What happens to our coverage when hospice provides care in our building?

Under a hospice arrangement the hospice assumes responsibility for the terminal diagnosis and related conditions, while the facility remains responsible for the resident daily care. In practice the line is blurry: your aide repositions the resident, the hospice nurse manages the wound, and both chart.

A family that is unhappy sues both, and each defendant points at the other. The most damaging outcome is not the allegation but two records that disagree about what was ordered, what was done and by whom.

Federal requirements direct that a written agreement define the responsibilities of each party. Treat that document as a liability instrument rather than a compliance formality. It should say who assesses, who repositions, who manages wounds, who administers medications, who responds after hours, and how a change of condition is communicated and documented on both sides.

Then add insurance provisions: each party carries professional liability at a stated limit, names the other as additional insured for the joint care, provides certificates, and gives notice of cancellation. Mutual indemnity for each party own negligence rather than a one-way indemnity, since neither party can control the other clinical staff.

Two charts on two systems for one resident is the structural problem. Hospice notes live in the hospice record and facility notes live in yours, and neither is complete. In litigation the plaintiff assembles both and highlights every inconsistency.

The workable control is a shared communication record kept in the facility chart: hospice visit logged, findings summarized, orders received, and facility response recorded. It does not merge the records but it makes the facility record internally coherent, which is what defends your position.

Pain management is the most common: the family alleges the resident suffered because medication was not given or was not adjusted. Determining whether that was a hospice failure or a facility administration failure is exactly the divided-responsibility problem, and the answer is in the medication administration record.

Pressure injuries on a hospice resident are the second, and they carry a specific defense that requires documentation: skin failure at end of life is a recognized clinical phenomenon, but the defense only works where the preventive interventions are charted. Undocumented, it reads as neglect.

Confirm your policy responds to both fact patterns and does not carry an exclusion for care rendered jointly with an outside provider, which some forms have and few operators check.