Failure to Obtain Physician Order for Hospice Services
Penalty
Summary
Surveyors identified a deficiency in which the facility failed to obtain and document a physician order for hospice services for one resident receiving hospice care. The facility’s hospice program policy, last reviewed April 22, 2025, did not specify that a physician order must be obtained for hospice services. Clinical record review for Resident 8 showed diagnoses including chronic obstructive pulmonary disease and protein-calorie malnutrition, and a significant change MDS dated December 19, 2025, indicated the resident was receiving hospice services under Section O for special treatments, procedures, and programs. However, review of the resident’s physician orders did not reveal any order for hospice services. In an interview, the NHA and DON confirmed that the resident did not have a physician order for hospice services and stated that it was the facility’s expectation that physician orders be in place for care and services. The deficiency was cited under 28 Pa. Code 201.14(a) Responsibility of licensee, 28 Pa. Code 211.12(d)(3)(5) Nursing services, and 28 Pa. Code 201.18(b)(1)(3) Management, based on the lack of a documented physician order for hospice services despite the resident being identified as receiving hospice care on the MDS and the absence of a policy requirement to obtain such an order.
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