Initial and Comprehensive Assessment of the Member

(A) The hospice provider must conduct and document in writing a member-specific comprehensive assessment that identifies the member's need for hospice care and services, and the member's need for physical, psychosocial, emotional, and spiritual care. This assessment includes all areas of hospice care related to the palliation and management of the terminal illness and related conditions. (B) Timeframe for Completion of the Initial and Comprehensive Assessments. The hospice registered nurse must complete an initial assessment within 48 hours after the election of hospice care in accordance with 130 CMR 437.412. The hospice interdisciplinary team, in consultation with the individual's attending physician (as applicable), must complete the comprehensive assessment no later than five calendar days after the election of hospice care in accordance with 130 CMR 437.412. (C) Content of the comprehensive assessment. The comprehensive assessment must identify the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the member's well-being, comfort, and dignity throughout the dying process. The comprehensive assessment must take into consideration the following factors: (1) the nature and condition causing admission (including the presence or lack of objective data and subjective complaints). (2) complications and risk factors that affect care planning. (3) functional status, including the member's ability to understand and participate in his or her own care. (4) imminence of death. (5) severity of symptoms. (6) drug profile. A review of all of the member's prescription and over-the-counter drugs, herbal remedies and other alternative treatments that could affect drug therapy. This includes, but is not limited to, identification of the following: (a) effectiveness of drug therapy. (b) drug side effects. (c) actual or potential drug interactions. (d) duplicate drug therapy. (e) drug therapy currently associated with laboratory monitoring. (7) Bereavement. An initial bereavement assessment of the needs of the member's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the member's death. Information gathered from the initial bereavement assessment must be incorporated into the plan of care and considered in the bereavement plan of care. (8) The need for referrals and further evaluation by appropriate health professionals. (D) Update of the comprehensive assessment. The update of the comprehensive assessment must be accomplished by the hospice interdisciplinary team (in collaboration with the individual's attending physician, if any) and must consider changes that have taken place since the initial assessment. It must include information on the member's progress toward desired outcomes, as well as a reassessment of the member's response to care. The assessment update must be accomplished as frequently as the member’s condition requires, but no less frequently than every 15 days.