Failure to Inform Residents or Representatives Prior to Hospice Referral
Penalty
Summary
The facility failed to inform four residents or their representatives about hospice care options prior to sharing their information with a hospice agency. According to the facility's Resident Rights policy, residents are to be fully informed in advance about care and treatment options and participate in planning their medical treatment. However, for four residents with severe cognitive impairments and complex medical conditions, there was no documentation in their electronic medical records indicating that the facility had discussed hospice services with them or their powers of attorney before the hospice agency was contacted. Interviews with the residents' representatives revealed that they were first contacted by the hospice agency, not the facility, regarding hospice services. These representatives expressed confusion and concern about how the hospice agency obtained their contact information and were disturbed by the unexpected nature of the calls, especially given the sensitive topic of end-of-life care. In some cases, representatives believed the calls could be attempts at financial abuse or posed a risk to the residents' safety, as they had not previously discussed hospice care with the facility. Staff interviews confirmed that the interdisciplinary team (IDT) identified residents who might benefit from hospice and that the facility's process should involve notifying residents or their representatives before contacting hospice providers. Nursing staff and the DON acknowledged that the facility did not always communicate with families prior to involving hospice agencies, and that this was a lapse in procedure. The hospice director also stated that families should be educated by the facility first, but admitted to being the initial point of contact for many families.