Failure to Update Care Plan for Resident Receiving Hospice Services
Penalty
Summary
The facility failed to ensure coordinated care and services between the facility and hospice for a resident who was admitted to hospice care. The resident had multiple diagnoses, including Alzheimer's disease, chronic kidney disease, encephalopathy, acute bronchitis, and congestive heart failure, and required significant staff assistance with activities of daily living (ADLs) due to severe cognitive impairment and functional limitations. Although the resident was admitted to hospice care and had a physician's order for hospice services, the facility did not update or create a facility care plan reflecting the resident's hospice status. The care plan in the electronic health record did not indicate that the resident was receiving hospice services, despite documentation from the hospice provider and orders from the primary care physician. The facility's policy required comprehensive, person-centered care plans to be developed and revised as residents' conditions changed, including when a resident was admitted to hospice. The lack of an updated care plan coordinating hospice and facility services placed the resident at risk for inadequate end-of-life care.