Every finding on record at Hospice in the Desert LLC

It is required that the hospice medical director or physician designee reviews the clinical information for each patient being evaluated for admission and provides written certification that it is anticipated that the patient's life expectancy is six months or less if the illness runs its normal course. The physician considers the following when making this determination: Related diagnosis(es), if any and current subjective and objective medical findings. This standard was not met as evidenced by clinical record review, document review and interview. In 2 of 11 (18%) clinical records reviewed revealed the physician narrative on the Certificate of Terminal Illness (CTI), the physician did not document the, "Related diagnosis(es), if any" when making the determination that it was anticipated that the patient's life expectancy was going to be six months or less if the illness runs it normal course. Document 1: The "Medical Director Job Description (Signed and Dated: 4/23/23)", stated in part, "Responsibilities: Certifying that the patient meets the medical criteria for hospice admission based upon available diagnostic and prognostic indicators, related diagnosis(es), if any, current subjective and objective medical findings . . ." Clinical Record 7: The patient elected the hospice benefit on 5/31/23. Initial nursing assessment completed by the agency Nurse Practitioner (NP) dated 5/31/23 stated, "...with a PMHx of HLD, HTN, aortic valve stenosis, ataxia, Barrett's esophagitis, vertigo, and diverticulosis." The NPs documentation for that date also stated, "...since 9/2022 his weight transitioned from 261 lbs to 180 lbs; BMI is 21.9; PPS is 30%; ... is becoming increasingly stiff and unable to move extremities without pain." The CTI physician narrative written by the Hospice Medical Director stated, "88 yo M with severe protein calorie malnutrition and failure to thrive." The physician did not document the "Related diagnosis(es)" when making the determination that it was anticipated that the patient's life expectancy was going to be six months or less if the illness runs it normal course. The physician did not document the "Current subjective and objective medical findings" when making the determination that it was anticipated that the patient's life expectancy was going to be six months or less if the illness runs it normal course. Clinical Record 8: The patient elected the hospice benefit on 6/8/23. Initial nursing assessment completed by the agency NP dated 6/8/23 stated, "... with a PMHx of HTN, HLD, TIAs, Shingle's, myalgia, Barrett's esophagitis and GERD." The NPs documentation for that date also stated "lost approximately 50-60 lbs since January and is now 130 lbs. Of that, his family reports 30 lbs has been in the last 3 months. 2 months ago, he was driving and living independently. His care coordinator found him at home barely able to walk and visibly thinner. EMS was notified and at hospital the patient was diagnosed with dehydration and malnutrition. The family then arranged to move the patient to an Adult Care Home; having lived there now about 2 weeks." The CTI physician narrative written by the Hospice Medical Director stated, "89 yo M with severe protein calorie malnutrition and failure to thrive." The physician did not document the "Related diagnosis(es)" when making the determination that it was anticipated that the patient's life expectancy was going to be six months or less if the illness runs it normal course. The physician did not document the "Current subjective and objective medical findings" when making the determination that it was anticipated that the patient's life expectancy was going to be six months or less if the illness runs it normal course. Upon interview on 8/17/23, both the Administrator/Director of Clinical Services (DCS) and the Alternate Administrator/Alternate DCS reviewed and agreed the Hospice Medical Director did not document the "Related diagnosis(es)" and the "Current subjective and objective medical findings" when making the determination that it was anticipated that the patient's life expectancy was going to be six months or less if the illness runs it normal course.