Home Visit
The item you use to protect your equipment and bag from surfaces in the patient's homes
What is a barrier?
The time frame of Start of Care (SOC) comprehensive assessment and the SOC initial assessments for spiritual care, social work and bereavement risk.
What is 48 hours for nursing and 5 days (SOC day1) for spiritual care, SW, and bereavement risk assessment.
CoP 418.54
Every 14 days frequency
What is the minimum requirement of nurse visit frequency (would need to be a comprehensive assessment and have an LNA sup visit if there is an LNA). Our policy is a visit every 7 days and LNA sup visit 1x a week.
Patients can refuse all disciplines EXCEPT q14 day nurse and f2f NP/MD.
The only time a live discharge and admission can happen on the same day.
What is a transfer. Remember, a transfer form by the discharging company needs to be signed and appropriately dated. This and a discharge summary need to go to admitting hospice. The DC summary will have Plan of Care, medications, care plans, DME and condition of patient - importance of up-to-date med review and reconciliation. Doing a transfer instead of a DC and admission preserves the BP - also if going into a third or later BP saves the admitting hospice from doing a f2f prior to admission.
90, 90 and 60 going forward
What are the number of days in the first two benefit periods and 60 days are the number of days in all of the subsequent benefit periods (BP).
The nurse will do a comprehensive assessment and recert note at least 14 days prior to end of BP. Going into the third BP an NP or MD/DO will need to do a face to face. The f2f can be done 30 days prior to the end of the BP.
The action of cleaning your hands before reaching into your bag (each time you reach in), placing equipment on a barrier, moving equipment to another area once used, and cleaning equipment before returning to your bag
What is clean bag technique
CoP is an acronym of this phrase
What is Conditions of Participation (Medicare rules governing hospice - and other healthcare entities)
Measurements - how often (and if no measurements needed - write no measurements needed)
How often to change dressings and PRN dressing changes and why
delineation of care (who is responsible for dressing changes, prn changes etc)
what to clean with and what supplies needed
What information is needed in a wound care order
If your patient's family is taking care of the wound make sure you say that. you can say that hospice is providing wound care supplies and education but family is responsible for wound care.
if patient is private, ask if you can observe and measure wound at least monthly if not weekly and state monthly instead of weekly for measurements. The point is, to make your orders accurate and individualized to that patient and their needs, including their needs around dignity and privacy - our patients deserve their autonomy as long as they can.
The form signed by patient or POA (power of attorney) 48 hours at least prior to discharge which lets the patient know how to dispute the discharge. If patient is disputing, we need to postpone discharge until resolved.
What is a NOMNC - Notice of Medicare Non Coverage
A statement stating the patient has a prognosis of six months or less written by the medical director. (or hospice physician) A verbal statement by medical director is given at time of SOC. Only a MD or DO can make this statement. This happens at time of admission and every subsequent benefit period.
What is a CTI (certification of terminal illness)
The expectation of charting in real time, in the home, in order to ensure that information charted is accurate and timely.
What is Point of Care Charting
in the event that the hospice determines there are conditions, items, services, or drugs that are unrelated to the individual's terminal illness and related conditions, the individual (or representative), non-hospice providers furnishing such items, services, or drugs, or Medicare contractors may request a written list as an addendum to the election statement.
What is the "Patient Notification of Hospice Non-Covered Items, Services, and Drugs" for short is sometimes referred to the 'the addendum'
If request at SOC of within 5 days of SOC the hospice will provide information in writing within 5 calendar days. If it is requested any time after the first 5 days then the information needs to be provided within 3 days.
If there are any changes to the POC then the patient or requester will need a copy of these changes at that time.
IF NOT PROVIDED IN THE TIME FRAME, MEDICARE WILL NOT COVER SERVICES FOR THE DAYS BETWEEN SOC AND WHEN ADDENDUM IS SENT OUT.
CoP 418.24
1w1, 2w11, 1w1
How to write an order frequency if you were seeing someone 1x the first week, 2 times a week for the next 11 weeks and 1 x the last week of the benefit period.
Plan for DME replacements and removal (education provided)
Plan for 2 weeks of medications to give patient enough time to meet with provider
Education on disease process, new goals of care, when to call hospice again
communication with provider indicating patient will be coming off of hospice and he/she will be primary provider.
What is safe discharge planning? This should all be charted as completed (all disciplines) and should be part of IDG discussions (verbally AND in your IDG note)
Routine
GIP
Respite
Continuous Care
What are the levels of care provided in hospice.
GIP and Continuous care are symptom management based
Respite is for the care giver in order to reduce care giver fatigue.
The action of asking questions, observing, doing a physical exam (if a nurse), and reviewing past visits or if a new patient past medical and psych social history.
What is an assessment?
You will find these in physical form behind Tammy's desk (Sandy's CEO assistant), or on the J-drive. You can always ask your manager if you're looking for a specific one. If you have any questions about these, you can talk to your manager.
Where are the policies and procedures located? Side note - You have access to Elsevier for nursing procedures, and you can contact HR for any HR related questions.
confusion
What would you write on consents if a power of attorney is signing consents for a reason the patient can't sign. (don't use diagnoses, use the symptom as the reason) weakness, obtunded, minimally responsive are other reasons.
When a patient is showing improvement or has hit a plateau and is no longer declining. The IDT has discussed this and along with the medical director realizes the patient is not meeting LCD guidelines for the disease.
What is being no longer terminally ill, or no longer eligible. Charting and IDG notes should match in these discussions, once decided, there should be safe discharge planning and a NOMNC needs to be signed at least 48 hours prior to discharge.
Admission visit, HUV1, HUV2, SFV (possible of 3), and discharge visit.
what are HOPE visits OR What visits will have mandatory and specific HOPE questions within those visits. (these replaced the HIS questions in Oct 2025)
Admission HOPE - SOC
HUV 1 between day 6-15
HUV 2 between days 16 - 30
SFV within 2 days if symptom impact is a 2 or above on admission or HUV1 or 2.
The action of making sure that the medications in the home (including oxygen) or at the facility match the medications listed on the MAR in the chart and if they do not match, update the MAR.
What is med reconciliation?
This should be done regularly.
You should also mark that it was completed on the MAR itself and note it during IDG - making sure you let the MD know that there were changes that she might not be aware of if the patient go the Rx from another provider.
The percentage of total patient hours that clinical staff (nurses, SW, chaplains and LNAs) spend with patients that need to be provided by volunteers - meaning if the team collectively spends 100 hours with patients, then we would need 5 volunteer hours (dudes the answer is right there :D)
What is 5%.
(CoP 518.78)
strike through the mistake and both the signer and the witness initial
what you would do if there was a mistake made on the consents
When a patient or family member wants to pursue aggressive treatment or for whatever reason they want to leave hospice.
what is revocation. They would sign revocation paperwork indicating they no longer want the hospice benefit. This is the choice of the patient or family - NOT the choice of the hospice. We don't revoke people off of hospice. They revoke their own hospice benefit.
Social worker, Chaplain, Nurse, LNA, Medical director (hospice physician), volunteers (and coordinator), bereavement coordinator are the people that all work together to ensure the best possible care and experience for the dying patient and their family. This group of individuals meet at least every 14 days to discuss the care of the patient.
what is an interdisciplinary team, the meeting to discuss the patient is the IDT or IDG meeting. Medicare requires it is done every 15 days, but generally it is done every 14 days.