CMS: Care Planning, Hospice Aide Services Top Survey Deficiencies 

Issues related to care planning and hospice aide and homemaker services topped the list of most common deficiencies found during regulatory surveys during 2019, according to the U.S. Centers for Medicare & Medicaid Services (CMS).  Nearly 60% of hospices surveyed did not successfully comply with the requirement that hospices must develop an individualized care plan for every individual and family served and provide services consistent with that plan. 

Patient assessment is another item that frequently appeared in survey results last year. Of the surveyed hospices, 42% reportedly had deficiencies in patient assessments, with many programs failing to provide key content and resources such as medication monitoring, pain assessment and updating comprehensive care plans.

“There’s so many things happening, it’s often difficult to capture those changes that can occur rapidly in hospice patients,” said Deborah Wesley, vice president of clinical services for Addison County Home Health & Hospice in Vermont, in a recent Hospice News webinar. “For patients that move across the care continuum from a facility into the home setting, it can be a moving target to capture all their updated care assessments. We reconcile the information from their discharge through to their home care in each clinician visit to continue capturing any changes in their assessment and care needs.”


In compliance with the IMPACT Act of 2014, organizations with certified hospice programs undergo a standardized survey every 36 months. These surveys are used to determine compliance with federal and state health agency requirements, or Conditions of Participation (CoPs), that hospice providers must meet to participate in Medicare and Medicaid programs. Understanding survey deficiencies can benefit a hospice in their future program planning and inform performance improvement efforts.

“One of the things we require our staff to do at every comprehensive assessment is a true medication reconciliation,” Amy Rose, vice president of clinical operations for Sangre de Cristo Community Care in Colorado. “We sweep through all the patient’s home cupboards and cabinets for anything the patient might be taking and lay them out, and the nurse is responsible for making sure that what is in our charts matches what the patient is actually taking.”

CMS indicated that 53% of hospices had deficiencies related to hospice aide and homemaker services. Deficiencies in this area included failure to train aides, mismanagement of staff and not meeting the needs of aides in their ability to serve a key role in delivering care to patients and families.


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