Prohealth Home Hospice

“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 2 of 17 (12%) clinical records reviewed of patients who received Hospice Aide (HA) services, the agency did not ensure that the HA received written patient care instructions to meet the patient’s needs. CLINICAL RECORD 3: The patient elected hospice care on 03/19/2026 with a primary diagnosis of hypertensive heart disease. The plan of care ordered Hospice Aide services two times a week. The HA care plan assigned the HA the task of shower every visit and provided direction for the HA regarding the patient’s compression stockings and use of oxygen. The initial comprehensive assessment documented that the patient had a PleurX drain. The HA care plan did not notify the HA of the presence of the PleurX drain or how to care for it during the shower. CLINICAL RECORD 4: The patient elected hospice care on 02/09/2026 with a primary diagnosis of lung cancer. The plan of care ordered Hospice Aide services two times a week. The HA care plan assigned the HA the tasks: peri care and bed bath every visit. On 03/19/2026 a Foley catheter was placed and remained intact as of review 04/15/2026. The HA care plan was not updated to include Foley catheter care. During interview on 04/16/2026, the Director of Compliance stated that the aides plans of care did not include all directions for the aide. DHS 131.26 (2)(a) (2)NURSE AIDE SERVICES. The hospice may provide nurse aide services as follows: (a) Assignment. Nurse aides are assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group. Written patient care instructions for a nurse aide shall be prepared by a registered nurse who is responsible for the supervision of a nurse aide as specified under par. (c).”

“It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to: assess the quality of care and services provided by the hospice aide; ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 2 of 17 (12%) clinical records reviewed for patients who received Hospice Aide (HA) services, the agency did not ensure that the Hospice Aide was supervised by a Registered Nurse no less frequently than every 14 days. CLINICAL RECORD 2: The patient elected hospice care on 02/03/2026 with a primary diagnosis of congestive heart failure. The plans of care for the certification period dated 02/03/2026 through 05/03/2026 ordered HA services one time a week. The first Hospice Aide (HA) visit was on 02/24/2026. There was no evidence of HA supervision as of 04/14/2026, with 49 days outstanding. CLINICAL RECORD 7: The hospice benefit of election was 01/22/2026 with a primary diagnosis of severe protein calorie malnutrition. The plans of care for the certification period dated 01/22/2026 through 04/21/2026 ordered HA services one time a week. The first Hospice Aide (HA) visit was on 02/20/2026. There was no evidence of HA supervision as of 04/15/2026, with 54 days outstanding. During an interview and a joint record review on 04/16/2026, the Director of Compliance stated that the supervision was not documented. DHS_131.26(2)(c)1 “(2)Nurse aide services. The hospice may provide nurse aide services as follows: (c) Supervision of nurse aides. 1. A registered nurse shall make an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the nurse aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient’s needs. The nurse aide does not have to be present during this visit.””

“It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes, at a minimum: physician orders. This standard was not met as evidenced by clinical record review and interview. In 2 of 26 (8%) clinical records reviewed, the agency did not ensure that the patient’s record contained physician orders to meet the patient’s needs. CLINICAL RECORD 5: The patient elected hospice care on 03/19/2026 with a primary diagnosis of protein calorie malnutrition. The initial plan of care and the plans of care updated every two weeks ordered a PICC (peripherally inserted central line catheter) dressing change. There were no orders for the frequency of the dressing change until 04/14/2026 when a physician’s order was written to change the dressing weekly. CLINICAL RECORD 18: The patient elected hospice care on 03/05/2026 with a primary diagnosis of recurrent bacterial pneumonia. The initial plan of care and the plan of care updated every two weeks documented interventions for instructing on Foley catheter care, catheter problems, and signs and symptoms of infection. The plans of care did not include physician orders on when the Foley catheter should be changed or the details of the size of the Foley catheter and if a flush was needed. During interview and a joint record review on 04/16/2026, the Director of Compliance stated that the interventions were missing and did not include required detail. DHS_131.33(3)(j) (3) “Content. A patient’s clinical record shall contain all of the following: (j) Physician orders.””