HospitalInspections.org

Based on review of facility policies, review of medical records, and interview with staff (EMP), it was determined the facility failed to inform each patient or patient's representative, of the patient's rights, in advance of furnishing or discontinuing care for three of three medical records reviewed (MR16, MR17, and MR18).
Findings include:
Review of facility policy, "Rights and Responsibility of Patients," dated January 2017, revealed, "... III Guidelines: Patient Rights ... B. Informed Decisions. You have the right to: ... 4. Make choices about your care based on your won spiritual and personal values."
Review of facility policy, "Freedom of Choice in Post-hospital Services," last reviewed July 2016, revealed, " ... III. Procedures. A. Home health services, hospice, or skilled nursing care. As part of the discharge plan, the Medicare Conditions of Participation at 42 CFR 482.43 and 424.20 require hospitals to provide the patient (or the individual acting on the patient's behalf) information on home health agencies (HHA) or skilled nursing facilities (SNFs) available to the patient, and include specific procedures such as informing the patient of their freedom to choose among participating Medicare providers. These requirements are incorporated into the following procedures: 1. Freedom to choose. i. Excela Health acknowledges and respects a patient's freedom to choose health services from any institution, agency, or person qualified to participate under Medicare. As such, the patient or the patient's representative shall be informed of their right to choose. ii. Hospital staff may discuss the services and advantages of Excela Health Home Care and Hospice and EPIC (Excela Physical Improvement Center) Rehab with patients who will require such services. ... 4. Documentation. The hospital coordinating the post-hospital service must provide and document in the patient's medical record that: i. the patient, or the individual acting on patient's behalf, was informed of their freedom to chose, and ii. Information identifying the provider to which the patient is referred in which the hospital has a disclosable financial interest. Documentation must be in the medical record and can be accomplished using the Freedom of Choice form (see IV.) ... ."
Review of MR16, MR17, and MR18 on March 1, 2018, revealed orders for comfort measures only, and were transferred to inpatient hospice level of care. Further review of MR16, MR17, and MR18 revealed no documentation of freedom of choice for hospice services.
Interview with EMP4 on March 1, 2018, at approximately 11:00 am, confirmed these findings and states, "I don't know why the social workers aren't doing this [using the Freedom of Choice form]."