DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION		 (X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER		 (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY COMPLETED
191674 A. BUILDING __________
B. WING ______________ 		02/13/2020
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
AMEDISYS HOSPICE 4021-B AMBASSADOR CAFFERY PARKWAY, SUITE 101, LAFAYETTE, LA, 70503
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See reverse for further instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation
LABORATORY DIRECTOR’S OR PROVIDER/SUPPLIER REPRESENTATIVE’S SIGNATURE

 TITLE

 (X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
(X4) ID
PREFIX
TAG		 SUMMARY STATEMENT OF DEFICIENCIES
(EACH DEFICIENCY SHOULD BE PRECEDED BY FULL
REGULATORY OR LSC IDENTIFYING INFORMATION)
L0554      
33204 Based on record review and interview, the agency failed to provide coordination and continuity of care to ensure alternatives for care were explored and appropriate referrals were made prior to discharge as per the agency's discharge policy for 1 of 5 sampled patients. (#2) Findings: Patient #2 was admitted to the agency on 6/15/2018 with diagnoses that included Alzheimer's Disease with Late Onset, Dementia, Heart Failure, Paroxysmal Atrial Fibrillation, and Muscle Wasting and Atrophy. Patient #2 was bed bound with durable medical equipment (DME) in the home that included a hospital bed with pressure prevention foam mattress, over bed table, nebulizer equipment, and oxygen equipment. The benefit period reviewed was 12/7/2019 to 2/4/2020. The patient was discharged to self-care on 1/26/2020. Review of an email from S1DOO to S3RD and copied to S2DON dated 1/15/2020 at 11:33 AM revealed, in part, the following: ...please review the following patients for possible discharge: ...(Patient #2) ...After review can you let me know who needs to be seen and I will schedule to go see them next week ... Review of an email from S3RD to S1DOO and copied to S2DON dated 1/23/2020 at 3:53 PM revealed, in part, the following: ...After discussion and further chart reviews, plan is as following: D/C (discharge) ... (Patient #2), notice to be given immediately .... Review of Patient #2's Client Coordination Note report dated 1/24/2020 by S2DON revealed: IDT (Interdisciplinary Team), (S4MD) question eligibility of terminal diagnosis. Consult with (S2DON) and (S3RD), review of documentation. No exacerbations noted ...Notification of non-coverage and detailed explanation to be delivered by clinicians on 1/24/2020. Review of Patient #2's Client Coordination Note report dated 1/24/2020 by S5RN revealed: ...PPS (Palliative Performance Scale) 30 (indicates totally bedbound and requires total care) ...pt (patient) rarely gets up now ...dependent for 6/6 ADLS (activities of daily living)..incontinent of bowel and bladder ...skin thin, frail, loose, pale, left arm stays contracted over chest, temporal muscle wasting noted, ribcage prominent through skin ...instructed caregiver ...husband ...and daughter ...on the phone about patients discharge ...daughter became very upset and husband refused to sign form until talking with all daughters ...working on getting appointment for patient referral to our home health ... Review of a verbal physician's order for Patient #2 dated 1/26/2020 revealed: "Patient to be discharged on 1/26/20. Patient no longer meets criteria regarding terminal status." Review of a verbal physician's order for Patient #2 dated 2/6/2020 at 4:41 pm revealed: "____ Home Health to eval (evaluate) and treat. 2/7/2020." Review of the agency's Discharge policy revealed: Policy: ...Alternatives for care will be explored, and appropriate referrals made, prior to discharge from the hospice. The Discharge process is as follows: a. Involves the patient, legal representative or family caregiver, and the attending physician primarily responsible for the care of the patient. c. The patient/family will be notified that discharge is being considered. f. The attending physician involved in the care of the patient should be consulted prior to discharge with his/her review and decision included in the discharge note and to ensure continuum of care, treatment and other services after discharge. There was no documentation that the agency explored other care alternatives or made appropriate referrals prior to discharge as per their dishcarge policy. An interview on 2/12/2020 at 3:30 PM was conducted with S5RN. She stated that she has been taking care for the patient, who has progressed to being more bedbound, for about a year. She stated that on Friday, 1/24/2020, she went to the patient's home to deliver the discharge form. She stated the form she attempted to provide was the Notice of Medicare Non-Coverage Form and no other discharge form with follow up medical care was provided. She reported that she explained that the patient no longer met Hospice criteria to the patient's sitter and husband and that she would be discharged on Sunday, 1/26/2020. She stated that the husband refused to sign the form until he spoke to his daughters. She stated that he then called one of his daughters on the phone and she became upset that they were discharging the patient. That same afternoon, one of the sisters called and spoke to S1DOO about the discharge and because the client is bedbound they were trying to get a physician to visit the home to make a home health referral which needs to be done face to face. However, the attempts to arrange for a home visit by a medical professional were not successful. An interview on 2/13/2020 at 11:05 AM was conducted with S4MD during which she was asked if there were any orders written for continuity for care such as referrals at the time she ordered to discharge patient #2. She stated, "No, I usually leave that up to the nurses to determine what additional services they may need." An interview on 2/13/2020 at 11:55 AM was conducted with S1DOO. During the interview, she reviewed the email form S3RD dated 1/24/2020 and confirmed that it said to discharge immediately and that the patient/family was notified that she was being discharged on Friday, 1/24/2020 and discharge occurred on the Sunday, 1/26/2020. She confirmed that there was no orders for referrals, no arrangements was made for DME the patient needed or for other services the patient may have required prior to discharge. She stated that she was unsure of the patient's current status and confirmed that the continuity of care was not maintained.