Bristol Hospice

“It is required that the hospice Interdisciplinary Group, in consultation with the individual’s attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by clinical record review and interview. In 7 of 18 (39%) clinical records reviewed, the agency did not ensure that the hospice interdisciplinary group (IDG) completed an initial comprehensive assessment no later than five (5) calendar days after the patient’s election of hospice care. Clinical Record 1: The patient elected the hospice benefit on 10/31/2024. The Registered Nurse (RN) initial assessment documented, “Patient willing to meet with Spiritual Counselor (SC).” The interdisciplinary group (IDG) notes dated 11/06/2024 (six (6) days after the election of hospice care) documented the SC “Attempted to notify family - awaiting a callback.” A clinical record review revealed no evidence the SC or Social Worker completed an initial assessment of the patient no later than 5 days after the election of hospice care. There was no evidence that the patient refused SW services. Clinical Record 2: The patient elected the hospice benefit on 05/29/2024. The SW completed the patient’s initial assessment on 06/04/2024, six (6) days after the election of hospice care. A clinical record review revealed no evidence of the SC initial assessment being completed and no documentation that the patient/family refused or requested a delay in the SC initial assessment. Clinical Record 7: The patient elected the hospice benefit on 07/16/2024. The SC completed the initial spiritual assessment on 07/22/2024, six (6) days after the election of hospice care. A clinical record review revealed no documentation that the patient/family refused or requested a delay in the SC initial assessment. Clinical Record 11: The patient elected the hospice benefit on 07/02/2024. The SC and SW initial assessments were completed on 07/08/2024 (six (6) days after the election of hospice care) and 07/09/2024 (seven (7) days after the election of hospice care), respectively. A clinical record review revealed no documentation that the patient/family refused or requested a delay in the SC or SW initial assessments. Clinical Record 13: The patient elected the hospice benefit on 11//21/2024. The SC initial assessment was completed on 11/29/2024 (eight (8) days after the election of hospice care). There was no evidence the SW initial assessment was completed. A clinical record review revealed no documentation that the patient/family refused or requested a delay in the SC or SW initial assessments. Clinical Record 16: The patient elected the hospice benefit on 10/02/2024. There was no evidence the SW initial assessment was completed. A clinical record review revealed no documentation that the patient/family refused or requested a delay in the SW initial assessment. Clinical Record 19: The patient elected the hospice benefit on 11/25/2024. There was no evidence the SW initial assessment was completed. A clinical record review revealed no documentation that the patient/family refused or requested a delay in the SW initial assessment. During an interview on 12/13/2024, the Executive Director and Clinical Supervisor confirmed that the IDG did not complete an initial comprehensive assessment within five calendar days after the election of hospice care and did not document that the patient and/or family/caregiver refused or delayed the initial assessments.”

“It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. This standard was not met as evidenced by clinical record review and interview. In 3 of 8 (38%) clinical records reviewed of patients receiving Hospice Aide services with changes related to the plan of care, the agency did not ensure the Hospice Aide (HHA) reported changes in the patient’s needs to the Registered Nurse (RN). Clinical Record 1: The patient elected hospice care on 10/31/2024 with the diagnosis of cerebral atherosclerosis. The plan of care ordered HHA services two (2) times per week. The HHA care plan dated 11/03/2024 assigned the HHA the relevant task: seated shower. The aide visit note dated 12/06/2024 reported the patient refused the “seated shower.” A clinical record review revealed no evidence the HHA reported the change related to the HHA care plan with the patient refusing the “seated shower” to the RN. Clinical Record 5: The patient elected hospice care on 06/12/2024 with the diagnosis of multiple sclerosis. The plan of care ordered HHA services one (1) time per week. The HHA care plan dated 06/16/2024 assigned the HHA the relevant tasks: bed bath, comb or brush hair, and fingernail care every visit. The HHA visit note dated 06/18/2024 documented that the patient refused the bed bath, comb or brush hair, and fingernail care. A clinical record review revealed no evidence the HHA reported the change related to the HHA care plan with the patient refusing the bed bath, comb or brush hair, and fingernail care to the RN. Clinical Record 9: The patient elected hospice care on 12/22/2023 with the diagnosis of unspecified dementia and unspecified severity with anxiety. The plan of care ordered HHA services two (2) times per week. The HHA care plan dated 06/04/2024 assigned the HHA the relevant tasks: fingernail care, and remove soiled arm sleeves, and replace with clean every visit. The HHA visit note dated 06/13/2024 documented the patient refused the tasks of fingernail care and removing soiled arm sleeves. A clinical record review revealed no evidence the HHA reported the change related to the HHA care plan with the patient refusing the fingernail care and soiled sleeve removal and replacement to the RN. The Executive Director and Clinical Supervisor confirmed in an interview on 12/13/2024 that the aide had not reported the changes in the patient’s needs and care plan to the RN as the changes related to the aide’s care plan.”

“It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician a copy of the hospice discharge summary and the patient’s record, if requested. This standard was not met as evidenced by clinical record review and interview. In 2 of 2 (100%) clinical records reviewed of patients who revoked the hospice benefit or were no longer terminally ill, the agency did not ensure a copy of the discharge summary was forwarded to the patient’s attending physician. Clinical Record 8: The patient elected the hospice benefit on 07/20/2024. On 07/26/2024, the patient’s family decided to transfer the patient to the hospital to pursue aggressive treatment and revoke the hospice benefit. A clinical record review revealed no evidence the discharge summary was forwarded to the physician. Clinical Record 9: The patient elected the hospice benefit on 12/22/2023, revoked the hospice benefit, and was discharged as no longer terminally ill on 06/15/2024. A clinical record review revealed no evidence the discharge summary was forwarded to the physician. During an interview on 12/13/2024, the Executive Director and Clinical Supervisor confirmed that the agency did not forward a copy of the discharge summary to the patient’s attending physician.”