Merit Hospice LLC

“It is required that each patient’s individualized written plan of care reflect patient and family goals and identify planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review, document review and interview. In 11 of 14 (79%) Clinical records revealed that the hospice agency did not ensure that each patient’s individualized written plan of care included interventions based on problems identified in the initial and updated comprehensive assessments. Agency Policy, titled ‘Interdisciplinary Group Plan of Care’ (undated), stated in part. “The Plan of Care will include an assessment of the individual’s needs and identification of services, including the management of discomfort and symptom relief. The Plan of Care will contain interventions to manage pain and symptoms.” Clinical Record 1: The patient elected their hospice benefit on 08/29/2024 with a diagnosis of Unspecified Severe Protein-Calorie Malnutrition with secondary Adult Failure to Thrive. On the initial comprehensive assessment, dated 08/29/2024, the Registered Nurse (RN) documented the patient had weight loss. The plan of care, dated 08/29/2024 to 11/26/2024, did not include any problems, goals, or interventions related to weight loss. Clinical Record 2: The patient elected their hospice benefit on 10/01/2024 with a diagnosis of Hemiplegia and Hemiparesis following Cerebral Infarction with secondary Dysphagia and Aphasia. On the initial comprehensive assessment, dated 10/01/2024, the Registered Nurse (RN) documented the patient had symptoms of dysphagia, constipation, bowel and bladder incontinence, and shortness of breath. The plan of care, dated 10/01/2024 to 12/29/2024, did not include any problems, goals, or interventions related to these symptoms. Clinical Record 3: The patient elected their hospice benefit on 10/16/2023 with a diagnosis of Senile Degeneration of the Brain. On the initial comprehensive assessment, dated 10/16/2023, the Registered Nurse (RN) documented the patient had symptoms of bowel and bladder incontinence, and agitation. The plan of care, dated 10/16/2023 to 01/13/2024, did not include any problems, goals, or interventions related to these symptoms. Clinical Record 4: The patient elected their hospice benefit on 08/22/2024 with a diagnosis of Congestive Heart Failure. On the initial comprehensive assessment, dated 08/22/2024, the Registered Nurse (RN) documented the patient had symptoms of decreased appetite, bowel and bladder incontinence, and fall risk. The plan of care, dated 08/22/2024 to 11/19/2024, did not include any problems, goals, or interventions related to these symptoms. Clinical Record 5: The patient elected their hospice benefit on 09/21/2024 with a diagnosis of Malignant Neoplasm of Unspecified Renal Pelvis. On the initial comprehensive assessment, dated 09/21/2024, the Registered Nurse (RN) documented the patient had symptoms of expressive aphasia, bowel and bladder incontinence, shortness of breath with moderate exertion, edema, and constipation. The plan of care, dated 09/21/2024 to 12/19/2024, did not include any problems, goals, or interventions related to these symptoms. Clinical Record 6: The patient elected their hospice benefit on 09/19/2024 with a diagnosis of Malignant Neoplasm of Colon with secondary Malignant Neoplasm of Lung. On the initial comprehensive assessment, dated 09/19/2024, the Registered Nurse (RN) documented the patient had symptoms of bowel and bladder incontinence. The plan of care, dated 09/19/2024 to 12/17/2024, did not include any problems, goals, or interventions related to these symptoms. Clinical Record 7: The patient elected their hospice benefit on 06/13/2024 with a diagnosis of End Stage Renal Disease. On the initial comprehensive assessment, dated 06/13/2024, the Registered Nurse (RN) documented the patient had symptoms of dysphagia, fall risk, bowel and bladder incontinence, and weight loss. The plan of care, dated 06/13/2024 to 09/10/2024, did not include any problems, goals, or interventions related to these symptoms. Clinical Record 8: The patient elected their hospice benefit on 03/21/2024 with a diagnosis of Alzheimer’s Disease. On the initial comprehensive assessment, dated 03/21/2024, the Registered Nurse (RN) documented the patient had symptoms of dysphagia, fall risk, bowel and bladder incontinence, and weight loss. The plan of care, dated 03/21/2024 to 06/18/2024, did not include any problems, goals, or interventions related to these symptoms. Clinical Record 9: The patient elected their hospice benefit on 10/24/2024 with a diagnosis of Malignant Neoplasm of Stomach. On the initial comprehensive assessment, dated 10/24/2024, the Registered Nurse (RN) documented the patient had symptoms of edema, bowel and bladder incontinence, and shortness of breath. The plan of care, dated 10/24/2024 to 01/21/2025, did not include any problems, goals, or interventions related to these symptoms. Clinical Record 10: The patient elected their hospice benefit on 10/30/2024 with a diagnosis of Heart Failure. On the initial comprehensive assessment, dated 10/30/2024, the Registered Nurse (RN) documented the patient had symptoms of weakness, bowel and bladder incontinence, and shortness of breath. The plan of care, dated 10/30/2024 to 01/27/2025, did not include any problems, goals, or interventions related to these symptoms. Clinical Record 14: The patient elected their hospice benefit on 11/29/2023 with a diagnosis of Senile Degeneration of the Brain. On the initial comprehensive assessment, dated 11/29/2023, the Registered Nurse (RN) documented the patient had symptoms of fall risk, decreased oral intake, and bowel and bladder incontinence. The plan of care dated 11/29/2023 to 12/12/2023 did not include any problems, goals, or interventions related to these symptoms. During interviews on 11/05/2024 and 11/06/2024, the Director of Nursing stated that the agency was aware of the issues with the individualized patient’s plan of care and that the hospice agency had a performance improvement project/plan currently open to correct the non-compliance.”

“It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 10 of 14 (71%) records reviewed it was revealed that the agency did not ensure the individualized written plan of care included the medical supplies necessary to meet the patient’s needs Clinical Record 1: The patient elected their hospice benefit on 08/29/2024 with a diagnosis of Unspecified Severe Protein-Calorie Malnutrition with secondary Adult Failure to Thrive. On the initial comprehensive assessment, dated 08/29/2024, the Registered Nurse (RN) documented the patient had bowel and bladder incontinence and wounds. The Director of Nursing stated the hospice agency provided medical supplies to the patient, however the plan of care dated 08/29/2024-11/26/2024 did not include the list of medical supplies. Clinical Record 2: The patient elected their hospice benefit on 10/01/2024 with a diagnosis of Hemiplegia and Hemiparesis following Cerebral Infarction with secondary Dysphagia and Aphasia. On the initial comprehensive assessment, dated 10/01/2024, the Registered Nurse (RN) documented the patient had bowel and bladder incontinence. The Director of Nursing stated the hospice agency provided medical supplies to the patient, however the plan of care dated 10/01/2024 to 12/29/2024did not include the list of medical supplies. Clinical Record 3: The patient elected their hospice benefit on 10/16/2023 with a diagnosis of Senile Degeneration of the Brain. On the initial comprehensive assessment, dated 10/16/2023, the Registered Nurse (RN) documented the patient had symptoms of bowel and bladder incontinence. The Director of Nursing stated the hospice agency provided medical supplies to the patient, however the plan of care dated 10/16/2023 to 01/13/2024 did not include the list of medical supplies. Clinical Record 4: The patient elected their hospice benefit on 08/22/2024 with a diagnosis of Congestive Heart Failure. On the initial comprehensive assessment, dated 08/22/2024, the Registered Nurse (RN) documented the patient had symptoms of bowel and bladder incontinence. The Director of Nursing stated the hospice agency provided medical supplies to the patient, however the plan of care dated 08/22/2024 to 11/19/2024 did not include the list of medical supplies. Clinical Record 5: The patient elected their hospice benefit on 09/21/2024 with a diagnosis of Malignant Neoplasm of Unspecified Renal Pelvis. On the initial comprehensive assessment, dated 09/21/2024, the Registered Nurse (RN) documented the patient had symptoms of bowel and bladder incontinence. The Director of Nursing stated the hospice agency provided medical supplies to the patient, however the plan of care dated 09/21/2024 to 12/19/2024 did not include the list of medical supplies. Clinical Record 6: The patient elected their hospice benefit on 09/19/2024 with a diagnosis of Malignant Neoplasm of Colon with secondary Malignant Neoplasm of Lung. On the initial comprehensive assessment, dated 09/19/2024, the Registered Nurse (RN) documented the patient had symptoms of bowel and bladder incontinence. The Director of Nursing stated the hospice agency provided medical supplies to the patient, however the plan of care dated 09/19/2024 to 12/17/2024 did not include the list of medical supplies. Clinical Record 7: The patient elected their hospice benefit on 06/13/2024 with a diagnosis of End Stage Renal Disease. On the initial comprehensive assessment, dated 06/13/2024, the Registered Nurse (RN) documented the patient had symptoms of bowel and bladder incontinence. The Director of Nursing stated the hospice agency provided medical supplies to the patient, however the plan of care dated 06/13/2024 to 09/10/2024 did not include the list of medical supplies. Clinical Record 8: The patient elected their hospice benefit on 03/21/2024 with a diagnosis of Alzheimer’s Disease. On the initial comprehensive assessment, dated 03/21/2024, the Registered Nurse (RN) documented the patient had symptoms of bowel and bladder incontinence. The Director of Nursing stated the hospice agency provided medical supplies to the patient, however the plan of care dated 03/21/2024 to 06/18/2024 did not include the list of medical supplies. Clinical Record 9: The patient elected their hospice benefit on 10/24/2024 with a diagnosis of Malignant Neoplasm of Stomach. On the initial comprehensive assessment, dated 10/24/2024, the Registered Nurse (RN) documented the patient had symptoms of bowel and bladder incontinence. The Director of Nursing stated the hospice agency provided medical supplies to the patient, however the plan of care dated 10/24/2024 to 01/21/2025 did not include the list of medical supplies. Clinical Record 10: The patient elected their hospice benefit on 10/30/2024 with a diagnosis of Heart Failure. On the initial comprehensive assessment, dated 10/30/2024, the Registered Nurse (RN) documented the patient had symptoms of bowel and bladder incontinence. The Director of Nursing stated the hospice agency provided medical supplies to the patient, however the plan of care dated 10/30/2024 to 01/27/2025 did not include the list of medical supplies. Clinical Record 14: The patient elected their hospice benefit on 11/29/2023 with a diagnosis of Senile Degeneration of the Brain. On the initial comprehensive assessment, dated 11/29/2023, the Registered Nurse (RN) documented the patient had symptoms of bowel and bladder incontinence. The Director of Nursing stated the hospice agency provided medical supplies to the patient, however the plan of care dated 11/29/2023 to 12/12/2023 did not include the list of medical supplies. During interviews on 11/05/2024 and 11/06/2024, the Director of Nursing stated that medical supplies were listed on the aide care plans, but those did not populate to the plan of care. The Director of Nursing stated the agency was aware of the issues with the individualized patient’s plans of care and that the hospice agency had a performance improvement project/plan currently open to correct the non-compliance.”

“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 5 of 14 (36%) clinical records reviewed in which an aide was accepted revealed that the agency did not ensure that the aide care plan provided clear and specific instructions for the aide. Clinical Record 2: The patient elected their hospice benefit on 10/01/2024 with a diagnosis of Hemiplegia and Hemiparesis following Cerebral Infarction with secondary Dysphagia and Aphasia. The aide care plan dated 10/01/2024 included the following relevant tasks: assist in the transfer “as needed,” and assist in ambulation “as needed.” The RN did not include specific indications for the “as needed” tasks. Clinical Record 5: The patient elected their hospice benefit on 09/21/2024 with a diagnosis of Malignant Neoplasm of Unspecified Renal Pelvis. The aide care plan dated 09/21/2024 included the following relevant tasks: assist in the transfer “as needed,” and assist in ambulation “as needed,” range of motion “as needed”, and incontinence care “as needed.” The RN did not include specific indications for the “as needed” tasks. Clinical Record 7: The patient elected their hospice benefit on 06/13/2024 with a diagnosis of End Stage Renal Disease. The aide care plan dated 06/13/2024 included the following relevant tasks: clean under the nails and file once a week and “as needed.” The RN did not include specific indications for the “as needed” tasks. Clinical Record 9: The patient elected their hospice benefit on 10/24/2024 with a diagnosis of Malignant Neoplasm of Stomach. The aide care plan dated 10/24/2024 included the following relevant tasks: clean under the nails and file once a week and “as needed.” The RN did not include specific indications for the “as needed” tasks. Clinical Record 12: The patient elected their hospice benefit on 10/03/2023 with a diagnosis of Parkinson’s Disease. The aide care plan dated 10/03/2023 included the following relevant tasks: nail care and cleaning once a week and “as needed.” The RN did not include specific indications for the “as needed” tasks. During an interview on 11/07/2024, the Director of Nursing was asked about the aide care plans have tasks assigned as needed. The Director of Nursing stated that she did not like the way the aide care plans were being completed and was working with the hospice agency nurses to improved them.”