The Business of Senior Care

Missed visits happen. Whether your agency is large or small, staff being able to provide 100% of the schedule shifts just doesn't happen. And that's ok. 

BUT, in order to be in compliance you need to make sure the client is ok with the missed visit AND document it in the client record. 

Today, let's take a look at a recent Colorado home care survey to help see what missed visits look like when they end up as a deficiency from survey.

It is a Class B home care agency, but can easily be applied to Class A. 

 

Date of Survey: 11/2/22
Regulation Topic: Missed Visits

Regulation #: Chapter 26, Section 5.14

Deficiency #: 650

Deficiency Text:

On 11/2/22, a review of Consumer #2's record revealed a start of care date of 2/9/22. Consumer #2 received PCW and HMK services.

a) The agency failed to ensure oversight of scheduled visits and changes in schedule times, via documentation or notifications to Consumer #2.

Review of the care plan dated 2/9/22 revealed, Consumer #2 was to receive services twice a week for three hours per shift. Consumer #2 was to receive the following PCW services; hair care on every shift per week. Consumer #2 was to receive the following HMK services; meal preparation, dusting, dishwashing, kitchen cleaning, vacuuming, sweeping, mopping, trash removal, bathroom cleaning, bed making, and shopping.

Review of Consumers #2's timesheets, from 2/27/22 to 5/21/22, revealed the consumer only received one visit the week of April 3rd. There was no documentation as to why the shift was missed or how Consumer #2's needs were met.

During an interview on 11/2/22 at 5:36 p.m., PCW #5 stated she did not recall a missed visit that week, nor did she recall filing out notification of a missed visit.

During an interview on 11/3/22 at 10:30 a.m., the agency manager acknowledged that a missed visit had occurred the week of April 3rd, but was unable to locate any documentation regarding the missed visit, or if Consumer #2 had been informed of the schedule change.

Sorry we missed you!!

The key to this deficiency is what was documented, or not, in the client’s record. Had there been a note put in that the client was contacted and the client was ok with not having services on that day then there is no deficiency.

So, how can you avoid this deficiency? There are 2 easy steps you can take to make sure you are in compliance.

Step 1: Make sure you have a Missed Visit policy and it includes a process for missed visits.

If this issue comes up during a survey, the first question from the surveyor will be, “Can I see your Missed Visit policy?” Now is a perfect time to make sure you have a policy. A comprehensive policy needs to include the following items:

• Process for informing a client and agreeing upon scheduled days/hours for services
• Agency will document any changes in the schedule, in advance if possible (i.e. vacation, holidays, illness, etc.)
• Documentation for attempts to contact the client if they do not respond
• For a missed visit, contact with the client to perform services or reschedule
• Back-up plan for missed visit cannot be 911

Step 2: Provide education to your team on how you want to document missed visits in the client record.

Another step towards making sure missed visits getting documented in the client record is to tell your team how you would like it done. One of the best ways to do this is to provide education to your staff on the process for missed visits, including with your office staff and where they should document.

For field staff, the main education is that they need to contact the office immediately if they arrive at a client’s house and are unable to provide services. If they knock on the door and no one answers, they need to contact the office. The office can help them triage what to do next.

For office staff, the education is a bit more comprehensive. Provide some steps for the staff to triage if they are notified of a missed visit. If they are concerned about the safety of the client, it could include contacting 911 if a client is not responding.

But, most importantly, the office staff needs to make a note about the missed visit in the record. Typically this is done in the Client EMR online and includes what the agency did about the missed visit.

I WANT MY OWN MISSED VISIT POLICY