Every finding on record at Hospice of Michigan, Inc.

It is required that the drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added or changes are made to existing medication. This standard was not met as evidenced by interview and observation. In 2 of 6 (33%) home visits conducted it was noted that the patient's current drug profile was not updated at the time of each comprehensive assessment when changes were made to an existing medication. CLINICAL RECORD 1/HOME VISIT 1: The patient elected the benefit on 06/27/2025. During an observed home visit on 01/06/2026 with the hospice aide (Personnel Record 7) to the Assisted Living facility and following medication reconciliation with the facility's printed drug profile, it was determined that the patient was taking Aspirin 81 mg daily, but it was not on the agency's current drug profile. Following record review, it was determined that the aspirin was discontinued 07/2025 but still remained on the facility's medication profile. CLINICAL RECORD 6/HOME VISIT 6: The patient elected the hospice benefit on 01/08/2025. During an observed home visit on 01/08/2026, the registered nurse (Personnel Record 4) identified expired medications in the comfort pack during medication reconciliation. The following medications, originally ordered on 01/08/2025, had expired on 12/05/2025: Hyoscyamine 0.125 mg (1 every 4 hours as needed for congestion/bladder spasms), Haldol liquid concentrate 2 mg/mL (0.5 mL by mouth or under the tongue every 6 hours as needed for nausea/restlessness), Lorazepam 0.5 mg tablet (1 tablet every 6 hours as needed for anxiety), Acetaminophen rectal suppository (1 every 6 hours as needed for mild pain/fever), and Bisacodyl rectal suppository 10 mg (1 daily as needed for constipation. This was confirmed with the registered nurse onsite. After a joint review of the records and discussion with the Manager of Clinical Operations, it was determined that the patient had been transferred to the assisted living facility around that time, and the medication was likely not removed from the drug profile during the transition. The Manager confirmed that the registered nurse case manager should have identified this discrepancy.

It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the following: interventions to manage pain and symptoms. This standard was not met as evidenced by clinical record review and interview. In 3 of 23 (13%) clinical records reviewed it was revealed that the agency did not ensure that the patients' individualized written plans of care included all the interventions to manage the assessed symptoms. CLINICAL RECORD 3: The patient elected the hospice benefit on 01/04/2025. At the time of admission on 01/04/2025, the patient was prescribed oxygen at 6 liters per minute via nasal cannula, to be used continuously, and this order was accurately reflected on the agency’s current medication list and plan of care. However, review of skilled nursing visit documentation demonstrated inconsistent reporting of the ordered oxygen flow rate. Multiple visit notes documented that the patient was receiving oxygen at flow rates below the prescribed 6 liters per minute, including: 11/26/2025: 4 L/min; 12/04/2025: 3.5 L/min; 12/11/2025: 5 L/min; 12/18/2025: 4.5 L/min; and 12/31/2025: 4 L/min. There were no interventions noted the plan of care related to titration of the oxygen. CLINICAL RECORD 13: The patient elected the hospice benefit on 10/11/2025 with a primary diagnosis of malignant neoplasm of the frontal lobe. At admission, the nurse documented that the patient was taking Metformin 500 mg daily for Type II Diabetes. However, review of both the initial and current plans of care revealed no identified problem, interventions, or goals addressing the patient’s diabetes. Additionally, the patient was receiving Decadron daily for brain swelling, which may further elevate blood glucose levels. CLINICAL RECORD 19: The patient elected the hospice benefit on 03/24/2025 with a diagnosis of Senile Degeneration of the Brain. Following documentation review, it was noted on 04/07/2025 that triage received a call on from the patient's daughter stating her mom's blood glucose level was 222 and she was instructed to contact hospice if above 200. The triage nurse documented that the chart was reviewed but there was no plan of care noted to address the blood glucose levels and no insulin, or any other medications for diabetes profiled on patient's plan of care. When reviewing a history and physical from 03/10/2025, the documentation showed the patient had Type II Diabetes and was on Farxiga 5 mg daily. There were no problems, interventions or goals noted related to diabetes. Following a joint review of the records and discussion with the Manager of Clinical Operations and the AVP Program Administrator, it was determined that the plans of care did not include interventions corresponding to the assessed problems.

It is required that the hospice assesses the skills and competencies of all individuals providing care, including volunteers providing services and, as necessary, provides in-service training and education programs where required. This standard was not met as evidenced by interview and personnel record review. 1 of 2 (50%) personnel records of registered nurses hired within the last three years reviewed, it was revealed that the agency did not ensure that a competency assessment was completed upon hire. PERSONNEL RECORD 9: This registered nurse was hired on 03/20/2023. The personnel record contained no documented evidence of a competency assessment. The Statewide Director of Quality stated in an interview on 01/09/2026, "We have looked all over and are unable to find anything."

It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the following: Drugs and treatment necessary to meet the needs of the patient. The documentation in the patient’s record is in accordance with the hospice’s policies and procedure. This standard was not met as evidenced by a review of clinical records and interviews.1 of 13 (8%) clinical records reviewed revealed that the agency did not ensure that the Plan of Care (POC) included the correct route for medication to be administered. Record 5: The patient elected Hospice benefit on 9/27/2022. Review of the POC dated 9/27/2022 and comprehensive assessment, revealed the patient had a tracheostomy and was taking nothing by mouth (NPO). The patient was to receive all medications and feedings through the gastrostomy tube. As medication changes were made the route of administration on all subsequent orders defaulted to "oral" as "PO or OR" and was not changed to "peg tube" or "PGT". During joint record review on 2/1/2023, the Clinical Operations Manager stated, "I can see that the route was not changed when the medication doses were changed."