Lesson 7
Hospice Care in the
Nursing Home
Basic Hospice
7-1
Learning Objectives
￭
￭
￭
￭
￭
Basic Hospice
Explain
E
l i Hospice
H
i Professional
P f i
l Management
M
t
responsibilities for nursing home (NH) residents
Discuss the requirements for the written agreement
between the hospice and the NH
Discuss the goals of a coordinated plan of care in the
NH setting
Review the coordination of services requirement
Describe orientation and training of staff in the NH
7-2
418.112 Condition of Participation:
p
that Provide Hospice
p
Care to
Hospices
Residents of a SNF/NF or ICF/MR
Must meet all of the Conditions of Participation
at 418.10 through 418.116
Basic Hospice
7-3
418.112(a)
( ) Standard-Resident Eligibility,
g
y,
Election and Duration of Benefits
￭
Medicare
M
di
patients
i
receiving
i i hospice
h
i services
i
and residing in a SNF, NF or ICF/MR are
subject to the Medicare eligibility criteria that
includes:
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Basic Hospice
Eligibility
Election
Duration of benefits
7-4
418.112(b) - Standard
Professional Management
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Hospice
H
i assumes responsibility
ibili for
f
professional management of the resident’s
hospice services provided
provided, in accordance with
the plan of care and hospice CoPs
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Arrange for hospice-related inpatient care in a
participating Medicare/Medicaid facility
Basic Hospice
7-5
418.112 (c) - Standard
Written Agreement
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The hospice
Th
h
i must have
h
a written
i
agreement
with the facility that specifies the provision of
hospice services in the facility
￭
The agreement must be signed by authorized
representatives of the hospice and facility
before the provision of hospice services.
services
Basic Hospice
7-6
Written Agreement
￭
Basic Hospice
(cont.)
IIncludes
l d communication
i i methods
h d and
d
documentation of same to ensure that the
needs of the patients are addressed and met
24 hours a day
7-7
Written Agreement
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A provision
i i that
h the
h facility
f ili immediately
i
di
l
notifies the hospice if any of the following
occur:
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Basic Hospice
(cont.)
Significant change in condition
Clinical complications
Need to transfer from the facility
Patient dies
7-8
Written Agreement
￭
Basic Hospice
(cont.)
A provision
i i that
h the
h hospice
h
i assumes
responsibility for determining the course of
hospice care including the determination to
change the level of services provided
7-9
Written Agreement
￭
Basic Hospice
(cont.)
The facility
Th
f ili is
i responsible
ibl to continue
i
to
furnish room and board care, meeting the
personal care and nursing needs that would
have been provided by the primary caregiver
at home at the same level of care provided
before hospice care was elected
7-10
Written Agreement
￭
Basic Hospice
(cont.)
The hospice
Th
h
i will
ill provide
id services
i
at the
h same
level to the same extent if the patient was in
his/her own home
7-11
Written Agreement
g
Delineation of Hospice’s Responsibilities
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Basic Hospice
Medical
M
di l direction
di ti &
management
Nursing
Counseling (including
spiritual, dietary and
b
bereavement)
)
Social work
Medical supplies
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7-12
DME and
d drugs
d
necessary for palliation
of p
pain & symptoms
y p
associated with terminal
illness and related
conditions
All other hospice
services necessary for
care of terminal illness
and related conditions
Written Agreement
p
Delineation of Hospice’s
Responsibilities (cont.)
￭
Basic Hospice
Hospice
H
i may use the
h facility
f ili nursing
i
personnel where permitted by State law and
as specified by the facility to assist in the
administration of prescribed therapies
included in the plan of care only to the extent
that the hospice would routinely use the
services of a hospice patient’s family in
implementing the plan of care
7-13
Written Agreement
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All
Alleged
d Violations
Vi l i
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Basic Hospice
(cont.)
A provision that the hospice must report all
alleged violations involving mistreatment,
mistreatment neglect,
neglect
or verbal, mental, sexual and physical abuse,
including injuries of unknown source and
misappropriation
i
i ti off patient
ti t property
t b
by anyone
unrelated to the hospice to the facility
administrator within 24 hours of the hospice
p
becoming aware of the alleged violation
7-14
Written Agreement
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B
Bereavement
S
Services
i
￭
Basic Hospice
(cont.)
The written agreement should include a provision
regarding the responsibility of the hospice for
providing bereavement services to the SNF/NF or
ICF/MR
7-15
418.112(d) Standard Hospice Plan of Care
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Basic Hospice
Established
E
t bli h d and
d maintained
i t i d in
i consultation
lt ti
with facility
Care provided must be in accordance with
plan
Identification of care and services,, and who is
responsible
Reflects participation of hospice, facility and
patient/family
ti t/f il
Changes discussed and approved
7-16
418.112 (e) Coordination of Services
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The hospice
Th
h
i must designate
d i
an IDG member
b
responsible for:
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Basic Hospice
Overall coordination of hospice care
Communication with facility and other health care
providers participating
p
p
p
g in the provision
p
of care to
ensure quality of care
7-17
Coordination of Services
￭
Basic Hospice
(cont.)
Ensure that
E
h the
h hospice
h
i IDG communicates
i
with the facility medical director, patient’s
attending physician and other physicians
participating in the provision of care so that
the medical care and the hospice care can
compliment and enhance the outcomes of the
patient
7-18
Coordination of Care
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Provide
P
id facility
f ilit with
ith patient-specific
ti t
ifi
information:
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Basic Hospice
Most recent plan of care
Election form
Advance directives (if any)
Certification and recertifications
Hospice contact information
Access to 24 hour on call system
Medication information/physician orders
7-19
418.112(f) Orientation and Training
of Staff Furnishing Care
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Basic Hospice
Hospice
H
i philosophy
hil
h
Hospice P & P’s
Pain control
Symptom management
Principles about Death
& Dying
7-20
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IIndividual
di id l responses to
t
death
Patient Rights
Appropriate forms
Record keeping
requirements
Nursing Home Responsibilities
Assess
resident
Maintain
MDS/RAI
Provide
personal care
Provide
activities
Meet all NH
regulations
Give
medications
Orient
hospice staff
Clean
room
Activities of
daily living
Notify hospice
of any
change in condition
Basic Hospice
Coordinate plan
with hospice
7-21
Hospice Responsibilities
Assess
resident
Financial
Fi
i l
responsibility
terminal
illness &
related
conditions
Orient &
Train NH staff
Basic Hospice
Coordinate PoC
with NH
Provide hospice
care & services
Professional
management
Monitor care
review & update
Determine level of care
Interdisciplinary
Group (IDG)
7-22
QAPI
Meet all
hospice CoPs
Medicare + Medicaid Eligible
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Hospice & NH must have written agreement
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Hospice assumes professional management
of the individual's hospice care
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Facility provides room & board
Basic Hospice
7-23
Medicare & Medicaid Payments for
Hospice Patients Residing in NH
State Medicaid
Agency
Hospice
Medicare
Administrative
Contractor
Basic Hospice
7-24
Nursing
Home
Lesson 7
Q
Questions?
Basic Hospice
7-25