La. Admin. Code tit. 48 § I-8235

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-8235 - Agency Operations

A. Premises (see definition of Hospice Premises).

1. Staff shall be able to distinguish and describe the scope and delineation of all activities being provided by the hospice.

2. Staff working areas are to be designed so that when planning for services, patient confidentiality is maintained.

3. The hospice shall have a distinct telephone number. If the telephone number is shared with other health care related agencies, the telephone operator(s) shall demonstrate knowledge and ability to distinguish and direct calls to the appropriate persons. If an answering service is used after normal hours, there shall be evidence of distinct hospice staff and the answering service should be able to direct calls to the appropriate persons for each service.

4. The hospice shall not share office space with a non-health care related entity. When office space is shared with another health care related entity the hospice agency shall operate separate and apart.

B. Hours of Operation

1. The hospice shall be required to have regular posted (in a prominent and easily accessible manner) business days and hours and be fully operational at least 8 hours a day, 5 days a week between 7 a.m. and 6 p.m. Hospice services are available 24 hours per day, 7 days a week, which include, at a minimum:

a. professional registered nurse services;

b. palliative medications;

c. other services, equipment or supplies necessary to meet the patient's immediate needs.

2. Hospice provides on-call medical and nursing services to assess and meet changing patient/family needs, provide instruction and support, and conduct additional on-site assessment or treatment, 24 hours a day, seven days per week.

a. The on-call RN shall triage calls and may delegate to another employee as appropriate.

C. Policies and procedures:

1. shall be written, current, and annually reviewed by appropriate personnel;

2. shall contain policies and procedures specific to agency addressing personnel standards and qualifications, agency operations, patient care standards, problem and complaint resolution, purpose and goals of operation, the hospice's defined service area, as well as regulatory and compliance issues, inclusive of but not limited to, a full disclosure policy when employing and assigning to a patient, a state certified hospice attendant;

3. shall clarify the agencys prohibited use of social media. The policy shall ensure that all staff, either contracted or directly employed, receive training relative to the restrictive use of social media that includes, at a minimum, confidentiality of patient information, preservation of patient dignity and respect, protection of patient privacy and personal and property rights;

4. shall meet or exceed requirements of the minimum standards and all applicable federal, state, and local laws, including but not limited to criminal histories conducted by the Louisiana State Police, or its designee, on all non-licensed persons providing nursing care, health-related services, or supportive services to any patient; and

5. shall include a process for checking the direct service worker registry and the Louisiana certified nurse aide registry upon hiring an employee, and every six months thereafter, to ensure that non-licensed direct care staff do not have a finding placed against him/her of abuse, neglect, or misappropriation of funds of an individual. If there is such a finding on the DSW and/or CNA registry, the applicant shall not be employed nor does a current employee have continued employment with the hospice agency.

D. Operational Requirements

1. Hospices responsibility to the community:

a. shall not accept orders to assess or admit from any source other than licensed physician or authorized physician representative (e.g. hospital discharge planner). Although the hospice may provide care to relatives of employees, the order to admit to the hospice shall be initiated by the primary attending physician;

b. shall use only factual information in advertising;

c. shall not participate in door to door solicitation;

d. shall not accept as a patient any person who is not terminally ill;

e. shall develop policy/procedure for patients with no or limited payor source;

f. shall have policy and procedures and a written plan for emergency operations in case of disaster including that at any time the hospice has an interruption in services or a change in the licensed location due to an emergency situation, the hospice shall notify the HSS no later than the next stated business day;

g. provide all services needed in a timely manner, at least within 24 hours, unless orders by the licensed medical practitioner indicate otherwise. However, admission timeframes shall be followed as indicated in the admission procedures subsection;

h. is prohibited from harassing or coercing a prospective patient or staff member to use a specific hospice or to change to another hospice;

i. shall have policy and procedures for post-mortem care in compliance with all applicable federal, state, and local laws;

j. may participate as community educators in community/health fairs; and

k. may provide free non-invasive diagnostic tests, such as blood pressure screening.

2. Hospices responsibility to the patient shall include, but is not limited to, the following:

a. be in compliance with Minimum Standards and all applicable federal, state, and local laws at all times;

b. provide all Core services directly by the hospice agency and any non-core services required to meet the patient/family's needs;

c. act as the patient advocate in medical decisions affecting the patient;

d. protect the patient from unsafe skilled and unskilled practices;

e. protect the patient from being harassed, bribed, and/or any form of mistreatment by any employee or volunteer of the agency;

f. provide patient information on the patient's rights and responsibilities;

g. provide information on advanced directives and LaPost in compliance with all applicable federal, state, and local laws;

h. protect and assure that patient's rights are not violated;

i. focus on enabling the patient remaining in the familiar surroundings of his/her place of residence as long as possible and appropriate;

j. encourage the patient/family to participate in developing the POC and provision of hospice services;

k. with the permission of the patient, include in the POC specific goals for involving the patient/family;

l. make appropriate referrals for family members outside the hospice's service area for bereavement follow-up;

m. whenever a hospice program manages and/or delivers care in a facility, ensure that an appropriate standard of care is provided to the patient in the facility, regardless of whether or not hospice is responsible for the direct provision of those services;

n. ensure that any facility where hospice care is provided meets appropriate licensing requirements and any payor source requirements when applicable;

o. ensure that any facility in which hospice care is provided have the following:

i. areas that are designed and equipped for the comfort and privacy of each patient and family member;

ii. physical space for private patient/family visiting;

iii. accommodations for family members to remain with the patient throughout the night;

iv. accommodations for family privacy after a patient's death;

v. decor which is homelike in design and function; and

vi. patients shall be permitted to receive visitors at any hour, including small children.

3. Responsibility of the hospice to the staff shall include, but is not limited to, the following:

a. provide safe environment whenever the hospice knows or has reason to know that environment might be dangerous;

b. have safety and emergency preparedness programs that conform with federal, state, and local requirements and that include:

i. a plan for reporting, monitoring, and follow-up on all accidents, injuries, and safety hazards;

ii. documentation of all reports, monitoring activity, and follow-up actions, education for patient/family, care givers, employees and volunteers on the safe use of medical equipment;

iii. evidence that equipment maintenance and safety requirements have been met;

iv. policies and procedures for storing, accessing, and distributing controlled drugs, supplies and equipment;

v. a safe and sanitary system for identifying, handling, and disposing of hazardous wastes; and

vi. a policy regarding use of smoking materials in all care settings;

c. have policies which encourage realistic performance expectations;

d. maintain insurance and workers compensation at all times;

e. provide adequate time on schedule for required travel;

f. meet or exceed Wage and Hour Board requirements;

g. provide adequate information, in-service training, supplies, and other support for all employees to perform to the best of their ability;

h. provide in-service training to promote effective, quality hospice care; and

i. have training on the prohibited use of social media.

4. Responsibility of the hospice prior to employment of a state certified hospice attendant includes, but is not limited to, the following:

a. the hospice provider shall notify HSS of the intent to hire a state certified hospice attendant; and

b. the hospice provider shall have documentation of certification of the state certified hospice attendant meeting the requirements of R.S. 40:2192.

5. Responsibility of the hospice subsequent to employment of a state certified hospice attendant includes, but is not limited to, the following:

a. the hospice provider shall disclose to its employees, patients, and patients' immediate family members that the state certified hospice attendant has successfully completed all state certification training and registry requirements for employment, including successful completion and release from a sentence served at a state prison;

b. upon change in status of employment of the state certified hospice attendant, the hospice provider shall notify HSS;

c. the hospice provider shall ensure that the state certified hospice attendant receives required continuing education or training requirements to maintain state certification in good standing continuously during employment by the hospice provider; and

d. the hospice provider shall ensure that the state certified hospice attendant has continuing education equivalent to a hospice aide/CNA, inclusive of the following:

i. a minimum of 12 hours of job-related in-service training annually, specific to their job responsibilities within the previous 12 months;

ii. at least two of the required 12 hours of annual job-related in-service training shall focus on end of life care; and

iii. ensure six of the 12 hours of required annual job-related in-service training shall be provided every six months.

6. Access by the hospice agency to the state certified hospice attendant registry established by the department pursuant to R.S. 40:2192 shall be limited to an inquiry for a specific state certified hospice attendant.

La. Admin. Code tit. 48, § I-8235

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing LR 15:482 (June 1989), amended LR 24:2271 (December 1998), Amended by the Department of Health, Bureau of Health Services Financing, LR 44600 (3/1/2018), Amended LR 46344 (3/1/2020).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and R.S. 40:2181-2192.