Every finding on record at Caringedge Hospice of Casper, LLC

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by clinical record review and interview. In 3 of 14 (21%) clinical records reviewed, the hospice did not ensure the initial comprehensive assessment was completed no later than five calendar days after the election of hospice care. Clinical Record 4: The patient elected the hospice benefit on 06/10/2022 with a terminal diagnosis of Alzheimer's disease. Clinical record review revealed the initial spiritual assessment was dated 06/20/2022, 10 days after the start of care. The initial comprehensive assessment was not completed within 5 calendar days of election of benefit, when the initial spiritual assessment was not completed until 10 days after the start of care and 5 days outstanding. Clinical Record 8: The patient elected the hospice benefit on 06/13/2023 with a terminal diagnosis of chronic obstructive pulmonary disease. Clinical record review revealed the initial spiritual assessment was dated 06/19/2023, 6 days after the start of care. The initial comprehensive assessment was not completed within 5 calendar days of election of benefit, when the initial spiritual assessment was not completed until 6 days after the start of care and 1 day outstanding. Clinical Record 14: The patient elected the hospice benefit on 01/04/2023 with a terminal diagnosis of congestive heart failure. Clinical record review revealed the initial psychosocial assessment was dated 01/12/2023, 8 days after the start of care. The initial comprehensive assessment was not completed within 5 calendar days of election of benefit, when the initial psychosocial assessment was not completed until 8 days after the start of care and 3 days outstanding. During a joint record review and interview on 01/24/2024, the Director of Nursing agreed there was no documented evidence that the initial spiritual and psychosocial assessments were completed no later than five days after the election of hospice care.

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. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed of patients who revoked hospice services, the hospice did not ensure the discharge summary was forwarded to the patient's attending physician. Clinical Record 11: The patient elected the hospice benefit on 07/28/2022 with a terminal diagnosis of Alzheimer's disease. The discharge summary dated 07/21/2023 included documentation that the family decided to revoke hospice services and the patient’s family member signed the revocation form on 07/21/2023. The clinical record contained no documented evidence that the discharge summary was forwarded to the patient’s attending physician. During a joint record review and interview on 01/22/2024, the Director of Nursing agreed there was no documented evidence that the discharge summary was forwarded to the patient’s attending physician.