Every finding on record at Anchorage Hospice, Inc.

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 (Registered Nurse) 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 9 (11%) clinical records reviewed with hospice aide services provided, the agency did not ensure the Registered Nurse provided specific patient care instructions for the hospice aide. CLINICAL RECORD 4: The patient elected the hospice benefit on 07/17/2025. The plan of care dated 07/17/2025 to 09/14/2025 included orders for skilled nursing, spiritual counselor, social worker, and hospice aide services. The nurse documented on the initial nursing assessment that the patient had a wound to the sacrum. The hospice aide plan of care/assignment dated 07/17/2025 did not include information to the aide related to the patient’s sacral wound. The RN documented on the nursing visit note dated 07/31/2025 that staples were removed from the right hip and right knee. The hospice aide assignment was reviewed on 08/13/2025 and continued to include the statement “patient has staples covered with a dressing to the right hip and above the right knee please do not get them wet.” The aide assignment was not updated when the staples were removed. During a joint review of the record and interview on 08/13/2025, the Director of Clinical Services (Personnel Record 8) stated she did know why the aide care plan was not updated but they would provide additional education to the clinical staff to update the aide plan of care.

It is required that if the care of a hospice patient is transferred to a Medicare/Medicaid certified facility, the hospice forwards to the receiving facility a copy of the hospice discharge summary described in HCDT 40.I, and the patient’s record, if requested. This standard was not met as evidenced by clinical record review and interview. In 1 of 1 (100%) clinical record reviewed with patient transfer, the agency did not ensure the hospice forwarded a copy of the discharge summary to the receiving facility. CLINICAL RECORD 14: The patient elected the hospice benefit on 10/12/2024 and was transferred to another hospice on 10/19/2024. There was no documented evidence in the clinical record that the discharge summary was sent to the receiving hospice. During an interview on 08/13/2025, the Director of Clinical Services (DCS) (Personnel Record 8) stated she remembers that they sent information to the receiving hospice, but apparently it was not documented. The DCS also stated that they would educate the staff on the live discharge process.

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 1 (100%) clinical record reviewed where the patient revoked the election of hospice services, the agency did not ensure the discharge summary was sent to the patient's attending physician. CLINICAL RECORD 13: The patient elected the hospice benefit on 10/12/2024 and choose to revoke hospice services on 01/07/2025. There was no documented evidence in the clinical record that the agency sent the discharge summary to the patient's attending physician. During an interview on 08/13/2025, the Director of Clinical Services (Personnel Record 8) stated she did not realize that the discharge summary needed to be sent to the attending physician when the patient was discharged.

It is required that each patient’s individualized written plan of care reflects patient and family goals, identifies planned interventions based on problems identified in the initial and updated comprehensive assessments, and includes all services necessary for the palliation and management of the terminal illness, including intervention to manage pain and symptoms. This standard was not met as evidenced by a review of clinical records and interviews. 3 of 11 (27%) records reviewed revealed the agency did not ensure that the patient's written plan of care included interventions to manage pain and symptoms. Clinical Record #1: was reviewed and identified the patient elected hospice care on 5/30/22. The Registered Nurse (RN) completed the initial comprehensive pain assessment on 5/30/22 and identified pain as an active problem. The plan of care dated 5/30/22 was reviewed and did not include interventions to manage pain and symptoms. Clinical Record #8: was reviewed and identified the patient elected hospice care on 5/18/22. The RN completed a pain assessment during the recertification comprehensive assessment on 8/31/21 and identified pain as an active problem. The plan of care dated 8/31/21 was reviewed and did not include interventions to manage pain and symptoms. Clinical Record #11: was reviewed and identified the patient elected hospice care on 12/22/21. The RN completed a pain assessment during the recertification comprehensive assessment on 6/6/22 and identified pain as an active problem. The plan of care dated 6/6/22 was reviewed and did not include interventions to manage pain and symptoms. During an interview, the Director of Nursing (Staff #6), reported that she was aware that the Aide plan of care should provide clear and specific instructions and did not know why the Aide plan of care was not clear and specific.