Failure to Coordinate Hospice and Facility Care Plans for ADL Assistance
Penalty
Summary
The facility failed to ensure that a hospice plan of care was properly developed and coordinated for a resident receiving hospice services, specifically regarding communication between the facility and the hospice provider about activities of daily living (ADLs). The resident, who had severe cognitive impairment and multiple diagnoses including dementia, encephalopathy, and a history of falls, required substantial to maximal assistance with ADLs and was dependent on a wheelchair. The care plan indicated the need for a mechanical lift for transfers and detailed the level of assistance required for various activities. An incident occurred when a hospice CNA provided a shower to the resident and, during the process, caused skin tears on the resident's left elbow, right forearm, and right ankle. The CNA did not follow the facility's care plan, which required the use of a mechanical lift for transfers, and instead transferred the resident to the shower chair alone. There was no documentation of communication between facility staff and the hospice aide regarding the resident's specific ADL care needs, nor was there documentation of the frequency or nature of care provided by the hospice aide. Interviews with the Nursing Home Administrator and Director of Nursing revealed that the hospice provider maintained its own care plan, which did not specify the level of assistance required for the resident, only the tasks to be performed. The facility staff did not communicate the resident's assistance needs to the hospice aides, and there was no policy in place to guide coordination of care between the facility and hospice provider. The service agreement between the facility and hospice required coordination and inclusion of both plans of care, but this was not implemented in practice.