CMS SOM App. M, Tag L531

An initial bereavement assessment of the needs of the

patient's family and other individuals focusing on the social, spiritual, and cultural

factors that may impact their ability to cope with the patient'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.

Interpretive Guidelines §418.54(c)(7)

Although a bereavement plan is initiated after the death of the patient, prior to the death,

the hospice must assess any grief/loss issues of the patient’s family through an initial

bereavement risk assessment that is incorporated in the plan of care. Bereavement issues

continue to be part of the ongoing assessments, and the bereavement plan of care after

death is based on all these assessments. Bereavement services may be offered prior to the

death when the initial assessment, comprehensive assessment, or updates to the

assessment identifies the need for the patient/family.

Social, spiritual and cultural factors that may impact a family member or other

individual’s ability to cope with the patient’s death would include, but not be limited to:

• History of previous losses;

• Family problems;

• Financial concerns;

• Communication issues;

• Drug and alcohol abuse;

• Health concerns;

• Legal and financial concern;

• Mental health issues;

• Presence or absence of a support system; and

• Feelings of despair, anger, guilt or abandonment.

These issues may not be readily apparent during the initial bereavement risk assessment,

but should be incorporated into the hospice plan of care if they become evident, and must

be considered in the bereavement plan of care.