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 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 NMDOH:
7.8.2.68 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.
B. 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 7.8.2.17 NMAC; and
(2) offer an ongoing employee psychological support program for end of life care issues.
C. 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,” 7.8.2.26
NMAC, and “Exceptions to admission, readmission and retention,” Subsection C of 7.8.2.20 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
the 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.
D. 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 7.8.2.20 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 7.8.2.20 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.
E. 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.
F. 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.
Top Takeaways:
• (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.
You must 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.
• (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-g
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
the resident is receiving.