Volume 2024 | No. 2
SURVEYOR
HOSPICE
SECTION 4: HUMAN RESOURCE MANAGEMENT HSP4-13A Overview of the requirement:
Hospice aides are assigned to patients by a registered nurse, who prepares written care instructions to be followed by the aide. The aide and RN communicate and collaborate to update the plan of care when needed. Evidence of compliance is assessed through review of patient records and direct observations of care. Many deficiencies were cited because the number of aide visits did not match the frequency stated in written orders. Additional findings related to insufficient documentation in the patient record.
Comment on deficiencies:
Frequency of citation:
56%
Services Hospice Care Hospice Inpatient Care HOSPICE SERVICES AND DISTINCTIONS Distinctions Age-Friendly Care Palliative Care Telehealth
Examples of surveyor findings:
n The aide visit frequency was ordered twice weekly. The record indicated only one visit per week. n The aide written instructions indicated to provide a shower each visit. At the observation visit, the aide indicated he would provide a bed bath and had been doing a bed bath for five months. n Aide written instructions included “as directed” as frequency under change linen, assist with bedside commode, and oral care. n No evidence of collaboration between aide and RN. Aide written instructions state to assist with ambulation with walker and assist to bathroom. RN comprehensive assessment indicated that patient is non ambulatory and needs to use wheelchair. n The aide written instructions do not include oxygen precautions, fall precautions, or skin breakdown precautions which were identified safety measures and applicable to the plan of care. n Though the DPCS was able to provide a verbal explanation that visits were refused by the family on an ongoing basis, and this is why aide services were ultimately discontinued, there was no evidence or documentation in the EMR related to the missed visits. n Numerous notations by the aide indicated that the task was not completed “per patient preference.” There was no documentation that the patient was functionally and cognitively able to make the decision. n Documentation in patient records should reflect that hospice aides provide services that are: Ordered by the interdisciplinary group. Included in the plan of care. Permitted to be performed under state law by such hospice aide. Consistent with the hospice aide training.
FREQUENT DEFICIENCIES IN HOSPICE AGENCIES
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
Tips for compliance:
HSP4-13A
HSP5-1A
HSP5-3C
HSP5-3D
HSP5-4A
HSP5-4B
HSP5-4F
Human Resources Management
Provision of Care and Record Management
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