was on oxygen. The aide care plan did not provide the aide with specific instructions for the oxygen during tasks. Clinical Record 6: The patient elected the hospice benefit on 12/22/2023 for the diagnosis of Alzheimer’s disease. The hospice aide care plan dated 12/22/2023 had the relevant tasks of bed bath and shaving the patient. The initial nursing assessment dated 12/22/2023 noted the patient was on oxygen at 2 liters per minute as needed and then on 1/18/2024 it was changed to continuously. The aide care plan did not notify the aide of the oxygen nor provide the aide with specific instructions for the oxygen during tasks. During an interview and joint record review with the Director of Nursing on 3/14/2024, it was confirmed the aide care plans did not include specific instructions for the aides.”

“It is required that a hospice aide provides services included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 6 (17%) clinical records reviewed in which aide services were accepted revealed the agency did not ensure the hospice aide provided services included in the plan of care. Clinical Record 1: The patient elected the hospice benefit on 11/18/2023 for the diagnosis of atherosclerotic heart disease. The aide care plan dated 2/7/2024 noted the bathing task type as a bed bath. Hospice aide note dated 3/8/2024 stated “Patient just finished lunch then shower was given.” Hospice aide note dated 3/11/2024 stated “Patient awake and shower given following all safety precautions.” During the aide observation visit on 03/14/2024, the hospice aide advised the site visitor she would be giving a “bed bath today but sometimes gave the patient a shower, depending on if the patient was able to get up that day.” This was also confirmed during an interview with the caregivers at the group home. During an interview and joint record review with the Director of Nursing on 3/14/2024, it was confirmed that the hospice aide care plan reflected a bed bath, and the aide noted a shower had been given.”