by hospicekeys | Oct 13, 2024 | Compliance and Regulatory - Directors, Hospice 101 - Aides, Hospice 101 - Chaplain, Hospice 101 - Nurses, Hospice 101 - Office Team, Hospice 101 - Social Workers, Interdisciplinary Team, Regulatory Compliance, Rules and Regulations - Chaplains, Rules and Regulations - Nurses, Rules and Regulations - Social Workers
The hospice interdisciplinary group (IDG) creates a patient’s plan of care and provides holistic care to the patient, caregiver, and family. Hospice Conditions of Participation require the IDG to “review, revise, and document the individualized plan as frequent as the patient’s condition requires, but no less frequently than every 15 calendar days.”
As such, the IDG meet at a minimum every 15 days. In many hospice organizations, the interdisciplinary group meets weekly to review patient status and to determine if changes are required to a patient’s plan of care. It is important that during the IDG meeting patients’ care plans are reviewed and updated based upon patients’ assessments. Timely and accurate documentation is critical; this documentation may be reviewed by surveyors and by CMS to ensure compliance with regulations.
Who is required to attend an IDG Meeting
Required members of the IDG meeting include:
- A doctor who is an employee or under contract with the hospice agency
- Registered nurse
- Social worker
- Pastoral or other counselor
These four individuals are minimum participants in the IDG meeting. If one of these members i missing from the IDG meeting, the meeting does not meet Medicare regulations and it is considered as if the meeting did not take place. . Care must be taken to ensure that the minimum requirement – IDG meeting with the participation of at least these four individuals at a minimum of once every 15 days – is met.
Additionally, a staff member is typically identified to serve as the scribe for the IDG meeting. The scribe captures any changes to a patient’s plan of care that are agreed upon during the meeting.
What activities occur during the IDG meeting?
When the meeting begins, all participants sign the meeting sign-in sheet. These sheets serve as documented proof that the hospice has met the Medicare Conditions of Participation – that the required members of IDG participated in the meeting. Sign in sheets are stored in a place that is accessible for review upon the request of auditors or surveyors.
Prior to the IDG meeting, a list is drawn up of the patients who will be reviewed during the meeting. For each of these patient’s members of the care team provide an update on the patient’s current condition, highlighting any concerns. The team then discusses the plan for the upcoming two weeks.
Patients may be ordered for discussion as follows:
- Deaths
- Admissions
- Recertifications
- Evaluation
Let’s review each of these in detail.
Deaths
Each death since the prior IDG meeting is reviewed. The team discusses whether bereavement has been requested or declined. In the case where bereavement has been requested, the individuals who will be receiving bereavement services are identified. Any further details or concerns on the services that will be provided are discussed.
Admissions
The RN Case manager discusses any new admissions since the prior IDG meeting, including patient diagnosis and hospice eligibility criteria. Visit frequency is discussed, hospice aide services, and patient psychosocial needs. Typically, all team members partake in this discussion including a discussion about patient medications and prognostic indicators.
Recertifications
At this stage in the IDG the team discusses all patients who are the end of their benefit period and need to be recertified. Any face-to-face visits that were conducted will be discussed and any that are still pending will need to be scheduled. For patients who were evaluated and are found not to meet criteria, the team discusses how to notify the family and details on how to transition the patient off of hospice care.
Evaluations
All remaining patients on the list are reviewed by the members of the IDG. The team discusses whether any changes to the plan of care are needed, whether any medications need to be changed or if any additional support is required (e.g., chaplain, volunteer). The plan of care may be updated if the team agrees that a change in visit frequency is required.
Updating patients’ plan of care
While each patient is discussed, any changes to the patient’s plan of care are entered into the patient’s chart, which is signed by the medical director.
by hospicekeys | Oct 7, 2024 | Compliance and Regulatory - Directors, Hospice 101 - Aides, Hospice 101 - Chaplain, Hospice 101 - Nurses, Hospice 101 - Office Team, Hospice 101 - Social Workers, Interdisciplinary Team
Hospice care is patient- and family-centered, where the patient’s and family’s preferences and needs drive the care plan.
The hospice interdisciplinary group (also referred to as Hospice IDG or IDG), also referred to as the interdisciplinary team (IDT) is a team of healthcare professionals who work together to create a plan tailored to the needs of hospice patients. The IDG is crucial because it reflects the fundamental principle of hospice care: a multidisciplinary and holistic approach to treating a patient. Hospice care is not just about managing medical symptoms; it involves addressing the physical, emotional, social, and spiritual needs of the patient and their family. This comprehensive care model requires combined expertise of different healthcare professionals working together as a cohesive team.
Multidisciplinary and 360-degree approach
The idea of a multidisciplinary approach is central to hospice care because a single healthcare professional cannot fully address the complex needs of a patient at the end of life. Hospice patients often experience pain, emotional distress, social isolation, and spiritual concerns, all of which need to be treated so that the patient has a peaceful and dignified end of life experience. Each of the members of the IDG can address different aspects of hospice patient needs.
Physical needs: Managed by the physician and nurse. The physician provides medical direction and oversees patient care while the nurse manages the patient’s medical needs such as pain control and symptom management.
Emotional and social needs: The social worker provides emotional and social support, caring for emotional health, caregiver stress, and family dynamics. Consideration is also given to connecting the family with community resources
Spiritual needs: These are managed by the chaplain, who offers spiritual care and counseling, based on the patient’s and family’s beliefs. The chaplain helps patients and families explore spiritual concerns, questions of meaning, or religious beliefs in the context of their journey.
Daily living needs: Hospice aides assist with personal care like bathing, dressing, and grooming. They ensure dignity and comfort in activities of daily living like bathing, dressing, and grooming.
Companionship and support: The hospice volunteer offers companionship and practical help, like errands or respite for family caregivers.
By involving individuals from different disciplines, hospice care can take a 360-degress approach to a patient’s needs. It means that every aspect of care – physical, emotional, social, and spiritual – is addressed by someone with the expertise to manage that particular dimension. This all encompassing approach is what makes hospice care unique and effective.
Are all member of the IDG required per CMS regulations?
Per CMS regulations, only core members must always be part of the IDG to ensure that hospice care addresses every critical aspect of the patient’s experience. Four disciplines are considered core required members of the team. These include:
- Physician
- Registered nurse
- Social worker
- Chaplain
Some professional members may be included in the IDG as needed, depending upon patient’s individual circumstances. These include:
- Hospice Aide
- Volunteer
- Therapists
- Bereavement Counselor
How is the IDG aligned with regulatory standards?
CMS requires that hospice care involve an interdisciplinary approach because it reflects the need to treat the “whole” patient, not just their medical condition. The IDG ensures that the care plan is tailored to the patient’s evolving needs and that it incorporates feedback from multiple disciplines to achieve the best outcomes. The interdisciplinary model is also a regulatory requirement under the hospice Conditions of Participation (CoPs). As such, surveyors will review the functioning of the IDG during inspections to ensure compliance. A well coordinated interdisciplinary team ensures regulatory compliance and quality patient care.
Why is the interdisciplinary hospice team essential?
Hospice care is patient and family centered, meaning that the patient’s and family’s preferences and needs drive the care plan. The IDG works collaboratively to ensure that the care plan remains flexible and responsive to changes in the patient’s condition. As hospice patients often experience rapid changes in health, having professionals from different disciplines ensures that all aspects of care can be addressed promptly and effectively.
In summary, the IDG reflects hospice’s holistic, multidisciplinary approach to care by ensuring that all dimensions of the patient’s well-being are addressed. Required team members focus on medical, emotional, and spiritual care, while optional members can be added to meet unique or additional needs. This alignment ensures that hospice remains flexible and patient-centered.
