Failure to Ensure Effective Communication and Documentation with Hospice Providers
Penalty
Summary
The facility failed to implement an effective communication process between the facility and the hospice provider for residents receiving hospice services. For one resident with multiple diagnoses including cerebrovascular accident, respiratory failure, congestive heart failure, diabetes, and major depressive disorder, the care plan documented the need for palliative care and outlined general care goals. However, the care plan did not include evidence of collaboration or communication with the hospice provider. Staff interviews revealed uncertainty about the contents of hospice binders, the process for obtaining supplies, and the accessibility of care plans, indicating a lack of clear procedures for documenting and sharing hospice-related information. Another resident with diagnoses of congestive heart failure, COPD, depression, and hypertension had a hospice care plan that directed staff to adjust care according to the resident's changing abilities and to work cooperatively with the hospice team. Despite this, the care plan lacked essential details such as hospice contact information, visit frequency, supplies and medications provided by hospice, and any durable medical equipment. The resident's hospice order and plan of care were available in the facility, but staff interviews again highlighted gaps in knowledge about the communication process and access to relevant information. The facility's policy allowed for contracting hospice services and outlined the need for coordination and communication, but in practice, there was no documented process ensuring that information was consistently shared and accessible to all staff. This deficiency was observed through record reviews, staff interviews, and direct observation, and affected at least two residents who were receiving hospice care.