Chapter DHS 131

DHS 131.25(2)(a) (a) Each member of the core team shall be an employee, including a volunteer of the hospice or be under a contract with the hospice as specified in par. (c).

DHS 131.25(2)(b) (b) With respect to services provided to a patient, each core team member shall do all of the following:

DHS 131.25(2)(b)1. 1. Assess patient and family needs.

DHS 131.25(2)(b)2. 2. Promptly notify the registered nurse of any change in patient status that suggests a need to update the plan of care.

DHS 131.25(2)(b)3. 3. Provide services consistent with the patient plan of care.

DHS 131.25(2)(b)4. 4. Provide education and counseling to the patient and, as necessary, to the patient’s family, consistent with the plan of care.

DHS 131.25(2)(b)5. 5. Participate in developing and revising written patient care policies and procedures.

DHS 131.25(2)(c) (c) The hospice may contract for physician services as specified in par. (a). A hospice may use contracted staff, if necessary, to supplement hospice employees in order to meet the needs of patients under extraordinary or other non-routine circumstances. A hospice may also enter into a written arrangement with another Medicare certified hospice program for the provision of core services to supplement hospice staff to meet the needs of patients. Circumstances under which a hospice may enter into a written arrangement for the provision of core services include unanticipated periods of high patient loads, staffing shortages due to illness or other short-term temporary situations that interrupt patient care and temporary travel of a patient outside of the hospice’s service area.

DHS 131.25(3) (3) Physician services. The hospice medical director, physician employees, and contracted physicians of the hospice, in conjunction with the patient’s attending physician, are responsible for the palliation and management of the terminal illness and conditions related to the terminal illness.

DHS 131.25(3)(a) (a) All physician employees and those under contract must function under the supervision of the hospice medical director.

DHS 131.25(3)(b) (b) All physician employees and those under contract shall meet this requirement by either providing the services directly or through coordinating patient care with the attending physician. If the attending physician is unavailable, the medical director, contracted physician, and or hospice physician employee is responsible for meeting the medical needs of the patient.

DHS 131.25(4) (4) Nursing services.

DHS 131.25(4)(a) (a) Nursing services shall be provided by or under the supervision of a registered nurse and shall consist of all of the following:

DHS 131.25(4)(a)1. 1. Regularly assessing the patient’s nursing needs, implementing the plan of care provisions to meet those needs and reevaluating the patient’s nursing needs.

DHS 131.25(4)(a)2. 2. Supervising and teaching other nursing personnel, including licensed practical nurses, nurse aides.

DHS 131.25(4)(a)3. 3. Evaluating the effectiveness of delegated acts performed under the registered nurse’s supervision.

DHS 131.25(4)(b) (b) Highly specialized nursing services that are provided so infrequently that the provision of such services by direct hospice employees would be impracticable and prohibitively expensive, may be provided under contract.

DHS 131.25(4)(c) (c) Licensed practical nursing services. If licensed practical nursing services are provided, the licensed practical nurse shall function under the supervision of a registered nurse with duties specified in writing and updated by a registered nurse.

DHS 131.25(5) (5) Social services.

DHS 131.25(5)(a) (a) Social services shall be provided by a qualified social worker and shall consist of all of the following:

DHS 131.25(5)(a)1. 1. Regularly assessing the patient’s social service needs, implementing the plan of care to meet those needs and reevaluating the patient’s needs and providing ongoing psychosocial assessment of the family’s coping capacity relative to the patient’s terminal condition.

DHS 131.25(5)(a)2. 2. Linking patient and family with needed community resources to meet ongoing social, emotional and economic needs.

DHS 131.25(6) (6) Counseling services. Counseling services shall be available to the patient and family to assist the patient and family in minimizing the stress and problems that arise from the terminal illness, related conditions, and the dying process.

DHS 131.25(6)(a) (a) Bereavement services. Bereavement services shall be provided to families of hospice patients. Each hospice shall have its own bereavement program. Bereavement services shall be:

DHS 131.25(6)(a)1. 1. Coordinated by an individual who possesses the capacity by training and experience to provide for the bereavement needs of families, including the ability to organize a program of directed care services provided to family members. DHS 131.25 (6).

DHS 131.25(6)(a)2. 2. Compatible with the core team’s direction within the plan of care for the patient.

DHS 131.25(6)(a)3. 3. Available for one year following the patient’s death as part of an organized program and provide all of the following:

DHS 131.25(6)(a)3.a. a. Orientation and training to individuals providing bereavement services to ensure that there is continuity of care.

DHS 131.25(6)(a)3.b. b. Service intervention either directly or through trained bereavement counselors.

DHS 131.25(6)(a)3.c. c. Assignment, supervision and evaluation of individuals performing bereavement services.

DHS 131.25(6)(a)3.d. d. Referrals of family members to non-hospice community programs where appropriate.

DHS 131.25(6)(b) (b) Dietary counseling. Dietary counseling services shall be provided only as authorized by the hospice and in conjunction with the plan of care. The services shall be provided by a registered dietitian or an individual who has documented equivalency in education or training. Dietary services shall be supervised and evaluated by a registered dietitian or other individual qualified under this paragraph who may delegate acts to other employees. Dietary counseling services shall consist of all of the following:

DHS 131.25(6)(b)1. 1. Assessment of nutritional needs and food patterns;

DHS 131.25(6)(b)2. 2. Planning diets appropriate for meeting patient needs and preferences; and

DHS 131.25(6)(b)3. 3. Providing nutrition education and counseling to meet patient needs, as well as necessary consultation to hospice employees.

DHS 131.25(6)(c) (c) Spiritual counseling. The hospice shall do all of the following:

DHS 131.25(6)(c)1. 1. Provide an assessment of the patient’s and family’s spiritual needs.

DHS 131.25(6)(c)2. 2. Provide spiritual counseling to meet these needs in accordance with the patient’s and family’s acceptance of this service, and in a manner consistent with patient and family beliefs and desires.

DHS 131.25(6)(c)3. 3. Make all reasonable efforts to facilitate visits by local clergy, pastoral counselors, or other individuals who can support the patient’s spiritual needs to the best of its ability.

DHS 131.25(6)(c)4. 4. Advise the patient and family of this service.

DHS 131.25 History History: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10; CR 19-092: am. (6) (a) 1., (b) Register July 2020 No. 775, eff. 8-1-20.

DHS 131.26 DHS 131.26 Non-core services.

DHS 131.26(1) (1) General requirements. A hospice is responsible for providing care and services to a patient and, as necessary, the patient’s family, based on the plan of care developed by the core team. Volunteers shall participate in the delivery of program services. The hospice may provide other services as follows:

DHS 131.26(1)(a) (a) Therapy services. Therapy services are provided in accordance with the plan of care for the patient and by individuals who meet qualification requirements for therapy service delivery such as evidence of current licensure or registration and academic training. Therapy services shall consist of all of the following:

DHS 131.26(1)(a)1. 1. Physical, occupational, speech and language pathology or respiratory therapy.

DHS 131.26(1)(a)2. 2. The provision of a patient assessment as directed by the plan of care.

DHS 131.26(1)(a)3. 3. The development of a therapy plan of care.

DHS 131.26(1)(b) (b) Homemaker services. If homemaker services are provided, they shall be provided in accordance with the patient’s plan of care and shall consist of:

DHS 131.26(1)(b)1. 1. Housekeeping activities.

DHS 131.26(1)(b)2. 2. Performing errands and shopping.

DHS 131.26(1)(b)3. 3. Providing transportation.

DHS 131.26(1)(b)4. 4. Preparing meals.

DHS 131.26(1)(b)5. 5. Other assigned tasks intended to maintain the capacity of the household.

DHS 131.26(2) (2) Nurse aide services. The hospice may provide nurse aide services as follows:

DHS 131.26(2)(a) (a) Assignment. Nurse aides are assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group. Written patient care instructions for a nurse aide shall be prepared by a registered nurse who is responsible for the supervision of a nurse aide as specified under par. (c).

DHS 131.26(2)(b) (b) Plan of care. The nurse aide shall provide care in accordance with the patient’s plan of care. Nurse aide services consist of, but are not be limited to all of the following:

DHS 131.26(2)(b)1. 1. Assisting patients with personal hygiene.

DHS 131.26(2)(b)2. 2. Assisting patients into and out of bed and with ambulation.

DHS 131.26(2)(b)3. 3. Assisting with prescribed exercises which patients and hospice aides have been taught by appropriate health care personnel.

DHS 131.26(2)(b)4. 4. Assisting patients to the bathroom or in using a bedpan.

DHS 131.26(2)(b)5. 5. Assisting patients with self-administration of medications.

DHS 131.26(2)(b)6. 6. Administering medications to patients if the aide has completed a state-approved medications administration course and has been delegated this responsibility in writing for the specific patient by a registered nurse.

DHS 131.26(2)(b)7. 7. Reporting changes in the patient’s condition and needs.

DHS 131.26(2)(b)8. 8. Completing appropriate records.

DHS 131.26(2)(c) (c) Supervision of nurse aides.

DHS 131.26(2)(c)1. 1. A registered nurse shall make an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the nurse aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient’s needs. The nurse aide does not have to be present during this visit.

DHS 131.26(2)(c)2. 2. If an area of concern is noted by the supervising nurse, then the hospice shall make an on-site visit to the location where the patient is receiving care in order to observe and assess the aide while the aide is performing care.

DHS 131.26(2)(c)3. 3. If an area of concern is verified by the hospice during the on-site visit, then the hospice shall conduct, and the nurse aide shall complete a competency evaluation.

DHS 131.26(2)(c)4. 4. A registered nurse shall make an annual on-site visit to the location where a patient is receiving care in order to observe and assess each aide while the aide is performing care.

DHS 131.26(2)(d) (d) Assessment of aide. The supervising nurse shall assess an aide’s ability to demonstrate initial and continued satisfactory performance in meeting outcome criteria that include all of the following, but is not limited to:

DHS 131.26(2)(d)1. 1. Following the patient’s plan of care for completion of tasks assigned to the nurse aide by the registered nurse.

DHS 131.26(2)(d)2. 2. Creating successful interpersonal relationships with the patient and family.

DHS 131.26(2)(d)3. 3. Demonstrating competency with assigned tasks.

DHS 131.26(2)(d)4. 4. Complying with infection control policies and procedures.

DHS 131.26(2)(d)5. 5. Reporting changes in the patient’s condition.

DHS 131.26 History History: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10.

DHS 131.27 DHS 131.27 Volunteers. Prior to beginning patient care, a volunteer shall be oriented to the hospice program and shall have the training for the duties to which he or she is assigned.

DHS 131.27 History History: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10.

DHS 131.28 DHS 131.28 Governing body.

DHS 131.28(1) (1) Each hospice shall have a governing body that assumes full legal responsibility for determining, implementing and monitoring the overall conduct and operation of the program, including the quality of the care and services.

DHS 131.28(2) (2) The governing body shall do all of the following:

DHS 131.28(2)(a) (a) Be responsible for the establishment and maintenance of policies and for the management, operation and evaluation of the hospice.

DHS 131.28(2)(b) (b) Adopt a statement that designates the services the hospice will provide and the setting or settings in which the hospice will provide care.

DHS 131.28(2)(c) (c) Ensure that all services are provided consistent with accepted standards of professional practice.

DHS 131.28(2)(d) (d) Appoint an administrator and delegate to the administrator the authority to operate the hospice in accordance with policies established by the governing body.

DHS 131.28(2)(e) (e) Ensure that nursing and physician services and drugs and biologicals are routinely available on a 24 hour basis 7 days a week.

DHS 131.28(2)(f) (f) Ensure that other covered services are available on a 24 hour basis when reasonable and necessary to meet the needs of the patient and family.

DHS 131.28 History History: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10.

DHS 131.29 DHS 131.29 Administration.