Failure to Collaborate with Hospice in Timely Care Plan Development
Penalty
Summary
The facility failed to develop and implement a comprehensive, person-centered care plan within 7 days after the completion of a comprehensive assessment for a resident receiving hospice services. Specifically, there was no documented participation or collaboration with the hospice interdisciplinary team (IDT) in revising or updating the resident's care plan, despite the resident being admitted with a primary diagnosis of vascular dementia and being placed on hospice care. The care plan did not reflect input from the hospice provider, and there were no hospice progress notes present in the resident's chart. Interviews with facility staff revealed that after being informed by a PACE agency physician that the resident would be on hospice, a significant change assessment was completed, and the resident's family was notified. However, the Director of Nursing confirmed that there was no IDT meeting or documented collaboration with the hospice agency in the care planning process. The facility's own policy requires a coordinated plan of care between the facility, hospice agency, and resident/family, but this was not followed in this case.