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Comprehensive Assessment and Plan of Care

Title: Comprehensive Assessment and Plan of Care              

CE/CME Offered:

CE/CME Credit Available: Nurse and Social Worker

Member Price: $35.00
Non-Member Price: $70.00

Payment Options:

Add to Cart without CE/CME
Add to Cart with Nurse CE
Add to Cart with Social Worker CE

Length: 1.5 hours
Description: The comprehensive assessment forms the foundation for the plan of care for the provision of end of life care.  The goal of this course is to provide the learner with the knowledge, skills and attitudes to demonstrate best practice in physical, psychological, emotional, spiritual, functional and grief and bereavement assessment as it relates to their discipline and expertise in order to provide optimal care to patients and their families.  This course will provide the learner with an overview of the Hospice Conditions of Participation in relation to the comprehensive assessment, the knowledge to meet compliance/regulatory requirements during the initial and comprehensive assessment process, and the skills to incorporate those requirements in the care planning process.  The team collaborative process, documentation of the specialty of hospice care and services and the value and importance of the expertise of many disciplines from assessment throughout the care planning process are discussed in this course.


  • Describe how the comprehensive assessment requirement of the new
    Conditions of Participation support interdisciplinary practice and optimal care
  • Explain how the hospice experience approach values and integrates interdisciplinary and collaborative assessment
  • Explain the role of Centers for Medicare and Medicaid Services (CMS) in hospice care
  • Identify timeframes on updates to the comprehensive assessment and plan of care
  • Outline processes to implement the comprehensive assessment requirement including documentation of the interdisciplinary collaborative process
  • Describe eight components of the comprehensive assessment
  • List three requirements that must be met before a patient can be admitted to hospice care under the Hospice Medicare Benefit
  • Describe the timelines for completing the initial and comprehensive assessment
  • Explain six components that must be included in the plan of care
Subject Matter Expert:

Susan Bruno, MSW, LCSW

Susan M. Bruno, MSW, ACSW, LCSW is the Director of Business Development at Empath Health. Susan has worked in the hospice industry since 1982 beginning as a hospice social worker and then a program director at Empath Health, one of the largest community based, not-for-profits in the country. She then had the opportunity to work in two other large hospice programs serving in various capacities such as Development Director (starting new hospice programs), Corporate Director of Psychosocial Services, and Vice President of Marketing and Business Development.  In 2001, she returned to Empath Health in the education and training Institute (Empath Health) as the Director of Business Development, working to improve end-of-life care throughout the country.

Susan has presented extensively over the past 30 years at the state and national level on program development, admission strategies, access to care, clinical excellence in end-of-life care and caregiver outreach.  In 2008-09 she toured the country, along with representatives of the Centers for Medicare/Medicaid Services (CMS), training the hospice industry on the new Hospice Medicare Conditions of Participation. She served on the National Hospice Organization’s Standards committee and was a contributing author to the NHO Standards of a Hospice Program and NHO Pathway for Patients and Families Facing Terminal Illness.  She has been a contributing writer and author of several articles and handbooks.

Susan DeMoya, MSN, RN, CHPN
Sue Demoya is a Learning Services Coordinator at Empath Health. Her focus is curriculum design and development. Sue loves the creative collaboration with the team as a course evolves, and freely admits to being totally enamored with her job.  Recent courses written include “Quieting your Mind through Meditation,” “Dyspnea at End of Life” and “Safety in the Workplace: Avoiding Trips, Slips, and Falls”. Courses such as “Quieting Your Mind Through Meditation,” that deal with the more esoteric side of hospice practice, really inspire Sue. She believes educating hospice professionals on these topics makes for a more well-rounded and engaged hospice practitioner.

Sue has worked in a variety of roles at Empath Health during the past 19 years, including many years as a staff nurse caring for patients and families, senior staff nurse and team manager. She transferred to Empath Health two years ago after obtaining her Master’s degree in Nursing Education.

She is also a Certified Hospice and Palliative Care nurse. Her field experience combined with her education and dedication to Empath Health make her an extraordinary addition to the Empath Health team.


Planners: Karen Lo, MS, BA, RN, Carol Johnston, RN, BA and Susan Bruno, MSW, LCSW have no relevant financial relationships to disclose

Subject Matter Experts:  Susan Bruno, MSW, LCSW and Susan DeMoya, MSN, RN, CHPN have no relevant financial relationships to disclose.

CE/CME Credit Hours: Nurse: 1.5 Contact Hours
Social Work: 1.5 Contact Hours
Completion: In order to complete this online activity and obtain CE/CME credit, participants must view the course in its entirety, correctly answer all case studies and quiz/test questions (as appropriate) and complete the evaluation. You will have access to the course for 90 days from the date of purchase.
CE/CME Info:

This activity is being provided through NHPCO’s collaboration with Empath Health.

Empath Health, ACE Provider #1256, is approved as a provider for social work continuing education by the Association of Social Work Boards (ASWB) www.aswb.org through the Approved Continuing Education (ACE) Program. The Empath Health maintains responsibility for the program.  ASWB Approval Period: January 28, 2014 through January 28, 2017. 

Social workers should contact their regulatory board to determine course approval for continuing education credits.  Social workers participating in this course will receive 1 Clinical continuing education clock hours.” 

Contact hours provided via Empath Health’s CE Broker Provider #50-1994 for nurses, marriage and family therapists, mental health counselors, social workers and nursing home administrators. 

Release Date:


Review Date: 04/17/2017

Expiration Date: 


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