Home Health & Hospice Week

The last thing you want to have happen is for your hospice to be at odds with nursing homes over pressure ulcer prevention or care for hospice patients.

The Conditions of Participation (CoPs) for both nursing homes and hospices require that the care plans for both providers "correspond to each other," says Dr. Harold Bob, a medical director fornursing homes and hospices in Baltimore, Md.

Best bet: Hospice of Lancaster County in Pennsylvania partners with nursing homes to devise a wound-care protocol for their hospice patients in that setting. "We will do wound assessment and measurements with the nursing home nurses and brainstorm about what to do," says Marygrace Lomboy, a nurse practitioner at the hospice.

A coordinated approach that includes the right care planning and documentation can help allay nursing home staff's fears of racking up F314 and other citations.

Nursing home surveyor guidance makes it very difficult for a surveyor to cite deficient care when the physician and nursing documentation reflect a specific plan of care for a given situation, Bob notes.

The physician notes also should spell out the rationale for the care plan and expected outcomes. For example, a physician's progress note for a patient near end of life might read: "Skin extremely fragile, and due to cachexia of terminal illness, breakdown is expected and non-preventable," says Bob. Also make sure the plan reflects the patient's and family's input and goals -- and discuss the plan with the patient's routine healthcare provider

The nursing home staff -- with input from hospice staff -- should make sure that the nursing home hospice patient's MDS reflects the plan of care for wounds and other care issues. That's importantto do, Bob emphasizes.

For example, Section M5 of the MDS allows you to check off wound-care interventions the resident is receiving. The MDS should also indicate that the resident is on hospice and has six months or fewer to live. To code the latter, you need a physician statement in the medical record to that effect.

The MDS should also definitely capture any advance directives -- for example, a do not resuscitate or do not hospitalize order, advises Jennifer Gross, a consultant with PointRight Inc. in Lexington, Mass. Also code any feeding restrictions, such as no artificial nutrition and hydration (IV fluids or tube feeding), she adds.