HOSPICE:  An assisted living facility that provides or coordinates hospice care and services shall meet the requirements in this section, in addition to the rules applicable to all assisted living facilities, 7.8.2 NMAC.

  1.             Definitions:  in addition to the requirements for all assisted living facilities pursuant to “DEFINITIONS,” NMAC, the following definitions shall also apply.

                                (1)           “Hospice agency” means an organization, company, for-profit or non-profit corporation or any other entity which provides a coordinated program of palliative and supportive services for physical, psychological, social and the option of spiritual care of terminally ill people and their families.  The services are provided by a medically directed interdisciplinary team in the person’s home and the agency is required to be licensed pursuant to 7.12 NMAC.

                                (2)           “Hospice care” means a focus on palliative, rather than curative care.  The goal of the plan of care is to help the patient live as comfortably as possible, with emphasis on eliminating or decreasing pain and other uncomfortable symptoms.

                                (3)           “Licensed assisted living provider” means a facility that provides twenty-four (24) hour assisted living and is licensed by the department of health.

                                (4)           “Hospice services” means a program of palliative and supportive services which provides physical, psychological, social and spiritual care for terminally ill patients and their family members.

                                (5)           “Care coordination requirements” means a written document that outlines the care and services to be provided by the hospice agency for assisted living residents that require hospice services.

                                (6)           “Palliative care” means a form of medical care or treatment that is intended to reduce the severity of disease symptoms, rather than to reverse progression of the disease itself or provide a cure.

                                (7)           “Terminally ill” means a diagnosis by a physician for a patient with a prognosis of six (6) months or less to live.

                                (8)           “Visit notes” means the documentation of the services provided for hospice residents and includes ongoing care coordination.

  1.             Employee training and support.  A facility that provides hospice services shall provide the following education and training for employees who assist with providing these services:

                                (1)           provide a minimum of six (6) hours per year of palliative/hospice care training, which includes one (1) hour specific to the hospice resident’s ISP, in addition to the basic staff education requirements pursuant to NMAC; and

                                (2)           offer an ongoing employee psychological support program for end of life care issues.

  1.             Individual service plan (ISP) requirements.

                                (1)           Each resident who receives hospice services shall be provided the necessary palliative care to meet the individual resident’s needs as outlined in the ISP and shall include one (1) hour of training specific to the resident for all direct care staff.

                                (2)           The assisted living facility, in coordination with the hospice provider, shall create an ISP that identifies how the resident’s needs are met and includes the following:

                                                (a)           the requirements set forth in the “Individual Service Plan,” NMAC, and “Exceptions to admission, readmission and retention,” Subsection C of NMAC;

                                                (b)           what services are to be provided;

                                                (c)           who will provide the services;

                                                (d)           how the services will be provided;

                                                (e)           a delineation of the role(s) of the hospice provider and the assisted living facility in the ISP process;

                                                (f)            documentation (visit notes) of the care and services that are provided with the signature of the person who provided the care and services; and

                                                (g)           a list of the current medications or biologicals that the resident receives and who is authorized to administer them.

                                (3)           Medications shall be self-administered, self-administered with assistance by an individual that has completed a state approved program in medication assistance or administered by the following individuals:

                                                (a)           a physician;

                                                (b)           a physician extender (PA or NP);

                                                (c)           a licensed nurse (RN or LPN);

                                                (d)           the resident if their PCP has approved it;

                                                (e)           family or family designee; and

                                                (f)            any other individual in accordance with applicable state and local laws.

  1.             Care coordination.

                                (1)           The assisted living facility shall be knowledgeable with regard to the hospice requirements pursuant to 7.12 NMAC and ensure that the hospice agency is well informed with regard to the assisted living provisions pursuant to Subsection C of NMAC.

                                (2)           The assisted living facility shall hold a team meeting prior to accepting or retaining a hospice resident in accordance with “Exceptions to admission, readmission and retention,” Subsection C of NMAC.

                                (3)           Upon admission of a resident into hospice care, the assisted living facility shall designate a section of the resident’s record for hospice documentation.

                                                (a)           The facility shall provide individual records for each resident.

                                                (b)           The hospice agency shall leave documentation at the facility in the designated section of the resident’s record.

                                (4)           The assisted living facility shall provide the resident and family or surrogate decision maker with information on palliative care and shall support the resident’s freedom of choice with regard to decisions.

                                (5)           Hospice services shall be available twenty-four (24) hours a day, seven (7) days a week for hospice residents, families and facility staff and may include continuous nursing care for hospice residents as needed.  These services shall be delivered in accordance with the resident’s individual service plan (ISP) and pursuant to 7.8.2 26 NMAC.

                                (6)           The assisted living facility shall ensure the coordination of services with the hospice agency.

                                                (a)           The resident’s individual service plan (ISP) shall be updated with significant changes in the resident’s condition and care needs.

                                                (b)           The assisted living facility shall receive information and communication from the hospice staff at each visit.

                                                                (i)            The information shall include the resident status and any changes in the ISP (i.e., medication changes, etc.).

                                                                (ii)           The information shall be in the form of a verbal report to the assisted living facility staff and also in the form of written documentation.

                                                (c)           The assisted living facility or the family/resident shall reserve the right to schedule care conferences as the needs of the resident and family dictate.  The care conferences shall include all care team members.

                                                (d)           Concerns that arise with regard to the delivery of services from either the assisted living facility or the hospice agency shall first be addressed with the facility administrator and the hospice agency administrator.

                                                                (i)            The process may be informal or formal depending on the nature of the issue.

                                                                (ii)           If an issue cannot be resolved or if there is an immediate danger to the resident the appropriate authority shall be notified.

  1.             Additional provisions.  An assisted living facility that provides or coordinates hospice care and services shall make additional provisions for the following requirements:

                                (1)           individual services and care:  each resident receiving hospice services shall be provided the necessary palliative procedures to meet individual needs as defined in the ISP;

                                (2)           private visiting space:

                                                (a)           physical space for private family visits;

                                                (b)           accommodations for family members to remain with the patient throughout the night; and

                                                (c)           accommodations for family privacy after a resident’s death.

  1.             Medicare and Medicaid restrictions.  Assisted living facilities shall not accept a resident considered “hospice general inpatient” which would be billable to medicare or medicaid because the facility will not qualify for payment by medicare or medicaid.

[ NMAC – N, 1/15/2010]