Every finding on record at Indianapolis Jewish Home, Inc.

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; and other alternative treatments that could affect drug therapy. The medication review process includes the identification of the effectiveness of drug therapy; drug side effects; actual or potential drug interactions; duplicate drug therapy; and drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and as appropriate, preventive measurements are implemented to manage the side effects. 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 clinical record review, document review, and interview. In 1 of 14 (7%) clinical records reviewed, it was revealed that the agency did not ensure that all current medications were included in the patient's drug profile. Agency Policy 11.10.1, Medication Profile (dated 06/2019), read in part, "The initial assessment performed by the registered nurse includes a review of all medications that the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicative drug therapy and non-compliance with drug therapy. The registered nurse checks all medications a patient may be taking and documents on the medication profile. All prescribed medications, over-the-counter medications and home remedies will be documented on the medication profile as well as date medication prescribed, dose, route and frequency." CLINICAL RECORD 4: The election of the hospice benefit was 03/20/2024. The initial nursing assessment dated 03/20/2024 read in part, "Patient is on oxygen via nasal cannula at 3 liters continuously." The drug profile dated 03/20/2024 did not include oxygen. In an interview on 02/19/2025, the Administrator reviewed the record, confirmed the above finding and stated, "There is not oxygen listed on the medication profile that was completed on admission.”

It is required that each patient’s individualized written plan of care reflects patient and family goals; and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 4 of 14 (29%) clinical records reviewed, it was revealed that the agency did not ensure that problems identified in the initial and updated comprehensive assessments had interventions in the patient's individualized written plan of care. CLINICAL RECORD 4: The patient elected the hospice benefit on 03/20/2024. The initial plan of care dated 03/20/2024-05/18/2024 read in part "DME: Oxygen Concentrator.” The plan of care lacked the oxygen dose, route and frequency of oxygen to be utilized by the patient. The initial plan of care dated 03/20/2024-05/18/2024 also read in part, "Plavix 75mg tablet by mouth daily.” The plan of care lacked interventions related to the patient being at risk for bleeding. CLINICAL RECORD 5: The patient elected the hospice benefit on 01/10/2024. The initial plan of care dated 01/10/2024-04/08/2024 read in part, "Eliquis 2.5mg tablet by mouth twice daily.” The plan of care lacked interventions related to the patient being at risk for bleeding. CLINICAL RECORD 7: The patient elected the hospice benefit on 01/06/2024. The initial plan of care dated 01/06/2024-03/05/2024 read in part, "Eliquis 5mg tablet by mouth twice daily.” The plan of care lacked interventions related to the patient being at risk for bleeding. CLINICAL RECORD 8: The patient elected the hospice benefit on 02/01/2024. The initial plan of care dated 02/01/2024-04/30/2024 read in part, "Eliquis 2.5mg tablet by mouth twice daily.” The plan of care lacked interventions related to the patient being at risk for bleeding. On 02/19/2025, the Administrator reviewed the records and confirmed the above findings that interventions for oxygen and bleeding risks were not included in the plans of care.

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 4 of 14 (29%) clinical records reviewed, with hospice aide services provided, it was revealed that the agency did not ensure that all written patient care instructions were included in the aide care plan. CLINICAL RECORD 4: The patient elected the hospice benefit on 03/20/2024. The initial nursing assessment dated 03/20/2024 read in part, "Patient is on oxygen via nasal cannula at 3 liters continuously.” The plan of care dated 03/20/2024-05/18/2024 ordered "HA (Hospice Aide) 2 times per week.” The aide care plan dated 03/20/2024 included relevant instructions of, "Shower two times per week.” The aide care plan lacked instructions regarding what the aide should do with the oxygen during the shower. CLINICAL RECORD 7: The patient elected the hospice benefit on 01/06/2024. A physician's order dated 02/05/2025 read in part, "Oxygen via nasal cannula at 2 liters continuously.” The plan of care dated 12/31/2024-02/28/2025 ordered "HA 2 times per week.” The aide care plan dated 02/07/2025 included relevant instructions of, "Shower two times per week.” The aide care plan lacked instructions regarding what the aide should do with the oxygen during the shower. CLINICAL RECORD 10: The patient elected the hospice benefit on 08/30/2024. A physician's order dated 08/30/2024 ordered wound care with a wound dressing to a wound on the patient's left leg. The plan of care dated 08/30/2024-11/27/2024 ordered "HA 5 times per week.” The aide care plan dated 09/04/2024 included relevant instructions of "Sponge bath five times per week.” The aide care plan lacked instructions regarding what the aide should do if the wound dressing on the patient's left leg were to become wet or dislodged during the sponge bath. CLINICAL RECORD 14: The patient elected the hospice benefit on 09/10/2024. A physician's order dated 09/10/2024 ordered wound care with a wound dressing to a wound on the patient's sacrum. The plan of care dated 09/10/2024-12/08/2024 ordered "HA 2 times per week.” The aide care plan dated 09/10/2024 included relevant instructions of "Shower two times per week.” The aide care plan lacked instructions regarding what the aide should do if the wound dressing on the patient's sacrum were to become wet or dislodged during the shower. In an interview on 02/19/2025, the Administrator reviewed the records and stated, "There is not oxygen or wound dressing instructions on these 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 5 of 14 (36%) clinical records reviewed, with hospice aide services provided, it was revealed that the agency did not ensure that hospice aide supervisory visits were completed no less frequently than every 14 days. CLINICAL RECORD 1: The patient elected the hospice benefit on 07/29/2022. The plans of care dated 07/29/2022-10/26/2022, 10/27/2022-01/24/2023, 01/25/2023-03/25/2023, and 11/15/2024-01/13/2025 ordered "HA (Hospice Aide) 2 times per week.” A hospice aide supervisory visit was dated 08/15/2022. The next hospice aide supervisory visit was dated 09/02/2022, 18 days later and 4 days outstanding. A hospice aide supervisory visit was dated 11/16/2022. The next hospice aide supervisory visit was dated 12/09/2022, 23 days later and 9 days outstanding. A hospice aide supervisory visit was dated 01/12/2023. The next hospice aide supervisory visit was dated 01/28/2023,16 days later and 2 days outstanding. A hospice aide supervisory visit was dated 02/09/2023. The next hospice aide supervisory visit was dated 02/25/2023, 16 days later and 2 days outstanding. A hospice aide supervisory visit was dated 11/11/2024. The next hospice aide supervisory visit was dated 12/02/2024, 21 days later and 7 days outstanding. CLINICAL RECORD 3: The patient elected the hospice benefit on 12/22/2022. The plans of care dated 12/22/2022-03/21/2023, 03/22/2023-06/19/2023, 06/14/2024-08/12/2024, and 10/12/2024-12/10/2024 ordered "HA 4 times per week.” A hospice aide supervisory visit was dated 03/01/2023. The next hospice aide supervisory visit was dated 03/17/2023, 16 days later and 2 days outstanding. A hospice aide supervisory visit was dated 05/08/2023. The next hospice aide supervisory visit was dated 05/26/2023, 18 days later and 4 days outstanding. A hospice aide supervisory visit was dated 07/02/2024. The next hospice aide supervisory visit was dated 07/18/2024, 16 days later and 2 days outstanding. A hospice aide supervisory visit was dated 11/07/2024. The next hospice aide supervisory visit was dated 11/28/2024, 21 days later and 7 days outstanding. CLINICAL RECORD 4: The patient elected the hospice benefit on 03/20/2024. The plans of care dated 05/19/2024-07/17/2024 and 07/18/2024-09/15/2024 ordered "HA 2 times per week.” A hospice aide supervisory visit was dated 05/28/2024. The next hospice aide supervisory visit was dated 06/13/2024, 16 days later and 2 days outstanding. The next hospice aide supervisory visit was dated 06/28/2024, 15 days later and 1 day outstanding. A hospice aide supervisory visit was dated 07/29/2024. The next hospice aide supervisory visit was dated 08/19/2024, 21 days later and 7 days outstanding. CLINICAL RECORD 9: The patient elected the hospice benefit on 06/17/2024. The plans of care dated 06/17/2024-09/14/2024 and 09/15/2024-12/13/2024 ordered "HA 3 times per week.” A hospice aide supervisory visit was dated 07/30/2024. The next hospice aide supervisory visit was dated 08/16/2024, 17 days later and 3 days outstanding. A hospice aide supervisory visit was dated 11/14/2024. The next hospice aide supervisory visit was dated 12/02/2024, 18 days later and 4 days outstanding. CLINICAL RECORD 10: The patient elected the hospice benefit on 08/30/2024. The plans of care dated 08/30/2024-11/27/2024 and 11/28/2024-02/25/2025 ordered "HA 5 times per week.” A hospice aide supervisory visit was dated 11/13/2024. The next hospice aide supervisory visit was dated 11/29/2024, 16 days later and 2 days outstanding. In an interview on 02/19/2025, the Administrator reviewed the records, confirmed the above findings and stated, "We recently identified an issue during our chart audits that aide supervisory visits were not always being completed every 14 days.”