Current through Register 1531, September 27, 2024
(A) A
hospice shall provide directly or arrange, pursuant to a written agreement, for
the provision of each of the following services at home, in the community and
in inpatient facilities: physician services, nursing services, social services,
direct service volunteer services, counseling services, and inpatient care for
palliative reasons.
(B) As needed,
the hospice shall provide or arrange for the following services:
(1) personal care homemaker;
(2) home health aide;
(3) therapeutic (dietary, occupational
therapy, physical therapy, speech, hearing, respiratory therapy);
(4) medical supplies and
appliances;
(5) pharmaceutical;
and
(6) respite services.
(C)
Physician
Services.
(1) Each hospice shall
designate a physician to serve as Medical Director. The medical director shall
have overall responsibility for the medical component of patient care and for
ensuring achievement and maintenance of quality standards of professional
medical care.
(2) The duties of the
medical director shall include but need not be limited to:
(a) Designating another physician to serve as
medical director in his or her absence.
(b) Consulting and cooperating with the
primary care provider or team maintaining the primary responsibility for the
patient care pursuant to 105 CMR 141.204(C)(3).
(c) Reviewing clinical material of the
referring care provider to document: basic disease process; the drug regimen;
and assessment of patient's health and prognosis at time of
admission.
(d) Performing an
admission history and physical for each patient who has no other primary care
provider.
(e) Maintaining liaison
with the patient's primary care provider or team and encouraging the patient's
primary care provider or team to provide primary care to his or her patient in
collaboration with the inter-disciplinary team.
(f) Assisting in developing the plan of care
for each patient/family with the coordination of the patient's primary care
provider or team.
(g) Attending and
actively participating in interdisciplinary team meetings.
(h) Reviewing the medical care provided in
patients' homes, and in inpatient and outpatient health care facilities as
applicable.
(i) Maintaining 24
hour, seven days a week medical coverage when primary care providers are
unavailable.
(j) Acting as a
consultant to patient's primary care provider and members of the
interdisciplinary team; helping to develop and review patient/family care
policies and procedures; serving on the interdisciplinary care team; and
reporting to the administrator regarding medical care delivered to the hospice
patient.
(k) Participating in
establishing written programmatic guidelines for symptom control
(e.g., pain, nausea, vomiting, or other symptoms.)
(3) A hospice must ensure that
each patient has a physician, or a medical team, who maintains the primary
responsibility for the patient's medical care. The physician may be the
patient's attending physician or may be a physician, including the medical
director, selected by the hospice.
(4) Each patient's medical record shall
clearly indicate the name of the physician or medical team who maintain the
primary responsibility for the patient's medical care.
(D)
Nursing
Services.
(1) The hospice shall
provide nursing services under the direction and supervision of a designated
registered nurse qualified by education and experience to direct hospice
nursing care.
(2) Nursing services,
including the services of a registered nurse, shall be available seven days a
week, 24 hours a day.
(3) The
designated registered nurse responsible for supervising nursing services shall
work in cooperation with the administrator and with the individual responsible
for clinical services coordination in order to:
(a) develop and implement nursing objectives,
policies and procedures;
(b)
develop job descriptions for all nursing personnel;
(c) establish staffing and on-call schedules
to meet patient/family needs;
(d)
develop and implement orientation programs.
(4) A registered nurse shall assess,
identify, plan, and evaluate care for the patient/family based on nursing
needs.
(a) For hospice programs admitting
pediatric patients, a registered nurse with clinical pediatric training and
experience shall coordinate the implementation of the plan of care for each
pediatric patient.
(5)
Nursing care shall be provided in accordance with recognized standards of
nursing practice.
(6) All nursing
services shall be documented in the patient/family record.
(E)
Social Work
Services.
(1) The hospice shall
provide social work services to the patient and family.
(2) Social work services shall be directed by
and shall be provided under the supervision of a licensed certified social
worker with an MSW or a licensed independent clinical social worker.
(3) Social work services shall be provided by
a licensed social worker qualified by education and experience.
(4) If social work services are provided
solely by one individual, that individual shall be a licensed certified social
worker with a MSW or a licensed independent clinical social worker.
(5) The individual responsible for directing
and supervising hospice social work services shall work in cooperation with the
administrator and the individual responsible for clinical services coordination
to:
(a) develop and implement social work
objectives, policies and procedures;
(b) develop job descriptions for all social
work personnel;
(c) develop
staffing and on-call schedules to meet patient/family needs;
(d) develop and implement orientation
programs.
(6) A social
worker shall assess the patient/family and identify psychosocial
needs.
(7) Social work services
shall be available seven days a week, as needed.
(8) Social work services shall be delivered
consistent with the patient/family care plan.
(9) All social work services shall be
documented in the patient/family record.
(10) Social work services shall be provided
in accordance with recognized standards of social work practice.
(F)
Direct Service
Volunteer Services.
(1) The
hospice shall provide direct service volunteer services.
(2) The hospice shall designate a coordinator
of volunteer services who shall develop and implement a direct service
volunteer program, coordinate the orientation, education, support and
supervision of direct service volunteers, define the roles and responsibilities
of direct service volunteers, and coordinate the utilization of direct service
volunteers with other hospice staff.
(3) The coordinator of volunteer services
shall document successful completion of a training and orientation program for
all direct service volunteers.
(4)
The orientation and training program for direct service volunteers shall
address at least the following:
(a) the
hospice program's goals and services;
(b) confidentiality and protection of
patients/families rights;
(c)
procedures for responding to such situations as medical emergencies or
deaths;
(d) the physiological and
psychological aspects of terminal disease;
(e) family dynamics, coping mechanisms, and
psychosocial and spiritual issues surrounding terminal disease, death and
bereavement;
(f) general
communication skills.
(5) A direct service volunteer shall be
informed of a patient's condition and treatment to the extent necessary to
carry out his functions.
(6)
Services provided by direct service volunteers shall be in accordance with the
written plan of care and shall be documented in the clinical record.
(7) Direct service volunteers shall have the
necessary qualifications and skills to provide the prescribed
service.
(8) Any volunteer
functioning in a professional capacity shall meet the standards of the
appropriate profession.
(9) The
hospice shall have available direct service volunteers sufficient to meet the
needs of patients/families.
(G)
Counseling
Services.
(1) The hospice shall
provide counseling services to assist patients and families as needed and in
accordance with the plan of care.
(2) Counseling services shall be provided by
professional staff or by volunteer staff under the professional supervision of
a qualified counselor.
(3)
Bereavement Counseling.
(a) The hospice shall provide bereavement
services to the family following the patient's death.
(b) Bereavement services shall provide
support to enable an individual/family to adjust to experiences associated with
death.
(c) Bereavement services
shall be available to the family for up to one year following the death of the
patient.
(d) Bereavement services
shall be delivered consistent with the bereavement plan of care and with
criteria for termination of such services and/or referral of the family to
other agencies or providers.
(e)
Bereavement services shall be coordinated with other community resources judged
by the interdisciplinary team to be useful to the family.
(f) Bereavement services shall be under the
direction and supervision of a person qualified by training and experience for
the development, implementation and assessment of a plan of care to meet the
needs of the bereaved.
(g) All
bereavement services provided shall be documented in the patient/family
record.
(4)
Spiritual Counseling.
(a) When spiritual counseling is provided to
a patient/family by a hospice it shall be provided by a qualified
interdisciplinary team member and/or through an arrangement with clergy and/or
other spiritual counselors in the community.
(b) Hospice spiritual services shall be
provided as desired by the patient/family and shall include but need not be
limited to the following:
1. spiritual
counseling in keeping with the patients/family beliefs;
2. communication with and support of
appropriate clergy or other spiritual counselors in the community;
3. consultation and education to
patients/families and interdisciplinary team members.
(c) When hospice spiritual services are
provided through an arrangement with clergy or other spiritual counselors in
the community there shall be documentation of ongoing communication between the
clergy or other spiritual counselors and the interdisciplinary team
members.
(d) The hospice shall make
reasonable efforts to arrange for visits of clergy or other spiritual
counselors in the community to patients who request such visits and shall
advise patient families of this opportunity.
(e) Spiritual services shall be provided
consistent with the plan of care and with criteria for termination of such
services and/or referral to other agencies or providers.
(f) Spiritual services provided shall be
documented in the patient/family record.
(5)
Psychosocial/Supportive
Counseling.
(a) When
psychosocial/supportive counseling is provided by the hospice, it shall be
provided by qualified counselors who are licensed, if applicable.
(b) A qualified counselor is an individual
with an advanced degree in social work, psychology, mental health counseling,
psychiatry or psychiatric nursing or the documented equivalent in education,
training and/or experience and who has clinical experience appropriate to the
counseling and casework needs of hospice patients/families.
(H)
Inpatient Care.
(1)
The hospice shall provide or arrange for short-term inpatient care for the
control of pain and management of acute and severe clinical problems that
cannot be managed in a home setting.
(2) Inpatient care shall be provided in
hospitals licensed pursuant to M.G.L. c. 111, § 51 or long term care
facilities licensed pursuant to M.G.L. c. 111, § 71 with whom the hospice
has entered into a written contract, or hospice inpatient facilities directly
owned and operated by a hospice program licensed pursuant to M.G.L. c.111,
§57D.
(3) Contracts for
inpatient care shall, in addition to the provisions of
105 CMR
141.212, include, at a minimum, the following
mutually agreed upon terms:
(a) that the
inpatient provider has established policies consistent with those of the
hospice program and that the inpatient care facility agrees to abide by the
patient care plan and protocol established by the hospice program;
(b) that the hospital or long term care
facility will provide the hospice with a copy of the discharge summary and, if
requested, a copy of the entire medical record; and
(c) that the hospice program shall make
available appropriate hospice care training of hospital or long term care
facility personnel who provide care under the agreement including staff
orientation.
(4) The
hospice, with respect to the hospice inpatient facility directly owned and
operated by the hospice program, shall:
(a)
meet the requirements of the federal Medicare Conditions of Participation for
hospices that provide inpatient care directly (42
CFR 418.100);
(b) meet at least the building and physical
plant requirements set out at
105 CMR
141.220 and additional physical plant
requirements set forth in the federal Medicare Conditions of Participation for
hospices that provide inpatient care directly (42
CFR 418.110) .
1. The space that constitutes a hospice
inpatient facility shall be contiguous space.
2. If a hospice inpatient facility is located
in a building that also houses other entities, the hospice inpatient facility
shall not be used as a thoroughfare.
(c) provide nursing services directly and
meet the following additional nursing staffing requirements:
1. A registered nurse shall be designated as
director of nursing (or equivalent title). He or she shall be a qualified
registered nurse who has administrative authority, responsibility and
accountability for the functions, activities and training of nursing services
staff.
2. A registered nurse shall
be on duty in the hospice inpatient facility to supervise nursing care and
nursing personnel 24 hours a day.
3. One registered nurse may serve as both
director of nursing and day shift nursing supervisor if he or she can carry out
adequately the responsibilities of both positions.
4. Additional licensed nursing and other
staff shall be provided to meet each patient's total care needs 24 hours a
day.
(d) develop written
policies and procedures governing infection control.
1. Such policies shall provide for the proper
disposal of infectious waste as required by
105 CMR 480.000:
Storage and Disposal of Infectious or Physically Dangerous Medical or
Biological Waste State Sanitary Code Chapter VIII;
2. If a hospice inpatient facility with an
isolation room does not provide the mechanical exhaust ventilation in
accordance with plans approved through standards set under
105 CMR
141.220, the facility's policies must outline
procedures for the transfer to a more appropriate facility of patients found to
have any infectious disease transmitted by airborne pathogens. The hospice
inpatient facility's admission policies shall preclude the admission of
patients with known infectious diseases transmitted by airborne pathogens if
the facility's isolation room does not meet the mechanical exhaust requirements
in accordance with said standards.
(e) meet the following dietary services
requirements:
1. All hospice inpatient
facilities shall provide adequate dietary services to meet the daily dietary
needs of patients in accordance with written dietary policies and
procedures.
2. All hospice
inpatient facilities shall have sufficient numbers of adequately trained
personnel to plan, prepare and serve the proper diets to patients.
3. All food service personnel shall be in
good health, shall practice hygienic food handling techniques and shall comply
with
105 CMR 590.000:
State Sanitary Code Article X - Minimum Sanitation Standards for Food
Service Establishments.
4.
All hospice inpatient facilities that admit patients in need of a special or
therapeutic diet shall provide for such diets to be planned, prepared and
served as prescribed by the patient's physician or primary care provider.
All therapeutic diets shall be planned, prepared and served
with consultation by a dietician.
5. All meals and snacks shall conform to the
quality standards of
105 CMR 590.000:
The State Sanitary Code.
a.
All food shall be maintained at safe temperatures. Food that is stored in a
freezer shall be wrapped, identified and labeled with the date received and
shall be used within the safe storage time appropriate to the type of food and
the storage temperature. If not used within an appropriate time limit, the food
shall be discarded.
b. Equipment
shall be provided and procedures established to maintain food at a proper
temperature during serving and transportation. Hot foods shall be hot and cold
foods shall be cold when they reach the patients.
6. All utensils, equipment, methods of
cleaning and sanitizing, storage of equipment or food, the habits and
procedures of food handlers, rubbish and waste disposal, toilet facilities and
other aspects of maintaining healthful, sanitary and safe conditions relative
to food storage, preparation and distribution of food shall be in compliance
with local health codes and
105 CMR 590.000:
State Sanitary Code Article X -Minimum Sanitation Standards for Food
Service Establishments.
(f) The medical director or physician
designee shall conduct regular onsite visits to the inpatient facility,
including daily visits if necessary to assess patient conditions and reevaluate
medical orders of unstable patients.