1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32 | R1 was placed on hospice for palliative care on 11/07/2020 and diagnosed by the hospice physician with senile degeneration, anorexia, depression, muscle weakness (functional quadriplegia), and chronic kidney disease (Stage II). R1 signed and dated a Do Not Resuscitate (DNR) form that requested no aggressive medical treatment on 01/27/2020, and Section C of R1’s DNR is checked requesting “No artificial means of nutrition, including feeding tubes.” On 05/13/2021, the hospice physician completed a Hospice Recertification Plan of Care and reported that R1 was terminally ill with a life expectancy of six (6) months or less. The directive of care was DNR and comfort measures. Hospice staff notified and provided updates to R1’s family regarding R1’s declining health. The hospice social worker maintained communication with R1’s family. R1’s family was notified by AD and by hospice staff that R1 was rapidly declining. On 07/11/2021, Witness #1 (W1) visited R1 at the facility, rescinded the DNR, and had R1 transported to a hospital for medical treatment. The hospital physician was made aware that R1 was receiving hospice care. The hospital physician treated R1, but informed R1’s family that any treatment would not change R1’s current condition and offered palliative care until R1’s passing on 07/17/2021. R1’s cause of death was cardiac arrest, hypertension, and sepsis. R1’s health was declining and R1’s life expectancy was terminal. R1 was cared for by the professional staff and the physician of the hospice company along with the staff at the facility. Based on the interviews conducted and records reviewed, R1 passed away at a hospital from terminal conditions while under hospice care and R1’s family was kept aware of R1’s condition, treatment, and decline.
The investigation into the allegations that R1 suffered from malnutrition and dehydration while in care revealed the following: R1 was diagnosed to be terminally ill and had a history of refusing to eat or drink. Facility staff and the hospice social worker reported that they made every attempt to encourage R1 to eat and drink, including sitting with R1, helping R1 drink milk and other beverages through a straw, and using a sponge to keep R1’s lips moist. R1 sometimes became agitated when staff continued to encourage them to eat and drink. The hospice nurse was aware of R1’s condition and R1’s refusal to eat or drink, informed facility staff not to force feed or force R1 to drink water due to possible aspiration, and stated that R1’s refusal of food and water was part of R1 transitioning to end of life. R1 was provided comfort care as their health continued to decline. The hospice physician was aware of R1’s condition and R1’s refusal to eat or drink and requested that hospice staff inform R1’s family that this was the process of R1’s end of life and any aggressive measures to aide R1’s condition would no longer be considered palliative care. Based on the interviews conducted and records reviewed, R1’s refusal to eat or drink was part of R1’s end of life process, R1’s family was made aware of R1’s condition, and facility and hospice staff made every attempt to get R1 to eat and drink while following the instructions from the hospice nurse and physician.
(Continued on 9099C) |