Failure to Arrange Hospice Services Upon Resident Request
Penalty
Summary
A deficiency was identified when the facility failed to arrange hospice services for a resident who requested them. The resident, who had a two-year history of cancer with metastasis to the brain and had recently completed unsuccessful radiation treatment, expressed a desire for hospice care along with their family. Documentation in the medical record showed that the primary care physician was informed and directed staff to contact hospice. However, there was no evidence in the medical record of a verbal order for hospice services following this request, nor was there documentation of any action taken to initiate hospice care until nearly two weeks later, when the resident was seen for pain management and a palliative care consult was ordered. Interviews with facility staff revealed inconsistencies and confusion regarding the process for initiating hospice services. The Assistant Director of Nursing stated that requests for hospice are communicated to social work, who then contacts hospice, but the Director of Social Services indicated that sometimes orders were not consistently relayed. The resident was ultimately discharged home with hospice services arranged to begin upon arrival, but the facility did not arrange for hospice services during the resident's stay despite the explicit request and physician direction.