Ftag of the Week – F684 Quality of Care (Part 2)

This week’s “Ftag of the Week” on the CMSCG Blog is, as promised, Part 2 of our overview of F684 Quality of Care, which is part of the Quality of Care regulatory group. Just a reminder – quality of care is a fundamental principle that applies to all care and treatment provided to a facility’s resident population. Our focus this week is on End of Life and Hospice Care as it relates to F684. The Intent of this regulation clearly states that the care and services provided need to meet professional standards of practice as well as meet each resident’s physical, mental and psychosocial needs.

Definitions are provided in this regulation regarding Hospice Care, Palliative Care as well as defining what is considered “terminally ill.” Hospice Care is comprised of the services identified and coordinated by your interdisciplinary team and these services define a specific plan of care that addresses the physical, psychosocial, spiritual and emotional needs of a terminally ill patient/ resident and/ or their family members.

Under this regulation, Palliative Care is defined as patient/ resident and family centered care that is focused on optimizing quality of life by anticipating, preventing and treating suffering. These are three very important words in developing your plan of care! The definition clearly states that throughout the continuum of illness addressing the physical, intellectual, emotional, social and spiritual needs of the patient/ resident as well as responsibility to facilitate autonomy, access to information and choice is the focus.

Most of us are aware that the life expectancy of a terminally ill person, if the illness runs it typical course, is 6 months or less. The regulation stresses the importance of conducting a comprehensive assessment to direct our team in developing the plan of care as well as our responsibility to address the choices and preferences of the resident who is nearing the end of life and is receiving Hospice Care through contracted services or is participating in a Palliative Care program. You need to identify and develop a plan regarding pain management, symptom control, treating an acute illness, how to address all advanced care planning choices, including hospitalization. There is an extensive list of areas to also need to be included in the plan of care following completion of your team’s assessment including: oral care, skin integrity, diagnostic testing, nutrition and hydration, activities/ psychosocial needs. Most importantly, we need to remember it is a resident-centered plan of care. The regulation also includes information on physician services under a contracted Hospice Plan, written agreements, etc. that need to be in place and have associated policies and procedures developed.

Remember that there is a Critical Element Pathway (CEP) for Hospice and End of Life Care and Services that is referenced in this regulation. Your team needs to be familiar with the content of this CEP. During observations, an evaluation will be completed to determine if there are signs of psychosocial distress or harm. You also need to ensure that Hospice contracted services are provided as per agreement, and you also need to ensure that services that the facility is responsible for providing are also in place. Keep at the forefront the need to ensure that there is the proper level of communication between all members of the interdisciplinary team.

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