Correct PPS usage

[AndersonJR, ADN]

I've been an RN for 5 years and in hospice for 3. I've often found in the past 3 years that the PPS and FAST scores I assign are higher than every other nurse I've discussed them with. Recently the Executive Director of my program came to do pt visits w/ me in an effort to help me streamline my caseload/charting/organization. During one of the visits I stated that I thought the pt was PPS 50% to which the ED said they were a 40% for sure. We then had a small discussion about what the difference between 40% and 50% was, w/ the ED saying that because the pt chose to lay in bed ~20 hrs/day then that would make the pt Mainly in bed (40%). 

It was my understanding that PPS is a functional scale so it's not about what the pt IS doing, but what they CAN do. That night I went to the source and read through the instructions that Victoria Hospice Society published and if I followed their instructions the pt would actually be a 60%! I printed out the instructions and brought them to the ED the next day and we had a debate during which I was told I was missing the point of the PPS and that every administrator in the program would disagree w/ me, that it didn't matter how Victoria Hospice Society INTERPRETTED the score because "we interpret it differently", and that my way of scoring "won't work here".  I have the same issue when it comes to FAST scores.

I know that there is a lot of clinical judgment wiggle room in PPS scores, but it clearly states in the instructions that it doesn't matter what the pt is choosing to do, but what they are actually capable of doing. This pt transfers completely independently, ambulates independently, needs some assistance w/ toileting, and has very rare incontinence. ED stated that if pt is unable to clean themselves properly after toileting (so there is a smear of BM in brief) that that counts as bowel incontinence. In my mind, pt is clearly at least 50%!

I'm having a hard time w/ this because the ED said she is going to write a new policy on how to "interpret" PPS scores, but it feels entirely unethical to me. It feels like they're trying to skew scores lower to make people qualify more easily. I was even told that if everyone scored PPS like I do that no one would qualify for hospice! What?!?! PPS isn't the only metric used for qualifying pts. Plus, most of the medicare diagnosis qualifying guidelines I've seen call for PPS below 70% - I don't know of any pt that actually qualifies for hospice that would have a PPS of 70 or higher.

Sorry this is such a long rambling post, I just don't know what to do. Do I stick to my guns and do what I think is best ethically? Or do I fold and just score how they want me to? Everything I've learned since nursing school is telling me to draw a hard line when it comes to ethics, but I don't want to get fired over this. Does every hospice program fudge qualifications to make pts look more appropriate? Isn't that Medicare fraud?

TL;Dr Disagree w/ boss about how to score PPS and now they're writing a new policy that contradicts actual PPS instructions. Driving me nuts ethically, but don't want to get fired.