Every finding on record at At Home Health Care Services, Inc Dba at Home Hospice

Based on interview and record review, it was determined that the hospice agency did not include an initial bereavement assessment as part of the comprehensive assessment for 5 of 11 sampled patients. Specifically, there was no documented evidence the needs of the patients' or family members needs focusing on social, spiritual and cultural factors had been met.(Patient identifiers: 1, 3, 4, 7 and 11) Findings include: A review of 11 medical records was completed from 4/18/22 through 4/21/22. No documentation could be provided to indicate that an initial bereavement assessment, that included social, spiritual and cultural factors that may impact a family or individuals ability to cope had been completed for 5 out 11 patients. On 4/20/22 at 4:11 PM, an email reply was received from the agency and reviewed. It stated: "Unfortunately you will not always find a bereavement assessment at the start of care. They will always be done as deemed necessary by the IDG(Interdisciplinary Group)or at the patients death if not before."

Based on interview and record review, it was determined the hospice agency did not provide medical social work (MSW) services to all patients in need of social services for 2 out of 11 patients. (Patient identifiers: 1 and 3) Findings include: 1. Patient 3 was admitted on 11/18/22, with a diagnosis of congestive heart failure. Patient 3's medical record review was completed on 4/21/22. On 3/9/22 it was documented in a nurse's notes that patient 3 had a change in emotional needs. "Patient stated he has been here too long and...thinks it's his time to go." On a "Hospice IDG (Interdisciplinary Group) meeting/care plan update" dated 3/15/22, it was checked that the patient had a change in emotional needs. "Patient believes he has lived too long." There was no documented evidence of any follow-up or interventions. On 4/21/22 at 4:11 PM, an interview was conducted with the Administrator and director of nursing (DON). They were asked how they determine whether there was a need for social work or spiritual counseling. The administrator stated the nurses assess if there is a need. The nurses should document that need. They would then put them on the schedule to be seen. On 4/21/22 at 3:26 PM, an interview was conducted with patient 3's daughter. She was asked if he was ever offered a social worker or spiritual counselor. She replied, he would probably refuse a spiritual counselor, but thought he would enjoy a social worker. There was no documented evidence in patient 3's medical record of a social work visit or spiritual counselor visit. 2. Patient 1 was admitted on 1/5/22, with a diagnosis of Hereditary hemorrhagic telangiectasia. Patient 1's medical record review was completed on 4/21/22. On a form titled "Hospice IDG meeting/care plan update" with the following dates: 3/1/22, 3/29/22 and 4/12/22 was reviewed. It was documented that "MSW will contact family via Telehealth for counseling." It was also documented under psychological/mental/emotional status that the following psychological interventions would be done with the patient: counseling and grief management would be assessed, performed, and instructed. Under additional interventions on the same document, it was checked for "Social worker and/or spiritual counselor to provide optimal intervention." There was no documented evidence of a social work or spiritual counseling visit in patient 1's medical record. On 4/21/22 at 4:11 PM, an interview was conducted with the Administrator and DON. They were asked if patient 1 ever saw a social worker. The administrator replied she was not sure why that patient did not see a social worker. She did not remember why. She stated they think a family member refused the services. On 4/21/22 at 3:30 PM, an interview was conducted with patient 1's wife. She was asked if she was ever offered a social worker or spiritual counselor. She replied, "I don't think they have." She was asked if they refused those services. She replied, they are fine spiritually; but did not refuse any services. She was then asked if she felt those services were needed. She was not sure what a social worker did, so was not sure if they needed one or not.