Every finding on record at Visiting Nurse Services of Iowa

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 to ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. This standard was not met as evidenced by clinical record review, document review and interview. In 5 of 17 (29%) clinical records reviewed of patients who received Hospice Aide (HA) services it was revealed that the agency did not ensure that a Registered Nurse (RN) made 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 HA. DOCUMENT 1: Policy Number HOS-SM-20 titled, Hospice Aide and Homemaker Services, Review Date: 11/18/2024, read in part, "All Hospice Aide supervisory visits will be made at least every 14 days." CLINICAL RECORD 8: The patient elected hospice care on 07/12/2024 with a diagnosis of Parkinson's Disease. The hospice plan of care dated 03/09/2025 through 05/07/2025 ordered HA services three (3) times weekly beginning 03/09/2025. The HA visits were provided beginning 03/09/2025 as ordered. The HA supervisory visits were provided on 04/30/2025 and 05/15/2025, with 1 day outstanding. CLINICAL RECORD 9: The patient elected hospice care on 10/12/2024 with a diagnosis of Chronic Obstructive Pulmonary Disease. The hospice plan of care dated 03/30/2025 through 05/28/2025 ordered HA services twice (2) times weekly beginning 03/30/2025. The HA visits were provided beginning 03/30/2025 as ordered. The HA supervisory visits were provided on 04/23/2025 and 05/08/2025, with 1 day outstanding. CLINICAL RECORD 12: The patient elected hospice care on 01/05/2025 with a diagnosis of Malignant neoplasm of unspecified part of left bronchus. The hospice plan of care dated 02/28/2025 through 04/28/2025 ordered HA services three (3) times weekly beginning 02/28/2025. The HA visits were provided beginning 02/28/2025 as ordered. The HA supervisory visits were provided on 03/19/2025 and 04/03/2025, with 1 day outstanding. CLINICAL RECORD 18: The patient elected hospice care on 04/03/2024 with a diagnosis of Cerebral atherosclerosis. The hospice plan of care dated 07/02/2024 through 09/29/2024 ordered HA services three (3) times weekly beginning 07/02/2024. The HA visits were provided beginning 07/02/2024 as ordered. The HA supervisory visits were provided on 08/21/2024 and 09/05/2024, with 1 day outstanding. CLINICAL RECORD 19: The patient elected hospice care on 07/18/2024 with a diagnosis of Malignant Neoplasm of Prostate. The hospice plan of care dated 07/18/2024 through 09/17/2024 ordered HA services twice (2) times weekly beginning 07/18/2024. The HA visits were provided beginning 07/18/2024 as ordered. The HA supervisory visits were provided on 07/31/2024 and 08/15/2024, with 1 day outstanding. In a joint record review and interview on 05/21/2025, the Team Director/Administrator confirmed that, per agency policy, HA supervisory visits were not completed every 14 days.

It is required that hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. This standard was not met as evidenced by document review and interview. Review of volunteer documents revealed the agency did not ensure that volunteers provided day-to-day administrative or direct patient care services in an amount that was equal to five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. DOCUMENT 5: A joint review of the agency's "Volunteer Hours Report" with the Team Director/Administrator [Personnel Record 5] and Volunteer Coordinator [Personnel Record 7] on 05/19/2025 revealed that volunteer utilization was 4.62% for 05/01/2024 through 04/30/2025. The Team Director/ Administrator confirmed the finding and stated, "We have a PIP [performance improvement plan] that was put in place in October 2024 for this and in April we finished at 7.5% for the month. We are almost there." During an interview on 05/19/2025, the Team Director/Administrator [Personnel Record 5] and Volunteer Coordinator [Personnel Record 7] confirmed that volunteer utilization was 4.62% and below the 5% requirement for 05/01/2024 through 04/30/2025. The hospice agency did not ensure that volunteers provided day-to-day administrative or direct patient care services in an amount that equaled five percent (5%) of the total patient care hours of all paid hospice employees and contract staff.