Hospice Administrator Hospice employee Has required education and experience Responsible for hospice daily operations Reports to the governing body

Hospice Services Physician Nursing Medical Social Services Counseling Physical Therapy Occupational Therapy Speech Language Pathology Hospice Aide Homemaker Volunteer Inpatient Care Medical Supplies, Drugs, Biologicals DME

Professional Management Written agreement Services are Authorized by the hospice Furnished safely and effectively by qualified personnel Follow the patient's Plan of care Hospice retains administrative and financial management, and oversight of staff and services

Multiple Locations Be Medicare approved before providing services to Medicare patients. Be part of the hospice. Share administration, supervision, and services with the hospice. Have clearly delineated lines of authority, professional, administrative control. Be continually monitored and managed by the hospice.

Medical Director Doctor of Medicine or Osteopathy Employed directly or under contract Hospice may contract with individual or group

Medical Director Responsibilities Medical Component of Hospice’s Patient Care Program Review Patient’s Clinical Information Certify And Recertify Terminal Illness

Clinical Record Content All assessments, Plans of Care, Clinical notes Signed notice of Pt. Rights, & election statement Responses to medications, symptom management, treatments and services Outcome measure data elements (from assessments)

Clinical Record Content (Con’t) Physician certification and recertification Physician’s orders Past and current findings Advance Directives

Pop Quiz What happens when the patient is transferred to another M’care/M’caid facility: A. The hospice must always send a copy of the patient’s discharge summary with the patient. B. The hospice must always send a copy of the patient’s clinical record with the patient.

Durable Medical Equipment Follow manufacturer recommendations for maintenance Develop Policies if no recommendation Instruct pt/family on proper use Contract with supplier meeting Medicare MEMPOS standards

Inpatient Care Limitation Total Medicare inpatient days can’t exceed 20% of total Medicare hospice days.

Restraints or Seclusion All patients have the right to be free from restraint or seclusion imposed as a means of coercion, discipline, convenience, or retaliation. Only used to ensure safety of patient, staff, or others when less restrictive interventions not effective no standing orders or PRN

Restraints or Seclusion least restrictive possible Safety is paramount Time limited Monitored by trained staff. Documentation of training available in personnel records

Hospice/Facility written agreement Communication and documentation strategy Facility notifies hospice of specific patient conditions Hospice determines appropriate hospice care Facility responsibility for 24 hour r/b & personal care Hospice provides drugs & DME r/t terminal illness

Hospice/Facility written agreement (Con’t) Hospice provide same services as patients at home Hospice use of facility personnel Hospice responsibility to report violations to facility Provision of bereavement services

CMS Hospice Center

Hospice Social Worker MSW from accredited school +1 year experience or BSW, or bachelor in psychology, sociology, or other related field & 1 year experience & supervised by MSW or BSW AND employed by hospice before 12/2/2008.