We received several survey citations for not collaborating with hospice. How can we improve collaboration to better help our hospice residents while avoiding citations?

Collaboration requires communication, so detail the who, what, when, where, why and how. 

Before hospice initiates care, there must be a written agreement between the hospice and facility establishing the division of responsibilities (for other required components of the agreement, review F849). For example, hospice often manages services related to terminal illness, but all services assigned must be based upon the resident’s assessments, which vary based upon the resident. 

With the agreement in place, to ensure collaboration from the outset, schedule a care plan meeting between hospice staff, the resident, family, facility staff and primary care physician soon after hospice enrollment. During this initial meeting, review who will deliver what services to ensure expectations align with the agreement and meet the resident’s needs.

Also, review the contact chain. Make sure nursing staff know when to contact hospice for changing conditions, and that they must still contact the resident’s physician and representative. Collaboration means all parties providing care understand what the resident needs and when to initiate hospice interventions. 

Once services begin, the medical record should demonstrate communication between facility staff and hospice, treatment interventions and resident responses. It’s important to document why interventions were needed, where and when an incident occurred, who discussed changes, how that communication occurred, what was decided, and how the resident responded to new services.