Failure to Coordinate and Document Hospice Services for a Terminally Ill Resident
Penalty
Summary
The deficiency involves the facility’s failure to collaborate with a hospice provider and coordinate hospice care planning and documentation for a resident receiving hospice services. The resident was an elderly female with a diagnosis of neurocognitive disorder with Lewy bodies and a documented terminal prognosis, with a significant change MDS indicating a condition that may result in a life expectancy of less than six months. Her care plan identified that she was on hospice services and outlined both facility and hospice responsibilities, including hospice RN, aide, social worker, chaplain, physician, and volunteer visits, as well as expectations for communication and care plan meetings. Record review showed that although there was a physician order to admit the resident to hospice care, the resident’s electronic chart did not contain required hospice documentation. Specifically, there was no Texas Medicaid Hospice Recipient Election/Cancellation form, no Physician Certification of Terminal Illness form, no current interdisciplinary notes, and no evidence of communication between the facility and the hospice provider in the resident’s record. Review of the hospice binder behind the nurses’ station revealed only an out-of-hospital DNR form for the resident, with no other hospice documentation present. Interviews further demonstrated a lack of clear coordination and designated responsibility for hospice communication. The resident’s POA reported that hospice staff were frequently present, had notified her of a change in condition, and had participated in a care plan meeting with facility staff, but this activity was not reflected in the facility’s documentation. The DON acknowledged that the hospice binder for the resident lacked key hospice documents and stated that hospice was at the facility daily for the resident, and that charge nurses could communicate with hospice, but did not identify a designated hospice coordinator. A posting in the hallway still listed a former ADON, whose employment had ended months earlier, as the hospice coordinator, and the DON did not identify a replacement. Review of the hospice contract showed that hospice was to make specific forms and interdisciplinary documentation available to the facility, and review of the facility’s end-of-life care policy showed no designated person or process for hospice collaboration and care coordination.
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