Job aids

Hospice care in an RCFE: the steps to remember

The short step lists from each lesson of Hospice care in an RCFE: the waiver, the plan and who does what, on one page. Print it for the station or the break room. Each list points back to its lesson, where the sources are linked.

Open the course Print a poster with a QR code

Decision guide

May hospice care begin for this resident?

Does the home hold a hospice care waiver from the Department of Social Services?

Yes
Did the resident, or the surrogate if the resident is incapacitated, contract with the hospice?
- Yes
  Have the licensee and the resident, or the surrogate, agreed to the hospice's written care plan?
  - Yes
    Has the hospice finished the resident-specific training for the staff the plan names?
    Yes
    Will the resident share a room with someone who has not signed the access statement?
    Yes
    Ask the roommate whether they agree, and get the signed statement. If they do not, ask the Department and the hospice what arrangements fully meet the resident's needs.
    No
    Begin under the plan, and keep the plan current and the record complete. For an ALW participant, tell the CCA, since the ISP also describes services outside ALW.
    No
    Ask the hospice to complete the training before care begins, and log each session.
  - No
    Ask the hospice for the written plan. Hospice services in the home wait until it is agreed.
- No
  Ask the resident or the surrogate to contract with the hospice they choose. The licensee does not contract for them.
No
Do not begin hospice care in the home yet. The licensee asks the Department about a hospice care waiver.

This guide checks the conditions section 87633 sets. It does not decide eligibility for hospice or for ALW, and it does not choose a hospice: the resident or the surrogate does.

Step through it one question at a time: alwbeta.com/training/courses/hospice-care-in-rcfe#decision-guide

Lesson 1

The hospice care waiver and its conditions

A resident of an RCFE, or a person about to move in, elects hospice. Before the first hospice visit in the home, the home, the hospice and the resident each have a part. This lesson covers the conditions the regulation sets, so the first decision is right: may hospice care begin here yet?

The Department's hospice care waiver is on file
The resident or surrogate contracts the hospice, not the licensee
The hospice's written plan is agreed before services start
Other residents' safety and rights are protected
The hospice and the resident share what the home needs
The plan addresses any restricted or prohibited condition

Lesson: alwbeta.com/training/courses/hospice-care-in-rcfe#lesson-hosp-waiver

Lesson 2

The hospice care plan: the shared document

The hospice care plan is where the hospice and the home write down who does what. Section 87633 lists what it contains. A plan missing a part leaves a gap on some shift. This lesson prepares you to read a draft plan, or write one, and to spot what is missing before it is agreed.

24-hour numbers for the hospice and the physician
Primary hospice contact; primary and alternate caregiver at the home
Hospice services in the home: type and frequency
Home duties, records and communication: type and frequency
No professional-only procedure for home staff
Revise the plan when services change

Lesson: alwbeta.com/training/courses/hospice-care-in-rcfe#lesson-hosp-care-plan

Lesson 3

Training facility staff before care begins

Before hospice care for a resident begins, the home's staff need to know what this resident needs and what their part is. Section 87633 makes the hospice care plan say who is trained, in what, and by whom. This lesson prepares a liaison and an administrator to plan that training and to show it happened.

The plan names the training, the staff and the trainer
Turning, incontinence care, hydration, infection control
Resident-specific training finished before care begins
Log trainer and credentials, attendees, subject, date, length
Keep training records three years
Document training on the illness's course and signs of impending death

Lesson: alwbeta.com/training/courses/hospice-care-in-rcfe#lesson-hosp-staff-training

Lesson 4

Records and medications for a hospice resident

A licensing visit, a new night caregiver or an emergency all start with the resident's record. Section 87633 lists what the record holds for a hospice resident and sets rules for medications. This lesson prepares you to check a record, a roommate's statement and the medication side against those lists.

Written request to stay on hospice; any advance directive
Hospice and surrogate contacts, easy to find
Terminal-illness certification; current agreed plan
Roommate's signed statement; arrange otherwise if withdrawn
Plan names who controls Schedule II to V drugs
Dosage record for centrally stored medications (CDSS form LIC 622 is the centrally stored medication and destruction record)

Lesson: alwbeta.com/training/courses/hospice-care-in-rcfe#lesson-hosp-records-medications

Lesson 5

Reports, changes and who does what

Hospice care in an RCFE works when each party knows its part and hears about changes quickly. This lesson covers what the licensee reports to the Department and when, what stays with the hospice and the home, and, for an ALW participant, where the care coordination agency fits. It ends with a case.

Hospice stop other than death: phone in one working day, writing in five
Plan deviation or threatening incident: same timelines
Report: who, what and when, the hospice's name and phone, actions taken
The hospice supplements; the home stays within its license
Unsafe to stay: any party raises it; the home may start a transfer
ALW participant: tell the CCA; incident reports to the CCA and DHCS in 24 or 72 hours

Lesson: alwbeta.com/training/courses/hospice-care-in-rcfe#lesson-hosp-who-does-what