Failure to Facilitate Timely Hospice Care per Resident Request
Penalty
Summary
The facility failed to honor a resident's right to self-determination by not facilitating timely access to hospice care as requested by the resident. The resident, an elderly female with a history of multiple myeloma in remission and poly osteoarthritis, was cognitively intact and her own responsible party. She began experiencing significant, persistent pain and requested hospice services to help manage her symptoms. The facility physician promptly wrote an order for hospice care and increased pain medication, but the initiation of hospice services was delayed due to facility policy requiring CEO approval before ancillary services could be provided. Despite the resident's ongoing pain and repeated requests for hospice, as well as communication from the DON to the CEO requesting approval, no timely action was taken. The DON provided documentation of her request to the CEO, but did not receive a response. The resident, her POA, and facility staff all confirmed that the delay was due to the need for corporate approval, and the CEO later stated that hospice contracts had to be reviewed on a case-by-case basis. The resident continued to experience high levels of pain during this period, with pain scores consistently between 6 and 8 out of 10, and only partial relief from pain medications. Interviews with facility staff, the resident, and her POA confirmed that the delay in hospice initiation was not due to clinical reasons but rather administrative requirements. The facility's own policies stated that hospice services are available to residents at the end of life and that the DON or designee should contact the hospice agency to determine the resident's wishes. However, these policies were not followed, resulting in an eight-day delay before hospice services were finally initiated for the resident.