Every finding on record at Am Hospice Inc

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, document review and interview. In 5 of 13 (38%) clinical records reviewed for patients who elected hospice aide services revealed the agency did not ensure hospice aides were supervised by a registered nurse (RN) who visits the patient’s home no less frequently than every 14 days. Document 1: Agency Policy titled Hospice Aide Services (no date) stated in part "Supervision of Hospice Aides. A Registered Nurse (RN) supervisor will possess at least 2 years of community based hospice or home health experience and will make an on-site visit to the patient's home no less frequently than every 14 days." Clinical Record 2: The plan of care (POC) dated to begin on 06/21/2024 ordered aide visits to be provided 5 times per week. Aide services were documented as provided as ordered from 06/21/2024 to 08/19/2024, yet the record lacked evidence of an aide supervisory visit every fourteen (14) days. Aide supervisory visits were completed on 07/01/2024 and 07/22/2024 which is a frequency of twenty-one (21) days, next aide supervisory visit was completed on 08/12/2024 which is a frequency of twenty-one (21) days. Clinical Record 3: The plan of care (POC) dated to begin on 07/03/2024 ordered aide visits to be provided 3 times per week. Aide services were documented as provided as ordered from 07/03/2024 to 09/30/2024, yet the record lacked evidence of an aide supervisory visit every fourteen (14) days. One aide supervisory visit was completed on 08/13/2024, which is 41 days from the start of the benefit period. Clinical Record 4: The plan of care (POC) dated to begin on 06/27/2024 ordered aide visits to be provided 1 time a week. Aide services were documented as provided as ordered from 06/27/2024 to 08/25/2024 beginning on 07/02/2024, yet the record lacked evidence of an aide supervisory visit every fourteen (14) days. Aide supervisory visit was completed on 08/13/2024. This is forty-eight days since the start of the benefit period. Clinical Record 6: The plan of care (POC) dated to begin on 07/08/2024 ordered aide visits to be provided 5 times per week for 8 weeks then 4 times a week for 1 week. Aide services were documented as ordered from 07/08/2024 to 08/30/2024, yet the record lacked evidence of any aide supervisory visit being completed from 07/08/2024 through 08/30/2024. Clinical Record 10: The plan of care (POC) dated to begin on 06/19/2024 ordered aide visits to be provided 1 time per week then 2 times per week. Aide services were documented as ordered, yet the record lacked evidence of an aide supervisory visit every fourteen (14) days. Aide supervisory visit was documented on 07/19/2024 and again on 08/30/2024 this is forty-four (44) days. During a joint review of the clinical record on 09/04/2024, the Director of Clinical Operations/DON stated, "There is a button they are supposed to press for the aide supervision, but it was not done."

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 1 of 2 (50%) records reviewed for patients discharged from the hospice revealed that the record lacked evidence of a written discharge summary, and that the discharge summary was forwarded to the attending physician. Clinical Record 13: The patient was discharged from services on 06/20/2024. The record lacked evidence that a discharge summary was written and forwarded to the attending physician. The Director of Operation/Director of Nursing stated in an interview during a joint review of the clinical record on 09/05/2024 that they had previously been on paper and are still working on the electronic process.

It is required that a hospice aide provides services ordered by the Interdisciplinary Group; included in the plan of care; permitted to be performed under state law and regulation; consistent with the hospice aide training. This standard was not met as evidenced by clinical record review. 3 of 9 (33%) clinical records receiving hospice aide services that revealed the Hospice Aide(s) did not follow the Registered Nurse developed and physician ordered visit frequencies identified in plans of care. Record #44083- The SOC of 08/24/2021, the ordered Hospice Aide (HA) visit frequency was 3 times a week. The weeks of 08/24/2021, 2 visits were completed. There was no documentation explaining the missed visit. Record #21245- The SOC of 10/19/2021, the ordered HA visit frequency was 2 times a week. The week of 10/19/2021, 1 visit was completed. There was no documentation explaining the missed visit. Record #72817- The SOC of 09/23/2021, the ordered HA Hospice visit frequency orders was 5 times a week. The week of 9/23/2021, 3 visits were completed. The Hospice aide could not have fulfilled the 5 x week visit order for week 1 as week 1 started on a Thursday. The agency "visit week" begins on Sunday. There was no documentation explaining the missed visits. During a joint record review, the Director of Clinical Services was unable to locate a "missed visit" note or a note to the RN Case Manager. During an interview on 10/27/2021, the agency Director of Nurses confirmed the hospice aides did not follow the care plan.