6 Colo. Code Regs. § 1011-1-21-6

Current through Register Vol. 47, No. 11, June 10, 2024

Section 6 CCR 1011-1-21-6 - PATIENT CARE SERVICES

6.1 Interdisciplinary Group: The hospice shall establish an interdisciplinary group whose responsibility shall include but not be limited to:

(A) Establishment of a plan of care which includes data elements that allow for measurement of outcomes;

(B) Provision and/or supervision of hospice care and services;

(C) The review and/or revision of the plan of care for each patient/family receiving hospice care; and

(D) Involvement of the patient/family in hospice care.

6.2 Admission Criteria:

(A) Upon admission to the hospice there shall be an evaluation of the patient's immediate needs related to their terminal condition. An initial plan of care shall be developed based upon the results of the immediate needs evaluation.

(B) An initial assessment of the patient's physical, psychosocial, spiritual and emotional status related to the patient's terminal illness and related conditions shall be completed by a registered nurse within forty-eight (48) hours.

(1) For patients receiving palliative care services under the Children with Life

Limiting Illness waiver program, the initial assessment shall be completed by a registered nurse within fourteen (14) calendar days of admission.

6.3 Within five (5) calendar days following admission, depending upon the patient's immediate needs, a comprehensive assessment shall be completed by the interdisciplinary group. For patients receiving palliative care services under the Children with Life Limiting Illness waiver program, a comprehensive assessment shall be completed by an appropriate interdisciplinary team member within 30 calendar days.

The comprehensive assessment shall identify the patient's physical, psychosocial, emotional and spiritual needs related to the terminal illness and related conditions that shall be addressed in order to promote the patient's well-being, comfort and dignity throughout the dying process. This includes a thorough evaluation of the caregiver's and family's willingness and capability to care for the patient.

The comprehensive assessment shall be updated as frequently as the patient's condition requires but no less than every 30 calendar days. For patients receiving intermittent respite and waiver services that are not provided within a continuous 30 day period, the comprehensive assessment shall be updated before reinitiating services.

6.4 An individualized written plan of care shall be developed to reflect patient and family goals and interventions based on the problems identified in the initial, comprehensive and updated comprehensive assessments. The plan of care shall include all services necessary for the palliation and management of the terminal illness and include but not be limited to:

(A) Interventions to manage pain and symptoms;

(B) A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs;

(C) Measurable outcomes anticipated from implementing and coordinating the plan of care;

(D) Drugs and interventions necessary to meet the needs of the patient;

(E) Medical supplies and appliances necessary to meet the needs of the patient;

(F) Coordination of care;

(G) Patient/family understanding and agreement with the plan of care, and

(H) When applicable, plans to meet the special needs of patients who are infants, children and adolescents.

6.5 The appropriate interdisciplinary group member shall coordinate the overall plan of care for each patient.

6.6 Except as set forth in paragraph (A) below, the interdisciplinary group (in collaboration with the individual's attending physician or nurse practitioner) shall review, revise and document the individualized plan as frequently as the patient's condition requires, but no less frequently than every 30 calendar days. A revised plan of care shall include information from the patient's updated comprehensive assessment and shall note the patient's progress toward outcomes and goals specified in the plan of care.

(A) For patients receiving intermittent respite and waiver services that are not provided within a continuous 30 day period, the time frame for review by an appropriate interdisciplinary group member begins upon the re-initiation of care.

6.7 A system of effective communication shall be developed and maintained to assure that all services are coordinated and provided in accordance with the plan of care, including family, attending physician or nurse practitioner and others providing care.

(A) To facilitate continuity of care when transferring within the hospice, to another hospice or to another provider, pertinent documentation shall be immediately forwarded to the receiving care provider.

(B) At the time of discharge, the hospice shall provide pertinent clinical records and any other documentation that may be requested to assist in post-discharge continuity of care.

6.8 Medical Director: The hospice shall designate a physician who shall act as medical director. The physician shall be a doctor of medicine or osteopathy who is an employee, or is under contract with the hospice, and has a current license in good standing to practice in the State of Colorado.

6.9 The medical director or physician designee shall be a member of the interdisciplinary group and be responsible for the medical component of the hospice's patient care program including, but not limited to, the following:

(A) Reviewing appropriate clinical material from the referring physician to validate the prognosis as anticipated by the patient's attending physician or nurse practitioner;

(B) Assisting in developing and medically validating the interdisciplinary plan of care for each patient/family with the coordination of the patient's attending physician or nurse practitioner;

(C) Rendering, as necessary, or supervising active medical care of the patient and maintaining a record of such care;

(D) Maintaining a regular schedule of participation in pertinent components of the hospice patient care program;

(E) Being readily available to the hospice program personally or naming a qualified physician designee;

(F) Acting as a consultant to and maintaining liaison with the attending physician or nurse practitioner and other members of the interdisciplinary group;

(G) Helping to develop and review patient/family care policies and procedures;

(H) Serving on appropriate committees;

(I) Reporting issues regarding the delivery of medical care; and

(J) Approving written protocols for symptom control such as pain or nausea.

6.10 Physician Services: The hospice shall ensure that each patient has an attending physician or nurse practitioner. If a patient has no attending physician or nurse practitioner, there shall be a mechanism for assuring the availability of one. The attending physician or nurse practitioner shall:

(A) Approve and sign the plan of care for the patient/family;

(B) Be available to the interdisciplinary group as necessary;

(C) Provide information to the interdisciplinary group in developing the plan of care; and

(D) Review the plan of care at least every 90 days.

6.11 Nursing Services: The hospice shall provide nursing care and services by or under the direction and supervision of a registered nurse with training and experience to direct hospice nursing care who shall be an employee of the hospice. Nursing services shall ensure that the patient's needs are met as identified in the patient's initial assessment, comprehensive assessment and updated assessments.

6.12 Highly specialized nursing services that are provided so infrequently that the provision of such services by direct hospice employees would be impracticable and prohibitively expensive, may be provided under contract.

6.13 Medical Social Services: The hospice shall provide medical social services provided by a qualified medical social worker based on the initial and comprehensive assessments, the patient/family's needs and acceptance of services.

6.14 Volunteer Services: The hospice shall utilize volunteers in roles as defined by the hospice that support patient care and administrative services.

6.15 The hospice shall maintain a volunteer program which meets the operational needs of the hospice and demonstrates overall coordination of volunteer services. The program shall include recruitment, orientation, training, supervision, monitoring and evaluation.

6.16 Patient services provided by volunteers shall be in accordance with the plan of care and shall be documented in the clinical record.

6.17 Bereavement Counseling: Before and for one year following the patient's death, the hospice shall provide bereavement services to families and others including individuals in residential facilities where the patient resided. These services shall be provided in accordance with the needs of the individual and furnished under the supervision of a qualified professional with experience or education in grief or loss counseling.

6.18 Spiritual Counseling: The hospice shall provide spiritual counseling services based on the initial and comprehensive assessment of the spiritual needs and acceptance of this service by the patient, family and significant others.

6.19 Hospice Aide Services: The hospice shall ensure that hospice aides have successfully completed a state approved certified nurse aide (CNA) training program and are currently certified by the Colorado Department of Regulatory Agencies (DORA).

6.20 Hospice Aide Services: Hospice Aides shall be supervised by a registered nurse every 14 days to assess the quality of care and services provided by the aide. The hospice aide does not need to be present during this visit. On-site supervision and evaluation of the hospice aide will be completed by a registered nurse annually and when an area of concern is noted.

6.21 Nursing services, physician services, drugs and biologicals shall be available 24 hours a day, seven days a week. Other hospice services shall be available 24 hours a day when medically necessary to meet the needs of the patient and family.

6.22 Termination of care: The hospice shall establish specific criteria for termination of care, including, but not limited to, the following:

(A) There shall be policies and procedures related to termination of care and/or referral; and

(B) The clinical record shall contain documentation of the reason care has been terminated.

6 CCR 1011-1-21-6