Current through Register No. 40, October 3, 2024
(a) At the time of admission, personnel of
the HH shall:
(1) Provide, both orally and in
writing, to the patient, their guardian or agent, if applicable, the HH's:
a. Policy on patient rights and
responsibilities;
b. Complaint
procedure;
c. List of care and
services that are provided directly by the HH; and
d. List of the care and services that are
provided by contract;
(2)
Obtain written confirmation acknowledging receipt of the items in (1) above
from the patient, their guardian or agent, if applicable;
(3) Collect and record the following
information:
a. Patient's name, home address,
home telephone number, and date of birth;
b. Name, address, and telephone number of an
emergency contact and guardian and/or agent, if applicable;
c. Name of patient's primary care provider
and their address and telephone number;
d. Copies of all legal directives such as
durable power of attorney, legal guardian or living will; and
e. Written and signed consent for the
provision of care and services; and
(4) Obtain documentation of informed consent
and consent for release of information.
(b) In addition to (a) above, at the time of
admission, the licensee shall provide a written copy to the patient and the
guardian or agent, if any, or personal representative, and receive written
verification of receipt for the following:
(1)
A patient's agreement including the following information:
a. The basic daily, weekly, and monthly
fee;
b. A list of the core services
required by He-P 824.15(a) and
(b) that are covered by the basic
fee;
c. Information regarding the
timing and frequency of cost of care increases;
d. The time period covered by the admissions
contract;
e. The HH's house
rules;
f. The grounds for immediate
termination of the agreement, pursuant to
RSA
151:21, V;
g. The HH's responsibility for patient
discharge planning;
h. Information
regarding nursing, other health care services or supplies not provided in the
core services, to include:
1. The availability
of services;
2. The HH's
responsibility for arranging services; and
3. The fee and payment for services, if
known;
i. The licensee's
policies and procedures regarding:
1.
Arranging for the provision of transportation;
2. Arranging for the provision of third party
services, such as a hairdresser or cable television;
3. Acting as a billing agent for third party
services;
4. Monitoring third party
services contracted directly by the patient and provided on the HH
premises;
5. Handling of patient
funds pursuant to RSA 151:24 and
He-P
824.14(af);
6. Bed hold, in compliance with
RSA
151:25;
7. Storage and loss of the patient's personal
property; and
8.
Smoking;
j. The
licensee's medication management services; and
k. The list of grooming and personal hygiene
supplies provided by the HH as part of the basic daily, weekly, or monthly
rate;
(2) A copy of the
most current version of the patients' bill of rights under RSA 151: 21 and the
HH's policy and procedure for implementing the bill of rights pursuant to
RSA
151:20, II;
(3) A copy of the patient's right to appeal
an involuntary transfer or discharge under
RSA
151:26, II(5); and
(4) The HH's policy and procedure for
handling reports of abuse, neglect, or exploitation which shall be in
accordance with RSA
161-F:46 and
RSA
169-C:29.
(c) The hospice care provider shall ensure
that medical direction is provided either from the patient's attending licensed
practitioner or the hospice medical director.
(d) Patients who are admitted or accepted for
services shall:
(1) Have a nursing assessment
at the following intervals to determine the level of care and services required
by the patient:
a. Within 48 hours of
admission; and
b. Thereafter as
required by the CMS conditions of participation; and
(2) Have a signed and dated order for any
service for which such order is required by the practice acts of the person
providing care, renewed at least every 90 days.
(e) The assessment required by (d)(1) above
shall contain, at a minimum, the following:
(1) Pertinent diagnoses including mental
status;
(2) A pain assessment,
including symptom control and vital signs;
(3) A physical assessment;
(4) A cognition and mental status
assessment;
(5) A behavioral
assessment;
(6) A psychosocial
assessment;
(7) Medication and
treatments;
(8) Functional
limitations;
(9) Nutritional
requirements;
(10) Any equipment
required; and
(11) Any safety
precautions.
(f) In
addition to the information required in (e) above, the nursing assessment shall
include:
(1) Reactions of the patient and
family members to terminal illness;
(2) History of the patient's and family
coping strengths and weaknesses;
(3) Social and financial concerns;
and
(4) Spiritual beliefs and
desires of the patient.
(g) If the assessment required by (d) above
is completed by an LPN, the assessment shall be reviewed and co-signed by the
registered nurse or physician that is supervising the LPN prior to the
development of the patient's care plan.
(h) The licensee shall establish an
interdisciplinary hospice care team composed of at least:
(1) A licensed practitioner;
(2) A registered nurse;
(3) A social worker; and
(4) A clergy person or counselor.
(i) The interdisciplinary hospice
care team shall:
(1) Establish the care
plan;
(2) Be the primary care
delivery team for a patient and his or her family through the total duration of
hospice care; and
(3) Be
responsible for supervising any patient care and services provided by
others.
(j) The
interdisciplinary team shall, in conjunction with the patient, the patient's
personal representative, and their family, develop an individualized care plan,
which reflects the changing care needs of the patient and family.
(k) The care plan required by (j) above shall
include:
(1) The date the problem or need was
identified;
(2) A description of
the problem or need;
(3) The goal
for the patient;
(4) The action or
approach to be taken by HH personnel;
(5) The responsible person(s) or position;
and
(6) The interventions used to
address problems identified in the assessment including:
a. Medications ordered;
b. Pain control interventions, both
pharmacological and non-pharmacological;
c. Symptom management treatment;
and
d. Services required including
frequency of visits.
(l) The care plan required by (j) above shall
be:
(1) Developed in conjunction with the
patient and their guardian or agent, if applicable;
(2) Completed within 3 days after completion
of the nursing assessment;
(3)
Reviewed and revised at least every 30 days by the interdisciplinary team
following the completion of each assessment; and
(4) Made available to all personnel that
assist the patients.
(m)
The patient and their family shall be encouraged to participate in all
components of care, including:
(1) Assessment
and problem identification;
(2)
Implementation of the plan of care; and
(3) Evaluation and revision of the plan, as
needed.
(n) At the time
of a patient's admission, the licensee shall obtain orders from a licensed
practitioner for medications, prescriptions and diet.
(o) A patient may refuse all care and
services.
(p) When a patient
refuses care or services that could result in a threat to their safety or that
of others, the licensee or their designee shall:
(1) Inform the patient of the potential
results of their refusal;
(2)
Notify the licensed practitioner and guardian or agent if any, of the patient's
refusal of care; and
(3) Document
in the patient's record the refusal of care and the patient's reason for the
refusal.
(q) Progress
notes shall be written by any member of the interdisciplinary team to document:
(1) Changes in the patient's physical,
functional and mental abilities;
(2) Changes in the patient's behaviors such
as eating or sleeping patterns; and
(3) Newly identified needs of the patient and
or their family.
(r) All
staff of the HH shall follow the approaches stated in the care plan.
(s) The licensee shall provide an emergency
data sheet to emergency medical personnel in the event of an emergency transfer
to another medical facility.
(t)
The data sheet referenced in (s) above shall include:
(1) The patient's full name and the name the
patient prefers, if different;
(2)
Name, address and telephone number of the patient's next of kin, guardian or
agent, if any;
(3)
Diagnosis;
(4) Medications,
including last dose taken and when the next dose is due;
(5) Allergies;
(6) Functional limitations;
(7) Date of birth;
(8) Insurance information;
(9) Advance directive; and
(10) Any other pertinent information not
specified in (1)-(9) above.
(u) Written notes shall be documented in the
patient's record for any unusual incident, occurrence, or explained absence
involving the patient which shall include the information required by
He-P
824.14(t) and the signature and title
of the person reporting the incident or occurrence.
(v) For each patient accepted for care and
services at the HH, a current and accurate record shall be maintained and
include, at a minimum:
(1) The written
confirmation required by
He-P
824.16(b)(1);
(2) The identification data required by
He-P
824.16(b)(2);
(3) The admission agreement required by
He-P
824.16(c)(1);
(4) Consent and medical release forms, as
applicable;
(5) Pertinent medical
information;
(6) The emergency data
sheet required by He-P
824.16(t);
(7) All orders from a licensed practitioner,
including the date and signature of the licensed practitioner required by
He-P
824.16(e)(2);
(8) All assessments required by
He-P
824.16(e)(1);
(9) All laboratory and x-ray reports if the
tests were taken at the HH;
(10)
All consults;
(11) All care plans
required by He-P 824.16(k)
including documentation that the patient or patient's guardian or agent, if
applicable, participated in the development of the care plan;
(12) All progress notes required by
He-P
824.16(r) including the signature of
the person providing the care;
(13)
All written notes required by
He-P
824.16(v) including the signature of
the person providing the care;
(14)
All daily medication records required by
He-P
824.17(aa);
(15) Discharge or transfer documentation,
which shall include:
a. In the case of patient
death:
1. Date and place of death;
and
2. Bereavement follow-up plan;
and
b. In the case of
discharge other than patient death or transfer:
1. Date and time of patient
discharge;
2. The physical, mental,
and medical condition of patient at discharge;
3. Discharge instruction and referral;
and
4. Signed licensed
practitioner's order for discharge, if applicable; and
(16) Documentation of any unusual
incidents involving the patient including the information required by (v)
above.
#9317, eff
11-8-08
