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Hospice Plan of Care: Addressing and Resolving Issues
Hospice Care: What It Takes
A specialized type of medical care, hospice care is meant for a person who is terminally ill and who is expected to have six months or less to live. However, for as long as the primary physician and the care team have certified a person to need hospice care, this service can be provided.
There are various services provided by the hospice care team, aside from managing the patient’s pain and providing medication and equipment. They also assist the patient and family members handle the emotional, spiritual, and psychosocial areas of death. Hospice care can take place in various places such as at home, at a freestanding hospice center, in a hospital, or in an accredited nursing facility. Most hospice patients cover costs through the Medicare Hospice Benefit.
In America, the National Hospice and Palliative Care Organization (NHCPO) is the main governing body of hospice care. It oversees professional education, quality and standards, regulation, and legislative affairs on hospice care in the country.
Goals of Hospice Care
The fundamental goal of hospice care is to give support and compassionate care for people who have a life-limiting illness and are possibly on the brink of death. Hospice caregivers help make their patient’s final days on earth as comfortable as possible, maintain their quality of life, and try to control their pain. The aim is to give them peace and dignity during the last days of their lives. The support that hospice caregivers provide goes beyond expert medical care and pain management. They also give emotional and spiritual support that is customized based on the patient’s needs and preferences.
Many hospice programs also provide services to help the immediate family or loved ones of the patient cope with the difficult situation of impending death. They provide grief support and counseling.
Providing Hospice Care
Families opt to enroll in hospice care to provide comfort and expert care to their loved one. It also eases their burden and prepares them for their loved one’s passing. Usually, a family member is designated as a primary caregiver and when necessary, also helps make decisions for the terminally-ill patient. Hospice team members provide additional care and other services by being on call 24/7. The patient may receive various levels of care depending on their status.
The hospice team supporting the patient is made up of members from various disciplines that consist of the following people:
· Physicians
· Volunteers
· Nurses
· Therapists
· Home Health Aides
· Spiritual Counselors
· Social Workers
· Bereavement Counselors
· Pharmacists
Hospice Plan of Care
One important aspect of hospice care is the establishment of the plan of care. A hospice plan of care is an individualized written plan prepared by the interdisciplinary team in accordance with the patient’s needs. There are clear standards laid out for the content of the plan of care. This individualized plan must indicate the patient and family goals. It should also show the interventions based on the identified problems and must also include all services necessary for the management of the illness. Proper training should be provided based on the identified care and service that must be given to the patient. Assessment activities which are performed by the inter-disciplinary team members should also be included in the plan of care. There is a timeframe standard set for team’s completion of the comprehensive assessment. It must be completed no less than five calendar days after the election of hospice care.
The hospice plan of care and the written certification of terminal illness are both needed in order to get Medicare coverage. Medicare also requires the Plan of Care to be updated based on the patient’s current status to make sure that the patient is actually receiving the care that he or she needs. The update should include the patient’s current condition – whether it has deteriorated or improved and whether the level of care has changed.
Hospice Plan of Care Deficiency
The top hospice survey deficiencies have remained consistent for the past few years. Number one on the list is the deficiency on the Hospice Plan of Care. This deficiency has remained in the top three for several years. In fact, in the year 2017, about 10% of hospices surveyed were identified as not complying with the plan of care standard. Some of the top issues related to plan of care deficiency are the following:
· Failure to deliver proper care as specified on the plan of care
· Failure to include the required specialists in the development of the plan of care
· Failure to incorporate updated comprehensive assessment information
According to the survey results, many hospices failed to observe the frequency of visits stated on the plan of care. Many also failed to deliver the interventions stated in it.
Practices that Promote Compliance to the Plan of Care Deficiency
Compliance with the plan of care deficiency can be tackled within three areas: clinical compliance, documentation compliance, and administrative compliance. For clinical compliance, all identified problems during assessment should be included in the plan of care. They should also be consistently updated during each visit. For documentation compliance, there should be consistent information and coordination of care documentation in the clinical record. There should be faithful documentation of whether problems are ongoing or resolved. When it comes to administrative compliance, validation should be performed to check whether the plan of care singles out each and every service that is needed in order to deal with the problems that were named in all of the assessments conducted. There should also be evidence of patients receiving the medication and treatments.
The hospice plan of care should be able to follow a specific process. First, problems that need to be addressed should be identified. Data elements should be complete. This includes pain scales or negotiated pain rate, symptom scales, PPS, MAC, etc. Second, individualized goals should be set. The outcomes should be specific and patient/family focused. Goals should also be fluid and should be flexible enough to be altered as the patient’s condition changes. Third, proper interventions should be identified. This includes specifying all the necessary interventions, who is the team member who will perform the intervention, and how often the intervention will be performed.
Hospices should be able to refer to the plan of care before each team member visit. This is to ensure the proper delivery of the listed interventions or whether they are modified accordingly. The plan of care should reflect what is actually happening.
Quality is Intentional!
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