Every finding on record at Mille Lacs Health System Home Care Hospice

Based on interview and document review the agency failed to consistently ensure the required interdisciplinary group meetings (IDG) members were present for each IDG meeting for 7 of 10 patients (P5, P6, P8, P10, P3, P4, P9) reviewed for comprehensive assessments. --- P3: P3's POC 4/28/24 to 6/26/24, identified a start of care date (SOC) 10/31/22. Diagnosis included neurocognitive disorder with Lewy bodies. P3 received skilled nurse (SNV), nursing aide (NA) and volunteer services. The Interdisciplinary Group (IDG) Meetings dated 1/10/24, 2/7/24, 2/21/24, 3/6/24, 3/20/24, 4/3/24, 4/17/24, and 5/1/24, identified the IDG team met to discuss P3's hospice care and treatment, however, team participants were not identified. The IDG team participation lists for 1/10/25, 2/7/24, 2/21/24, and 3/20/24, identified P3's registered nurse (RN), the hospice physician and licensed social worker (LSW) did attend the meeting, however the hospice chaplain did not. The IDG team participation lists for 4/3/24, 4/17/24, and 5/1/24, identified P3's RN and the hospice physician did attend the meeting, however, the hospice LSW and chaplain did not. P4: P4's POC 12/30/23 to 2/27/24, identified a SOC date of 1/14/21 and included a diagnosis of Alzheimer's disease. P4 received SNV, NA and LSW visits. The IDG meeting dated 1/10/24, identified the IDG team met to discuss P4's hospice care and treatment, however, team participants were not identified. The IDG team participation list for 1/10/25, identified P4's registered nurse (RN), the hospice physician, and the licensed social worker (LSW) did attend the meeting, however, the hospice chaplain did not. P9: P9's POC 7/30/24 to 9/27/24, identified a SOC 2/1/24. Diagnosis included diabetes mellitus with chronic kidney disease. P9 received SNV and NA visits. P9's IDG meetings dated 5/29/24, 6/13/24, 6/26/24, 7/11/24, 7/24/24, and 8/7/24, identified the IDG team met to discuss P9's hospice care and treatment. Team participants in attendance included two of P9's RN's and the hospice physician. P9's LSW and the hospice chaplain did not attend the meetings. A joint interview was conducted with the director of nursing (DON) and nurse manager (NM) on 8/12/24 at 1:15 p.m. The DON stated the agency did not currently have a chaplain and tried to incorporate the patient's own chaplain when needed. The NM stated the agency had lost its LSW in March 2024, and were using an interim LSW until they hired someone. The interim LSW did not attend any of the IDG meetings. The agency had just recently hired another LSW and would be attending the meetings going forward. When interviewed on 8/14/24, at 9:15 a.m. the NM stated the agency had a chaplain until last month when he resigned, however, the chaplain had not attended any of the agency IDG meetings. They had tried to talk to a couple of local chaplains, but none were interested in taking the volunteer position. The NM was aware a spiritual team member and LSW should be present at the agency IDG meetings to provide input regarding patient care related to their areas of practice. They had just hired a LSW and she would be attending every two-week meetings in the future. The agency was still working on finding a spiritual counselor or chaplain. The agency's undated policy Interdisciplinary Group identified the interdisciplinary group would work together to meet the physical, medical, psychosocial, emotional, and spiritual needs of their clients and families. The IDG group included a doctor of medicine who was an employee or under contract with the hospice agency, a registered nurse, licensed social worker and a pastoral or other counselor. P8 P8's POC 6/13/24 to 9/10/24, identified the start of care (SOC) date was 6/13/24. Diagnosis included malignant neoplasm of lower lobe left bronchus with secondary malignant neoplasm of brain and other parts of the nervous system. P8 received skilled nurse, nursing aide and medical social worker. The Interdisciplinary Group (IDG) Meeting dated 6/26/24, 7/11/24, 7/24/24, and 8/7/24, identified the IDG team met to discuss P8's hospice care and treatment. The IDG team participation list for 6/26/24, 7/11/24, and 7/24/24 Identified P8's registered nurse (RN) and the hospice physician attended the meeting, however, the licensed social worker (LSW) and chaplain did not. The IDG team participation list for 8/7/24, identified P8's RN and the LSW attended the meeting, however, the hospice physician and chaplain did not. P10 P10's POC 7/31/24 to 10/28/24, identified the start of care (SOC) date as 5/2/24. Diagnosis included malignant neoplasm of the colon. The IDG meetings dated 5/15/24, 5/29/24, 6/13/24, 6/26/24, 7/11/24, 7/24/24, and 8/7/24, identified the IDG team met to discuss P10's hospice care and treatment. The IDG team participation list for 5/15/24 and 6/13/24 identified P10's RN, the physician, and P10's nurse aide attended the meeting, however the LSW and chaplain did not. The IDG team participation list for 5/29/24, 6/26/24, 7/11/24, and 7/24/24, identified P10's RN and the physician attended the meeting, however, the LSW and chaplain did not. The IDG team participation list for 8/7/24 identified P10's RN and the LSW attended, however the chaplain and the physician did not. P5 P5's plan of care (POC) 2/14/24 to 5/13/24, identified a start of care date (SOC) 11/16/23. Diagnosis included Alzheimer's disease. P5 received skilled nurse, nursing aide and volunteer services. The Interdisciplinary Group (IDG) Meeting(s) dated 1/10/24, 2/7/24, 2/21/24, 3/6/24, 3/20/24, 4/3/24, 4/17/24, and 5/1/24, identified the IDG team met to discuss P5's hospice care and treatment. The IDG team participation list for 1/10/25, 2/7/24, 2/21/24, and 3/20/24, identified P5's registered nurse (RN), the hospice physician and licensed social worker (LSW) did attend the meeting; however, the hospice chaplain did not attend. The IDG team participation list for 4/3/24, 4/17/24, and 5/1/24, identified P5's RN, and the hospice physician did attend the meeting; however, the hospice LSW and chaplain did not. P6 P6's POC 2/25/24 to 5/25/24, identified a start of care date (SOC) 2/26/24. Diagnosis included Mesothelioma of pleura (cancer of the linings around the lungs). P6 received skilled nurse, nursing aide, and physical therapy. The Interdisciplinary Group (IDG) Meeting dated 3/6/24, 3/20/24, 4/3/24, and 4/17/24, identified the IDG team met to discuss P6's hospice care and treatment. The IDG team participation list for 3/20/24, identified P6's registered nurse (RN), the hospice physician and licensed social worker (LSW) did attend the meeting; however, the hospice chaplain did not. The IDG team participation list for 4/3/24, and 4/17/24, identified P6's RN, and the hospice physician did attend the meeting; however, the hospice LSW and chaplain did not.

Based on interview and document review the hospice agency failed to have individualized as needed (PRN) and range visits based on an assessment, to determine what was actually needed for 5 of 8 patients (P7, P3, P8, P6, P1) reviewed and identified they received PRN hospice services. Findings include: P7's Plan Of Care (POC) dated 10/21/20, identified P7 was admitted to hospice services on 8/24/20, and received skilled nurse, medical social work, home health aide and physical therapist visits scheduled. P7's POC failed to identify PRN visits could be provided. P7's medical record identified P7 received additional medical social work PRN visits which included a visit on 9/15/20. P3's POC dated 10/22/20, identified P3 was admitted to hospice services on 10/22/20, and received scheduled skilled nurse and medical social work visits. P3's POC failed to identify PRN visits could be provided. P3's medical record identified P3 received additional skilled nursing PRN visits on 11/27/20, 12/11/20, and 12/18/20, and medical social worker PRN visits on 11/20/20. P8's POC dated 12/7/20, identified P8 was admitted to hospice services 2/14/20, and received scheduled skilled nurse visits, home health aide visits and homemaker visits. P8's POC failed to identify PRN visits could be provided. P8's medical record identified P8 received additional PRN skilled nurse visits on 12/23/20, 2/19/21, and 2/26/21. P6's POC dated 9/4/20, identified P6 was admitted to hospice services 9/4/20, and received scheduled skilled nurse, medical social work and home health aide visits. P6's POC failed to identify PRN visits could be provided. P6's medical record identified P6 received additional PRN skilled nurse visits on 9/23/20, 10/12/20, and 10/13/20. P1's POC dated 7/9/21, identified P1 was admitted to hospice services on 1/14/21, and received only scheduled volunteer visits. P1's POC dated 9/3/21, identified no frequency of visits. P1's Interdisciplinary Team (IDT) Meeting dated 10/6/21, identified P1 received scheduled skilled nurse, home health aide and volunteer visits. P1's medical record identified P1 received additional medical social worker PRN visits on 3/26/21, 4/29/21, 5/14/21, and 5/24/21, and skilled nurse PRN visits on 1/22/21, and 1/29/21. On 10/13/21, at 9:52 a.m. hospice manager (HM)-A confirmed the above findings and indicated the agency did not include PRN visits for the patient's POC, as may be necessary. The undated agency policy Covered Services identified covered services must be reasonable and necessary for the palliation or management of the terminal illness as well as related conditions. The policy also identified the services must be consistent with the plan of care. The undated, agency policy Interdisciplinary Group, identified all care and services furnished to clients and their families would follow an individualized written plan of care developed by the interdisciplinary group, attending physician (if any), the client or representative, and the primary caregiver if any of them so desire. The policy further identified the plan of care would include all services necessary for the palliation and management of the terminal illness and related conditions. The policy identified the role of the group would ensure that the care and services would be provided in accordance with the plan of care.

Based on interview and document review, the hospice failed to ensure a registered nurse (RN) provided a supervisory visit of home health aide services at least every 14 days for 3 of 8 patients (P1, P7, P8) who's records were reviewed. Findings include: P1's plan of care (POC) dated 7/9/21, identified P1 was admitted to hospice services on 1/14/21, and received only scheduled volunteer visits. P1's POC dated 9/3/21, identified no frequency of visits. P1's Interdisciplinary Team (IDT) Meeting dated 10/6/21, identified P1 received home health aide visits two times a week. P1's medical record identified P1 had a supervisory visit on 8/27/21. P1's next supervisory visit was completed 10/1/21. P1's medical record lacked a supervisory visit completed in September of 2021. On 10/13/21, at 9:52 a.m. hospice manager (HM)-A confirmed P1 did not receive a supervisory visit in the month of September. P7's POC dated 10/21/20, identified P7 was admitted to hospice services on 8/24/20, and received home health aide (HHA) visits two times a week. P7's medical record identified P7 HHA visits began 8/27/20, and P7's first supervisory visit was completed on 9/17/20, twenty one days after P7's initial HHA visit was completed. On 10/14/21, at 7:40 a.m. HM-A confirmed the above findings for P7. P8's POC's dated 10/7/20, and 12/7/20, identified P8 was admitted to hospice services 2/14/20, and received home health aide visits one time a week. P8's medical record lacked documentation of supervisory visits from 11/12/20, to 1/12/21. On 10/14/21, at 12:55 p.m. HM-A confirmed the above findings for P8. HM-A indicated one nurse who was no longer employed at the agency documented supervisory visits were only to be completed monthly. HM-A then indicated two other nurses had missed the other two needed supervisory visits. HM-A indicated she expected supervisory visits to be completed timely, at least every 14 days. The undated, agency policy Service Assignment And Supervision identified the purpose was all services provided by hospice were evaluated the interdisciplinary team, primary physician, client and or caregiver. The policy also identified supervision of the aide included that the RN supervised at least every 14 days, either when the aide was present to observe and assist, or when the aide was absent to assess relationships and determine whether goals were being met.