16 Del. Admin. Code § 3380-6.0

Current through Register Vol. 28, No. 5, November 1, 2024

Section 3380-6.0 - Service to Patients

6.1 General services:

6.1.1 The hospice organization shall be considered the responsible provider of the services and shall be ultimately responsible for the quality of services rendered.

6.1.2 A hospice contracting for components of its program shall require as part of the contract, that the contractor comply with the provisions of the hospice regulation regarding a coordinated program of home and inpatient care services.

6.1.3 The hospice organization shall develop, implement and revise, as necessary, written policies and procedures for the operation of a coordinated program of home and inpatient services to cover at least the following:

6.1.3.1 Delineation of responsibility for delivering and for maintaining coordinate care.

6.1.3.2 Direct provision of services provided by the hospice organization.

6.1.3.3 Mechanisms for assuring quality hospice care when segments of care are provided by contracting parties.

6.1.3.4 Statement of how coordination of services is to be assured.

6.1.3.5 Home care services shall be provided by an organization which has received Medicare/Medicaid certification.

6.1.3.6 Inpatient care shall be provided in a licensed facility which is primarily engaged in providing to inpatients those services defined in Title 16 of the Delaware Code pertaining to Acute Care Hospitals, Intermediate Care Facilities and Skilled Care Facilities.

6.1.3.7 Bereavement services shall be available to the family for at least one year following the death of the patient.

6.2 Medical services:

6.2.1 All persons admitted to a hospice shall be under the care of a licensed physician.

6.2.2 All hospice programs shall arrange for one (1) or more licensed physicians to be called in an emergency. Names and phone numbers should be posted.

6.2.3 Patient/physician encounters shall be at a frequency not less than that described in the written plan of care or as otherwise required to meet demonstrated patient/family needs.

6.2.4 Medical services to be provided in an inpatient setting shall be consistent with those regulations established in Title 16 of the Delaware Code pertaining to Acute Care Hospitals, ICF and SNF.

6.2.5 Transfer Agreements shall be negotiated between the hospice organization and inpatient facilities to insure a smooth transition should the need for such services develop.

6.3 Specialized services:

6.3.1 All specialized services shall be ordered, in writing, by the interdisciplinary care team physician, such as physical therapy, occupational therapy, speech therapy, etc.

6.3.2 An interdisciplinary care team member will notify the patient/family, as soon as possible, when a special service has been ordered.

6.4 Nursing services:

6.4.1 Nursing services provided within an inpatient facility will be consistent with the regulations contained within Title 16 of the Delaware Code pertaining to Acute Care Hospitals, ICF and SNF.

6.4.2 Hospice nursing services shall be available directly, via written agreement seven days a week, 24 hours per day under the supervision of a director of nurses who is licensed in the State of Delaware.

6.4.3 Written policies and procedures for nursing services shall be developed and implemented by the hospice to incorporate objectives and maintain the standards of nursing practice as well as coordinate, integrate and provide continuity of patient/family care in conjunction with other services during illness and after discharge/death to assure physician orders are followed.

6.5 Medications:

6.5.1 All medications administered to patients shall be ordered in writing and signed by the patient's physician or the interdisciplinary care physician.

6.5.2 Existing regulations for medications administered to patients in inpatient facilities will be applicable to hospice patients in inpatient facilities.

6.5.3 Medication administered to hospice patients should be consistent with the hospice philosophy which focuses on palliation; i.e., controlling pain and relieving other symptoms which are manifested during the dying process.

6.5.4 Resource materials relating to the administration and untoward effects of medications and treatments used in pain and symptom control will be readily available to nursing personnel.

6.5.5 The hospice must develop and implement written policies and procedures to include the requirements of the Department of Health and Social Services' Protocol Regarding the Safe Disposal of Unused Prescription Medication Following the Death of an In-Home Hospice Patient (refer to Appendix A).

6.6 Inpatient services:

6.6.1 Develop and implement written policies and procedures for inpatient services which provide for facilities and services which create a home-like atmosphere and reflect hospice philosophy insofar as possible under physical and utilization constraints. These policies may include, but should not be limited to, the following:

*

Visiting.

*	Food preparation by the patient and family.

*	Provision for family sleeping area.

*	Personal items.

6.7 Inservice training and continuing education shall be offered on a regular basis. Documentation of this training and continuing education will be maintained and available on request to the licensing authority.

6.8 Records:

6.8.1 The hospice organization shall maintain a complete record for each patient/family which contains all information pertaining to supportive management of the patient/family and which is maintained in conformance with generally accepted medical record practices. Records necessary to record the daily treatment of the patient should be maintained at the site of treatment.

6.8.2 Each patient/family record shall be retained by the hospice organization for a five-year period after death or discharge from the hospice. In the case of a minor, records shall be kept for a five year period after death. If the minor is discharged from the hospice, records shall be kept for a five year period after the minor attains majority.

6.8.3 The patient care plan will give direction to the care given in meeting the physiological, psychological, sociological and spiritual needs of patient/family. The plan will identify those care givers who will be participating in this plan. The plan will specifically address maintenance of patient independence and control.

6.8.4 The plan will be recorded in ink and maintained as part of the patient/family record.

6.8.5 All services ordered and rendered shall be entered in the patient/family record.

6.8.6 Written documentation of all interdisciplinary care team meetings is necessary.

6.8.7 The plan of care must be prepared within three days of the patient's admission to the home care component of the hospice program and within two days of admission to the inpatient component of the hospice program.

6.8.8 All required records maintained by the hospice organization shall be open to inspection by the authorized representatives of the Department of Health and Social Services.

16 Del. Admin. Code § 3380-6.0

18 DE Reg. 135(8/1/2014)
25 DE Reg. 781( 2/1/2022) (Final)