Every finding on record at Hospice of Michigan, Inc.

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 a review of clinical records. In 2 of 13 (15%) records reviewed the hospice did not ensure that that the interdisciplinary group completed an initial comprehensive assessment within 5 calendar days after the patient elected hospice care. Clinical Record 10 - The patient was admitted to hospice on 8/10/21 and the Social Worker did not see the patient until 8/17/21, which was 7 days after the patient elected their hospice benefit. There was no note that described why the visit was not done within 5 days after the election of the hospice benefit. Clinical Record 11 Patient was admitted to hospice on 9/20/22 and the Social Worker did not see the patient until 9/26/22, which was 6 days after the patient elected their hospice benefit. There was no note that described why the visit was not done within 5 days after the election of the hospice benefit.

It is required that the update of the comprehensive assessment is completed by the hospice Interdisciplinary Group, who, in collaboration with the individual’s attending physician, if any, consider the changes that have taken place since the initial assessment. The update of the comprehensive assessment includes: Information on the patient’s progress toward desired outcomes; and Reassessment of the patient’s response to care. The assessment update is completed: As frequently as the condition of the patient requires; and No less frequently than every 15 days. This standard was not met as evidenced by a review of clinical records and interviews. In 3 of 12 (25%) records reviewed, there was no documented update of the comprehensive assessment completed by all members during review by the IDG. Clinical Record 1 - Documentation from the most recent IDG meeting on 1/19/22 was missing evidence of an update note completed by the meeting's "scribe". The scribe wrote "n/a" in the area designated for documenting any updates to the comprehensive assessment. Clinical Record 3 - Documentation from the most recent IDG meeting on 1/19/22 was missing evidence of an update note completed by the meeting's "scribe". The scribe wrote "n/a" in the area designated for documenting any updates to the comprehensive assessment. Clinical Record 12 - Documentation from the most recent IDG meeting on 1/19/22 was missing evidence of an update note completed by the meeting's "scribe". The scribe wrote "n/a" in the area designated for documenting any updates to the comprehensive assessment. In a joint review of clinical records, the Administrator confirmed that the notes were missing and that she was the "scribe" who wrote "n/a" on the meeting notes.

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. (L625) 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 a review of clinical records and interviews. In 1 of 10 (10%) records in which the hospice aide was accepted, the aide plan of care was missing evidence of clear and specific written instructions for the aide assignment, thus leaving the aide to make decisions outside of the aide's scope of practice. Record 7 - The aide care plan dated 9/2/22 assigned the aide to complete a bed bath "1x/week" and a shower "1x/week". The aide was scheduled to visit the patient "3x/week" and there was no clear direction on when the specific bath was to be performed and whether the patient was alert and oriented and able to make decisions in regard to their personal care. The Administrator confirmed during interview that the plan of care had 2 bath types assigned without specific directions for the aide, thus leaving the aide to make a decision regarding the care to be provided.