Hospice Condition of Participation: Care for Respite Purpose

418.108 (b) Standard: Inpatient Care for Respite Purposes

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1. Inpatient for respite purposes must be provided by one of the following:
i. A provider specified in paragraph (a) of this section.

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ii. Medicare or Medicaid-certified nursing facility that also meets the standards specified in 418.110 (f).

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2. The facility providing respite care must provide 24-hour nursing services that meet the nursing needs of all patients and are furnished in accordance with each patient’s plan of care. Each patient must receive all nursing services as prescribed and must be kept comfortable, clean, well-groomed, and protected form accident, injury, and infection.

Interpretive Guidelines 418.108(b)(2)

The hospice must assure that the inpatient facility has enough nursing personnel present on all shifts to guarantee that adequate safety measures are in place for the patients, and the routine, special, and emergency needs of all patients are met at all times.

418.108 (c) Standard: Inpatient Care Provided Under Arrangements

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If the hospice has an arrangement with a facility to provide for short-term inpatient care, the arrangement, coordinated by the hospice and at a minimum specifies-
1. That hospice supplies the inpatient provider a copy of the patient’s plan of care and specifies that the inpatient services to be furnished;

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2. That the inpatient provider has established patient care policies consistent with those of the hospice and agrees to abide by the palliative care protocols and plan of care established by the hospice for its patients;

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3. That the hospice patient’s inpatient clinical record includes a record of all inpatient service furnished and events regarding care that occurred at the facility; that a copy of the discharge summary be provided to the hospice at the time of discharge; and that a copy of the impatient clinical record is available to the hospice at the time of discharge;

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4. That the inpatient facility has identified an individual within the facility who is responsible for the implementation of the provisions of the agreement;

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5. That the hospice retains responsibility for ensuring that the training of personnel who will be providing the patient’s care in the inpatient facility has been provided and that a description of the training and the names of those giving the training are documented; and

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6. A method for verifying that the requirements in paragraphs(c)(1) through (c)(5) of this section are met.

Interpretive Guidelines 418.108(c):
Hospices may have arrangements with more than one facility for the provision of inpatient care.

Procedures and Probes 418.108(c)

• Ask the hospice clinical manager what facilities they use and how they monitor the care their patients receive at each facility. If you have questions concerning the provision of care or the hospice’s explanation of how they monitor care at the facility(ies), ask to review a copy of their written agreement.
• Ask how the hospice assures that all staff caring for hospice patients at the inpatient facility(ies) have been trained in the hospice philosophy of care and are able to provide patient care according to the hospice plan of care. If necessary, contact or visit the facility(ies) as needed to verify compliance.

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