Current through Register Vol. 39, No. 6, September 16, 2024
The governing body shall ensure through policies and
implemented procedures that the following services encompassing the essential
elements of hospice care be provided, either directly by hospice personnel, or
by contractual arrangement:
(1)
Hospice nursing services, available 24 hours a day, by or under the supervision
of a registered nurse; provided in accordance with the North Carolina Nurse
Practice Act (G.S. 90, Article 9A) and the hospice care plan; and sufficient to
ensure that nursing needs of each patient are met.
(a) Registered nurse duties include the
following as a minimum:
(i) regularly assess
the nursing needs of the hospice patient;
(ii) develop and implement the patient's
hospice nursing care plan;
(iii)
provide hospice nursing services, treatment, and diagnostic and preventive
procedures;
(iv) initiate nursing
procedures appropriate for the patient's hospice care and safety;
(v) observe signs and symptoms and report to
the physician any unexpected changes in the patient's physical or emotional
condition;
(vi) teach, supervise,
and counsel the hospice patient and family members about providing care for the
patient at home; and
(vii)
supervise and train other nursing service personnel.
(b) Licensed practical nurse duties are
delegated by and performed under the supervision of a registered nurse.
Consistent with the hospice care plan, duties may include:
(i) participating in assessment of the
patient's condition;
(ii)
implementing nursing activities, including the administration of prescribed
medical treatments and medications;
(iii) assisting in teaching the hospice
patient and family members about providing care to the patient at home;
and
(iv) delegating tasks to nurse
aides and supervising their performance of tasks within the limitations
established in
21 NCAC
36.0225(d)(2) adopted by
reference.
(c) The
agency must retain current nursing on-call schedules and previous schedules for
one year and make them available, on request, to the Department.
(2) Social work services which
shall include, but not be limited to conducting an assessment of the
psychosocial needs of the patient and family with the establishment of goals in
the care plan to meet those needs; on-going counseling related to issues of
death and dying to the patient and family as needed; and assisting the patient
and family in the utilization of appropriate community resources.
(3) Spiritual counseling shall be offered to
each hospice patient/family. The hospice shall assure that:
(a) no spiritual value or belief system is
imposed on patients and families;
(b) a spiritual assessment is completed on
each patient during the admission process; and
(c) a liaison and consultation is maintained
with the patient family clergy or spiritual caregiver and other community based
clergy or spiritual caregivers.
(4) Patient family volunteer services for a
broad range of activities under the direction of the coordinator of patient
family volunteers.
(5) Inpatient
care services, for symptom management or respite care in a licensed hospital,
nursing facility or licensed hospice inpatient facility, unless the hospice
operates its own inpatient facility. The hospice shall assure that:
(a) a written agreement, is signed by both
providers, which assures that the inpatient facility will provide care and
services to hospice patients when necessary;
(b) the inpatient provider has policies
consistent with the needs of hospice patients and their families and will, if
necessary, modify policies such as visiting hour restrictions and routine
tests, to meet those needs;
(c) the
hospice monthly updated plan of care is furnished to the inpatient provider to
ensure that the regimen established is followed as closely as feasible during
the inpatient stay;
(d) all
inpatient treatment and services are documented in the inpatient medical record
and copy of the discharge summary retained as part of the hospice record;
and
(e) effective transition from
one type care to another be maintained with continuity of care being the
primary goal.
(6) If the
hospice provides or arranges for nurse aide services, those services shall be
provided in accordance with physician's orders and interdisciplinary team care
plan.
(a) Nurse aides shall only be assigned
duties for which competence has been demonstrated and recorded in appropriate
personnel records.
(b) Nurse aide
duties may include, but are not limited to:
(i) providing or assisting with personal
care, i.e. bathing, mouth care, hair and skin care;
(ii) checking vital signs and observing the
patient's condition;
(iii)
assisting with ambulation and limited, routine exercises.
(c) All nurse aide services shall be
performed in accordance with a written assignment prepared by and under the
supervision of the registered nurse. Supervision shall include a visit to the
home by the nurse at least every two weeks, with or without the aide's
presence, to assess the care and services provided. Documentation of
supervisory visits shall be maintained in the medical record and include an
assessment of the aide's performance in carrying out assigned duties and of the
aide's relationship with the patient and family.
(7) Additional services shall be offered
either directly by the hospice or by arrangement when ordered by the physician.
These include physical therapy, occupational therapy, nutritional assessment
and dietary counseling and other services as needed and ordered by the
physician in accordance with the hospice plan of care.
(8) Bereavement counseling shall be offered
to family members and others identified in the bereavement plan of care for a
period of 12 months after the patient patient's death. The hospice shall assure
that:
(a) an assessment of survivor risk
factors is completed during the patient's admission to hospice and during the
patient's illness;
(b) the
bereavement care plan is established within six weeks after the patient's
death;
(c) the bereavement care
plan shall contain information about who shall receive bereavement services and
what services will be offered;
(d)
the bereavement care plan is reviewed quarterly at a minimum or more often as
needed; and
(e) discharge from
bereavement services before the 12 months expire is justified and
documented.
Authority
G.S.
131E-202;
Eff. November 1,
1984;
Amended Eff. February 1, 1996; June 1, 1991; November 1,
1989;
Pursuant to
G.S.
150B-21.3A, rule is necessary without
substantive public interest Eff. December 22,
2018.
