Every finding on record at Heart to Heart Hospice of Terre Haute, LLC

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 14 (14%) clinical records reviewed of patients who received Hospice Aide (HA) services, the agency did not ensure that the Hospice Aide received written patient care instructions to meet the patient's needs. CLINICAL RECORD 13: The patient elected the hospice benefit on 06/15/2025 with a diagnosis of corticobasal degeneration. The patient resided in a skilled nursing facility (SNF). A physician's order dated 08/10/2025 ordered "Oxygen at 2 liters via nasal cannula continuously." The plan of care dated 06/15/2025 through 09/12/2025 ordered "HA 2 times per week." The Hospice Aide care plan dated 07/09/2025 assigned the HA the relevant task: "Shower every visit." The Hospice Aide care plan was not updated to include instructions for the HA regarding the patient's use of oxygen during the shower. CLINICAL RECORD 15: The patient elected the hospice benefit on 06/17/2025 with a diagnosis of chronic obstructive pulmonary disease (COPD). The patient resided in a SNF. A physician's order dated 06/30/2025 ordered "Oxygen at 4 liters via nasal cannula continuously." The plan of care dated 06/17/2025 through 08/03/2025 ordered "HA 2 times per week." The Hospice Aide care plan dated 06/17/2025 assigned the HA the relevant task: "Shower every visit." The Hospice Aide care plan was not updated to include instructions for the HA regarding the patient's use of oxygen during the shower. During joint record reviews and an interview on August 21, 2025, the Executive Director confirmed that oxygen instructions were not included in the Hospice Aide care plans.

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; and 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 1 of 14 (7%) clinical records reviewed of patients who received Hospice Aide (HA) services, the agency did not ensure that the Hospice Aide was supervised by the Registered Nurse (RN) at least every 14 days. CLINICAL RECORD 8: The patient elected the hospice benefit on 04/15/2025. The patient resided at home. The plan of care, dated 04/15/2025 through 07/13/2025, ordered "HA 2 times per week starting 05/01/2025." The first Hospice Aide visit was dated 05/01/2025, with HA visits completed as ordered. The Registered Nurse completed HA supervisory visits on 05/07/2025, 05/21/2025 (14 days), and 06/06/2025 (with 16 days outstanding). During a joint record review on 08/20/2025, the Executive Director confirmed that Hospice Aide supervisory visits were completed by the RN less frequently than every 14 days.

It is required that hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. This standard was not met as evidenced by document review and interview. The agency did not ensure that volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. A review of the agency's "Volunteer Cost Savings Report" for 2024 (01/01/2024 through 12/31/2024) revealed that the total percentage of hours worked by volunteers for the year 2024 was 3.82%. Documentation of a performance improvement plan (PIP) initiated in January 2025 to increase the percentage of volunteer hours to 5% was reviewed. The agency's Volunteer Cost Savings Report for 2025 revealed that the total percentage of hours worked by volunteers for 01/01/2025 through 07/31/2025 was 2.81%. During an interview on 08/20/2025, the Executive Director confirmed the finding, stating, "It has been hard since the COVID pandemic to find people who want to volunteer. Our volunteer coordinator is currently in the process of onboarding six new volunteers." The agency did not ensure that volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff.