Lifeline Hospice, Inc.

“Based on record review and interview, the hospice IDG failed to ensure supervision of care and services for the terminal illness for one (Pt #4) of 15 patients. This failed practice could result in POCs that are not individualized to the patient’s condition and discrepancies between the POC and the services actually provided. (See L0539) Based on record review and interview, the hospice IDG failed to ensure a POC was full developed and completed for one (Pt #4) of 15 patients. This failed practice could result in POCs that: 1. Do not identify appropriate interventions.2. Do not address specific conditions.3. Do not coordinate between disciplines.4. Do not enhance the quality of a patient’s life. (See L0543)Based on record review and interview, the hospice IDG failed to ensure the POC included individualized patient and family goals and interventions for one (Pt #4) of 15 patients. This failed practice could result in patient and family having missed opportunities for: 1. Individualized intervention for symptom management.2. Better pain relief.3. Support services targeted to the patient’s condition and preferences. (See 545)Based on record review and interview, the hospice failed to ensure the POC included all services necessary for the palliation and treatment of the terminal illness for one (Pt #4) of 15 patients. This failed practice could cause unnecessary suffering and a reduced quality of life for patients. (See L0546) Based on record review and interview, the hospice failed to ensure the POC included the scope and frequency of services specific to the patient and family needs for one (Pt #4) of 15 patients. This failed practice could cause the patient and family to experience increased caregiver burden and reduced satisfaction. (See L0547)Based on record review and interview, the hospice failed to ensure the POC included palliation and management of the terminal illness and related conditions for one (Pt #4) of 15 patients. This failed practice could cause the patient and family to suffer harm due to the patient’s need for comfort and well-being not being met. (See L0549)Based on record review and interview, the hospice failed to ensure the POC included necessary medical supplies for one (Pt #4) of 15 patients. This failed practice could cause a lower quality of life and distress for the patient and family. (See 550)Based on record review and interview, the hospice failed to ensure1. A POC was developed and implemented for one (Pt #4) of 15 patients. 2. IDG meetings were conducted at least every 15 days for six (Pt # 7. 8. 9. 11, 12, and 14) of 15 patients. This failed practice could cause patient harm and poor outcomes from no oversite of care. (See 552)”

“Based on record review and interview, the hospice failed to develop a POC that addressed: 1. Patient and family goals for one (Pt #4) of 15 patients.2. Patient comfort and dignity for one (Pt #4) of 15 patients.3. Patient and family needs for one (Pt #4) of 15 patients. This failed practice had the likelihood for the patient to have a loss of comfort and dignity and the family to experience emotional and psychological strain. (See L0650) Based on record review and interview, the hospice failed to ensure a POC was individually developed for one (Pt #4) of 15 patients. This failed practice had the likelihood to for the patient to have unmet emotional and spiritual needs and inadequate symptom management. (See L0652) Based on record review and interview, the hospice failed to ensure:1. The development and update of POCs for one (Pt #4) of 15 patients. 2. Clinical notes were completed in the record for one (Pt #4) of 15 patients. This failed practice had the likelihood to lead to:1. Incomplete quality assessments.2. Potential deficiencies in patient safety and care coordination.3. Patient and family concerns not being addressed. (See L0672)”

“Based on record review and interview, the hospice failed to ensure:1. The development and update of POCs for one (Pt #4) of 15 patients.2. The completion of clinical notes for one (Pt #4) of 15 patients. This failed practice placed all patients and families at risk of:1. Incomplete quality assessments.2. Potential deficiencies in patient safety and care coordination.3. Patient and family concerns not being addressed. (See L0672)Based on record review and interview, the hospice failed to ensure the patients record included all necessary information for three (Pt #4, 7, and 11) of 15 patients. This failed practice placed all patients and their families at risk of inaccurate care planning and not being provided care that is consistent and coordinated. (See 674)Based on record review and interview, the hospice failed to ensure physician’s orders were obtained for one (Pt #4) of 15 patients. This failed practice placed all patients and their families at risk of unnecessary harm, adverse reactions or complications. (See 678)”

“Based on record review and interview, the hospice IDG failed to ensure supervision of care and services for the terminal illness for one (Pt #4) of 15 patients. This failed practice could result in POCs that are not individualized to the patient’s condition and discrepancies between the POC and the services actually provided. Findings: Pt #4A review of the clinical record showed no POC was developed after the admission date of 02/09/26. IDG meetings were held 02/19/26, 03/05/26, and 03/19/26 with no:1. Disciplines of services ordered for patient care. 2. The frequencies necessary for patient care.3. The patient interventions (wound care, etc.) or goals.4. The needed supplies and equipment for patient services.On 07/22/26 at 12:11 pm, Staff A stated there were no:1. POC in the record.2. The IDG did not address the patient’s needs.3. Physician orders were not written to address the patient needs.”

“Based on record review and interview, the hospice IDG failed to ensure a POC was full developed and completed for one (Pt #4) of 15 patients. This failed practice could result in POCs that:1. Do not identify appropriate interventions.2. Do not address specific conditions.3. Do not coordinate between disciplines.4. Do not enhance the quality of a patient’s life. Findings: Pt #4A review of the clinical record yielded no POC after the patient admission 02/09/26 and IDG meetings conducted on 02/19/26, 03/05/26, and 03/19/26. On 07/22/26 12:11 p.m., Staff A stated there is no POC for Pt #4.”

“Based on record review and interview, the hospice IDG failed to ensure the POC included individualized patient and family goals and interventions for two (Pt #2 and 4) of 15 patients. This failed practice could result in patient and family having missed opportunities for:1. Individualized intervention for symptom management.2. Better pain relief.3. Support services targeted to the patient’s condition and preferences. Findings: Pt #2A review of a POC dated 12/17/25 - 01/07/26 with IDG updates dated 12/29/25 which showed the patient’s terminal diagnosis as hypertensive chronic kidney disease unspecified. The POC showed no interventions or goals related to the terminal diagnosis. Pt #4A review of the patient record showed a clinical admission dated of 02/09/26 and IDG meetings conducted 02/19/26, 03/05/26 and 03/19/26 showed no development of a POC. On 07/22/26 12:11 p.m., Staff A stated there is no POC for Pt #4.”

“Based on record review and interview, the hospice failed to ensure the POC included all services necessary for the palliation and treatment of the terminal illness for one (Pt #4) of 15 patients. This failed practice could cause unnecessary suffering and a reduced quality of life for patients. Findings: Pt #4A review of the clinical record yielded no POC after the patient admission 02/09/26 and IDG meetings were conducted 02/19/26, 03/05/26, and 03/19/26. Showed no orders for pain management related to the terminal diagnosis of vascular dementia and Stage 4 pressure. On 07/22/26 12:11 p.m., Staff A stated there was no POC for Pt #4.”

“Based on record review and interview, the hospice failed to ensure the POC included the scope and frequency of services specific to the patient and family needs for one (Pt #4) of 15 patients. This failed practice could cause the patient and family to experience increased caregiver burden and reduced satisfaction. Findings: Pt #4A review of the clinical record showed no POC was developed after the admission date of 02/09/26 and IDG meetings were held 02/19/26, 03/05/26, and 03/19/26. The clinical record showed no ordered disciplines and frequency of patient visits. On 07/22/26 at 12:11 pm, Staff A stated there was no POC for Pt #4.”

“Based on record review and interview, the hospice failed to ensure the POC included palliation and management of the terminal illness and related conditions for one (Pt #4) of 15 patients. This failed practice could cause the patient and family to suffer harm due to the patient’s need for comfort and well-being not being met. Findings: Pt #4A review of the clinical record showed no POC after the patient admission 02/09/26 and IDG meetings conducted 02/19/26, 03/05/26, and 03/19/26. The clinical record showed no orders for medications and treatments ordered for the patient. On 07/22/26 12:11 p.m., Staff A stated there is no POC for Pt #4.”

“Based on record review and interview, the hospice failed to ensure the POC included necessary medical supplies for one (Pt #4) of 15 patients. This failed practice could cause a lower quality of life and distress for the patient and family. Findings: Pt #4A review of the clinical record yielded no POC after the patient admission 02/09/26 and IDG meetings conducted 02/19/26, 03/05/26, and 03/19/26. The clinical record showed no for supplies necessary to meet the patient needs. On 07/22/26 12:11 p.m., Staff A stated there was no POC for Pt #4.”

“Based on record review and interview, the hospice failed to ensure1. A POC was developed and implemented for one (Pt #4) of 15 patients. 2. IDG meetings were conducted at least every 15 days for six (Pt # 7. 8. 9. 11, 12, and 14) of 15 patients. This failed practice could cause patient harm and poor outcomes from no oversite of care. Findings: Pt #4A review of the patient clinical showed no individualized POC after the patient admission on02/09/26 and IDG meetings conducted 02/19/26, 03/05/26, and 03/19/26. Pt #7A review of the clinical record showed a POC dated 05/24/26 to 08/01/26 with IDG meetings conducted on 05/28/26, 06/25/26 (28 days between IDG meetings), and 07/09/26. Pt # 8A review of the clinical record showed a POC dated 05/27/26 to 08/24/26 with IDG meetings conducted on 05/28/26, 06/25/26 (28 days between IDG meetings), and 07/09/26. Pt #9A review of the clinical record showed a POC dated 05/18/26 to 08/15/26 with IDG meetings conducted on 05/28/26, 06/25/26 (28 days between IDG meetings), and 07/09/26. Pt #11A review of the clinical record showed a POC dated 05/18/26 to 08/15/26 with IDG meetings conducted on 05/28/26, 06/25/26 (28 days between IDG meetings), and 07/09/26. Pt #12A review of the clinical record showed a POC dated 04/29/26 to 06/25/26 with IDG meetings conducted on 04/30/26, 05/28/26 (28 days between IDG meetings), and 06/25/26 (28 days between IDG meetings). Pt #14A review of the clinical records showed a POC dated 03/31/26 to 06/28/26 with IDG meetings conducted on 04/02/26, 04/16/26, 04/30/26, 05/28/26 (28 days between IDG meetings), and 06/25/26 (28 days between IDG meetings). On 07/22/26 12:11 p.m., Staff A stated:1. There was no POC for Pt #4.2. The IDG meetings were not held every 15 days.”

“Based on record review and interview, the hospice failed to develop a POC that addressed: 1. Patient and family goals for one (Pt #4) of 15 patients.2. Patient comfort and dignity for one (Pt #4) of 15 patients.3. Patient and family needs for one (Pt #4) of 15 patients. This failed practice had the likelihood for the patient to have a loss of comfort and dignity and the family to experience emotional and psychological strain. Findings: Pt #4A review of the patient record showed the patient had an initial nursing assessment 02/09/26 with IDG meetings 02/19/26, 03/05/26, and 03/19/26. No care plan was ever developed that addressed:1. The patient and family goals.2. Enhancing the patient comfort and dignity.3. The patient and family needs. On 07/22/26 at 12:11 p.m., Staff A stated a POC was never not individually developed.”

“Based on record review and interview, the hospice failed to ensure:1. The development and update of POCs for one (Pt #4) of 15 patients.2. The completion of clinical notes for one (Pt #4) of 15 patients. This failed practice placed all patients and families at risk of:1. Incomplete quality assessments.2. Potential deficiencies in patient safety and care coordination.3. Patient and family concerns not being addressed. Findings: Pt #4A review of the clinical record showed:1. A POC was not developed. 2. Blank RN assessment notes dated 02/13/26, 02/23/26, 03/03/26, 03/06/26/, 03/10/26, 03/13/26.3. The RN assessment dated 02/21/26 showed a Stage 4 and a Stage 2 pressure ulcer present since admission 02/09/26. Comprehensive RN assessment notes dated 02/09/26, 02/16/26, and 02/27/26 had blank wound care worksheets. On 07/22/26 at 12:11 p.m., Staff A stated:1. A POC was not developed for Pt #4.2. RN assessments were blank and incomplete.3. Three wound care worksheets were blank and incomplete on the comprehensive RN assessments.”

“Based on record review and interview, the hospice failed to ensure the patients record included all necessary information for three (Pt #4, 7, and 11) of 15 patients. This failed practice placed all patients and their families at risk of inaccurate care planning and not being provided care that is consistent and coordinated. Findings: Pt #4A review of the clinical record showed:1. Blank RN assessment notes dated 02/13/26, 02/23/26, 03/03/26, 03/06/26/, 03/10/26, 03/13/26.2. The RN assessment dated 02/21/26 showed a Stage 4 and a Stage 2 pressure ulcer present since admission 02/09/26. Comprehensive RN assessment notes dated 02/09/26, 02/16/26, and 02/27/26 had blank wound care worksheets. The record showed no patient responses to:1. The patient medication regimen.2. Patient symptom treatment.3. The patient’s wound care regimen.4. The services that had received. Pt #7A review of a POC dated 05/04/26 to 08/01/26 showed RN assessment notes dated 06/11/26, 06/19/26, 07/10/26, and 07/17/26 that were blank and incomplete. Pt #11A review of a POC dated 05/15/26 to 08/15/26 showed RN assessment notes dated 05/21/26, 05/28/26, 06/04/26, 06/11/26, and 06/14/26 that were blank and incomplete. On 07/22/26 at 12:11 p.m., Staff A stated nurses notes for Pt #4, 7, and 11 were blank and incomplete.”

“Based on record review and interview, the hospice failed to ensure physician’s orders were obtained for one (Pt #4) of 15 patients. This failed practice placed all patients and their families at risk of unnecessary harm, adverse reactions or complications. Findings: Pt #4A review of the clinical record showed an initial nursing assessment was completed 02/09/26 with IDG meetings held on 02/19/26, 03/05/26, and 03/19/26. The record clinical showed no orders for:1. The disciplines to provide services.2. The frequencies of services being provided.3. The medications that the patient needed for treatment.4. The wound care orders for a Stage 4 and Stage 2 pressure ulcer.5. The supplies and equipment. On 07/22/26 at 12:15 p.m., Staff A stated Pt #4 had no physician orders and no developed POC.”

“Based on record review and interview, the hospice failed to ensure a bereavement care plan was initiated or was included as a part of the overall POC after the initial and ongoing spiritual/bereavement assessments for (Patients #1, 2, 3, 4, 5, 6, 7 and #11) of 11 patients. Findings: Patient #1 A review of the clinical record showed an election of the hospice benefit on 01/07/22 with a completion of the initial spiritual/bereavement assessment on 01/10/22 and an additional spiritual/bereavement assessment on 03/14/24. A review of a POC dated 02/26/24 to 04/25/24 and IDG updates to the POC on 03/07/24, 03/21/24, 04/04/24 and on 04/18/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #2 A review of the clinical record showed an election of the hospice benefit on 03/18/22 with a completion of the initial spiritual/bereavement assessment on 03/21/22. A review of a POC dated 03/07/24 to 05/05/24 and IDG updates to the POC on 03/07/24, 03/21/24, 04/04/24 and on 04/18/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #3 A review of the clinical record showed an election of the hospice benefit on 03/01/18 and showed no completion of the initial spiritual/bereavement assessment and showed no documentation of patient refusal of an initial spiritual/bereavement assessment. A review of a POC dated 04/02/24 to 05/31/24 and IDG updates to the POC on 04/04/24 and on 04/18/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #4 A review of the clinical record showed an election of the hospice benefit on 03/19/20 with a completion of the initial spiritual/bereavement assessment on 03/19/20. A review of a POC dated 02/27/24 to 04/26/24 and IDG updates to the POC on 03/07/24, 03/21/24, 04/04/24 and on 04/18/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #5 A review of the clinical record showed an election of the hospice benefit on 07/02/20 with a completion of the initial spiritual/bereavement assessment on 07/07/20. A review of a POC dated 04/12/24 to 06/10/24 and IDG updates to the POC on 04/18/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #6 A review of the clinical record showed an election of the hospice benefit on 03/15/24 with a completion of the initial spiritual/bereavement assessment on 03/18/24. A review of a POC dated 03/15/24 to 06/12/24 and IDG updates to the POC on 03/21/24, 04/04/24 and on 04/18/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #7 A review of the clinical record showed an election of the hospice benefit on 06/23/23 with a completion of the initial spiritual/bereavement assessment on 06/27/23. A review of a POC dated 02/18/24 to 04/17/24 and IDG updates to the POC on 02/22/24, 03/07/24, 03/21/24 and on 04/04/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. Patient #11 A review of the clinical record showed an election of the hospice benefit on 11/03/21 with a completion of the initial spiritual/bereavement assessment on 11/08/21. A review of a POC dated 12/23/23 to 02/20/24 and IDG updates to the POC on 12/28/23, 01/11/24, 01/25/24, 02/08/24 and on 02/22/24 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no changes in orders. On 04/25/24 at 1:50 p.m. to 2:50 p.m., Staff A stated: 1. The patients are given a bereavement risk score at the time of the initial spiritual/bereavement assessment and are advised of spiritual and bereavement services provided by the Hospice. If at any time the patient or family requests spiritual or bereavement services, the social worker or chaplain is added to the POC. The bereavement program consists of intermittently timed mail outs and follow up telephone calls which begin after the patients death; 2. Documentation for patient #3 shows no reason why the patient did not have an initial or follow up spiritual/bereavement assessment and; 3. The Hospice does not maintain a written POC for bereavement; bereavement is not included on the overall POC unless the patients family or caregiver is assessed as a high risk for bereavement.”

“Based on record review and interview, the hospice failed to ensure the plan of care was developed to include interventions and goals necessary for the identification, palliation and management of pain for one (Patient #6) of 11 patients. Findings: Patient #6 A plan of care dated 03/15/24 to 06/12/24 and IDG plan of care updates dated 03/21/24, 04/04/24 and 04/18/24 failed to include interventions necessary for the palliation and management of pain. A recertification assessment dated 03/15/24 identified the patient had facial grimacing and moaning; and pain was unable to be accurately assessed. Review of a medical History and Physical dated 12/05/22 documented the patient had hip and knee pain. Communication notes to the nurse practitioner dated 03/19/24 stated the patient was continuing to express signs and symptoms of pain and requested an order for Ativan per mouth every 12 hours as needed for pain. On 04/25/24 at 2:35 p.m., Staff A stated: 1. The POC did not include interventions for the palliation and management of pain and; The nurse practitioner thought the facial grimacing and moaning reported on 03/19/24 were related to behaviors and not pain.”

“Based on record review and interview, the hospice failed to ensure skilled nurse services were provided in accordance with the plan of care frequency for two (Patients #1 and #9) of 11 patients. Findings: Patient #1 A review of the plan of care dated 02/26/24 to 04/25/24 ordered SN visits at a frequency of one every week. Documentation showed during the weeks of 02/26/24 to 03/02/24 no SN visits were made (one visit ordered, no visit made). Documentation showed no patient or family refusal of visits and no changes in the ordered frequency for the SN. Patient #9 A review of the plan of care dated 02/26/24 to 04/25/24 ordered SN visits at a frequency of two times every week. Documentation showed during the weeks of 12/03/23 to 12/09/23 one SN visit was conducted on 12/07/23 (two visit ordered, one visit made). Documentation showed no patient or family refusal of visits and no changes in the ordered frequency for the SN. On 04/25/24 at 1:50 p.m. to 2:50 p.m., Staff A stated skilled nurse frequencies were not followed as ordered for patients #1 and #9.”

“Based on record review and interview, the hospice failed to ensure social work services were included on the POC for one (Patient #2) of 11 patients. Findings: Patient #2 A review of a POC dated 03/07/24 to 05/18/24 and IDG updates to the POC on 03/21/24, 04/04/24 and on 04/18/24 documented no social work services as a part of the POC. Documentation showed no patient refusal of social work services and no changes in orders. On 04/25/24 at 2:05 p.m., Staff A stated documentation showed no patient refusal of social work services and social work services should have been discussed during the IDG team meetings.”

“Based on record review and interview, the hospice failed to ensure on-site aide supervisory visits were completed every 14 days for two (Patients #6 and #7) of 11 patients. Findings: Patient #6 A review of the plan of care dated 03/15/24 to 06/12/24 showed a home health aide visit frequency of three times per week. Documentation showed supervisory visits were made on 03/29/24 and a scheduled supervisory visit on 04/12/24 was not started or completed (26 days between last conducted supervisory visit and the date of clinical record review on 04/24/24). Patient #7 A review of the plan of care dated 02/18/24 to 04/17/24 showed a home health aide visit frequency of two times per week. Documentation showed supervisory visits were made on 03/21/24 and a scheduled supervisory visit on 04/12/24 was not started or completed (33 days between last conducted supervisory visit and the date of clinical record review on 04/24/24). On 04/25/24 at 2:35 p.m. to 2:40 p.m., Staff A stated supervisory aide visits were not conducted/completed every 14 days for patients #6 and #7.”

“Based on record review and interview, the hospice failed to ensure documentation of physician certificate of terminal illness for subsequent certification periods for two (Patients #2 and #7) of 11 patients. Findings: Patient #2 A review of the clinical record showed a start of care date of 03/18/22 and subsequent recertification plans of care dated 03/13/23 to 05/11/23; 05/12/23 to 07/10/23; 07/11/23 to 09/08/23; 09/09/23 to 11/07/23; 11/08/23 to 01/06/24 and 01/07/24 to 03/06/24. Documentation showed no certificate of terminal illness for ongoing hospice services or related physician statement of imminence of death during the identified subsequent certification periods. Patient #7 A review of the clinical record showed a start of care date of 06/23/23 and subsequent recertification plans of care dated 08/22/23 to 10/20/23; 10/21/23 to 12/19/23 and 12/20/23 to 02/17/24. Documentation showed no certificate of terminal illness for ongoing hospice services or related physician statement of imminence of death during the identified subsequent certification periods. On 04/25/24 at 2:05 p.m. to 2:40 p.m., Staff A stated patients #2 and #7 had no certificate of terminal illness or related physician statement of imminence of death for identified subsequent certification periods.”

“Based on record review and interview, the hospice failed to ensure completion of a discharge summary of care for one (Patient #11) of 11 patients. Findings: Patient #11 A review of the clinical record showed the patient was discharged from the hospice on 02/21/24 to in-patient residential care services at the patients family request. Documentation showed no discharge summary of care was completed or provided to the attending physician. On 04/25/24 at 3:00 p.m., Staff A stated the hospice did not complete or provide a discharge summary of care to the attending physician for patient #11.”

“Based on observation, record review and interview, the hospice failed to ensure the IDG communicated and coordinated the patients care with the residential care facility (Nursing Home) for three (Patients #2, 3 and #4) of 11 patients. Findings: On 04/24/24 at 3:00 p.m., an onsite visit to the residential care facility for patients #2, 3 and #4 was conducted. Observations at the residential care facility nursing station showed no hospice chart (binder) for patients #3 and #4. A hospice chart (binder) for patient #2 showed documentation it was last updated with POC information on 10/23/23. NH Staff 1 (name and title withheld) stated there should have been a hospice chart at the nursing desk for all three of the hospice patients and did not know what services patients #1, 2 and #3 received other than hospice aide services three times a week. Patient #2 A review of the POC dated 03/07/24 to 04/05/24 showed orders for SN one time a week, hospice aide three times a week and chaplain services one time a month. Documentation showed no IDG communications or coordination of care with the residential care facility (Nursing Home). Patient #3 A review of the POC dated 04/02/24 to 05/31/24 showed orders for SN one time a week, hospice aide three times a week and volunteer services one time a month. Documentation showed no IDG communications or coordination of care with the residential care facility (Nursing Home). Patient #4 A review of the POC dated 02/27/24 to 04/26/24 showed orders for SN one time a week, hospice aide three times a week and chaplain services one time a month. Documentation showed no IDG communications or coordination of care with the residential care facility (Nursing Home). On 04/25/23 at 2:05 p.m. to 2:20 p.m., Staff A stated: 1. Patients #3 and #4 should have had a hospice chart (binder) at the Nursing Home kept at the nursing desk; 2. The hospice did not update the hospice chart (binder) with updated POCs since the COVID pandemic occurred when the Nursing Home limited care with the patients and they (Nursing Home) have not resumed patient conferences with the hospice and; 3. The hospice staff do not routinely document contact with the Nursing Home staff.”