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I was on a panel Tuesday at a meeting regarding the provision of hospice services in a nursing facility. One of the issues that were of concern to the providers was who bathes a nursing facility resident who is receiving hospice services.
I have always felt this was a question of whether the bath is related to the terminal illness, as that is the primary consideration in provision of hospice services. The speakers for the state seemed to say it was their position that if the hospice was not providing the baths, it was a condition level deficiency.
My understanding was that this was based upon the notion that Home Health Services are core services for hospice and, therefore, not delegable to the nursing facility.
I have had a chance to consider this further and to discuss the issue with other individuals and have come to the following conclusion. CMS does NOT think the hospice should always provide the bath, but should only provide the bath if it is related to the terminal illness. As a practical matter, the surveyors will most likely presume that bathing is related to the terminal illness and expect the agency to provide it.
However, if bathing is not related to the terminal illness, the hospice provider should not be providing the bath. The IDG needs to assess the patient and determine whether bathing is a necessary part of hospice care. If it is not, the hospice and the nursing facility need to document it and the nursing facility needs to provide the care.
For hospice providers that are concerned that they are passing on 100% reimbursement and then providing services the nursing facility should provide, perhaps negotiating less than 100% reimbursement as a reflection of the hospice taking on bathing or reflecting in the contract that bathing is performed by the nursing facility, unless related to the terminal illness would ways to address this issue.
Neither the hospice nor the nursing facility should ever simply say – the hospice bathes the patients or the nursing home bathes the patients. Doing so runs the risk of a recoupment, or worse.
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