Hospice care is often one of the most misunderstood and underused aspects of care in the ALF setting. Hospice is a special kind of care that focuses on increasing the quality of life for people who are experiencing advanced chronic conditions during the end of life and can be used to help support terminally ill residents who need advanced care to manage their condition. While hospice services are permitted for usage in an ALF be sure to follow the regulation below provided by CCLD:

87633 HOSPICE CARE FOR TERMINALLY ILL RESIDENTS 

(a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon and who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services from a hospice agency in the facility, when all of the following conditions are met:

(1) The licensee has received a hospice care waiver from the department.

(2) The licensee remains in substantial compliance with the requirements of this section, with the provisions of the Residential Care Facilities for the Elderly Act (Health and Safety Code Section 1569 et seq.), all other requirements of Chapter 8 of Title 22 of the California Code of Regulations governing Residential Care Facilities for the Elderly, and with all terms and conditions of the waiver.

(3) Hospice agency services are contracted for by each terminally ill resident or prospective resident individually, or the resident’s or prospective resident’s Health Care Surrogate Decision Maker if the resident or prospective resident is incapacitated, not by the licensee on behalf of a resident or prospective resident. These hospice agency services must be provided by a hospice agency both licensed by the state and certified by the federal Medicare program.

(4) A written hospice care plan which specifies the care, services, and necessary medical intervention related to the terminal illness as necessary to supplement the care and supervision provided by the facility is developed for each terminally ill resident or prospective resident by that resident’s hospice agency, and agreed to by the licensee and the resident, or prospective resident, or the resident’s or prospective resident’s Health Care Surrogate Decision Maker, if any, prior to the initiation of hospice services in the facility for that resident, and all hospice care plans are fully implemented by the licensee and by the hospice(s).

(5) The acceptance or retention of any terminally ill resident or prospective resident in the facility does not represent a threat to the health and safety of any facility resident, or result in a violation of the personal rights of any facility resident.

(6) The hospice agency and the resident or prospective resident agree to provide the licensee with all information necessary to allow the licensee to comply with all regulations and to assure that the resident’s or prospective resident’s needs will be met.

(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following:

(1) The name, office address, business telephone number, and 24-hour emergency telephone number of the hospice agency and the resident’s physician.

(2) A description of the services to be provided in the facility by the hospice agency including but not limited to the type and frequency of services to be provided.

(3) Designation of the resident’s primary contact person at the hospice agency, and resident’s primary and alternate care giver at the facility.

(4) A description of the area of licensee’s responsibility for implementing the plan including, but not limited to, facility staff duties; record keeping; and communication with the hospice agency, resident’s physician, and the resident’s responsible person(s), if any. This description shall include the type and frequency of the tasks to be performed by the facility.

(A) The plan shall specify all procedures to be implemented by the licensee regarding the storage and handling of medications or other substances, and the maintenance and use of medical supplies, equipment, or appliances.

(B) The plan shall specify, by name or job function, the licensed health care professional on the hospice agency staff who will control and supervise the storage and administration of all controlled drugs (Schedule II – V) for the hospice client. Facility staff can assist hospice residents with self-medications without hospice personnel being present.

(C) The plan shall neither require nor recommend that the licensee or any facility personnel other than a physician or appropriately skilled professional implement any health care procedure which may legally be provided only by a physician or appropriately skilled professional.

(5) A description of all hospice services to be provided or arranged in the facility by persons other than the licensee, facility personnel, or the hospice agency including, but not limited to, clergy and the resident’s family members and friends.

(6) Identification of the training needed, which staff members need this training, and who will provide the training relating to the licensee’s responsibilities for implementation of the hospice care plan.

(A) The training shall include but not be limited to typical needs of hospice patients, such as turning and incontinence care to prevent skin breakdown, hydration, and infection control.

(B) The hospice agency will provide training specific to the current and ongoing needs of the individual resident receiving hospice care and that training must be completed before hospice care to the resident begins.

(7) Any other information deemed necessary by the Department to ensure that the terminally ill resident’s needs for health care, personal care, and supervision are met.

(c) The licensee shall ensure that the hospice care plan complies with the requirements of this section, with the provisions of the Residential Care Facilities for the Elderly Act (Health and Safety Code Section 1569 et seq.), and all other requirements of Chapter 8 of Title 22 of the California Code of Regulations governing Residential Care Facilities for the Elderly.

(d) The licensee shall ensure that the hospice care plan is current, accurately matches the services actually being provided, and that the client’s care needs are being met at all times.

(e) The Department may require that the licensee obtain a revision of the hospice care plan if the plan is not fully implemented, or if the Department has determined that revision of the plan is necessary to protect the health and safety of any facility resident.

(f) The licensee shall maintain a record of all hospice-related training provided to the licensee or facility personnel for a period of three years. This record shall be available for review by the Department.

(1) The record of each training session shall specify the names and credentials of the trainer, the persons in attendance, the subject matter covered, and the date and duration of the training session.

(g) In addition to the reporting requirements specified in Section 87211, Reporting Requirements, the licensee shall submit a report to the Department when a terminally ill resident’s hospice services are interrupted or discontinued for any reason other than the death of the resident, including refusal of hospice care or discharge from hospice. The licensee shall also report any deviation from the resident’s hospice care plan, or other incident, which threatens the health and safety of any resident.

(1) Such reports shall be made by telephone within one working day, and in writing within five working days, and shall specify all of the following:

(A) The name, age, sex of each affected resident.

(B) The date and nature of the event and explanatory background information leading up to the event.

(C) The name and business telephone number of the hospice agency.

(D) Actions taken by the licensee and any other parties to resolve the reportable event and to prevent similar occurrences in the future.

(h) For each terminally ill resident receiving hospice services in the facility, the licensee shall maintain the following in the resident’s record:

(1) A written request for acceptance or admittance to or retention in the facility while receiving hospice services, along with any advance directive and/or request regarding resuscitative measures form executed by the resident or (in certain instances) the resident’s Health Care Surrogate Decision Maker.

(2) The name, address, telephone number, and 24-hour emergency telephone number of the hospice agency and the resident’s Health Care Surrogate Decision Maker, if any, in a manner that is readily available to the resident, the licensee, and facility staff.

(3) A copy of the written certification statement of the resident’s terminal illness from the medical director of the hospice or the physician member of the hospice interdisciplinary group and the individual’s attending physician, if the individual has an attending physician.

(4) A copy of the resident’s current hospice care plan approved by the licensee, the hospice agency, and the resident, or the resident’s Health Care Surrogate Decision Maker if the resident is incapacitated.

(5) A statement signed by the resident’s roommate, if any, or any resident who will share a room with a person who is terminally ill to be accepted or retained as a resident, indicating his or her acknowledgment that the resident intends to receive hospice care in the facility for the remainder of the resident’s life, and the roommate’s voluntary agreement to grant access to the shared living space to hospice caregivers, and the resident’s support network of family members, friends, clergy, and others.

(A) If the roommate withdraws the agreement verbally or in writing, the licensee shall make alternative arrangements which fully meet the needs of the hospice resident.

(i) Prescription medications no longer needed shall be disposed of in accordance with Section 87465(i).

(j) A written health condition exception request and approval from the Department in accordance with Section 87616, is not needed for any restricted health conditions listed in Section 87612, Restricted Health Conditions, or for any prohibited health conditions listed in Section 87615, Prohibited Health Conditions, provided the resident or prospective resident has been diagnosed as terminally ill and is currently receiving hospice care in compliance with Section 87633, Hospice Care for Terminally Ill Residents, and the treatment of the restricted and/or prohibited health conditions is addressed in the hospice care plan.

(1) In caring for a resident’s health condition, facility staff, other than appropriately skilled health professionals, shall not perform any health care procedure that under law may only be performed by an appropriately skilled professional.

(k) The licensee shall maintain a record of dosages of medications that are centrally stored for each resident receiving hospice services in the facility.

(l) Residents receiving hospice care or prospective residents already receiving hospice care when accepted as residents who are bedridden may reside in the facility provided the facility meets the requirements of Section 87606, Care of Bedridden Residents.

(h) provides in summary: “Nothing in this section [which deals with terminally ill residents and hospice care] shall be construed to relieve a licensed residential care facility for the elderly of its responsibility to notify the appropriate fire authority of the presence of a bedridden resident in the facility as required under subdivision (f) of Section 1569.72 and to obtain and maintain a fire clearance as required under Section 1569.149.”

(m) Nothing contained in this section or in Chapter 8 precludes the Department from requiring the relocation of a terminally ill resident whose needs for personal care and supervision or health care are not being met in the facility.

Top Takeaways:

  • (3) Hospice agency services are contracted for by each terminally ill resident or prospective resident individually, or the resident’s or prospective resident’s Health Care Surrogate Decision Maker if the resident or prospective resident is incapacitated, not by the licensee on behalf of a resident or prospective resident. These hospice agency services must be provided by a hospice agency both licensed by the state and certified by the federal Medicare program.

Ensure residents and their responsible party play a role in the decision to use hospice services. This is a very delicate time, and you must allow the resident and the family to decide they are ready to receive hospice care and which provider to use.

  • (b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: 1-7

Just as with any other resident in your community, you must have a written care plan for any resident under hospice services. This plan should include all pertinent information related to the care the resident is receiving.