Failure to Maintain Required Hospice Election Documentation
Penalty
Summary
The facility failed to maintain complete hospice records for a resident receiving hospice services, specifically by not having a Hospice Election form on file. SOM Appendix PP requires that when a LTC facility arranges hospice care under a written agreement, a designated interdisciplinary team member with a clinical background must obtain specific hospice documentation, including the hospice election form, physician certifications, plan of care, and related information. The facility’s Hospice Services Facility Agreement, dated 12/2/25, also documented that the facility would arrange hospice services and that the designated facility member would obtain hospice coordination of care information and physician certification, including but not limited to the Hospice Election Form. Resident #18 was admitted with multiple diagnoses including leukemia, dementia, anxiety, and depression and was receiving hospice services. A review of this resident’s medical record and hospice documentation showed that the Hospice Election form was not included in the records maintained at the facility. On 4/2/26 at 11:46 AM, the Clinical Registered Nurse (CRN) confirmed that Resident #18’s Hospice Election form was not on record at the facility prior to requesting a copy from the hospice company that morning. On 4/6/26 at 2:15 PM, the CRN further clarified via email that she did not believe the election form needed to be included in the hospice documentation kept at the facility level.
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