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
261616 A. BUILDING __________
B. WING ______________ 		11/14/2019
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
VITAS HEALTHCARE CORPORATION MIDWEST 1801 PARK 270 DRIVE - SUITE 150, SAINT LOUIS, MO, 63146
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)
L0585      
29559 Based on policy review, record review, and interviews, the agency failed to ensure licensed professionals offered hospice care in accordance with current professional standard, agency policy. A patient with uncontrolled pain did not want to go to the hospital for symptom control. The agency failed to offer continuous care to the patient. The hospice case manager and hospice nurse practitioner that were managing care of the patient were unaware that continuous care was a level of care option for a hospice patient. The deficient practice has the potential to affect all patients on hospice service. Findings included: Review of the agency policy titled "VS Continuous Care" last updated 06/2017 showed in part that the purpose of continuous care is for periods of crisis. Nursing care may be covered on a continuous basis for as much as 24 hours a day during periods of crisis as necessary to maintain an individual at home. A period of crisis is a period in which the individual requires continuous care to achieve palliation and management of acute medical symptoms. PATIENT/RECORD #3: Review of the clinical record showed: - The patient was admitted to hospice service on 05/23/17; - The patient's primary terminal diagnosis was kidney cancer; and - The patient was having severe uncontrolled pain in his/her leg and hip area due to unknown origin on 10/20/19. During an interview on 11/14/19 at 10:31 AM, Registered Nurse (RN-A) stated the following: - He/she was a nurse case manager, and worked for the hospice for three years; - He/she was the case manager for patient #3; - He/she assessed the patient to have uncontrolled pain on the evening of 10/20/19; - The family, patient, and him/herself had a discussion on how to address the uncontrolled pain. The patient was adamant that he/she did not want to leave home. The patient agreed to enter into GIP (GIP = General inpatient service or short term inpatient care at a hospital or skilled nursing facility) the next following day (10/21/19); and - When asked if the hospice team had considered continuous care for the patient considering the patient was adamant about not leaving his/her home, the nurse responded "I'm not familiar with that, I didn't think we offered that". During an interview on 11/14/19 at 10:53 AM, Registered Nurse (RN-B) stated the following: - He/she was a nurse practitioner, and worked for the hospice since February 2019; - He/she was informed that the patient had uncontrolled pain and was being admitted to GIP at the local hospital; - He /she was assisting the other hospice nurses in managing the patient; and - When asked if the hospice team had considered continuous care for the patient considering the patient was adamant about not leaving his/her home, the nurse responded that he/she "not sure what continuous care is". Review of the interdisciplinary care team/Group (IDT/IDG) meeting notes, coordination notes, and available communication notes showed no consideration or offer of continuous care. The patient was in uncontrolled pain, and was adamant that he/she did not want to leave his/her home for treatment of the pain on 10/20/19. Findings were reviewed with the agency clinical manager on 11/14/19 at 11:05 AM, The clinical manager stated that he/she was unaware that the patient was adamant that he/she did not want to leave home when having uncontrolled pain. The agency offers continuous care as a level of care option. When the clinical manager was informed that two nurses managing care of the patient were unaware that continuous care was a level of care option, he/she stated that both the nurses involved were "fairly new" and "sounds like we need to do some education".