Hospice Care in a Nursing Home: Coordinate Two Plans and One Resident's Daily Care

Establish the paired responsibilities

42 CFR 483.70(n) requires a signed agreement before hospice services begin under the arrangement. It addresses each organization's services, documented communication around the clock, immediate notification of specified changes and a designated facility coordinator. The nursing home continues its room-and-board, personal-care and nursing responsibilities in coordination with hospice.

The hospice has its own obligations under 42 CFR 418.112, including professional management of hospice services and a coordinated plan. The two organizations need to reconcile their actual responsibilities, not simply exchange logos on a generic agreement.

Work a conflicting daily-care instruction

In a fictional case, the resident's current preference is for a later morning personal-care routine. The hospice team's current plan reflects that preference. The facility's older task list still assigns the earlier time. An evening report also describes a changed need that may require professional review, but it was entered only in the nursing home's record.

The facility coordinator addresses two different failures. First, the team reconciles the routine with the resident, relevant clinicians and current plans, updates the facility task list and checks the next morning's actual experience. Second, staff use the established immediate communication route for the changed need; they do not wait for the next scheduled hospice visit or assume a chart entry alerted the other team.

The completed coordination record shows the original conflict, the resident's preference, who reviewed it, the current agreed approach, the communication time and acknowledgment, and the later implementation check. It does not invent a new clinical order or imply that the coordinator can independently change treatment.

Keep the plan and contact packet current

The nursing home rule identifies information the designated coordinator obtains from hospice, including the current hospice plan, election and certification information, relevant orders and medication information, personnel contacts and access to the 24-hour on-call system. The facility's written plan must include the current hospice plan and its own services.

A useful packet therefore distinguishes three dates: when hospice revised its plan, when the facility received it and when relevant facility instructions were updated. An uploaded document with no implementation step can leave staff using the earlier approach.

Test a covering employee's ability to reach hospice after hours and identify the facility's backup coordinator. If the contact succeeds only because one weekday employee knows a personal number, the arrangement is fragile. Protect resident information through authorized communication routes while making the necessary care coordination available.

Resolve gaps in delivered service

The CMS hospice and end-of-life survey pathway examines whether planned services occur, whether residents' choices are reflected and whether the two teams communicate changes and concerns. It also distinguishes hospice-specific concerns from the nursing home's continuing obligations.

If one organization says the other was responsible for a task, return to the actual agreement and resident-specific plan. Address the current resident need promptly through qualified staff, then resolve the responsibility gap. A contract dispute must not become the reason both teams leave a needed service undone.

For a full-platform buyer, the completed example should trace a hospice plan revision into the nursing home's daily task, an acknowledged change notification and a later resident-centered check. This guide concerns care coordination; hospice election, coverage and payment decisions require their separate processes.