Right Choice Hospice

“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. Includes all services necessary for the palliation and management of the terminal illness, including the following: Intervention to manage pain and symptoms. This standard was not met as evidenced by clinical record review and interview. In 1 of 6 (17%) clinical records reviewed revealed that the agency did not ensure that the plan of care included necessary interventions identified in the initial and comprehensive assessments. CLINICAL RECORD 3: The patient elected the hospice benefit on 07/10/2025 with a diagnosis of lung cancer and died on 07/19/2025. On the initial comprehensive assessment dated 07/10/2025, the patient was admitted with a “morphine pump” for pain control. There were no specific interventions related to an overall pain management plan that included the use of a pump. There were no interventions to care for the pump or care of insertion site/rotation of the site. There were also no specific interventions related to the education of the patient/family/caregivers related to the use of the pump for pain control, or what to look for regarding identifying specific signs/symptoms requiring notification to hospice. A pain care plan was present which included “treatment of pain requiring MSO4 [Morphine] pump” there were no other interventions documented. During a joint record review and interview on 08/12/2025, the Clinical Manager agreed that there were no specific interventions related to the morphine pump that the patient had utilized for pain control. The Clinical Manager said that an infusion center was monitoring the pump and therefore she didn’t realize that she should add specific interventions to the plan of care.”

“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 1 of 3 (33%) clinical records reviewed in which hospice aide services were provided revealed that the hospice did not ensure that the Registered Nurse (RN) provided the hospice aide (HA) with clear and accurate patient-specific written care instructions on the aide’s care plan related to bathing. CLINICAL RECORD 1: The patient elected the hospice benefit on 07/06/2024. The hospice aide’s plans of care dated 09/30/2024, 12/27/2024, 04/30/2025, and 07/02/2025, all included instructions for a bed bath and a sponge bath to be completed every visit. There was no documented evidence that the nurse specified when the patient should have a bed bath versus a sponge bath. During a joint record review and interview on 08/14/2025, the Clinical Manager agreed that the hospice aide was not provided with specific written instructions on whether to give a bed bath or sponge bath.”

“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 3 (33%) clinical records reviewed of patients who had hospice aide services it was revealed that the agency did not ensure that the aide was providing the services as included on the hospice aide’s plan of care. CLINICAL RECORD 1: The patient elected the hospice benefit on 07/06/2024. The hospice aide plan of care dated 04/30/2025, listed the visit frequency as five (5) times per week with the relevant tasks of a bed bath and sponge bath every visit. The hospice aide’s documented on 06/18/2025- 06/20/2025, 06/23/2025- 06/27/2025, 07/03/2025- 07/07/2025, 07/14/2025-07/18/2025 and 07/28/2025- 08/01/2025, 08/04/2025- 08/08/2025, that a bed bath, sponge bath, and shower were all “completed.” The shower was not included in the aide plan of care. During a joint record review and interview on 08/13/2025, the Clinical Manager agreed that the hospice aide did not specify that the bed bath was provided per the plan of care. The Clinical Manager said it looked like the aide was checking all three options.”

“It is required that each hospice patient must maintain a clinical record containing past and current findings. The record may be maintained electronically or on paper, and it includes physician orders. This standard was not met as evidenced by clinical record review and interview. In 1 of 6 (17%) clinical records reviewed revealed that the agency did not ensure that orders were obtained for all necessary treatments and services. CLINICAL RECORD 3: The patient elected the hospice benefit on 07/10/2025 with a diagnosis of lung cancer and died on 07/19/2025. The initial comprehensive nursing assessment documented that the patient had a “morphine pump” for pain management. The record lacked evidence of physician orders for the medication, infusion concentration, initial infusion rate, a dose for “breakthrough pain,” or whether the drug could be titrated to control the pain. There were also no specific orders related to the pump or infusion site type. The medication profile included the dose of 0.11 mg morphine per hour continuous without any other directions. During a joint record review and interview on 08/12/2025, the Clinical Manager said that the infusion center had obtained the orders for the medication, and she did not include the orders from the infusion center for the hospice record.”