Section 131.25. Core services.

 

(1)   General requirements. A hospice is responsible for providing care and services to a patient and, as necessary, the patient's family, based on the plan of care developed by the core team. Volunteers shall participate in the delivery of program services.

(2)   Core team.

(a) Each member of the core team shall be an employee, including a volunteer of the hospice or be under a contract with the hospice as specified in par. (c) .

(b) With respect to services provided to a patient, each core team member shall do all of the following:

1. Assess patient and family needs.

2. Promptly notify the registered nurse of any change in patient status that suggests a need to update the plan of care.

3. Provide services consistent with the patient plan of care.

4. Provide education and counseling to the patient and, as necessary, to the patient's family, consistent with the plan of care.

5. Participate in developing and revising written patient care policies and procedures.

(c) The hospice may contract for physician services as specified in par. (a) . A hospice may use contracted staff, if necessary, to supplement hospice employees in order to meet the needs of patients under extraordinary or other non-routine circumstances. A hospice may also enter into a written arrangement with another Medicare certified hospice program for the provision of core services to supplement hospice staff to meet the needs of patients. Circumstances under which a hospice may enter into a written arrangement for the provision of core services include unanticipated periods of high patient loads, staffing shortages due to illness or other short-term temporary situations that interrupt patient care and temporary travel of a patient outside of the hospice's service area.

(3)   Physician services . The hospice medical director, physician employees, and contracted physicians of the hospice, in conjunction with the patient's attending physician, are responsible for the palliation and management of the terminal illness and conditions related to the terminal illness.

(a) All physician employees and those under contract must function under the supervision of the hospice medical director.

(b) All physician employees and those under contract shall meet this requirement by either providing the services directly or through coordinating patient care with the attending physician. If the attending physician is unavailable, the medical director, contracted physician, and or hospice physician employee is responsible for meeting the medical needs of the patient.

(4)   Nursing services.

(a) Nursing services shall be provided by or under the supervision of a registered nurse and shall consist of all of the following:

1. Regularly assessing the patient's nursing needs, implementing the plan of care provisions to meet those needs and reevaluating the patient's nursing needs.

2. Supervising and teaching other nursing personnel, including licensed practical nurses, nurse aides.

3. Evaluating the effectiveness of delegated acts performed under the registered nurse's supervision.

(b) Highly specialized nursing services that are provided so infrequently that the provision of such services by direct hospice employees would be impracticable and prohibitively expensive, may be provided under contract.

(c) Licensed practical nursing services. If licensed practical nursing services are provided, the licensed practical nurse shall function under the supervision of a registered nurse with duties specified in writing and updated by a registered nurse.

(5)   Social services .

(a) Social services shall be provided by a qualified social worker and shall consist of all of the following:

1. Regularly assessing the patient's social service needs, implementing the plan of care to meet those needs and reevaluating the patient's needs and providing ongoing psychosocial assessment of the family's coping capacity relative to the patient's terminal condition.

2. Linking patient and family with needed community resources to meet ongoing social, emotional and economic needs.

(6)   Counseling services. Counseling services shall be available to the patient and family to assist the patient and family in minimizing the stress and problems that arise from the terminal illness, related conditions, and the dying process.

(a) Bereavement services. Bereavement services shall be provided to families of hospice patients. Each hospice shall have its own bereavement program. Bereavement services shall be:

1. Coordinated by an individual recognized by the governing body to possess the capacity by training and experience to provide for the bereavement needs of families, including the ability to organize a program of directed care services provided to family members.

2. Compatible with the core team's direction within the plan of care for the patient.

3. Available for one year following the patient's death as part of an organized program and provide all of the following:

a. Orientation and training to individuals providing bereavement services to ensure that there is continuity of care.

b. Service intervention either directly or through trained bereavement counselors.

c. Assignment, supervision and evaluation of individuals performing bereavement services.

d. Referrals of family members to non-hospice community programs where appropriate.

(b) Dietary counseling. Dietary counseling services shall be provided only as authorized by the hospice and in conjunction with the plan of care. The services shall be provided by a registered dietician or an individual who has documented equivalency in education or training. Dietary services shall be supervised and evaluated by a registered dietician or other individual qualified under this paragraph who may delegate acts to other employees. Dietary counseling services shall consist of all of the following:

1. Assessment of nutritional needs and food patterns;

2. Planning diets appropriate for meeting patient needs and preferences; and

3. Providing nutrition education and counseling to meet patient needs, as well as necessary consultation to hospice employees.

(c) Spiritual counseling. The hospice shall do all of the following:

1. Provide an assessment of the patient's and family's spiritual needs.

2. Provide spiritual counseling to meet these needs in accordance with the patient's and family's acceptance of this service, and in a manner consistent with patient and family beliefs and desires.

3. Make all reasonable efforts to facilitate visits by local clergy, pastoral counselors, or other individuals who can support the patient's spiritual needs to the best of its ability.

4. Advise the patient and family of this service.

History: CR 10-034 : cr. Register September 2010 No. 657 , eff. 10-1-10.