hospice of hope's
TRANSCRIPT
The Monthly Membership Publication of the National Hospice and Palliative Care Organization September 2013
continued on next pageInside
2013 Circle of Life Honorees
New Report on the Achievements of WHV Partners
Free Resources for Pain Awareness Month
A Message From Don
Member News
Compliance Tip
Videos Worth Watching
T he Hospice of Hope tagline, “We Listen We Care,” sums up beautifully the driving force behind our decision to build Kenton Pointe, a 32-bed assisted living community that just
opened in February of 2013.
While the idea was first introduced during a leadership retreat in 2008, it was through a formal Community Needs
Assessment — which we conducted between September 2008 and March of 2009 — that solidified our decision and helped guide the project’s development and funding.
This article discusses some of the key components of the Assessment process we followed as well as suggestions to inform
your own expansion work, based on our experience.
By Kavin Cartmell
Hospice of Hope’s Expansion into Long Term Care
If a patient decides to forgo eating and drinking in order to hasten death, how should a hospice respond? The NHPCO Ethics Advisory Council offers a case study and questions in the spirit of fostering robust discussion on this difficult issue — with the ultimate goal of helping hospices become better prepared should such a situation arise.
In her new book, One Foot Forward, photographer and author, Judith Fox, shares the poignant stories and portraits of 20 widowed women and men who’ve grieved, accepted, and persevered in the face of losing a loved one. In this heartwarming interview, she shares her very personal reasons for choosing this topic as the subject of her second book.
Much of what we’ve learned over the past year can help us address the new quality reporting requirements that become effective in CY2014. In this article, the NCHPP QAPI Steering Committee shares direct feedback from their experiences to help inform our future work.
continued from previous page
2 NHPCO NewsLine
continued on page 4
Building on What We’ve Already Done
For Hospice of Hope, providing community benefit programs and services — beyond traditional hospice care — was not a new concept.
The organization is located in the primarily rural area of Maysville, Kentucky, and serves six counties in northern Kentucky and six counties in southern Ohio.
For many years, we have instituted community health programs and services based on feedback from residents in our service area. For example, in the mid-1990s, during the surge in the managed care market, we developed an infusion therapy service for home health patients. Then, in response to phone calls inquiring about private sitters, we opened a private duty agency. Our longstanding ‘modus operandi’ has always been to behave in a way that intentionally benefits the entire community.
The initial vision to develop an assisted living community emerged from discussions during our annual leadership strategic planning retreat in 2008. At this
retreat, senior leaders were asked to research ideas that would:
• Create new, unique and innovative revenue-generating opportunities
• Identify ways to re-engineer our organization, and/or
• Build upon the strengths within our organization.
One of the ideas was to build an assisted living facility for our community’s elderly residents — which appeared to be one need that community leaders had not yet been able to resolve. While several proprietary companies had investigated the possibility,
none had been able to secure the capital funding for construction.
At the same time, Hospice of Hope staff was interested in building a freestanding hospice inpatient facility but, based on our market research, we believed we could only sustain an eight-bed unit. As the solution, we decided to explore the feasibility of combining both ideas and building one large-scale campus that included both an assisted living community (Kenton Pointe) and an eight-bed inpatient facility (the Care Center at Kenton Pointe).
AA Highway
Assisted Living(Kenton Pointe)
Rainbow Meadows
Townhomes
9
Kenton StationGolf Course
N
S
EW
Inpatient Care(Care Center)
NHPCO NewsLine 3
I hope you have carefully read the NHPCO Regulatory Alert of August 6. While 14 pages long, it is actually a very concise summary of the final
49-page FY2014 Hospice Wage Index that CMS released on August 2.
I have to say, this is the first time I have ever seen so many other things addressed in the Wage Index — from coding changes to new quality reporting requirements. As you review the Alert, know that NHPCO invested much time in gathering feedback from the field when the proposed Wage Index was released, and submitted a 36-page comment letter with our collective feedback. Know too that, despite our best efforts, CMS did not incorporate many of our suggestions, with the exception of granting a one-year delay concerning discontinuation of the debility and adult failure-to-thrive diagnosis codes.
I think this is a reflection of the new normal. I also think it is especially critical that we cooperate fully — by providing the most accurate, high-quality information possible in our hospice claims and cost reports as well as in our patient-care documentation. It is quite apparent that CMS is relying on this data to make decisions about the future direction of hospice care, so providing accurate, high-quality information will reflect well on all of us — and help ensure that patients and families continue to receive the care they need.
We are already doing an excellent job of communicating our commitment to quality on Capitol Hill. The 2013 Advocacy Intensive, which was held on July 29 and 30, is evidence of this. I’m happy to report that 231 staff from 120-plus hospices attended, representing 41 states. But, most importantly, all members of the interdisciplinary team were represented and they were able to share stories from the bedside that resonate most with members of Congress. (See the HAN website for a slideshow of photos from this event, and page 27 for a list of the participants.)
On behalf of NHPCO, let me extend special thanks to the Intensive’s sponsor, Outcome Resources, and to the Intensive participants who worked very hard to represent the best of hospice in more than 350 Congressional meetings. And, despite the challenges that lie before us, let me also urge each of you to represent the very best of hospice in all you do. Because we each carry the hospice flag.
J. Donald Schumacher, PsyD President/CEO
We Each Carry the Hospice Flag
continued from page 2
Kenton Pointe Assisted Living Community in planning stage
4 NHPCO NewsLine
Determining If the Idea Had Legs
Broadly speaking, a Community Needs Assessment is a systematic process to identify and analyze a community’s health needs and assets, thereby determining any specific unmet needs. The ultimate findings are prepared as a written document that includes a description of the community being served; the process used to conduct the assessment (e.g., who was solicited for input and how the input was solicited); and the health needs identified through the process.
To help determine if our initial vision “had legs,” we conducted a formal Assessment in early 2009 which included answering the questions shown at right.
Let me summarize here some of the key components of the Assessment process that we followed.
Collecting Information to Define the Purpose and Scope
A Community Needs Assessment should document the health status, behaviors and needs of its community members through the collection and analysis of pertinent data.
Hospice of Hope has always been actively engaged in various community coalitions, and having these established relationships opened the door to a wealth of existing data. (It can clearly be extremely valuable to know who else in your
Questions to Ask as Part of the Assessment
1. What does the healthcare system in our community look like?
2. What are the strengths and risks assessment of our healthcare systems?
3. What is occurring or might occur that positively affects the health of our community?
4. What is occurring or might occur that negatively affects the health of our community?
5. Describe the characteristics of the healthcare workforce in our community.
6. Evaluate the effectiveness, accessibility, and quality of healthcare services in our community.
7. What other home and community-based services are provided in our community?
8. What other long-term care and health services are currently available in the community?
9. Who operates them? Are they available to everyone? What is missing that might be important
for keeping seniors close to home?
10. What other senior services are currently available, and how strong are the organizations that
provide them? (Is there a senior center, senior transportation, senior meal site, adult day services?
Who provides these services? Are these providers supportive of the proposed project?)
11. How many people really need assisted living, and would they be willing to move into an
assisted living home?
12. What agencies have been involved in this effort, and what level of coordination exists? (Identify
agencies and individuals that could lend support, and work to bring them into the project.)
13. Are community leaders committed and ready to take action? (Identify key community leaders
whose support you still need. Document the commitment you already have.)
14. Can you demonstrate that this project has support at the regional level?
15. Is there a good site available within the community, and can it be secured?
NHPCO NewsLine 5
The Assessment
should include direct
input from members
of the community
community is collecting data — and reach out to them.)
The Assessment should also include qualitative data — namely direct input from members of the community — that is collected through interviews, community meetings, focus groups, and other means. There should be a discussion of the availability of other home and community based services, as well as other residential long-term care resources and the impact of the proposed project on them. The Assessment should also evaluate the amount of community support for the project, and overall community readiness.
One of the Assessment’s main purposes is to determine the number of individuals who would likely be appropriate for the proposed service as well as who among them have indicated a willingness to utilize the services if available. Talking with community leaders, family members, current service providers, and community residents can accomplish this.
It’s also worth noting that the Assessment process can be used to identify the capacity gaps in an existing infrastructure too. It can provide a means for improved
communication and coordination among all interested agencies and individuals — prompting community members and a variety of stakeholders to become more involved in the decision-making process. This, in turn, can help you build community support and commitment for the project.
Based on our initial research, we were able to define the following desired scope for our project:
• As a recognized unmet need in our community, Hospice of Hope will create a “Senior Living” environment that residents will want to consider and choose when making lifestyle decisions.
• Design, location, amenities and grounds will create a desired homelike environment in a safe supervised atmosphere.
• Hospice of Hope will garner support from local, state and federal government agencies.
Using the information and data we had collected, we began researching past proposed assisted living projects, continued to refine our needs assessment data, and began pursuing initial funding options.
continued on next page
Kenton Pointe Assisted Living Community
at completion
6 NHPCO NewsLine
By the fall of 2009, our board of directors formed a committee to explore options and the feasibility of the project, which included hiring a consultant to conduct a specific market analysis. Over the next several months, we evaluated potential land sites and developed a business plan.
Documenting and Communicating the Results
Developing and sustaining community interest and support was critical to our success. The importance of this step cannot be overemphasized. You do not want to put your effort into something that will ultimately fail due to a lack of community support, which is the fate of many well-intentioned projects. Even if you have a good idea, community and regional support ‘doesn’t just happen.’ You have to systematically educate and inform people, and if they think the project is a good idea, you have to nurture and sustain that support. When you get to the point of seeking funding, your proposals will not be rated highly unless you can clearly demonstrate the proposed
project is a high priority for the community and region. At Hospice of Hope, we maintained contact with our state and federal elected officials and their legislative aides, so they could identify potential funding opportunities available for their district.
External Stakeholders: A Valuable Resource
External stakeholders can be a valuable resource to your organization, depending on the project.
For our project, Hospice of Hope conducted routine meetings with the city manager, city engineer, district economic development director, industrial authority director, and the local USDA-Rural Development area specialist. Through these relationships, we were able to secure:
• In-kind infrastructure of new road, water and sewage extensions for the property
• A substantial Community Development Block Grant from the state of Kentucky;
• A federal low-interest loan from the USDA; and
• In-kind acreage on our land site.
We were also able to effectively secure additional financial resources through various corporate foundations and a building campaign.
The price of this project (for both the assisted living and hospice inpatient facilities) exceeded $9 million — all of which was raised through the above-mentioned funding sources. (I’m especially proud that our board of trustees and Strategic Planning Committee each had 100 percent participation in the building campaign.)
Relationship building is obviously a key component of a successful project. A broad-based coalition of support will assure funders that the project is a community priority. At Hospice of Hope, we were extremely fortunate that there were no existing assisted living facilities in our Kentucky market and only one competitor in our southern Ohio market.
continued from previous page
Look to the
specific end users
for additional
guidance
NHPCO NewsLine 7
Planning for Action
As I mentioned earlier, engaging directly with members of the community for their input can be invaluable. It’s also important to look to the specific end users for additional guidance.
Hospice of Hope conducted various focus groups with senior civic organizations to solicit input about amenities that would be most desirable at Kenton Pointe. We also chose to dream and plan on a broader scale, so our master plan for a comprehensive senior living community included independent patio homes, a senior center, and a medical model, with adult day care and dementia care units.
When evaluating the project for future use, we also considered what components and needs should be incorporated into the site design.
In some communities, combining more than one function inside a building makes economic sense, so assisted living may be part of a multi-use facility. For example, some communities have proposed combining assisted living with adult day services, senior meal service, hospice, housing for healthcare workers, administrative office space, frontier extended stay clinics, and other compatible uses.
For our project, we utilized the multi-function approach with
continued on next page
A Free Tool to Help You Assess Your Community’s Needs
NHPCO developed a community assessment tool in 2011 to help hospice providers identify unmet needs in their community as well as their ability to fill them, either alone or in collaboration with others.
Designed as an Excel Workbook, the community assessment guides you through an eight-step process. Preview or download this free member resource now. (It’s also posted on the NHPCO website at www.nhpco.org/access.)
8 NHPCO NewsLine
ancillary support services. The kitchen, laundry and maintenance functions are housed in the Kenton Pointe assisted living facility, while our eight-bed hospice inpatient facility, the Care Center at Kenton Pointe, contracts with it for services. Using this model eliminated the need for a larger hospice-care-center footprint.
Making Our Community a Better Place to Live
As you well know, statistically, baby boomers are the largest generation in American history, accounting for about 77.6 million Americans. As this generation enters retirement, we need to
help improve access and offer services to better accommodate the changing needs. In our community, building Kenton Pointe was one way to do that.
In addition to its value for elderly residents, the facility is bringing much-needed employment and revenue to our service area. Our Community Development Block Grant funding stipulated that we would generate 40 low-to-moderate income positions within five years of the initial funding. We were able to accomplish this within one year, with the added benefit of having the payback clause of the funds forgiven.
We continue to keep our eyes on the changing world — and on our changing environment. We hold to the ideal of creating places and services where people feel safe and ultimately choose to be in. We expect to continue to grow and expand to meet the ever-changing needs of our community, as we’ve strived to do over our 25-year history.
Kavin Cartmell is the executive director of Hospice of Hope, based in Maysville, Kentucky, a position she has held since 1997. She is also an active member of NHPCO, and currently serves on the NHPCO board of directors and as chair of the NHPCO Regulatory Committee.
continued from previous page
Pull quote here?
NHPCO NewsLine 9
MSW FOR HOSPICEPART TIME AT
KALISPELL REGIONAL HEALTHCARE
Meets Hospice Conditions of Participation providing quality psychosocial services to patients and families. Participates and coordinates care with the interdisciplinary team. Serves as an ambassador to all Home Options departments. Qualifications:1. MSW Degree2. Minimum 1 year social work experience in a healthcare setting3. Current CPR4. Excellent communication and time management skills5. Ability to work effectively with all types of patients6. Ability to work with little supervision7. Reliable Vehicle, current drivers license and minimum of liability auto insurance8. Must have capability to connect to internet or phone lines for data exchange
Job Duties:Performs comprehensive psychological assessments that reflect the patient’s, mental, emotional, social financial, bereavement and environmental status. Develops and maintains an individualized plan of care based on patient and family needs. Communicates and coordinates with IDT and all others involved in the patient’s care. Evaluates the effectiveness of the plan of care by measurement of patient progress towards goals. Provides bereavement counseling and follow-up for the families and caregivers of hospice patient. Develops and implements a plan for delivering bereavement follow-up to hospice families for one (1) year following the death of the patient. Performs a comprehensive assessment of bereavement needs. Develops a plan of care, updating as needed. Makes referrals to outside resources as appropriate. May provide bereavement services to members of the community.
COME JOIN A FABULOUS TEAM!!!!!!!
HOME OPTIONSKALISPELL REGIONAL HEALTHCARE
310 SUNNYVIEW LANE | KALISPELL, MT 59901 | EOE
APPLY ON LINE AT www.kalispellregional.org
The Tribute ProjectHonor. Remember. Invest.
Honor your organization, the founder, retiring CEO, board member, volunteer or another member of the caregiving team. Remember the legacy of a family member, colleague or friend. Invest in the hospice and palliative care community.
To learn more, call 877-470-6472 / 703-516-4928
or visit www.nationalhospicefoundation.org
R E L A U N C H : M y . N H P C O . o r g
care | share | connect
Visit the new and improved My.NHPCO. Upload a photo, update your pro�le and connect with members of the hospice and palliative care community. You can also add your Linkedin, Facebook, Twitter or other social networking details to your pro�le.
Talk to you soon on the new My.NHPCO!
Advertisem
entA
dver
tisem
ent
By Patrick T. Smith; Elizabeth Collins; Tim Cox; Deborah Jacques; Bonnie Meyer; and Kate Pepin
If a patient decides to forgo eating and drinking in order to hasten his or her own death, how should a hospice respond?
From a legal standpoint, “voluntarily stopping eating and drinking” (VSED) is an option for individuals in all 50 states and distinct from the natural reduction in nutritional intake that accompanies the dying process.
It is a voluntary decision by patients with decision-making capacity, with the explicit intention of hastening death.1
While legal, the peer-reviewed literature does not reflect strong ethical consensus about whether, how, and for what reasons
hospices should or should not participate in patients’ care decisions about VSED.
The NHPCO Ethics Advisory Council offers the following case study and questions in the spirit of fostering robust
discussion on this difficult ethical issue. The Council also encourages each hospice to explore these questions
in their organizational ethics committees, with the ultimate goal of establishing a policy or guidelines
to address VSED so staff is prepared when such situations arise. Some resources that
may help inform these internal discussions are provided at the end of this article.
VSED and Hospice Care:A Case Study
10 NHPCO NewsLine
The Case of Dr. S
Dr. S was a 58 year-old well-respected gynecologist who was admitted to hospice home care on November 1. He had been diagnosed with amyotrophic lateral sclerosis (ALS) three years prior. Progressive weakness in his arms forced him to retire from his work just one year after diagnosis. As he lost total functional use of his arms and shoulders, Dr. S became dependent for all care. He remained able to stand and walk 10 to 15 feet with one assist. At the time of admission, his respiratory status and swallowing were not impaired. His appetite was good and the only medication he required was baclofen for muscle spasms.
Dr. S lived with his second wife and had two adult children from his first wife, both of whom were involved in his life. His first wife died from ALS 15 years earlier. Within days of admission, the patient requested transfer to the hospice house. During his first month there, he went home via ambulance once or twice weekly for evening meals with his family. By December, his lower extremities were weaker and he required a two-person assist for transfers.
In January of the next year, Dr. S began telling the hospice staff that he was planning to go on a “fast” sometime in the near future. He stated that his plan was to
refuse all nutrition and hydration and to discontinue most of his medications, with the purpose of “hastening his death.” At a meeting with the hospice staff and his family, he confirmed that the head of an ALS support group counseled him that through these efforts he should pass away peacefully “within 10 to 14 days.” Dr. S’s wife and children were quietly supportive of his plan. However, Dr. S was not ready to start the fast until after he received an award from a local group honoring his contributions to the community. The ceremony was planned for later that month.
An impromptu meeting of the hospice ethics committee convened the following week. In the meeting, clinical staff and committee members wrestled with conflicting thoughts and powerful feelings regarding Dr. S’s proposed plan of care. Some strongly believed that a core element of the philosophy of hospice care was to allow patients to die “on their own terms,” and that Dr. S’s wishes should be honored and supported by the team. Others strongly believed that hastening death — by whatever means — was directly contrary to the hospice philosophy of care, and that the team should explain to Dr. S that it could not support his proposed plan to begin VSED. Interestingly, many present
VSED and Hospice Care:A Case Study
From a legal
standpoint, VSED
is an option for
individuals in all
50 states…
NHPCO NewsLine 11
continued on next page
at the meeting explained that they held both beliefs simultaneously, and openly wrestled with distress in trying to resolve the perceived tension between the two.
Following the ethics committee meeting, it was explained to Dr. S that the hospice would not be able to hasten his death and would not participate by withholding nutrition, hydration or medications. The staff would continue to offer meals three times a day, as well as prescribed medications as ordered. Dr. S would make the choice to either accept or refuse nutrition, hydration, and medications, and this would be documented at every shift. The staff would treat him with respect and provide the same level of comfort care afforded all patients at the hospice house. Dr. S and his wife understood and agreed to the plan, if and when he chose to fast.
Dr. S attended the award ceremony, and soon after began telling the staff that he planned to start the fast on either February 15 or 22. On February 11, Dr. S’s son approached his hospice nurse and expressed concern, referring to the plan as “assisted suicide.” The son was counseled that voluntarily
stopping eating and drinking was not assisted suicide and it was his father’s choice and right. However, the son’s statement clearly added to the staff’s struggle with accepting Dr. S’s plan.
Dr. S began his fast on February 19. After three days, Dr. S decided to modify his plan, hydrating with sips of water. His baclofen was offered in transdermal form, but he refused and took only ibuprofen. Dr. S remained quite comfortable and continued to enjoy going out to the sunroom and gardens. He refused most medications, including lorazepam, because, in his words, it made him “too sleepy to enjoy the gardens.”
In numerous conversations with the medical team at the hospice house, Dr. S talked about his reasons for fasting, which he summed up as “can’t garden, can’t work, no reason to live.” He did not seem to realize the impact of these statements, which were often spoken in the presence of his adult children. As time went on, he became frustrated and angry. The nursing staff became even more uncomfortable when he frequently said to them, “I’ll give you $100 for a Coke,” to which they always replied, “I can
get you a Coke anytime, if that’s what you want.”
On March 6, 18 days into his fast, Dr. S was on the verge of tears, “I am going nowhere,” he cried out. “This is taking too long!” The ALS support group counselor continued to visit Dr. S, but less frequently at this point. Dr. S continued to refuse most medications offered for comfort.
One week later, Dr. S’s primary physician reiterated her continued support for the hospice staff and urged the staff to continue to offer medication in appropriate amounts for appropriate reasons. She stated that the patient’s choice to hasten his death put everyone, including herself, “in a precarious position.”
Over the next five weeks, Dr. S had a steady, very slow decline. He remained alert and oriented with only intermittent signs of confusion. Consistent with his wishes, hospice staff continued to get him dressed and, with the aid of a Hoyer lift, into his wheelchair until three days before he transitioned into an active phase of dying. He died comfortably with his family at his side, on April 14 — approximately eight weeks after he began his fast.
12 NHPCO NewsLine
continued from previous page
Discussion Questions
1. Given the hospice philosophy of supporting the goals of the patient, what ethical issues do you think emerge in the case of Dr. S?
2. When he began his fast, Dr. S’s death was not imminent; his functional decline was accelerating, but he had a prognosis of several months until death. Is a patient’s projected time until death ethically relevant when considering if and how hospice teams should support a choice to begin VSED? Why or why not?
3. The hospice staff in this case honored the wishes of Dr. S by not placing trays of food in front of him. However, the staff did ask him three times a day if he wanted food just in case he changed his mind. Does this response by the care team cross the line in not respecting Dr. S’s wishes? Why or why not?
Six members of the NHPCO Ethics Advisory Council contributed to this article: Patrick T. Smith (co-chair); Elizabeth Collins (co-chair); Tim Cox; Deborah Jacques; Bonnie Meyer; and Kate Pepin. To learn about the Council and its work, visit the NHPCO website.
References:1 Quill, T. E., Lo, B., & Brock, D. W. (1997). A
comparison of voluntarily stopping eating and drinking, terminal sedation, physician-assisted suicide, and voluntary active euthanasia. JAMA, 278(23), 2099-2104.
Resources to Inform Further Discussion:
Bernat, J. L., Gert, B., & Mogielnicki, R. P. (1993). Patient refusal of hydration and nutrition: An alternative to physician-assisted suicide or voluntary active euthanasia. Archives of Internal Medicine, 153(24), 2723-2731.
Ganzini, L., Goy, E. R., Miller, L. L. et al. (2003). Nurses’ experiences with hospice patients who refuse food and fluid to hasten death. New England Journal of Medicine, 349(4), 359-65.
Jansen, L. A. (2004). No safe harbor: The principle of complicity and the practice of voluntary stopping of eating and drinking. Journal of Medicine and Philosophy, 29(1), 61-74.
Miller, F. G. & Meier, D. E. (1998). Voluntary death: A comparison of terminal dehydration and physician-assisted suicide. Annals of Internal Medicine, 128(7), 559-562.
Quill, T. E., Lo, B., & Brock, D. W. (1997). A comparison of voluntarily stopping eating and drinking, terminal sedation, physician-assisted suicide, and voluntary active euthanasia. JAMA, 278(23), 2099-2104.
Schwarz, J. (2007). Exploring the option of voluntarily stopping eating and drinking within the context of a suffering patient’s request for a hastened death. Journal of Palliative Medicine, 10(6), 1288-1297.
The son was
counseled that
VSED was his
father’s choice
and right
NHPCO NewsLine 13
O n September 3, a new book was released by the
award-winning photographer and author, Judith Fox, on a topic that NHPCO members help families deal with every day: the loss of a loved one.
In One Foot Forward, Fox shares the poignant stories and portraits of 20 widowed women and men who have grieved, accepted, and persevered in the face of losing their spouses to sudden death and chronic illness.
As educator, author and psychotherapist, Marcia Lattanzi Licht, so aptly put it, “These
stories speak the language of loss — telling quiet secrets, those not often spoken.”
The topic of this new book is also one that is very close to Fox’s heart. She lost her first husband, Jerry, to an aggressive cancer in 1992, and for the past 15 years has supported her second husband, Dr. Ed Ackell, who was diagnosed with Alzheimer’s disease just three years after they married.
In 1998, after a successful career as a business leader and entrepreneur in both New York
and Virginia, Fox returned to an earlier career in photography. Her photographs are in private and corporate collections as well as five museum collections: the Los Angeles County Museum of Art; the Museum of Photographic Arts; the Virginia Museum of Fine Art; the Southeast Museum of Photography; and the Harry Ransom Center in Austin.
In this interview, she explains why she chose to make this topic the subject of her second book — and the reason she chose to donate 100 percent of her royalties to NHPCO affiliate, the National Hospice Foundation.
with Judith Fox
on One Foot Forward
Q&A
14 NHPCO NewsLine
Did the death of your first husband prompt you to write on this topic?
Most certainly. I was widowed at 50 and knew no one else who was widowed. Suddenly I found myself in the middle of a world I was totally unprepared for and knew nothing about. Even though I had a career, supportive family, and caring friends, I think my grief and mourning would have been a little easier if I knew how other widows and widowers survived and what their experiences were like.
So I wrote One Foot Forward because I wanted to share the knowledge and understanding that I didn’t have when Jerry died. I wrote the book that would have helped me then — and that I hope will help other people now.
Has writing this book helped in your own grief and ability to cope with your second husband’s illness?
With Ed’s diagnosis of Alzheimer’s disease more than 15 years ago, I really have been experiencing anticipatory grief for many years now. Because I was widowed before, it’s difficult not to think about the pain that I know is ahead of me when Ed dies. Writing One Foot Forward was a way to find some personal comfort as Ed’s life is coming to an end.
The varied experiences that the people in my book talk about help me to better understand and frame what I’m going through because, even though each loss is specific, it’s also universal. But One Foot Forward would not have been written without my first book. I Still Do: Loving and Living with Alzheimer’s explores both my husband’s and my experiences with the disease and caregiving, but also reflects on matters such as love, commitment, mortality, hope, and survival. The responses to that book were so touching and rewarding that I wanted to engage in another conversation that was important to me and that I believe is significant to others.
How do you feel that the photographs themselves add to these stories of loss?
I believe in the power of words and photographs and feel fortunate that I can use both to help me tell the stories that I’m passionate about. Text and images speak to different parts of our brains and enrich the narrative in different — but complementary — ways.
The photographs in the book are candid close-ups that were taken during informal, but very open and revealing conversations that I had with the widows and widowers I profiled. The interviews were recorded and
Learn More
To learn more about Judith, her new book, One Foot Forward, and her other works, visit www.judithfox.com.
Members interested in supporting the National Hospice Foundation through the purchases of this new book, can also do so online — see One Foot Forward on Amazon.com.
One Foot
ForwardStories and Faces of
Widows and Widowers
Judith Fox
Foreword by Joanne Lynn, MDEssay by Michele Reiss, PhD
NHPCO NewsLine 15
continued on next page
my 35 mm camera was hand-held, but very soon into the conversation I think they forgot about the recording and the camera. What emerged were unique experiences that were also universal.
I hope that the photographs capture the complexity of each individual’s loss and humanity — their pain, strength, vulnerability, and dignity. I believe that photographs teach us—and reach us—at a visceral and emotional level and leave us feeling better understood.
What do you hope that readers will gain from this book?
Death is an inevitable — and very difficult — part of life. But if we are fortunate enough to love and to have a significant relationship, one of the individuals in the relationship is eventually going to be widowed.
So we might as well learn to talk about death and grief, and understand what it’s like to live through. Nothing is going to make the pain of that loss easy. But we can survive — and we do move forward because that’s also part of life. Human beings are resilient.
I think most of us manage to move through our losses and many of us thrive and create new and interesting futures, though they’re different from what they might have been. I hope that the people who read One Foot Forward will understand that they are not alone. They will survive and they can — and will — move forward. As those in hospice know so well, there are many ways to grieve and there is no single formula or time table that works for everyone.
What led to your decision to donate your royalties from the book to the National Hospice Foundation?
My books were created out of a desire to encourage conversations that I believe are important — and I hope are helpful. I’m contributing 100 percent of my royalties to NHF because I believe in the hospice and palliative care mission and from the time I learned that One Foot Forward was going to be published, I knew I wanted to give all my royalties to further those efforts. After doing research, I felt that NHPCO was the organization I wanted to support. Both my parents benefited from hospice care and my husband is currently being helped — as am I — by compassionate people at The Elizabeth Hospice in San Diego.
16 NHPCO NewsLine
continued from previous page
LydiaLewis
“It’s because of my personal experiences that I’ve really come
to understand death as a continuum of life.”
MarilynColby
“The hospice facility
wasn’t a place of sadness;
it was magical.”
KenFousel
“I was a ‘macho,
I-can-do-it-by-myself-and-
I-don’t-need-any-help’
kind of guy until I became
my wife’s caregiver.”
NHPCO NewsLine 17
When life gets serious you’ll want our serious experience on your side.
It can easily happen.
Your employees and volunteers have more on their minds than their driving. It may be a patient in distress, a grieving family or just the nagging pressure of falling behind abusy schedule. Auto accidents are a major cause of lawsuits against hospices and homehealth care agencies as well as a cause of serious injuries and lost time.
Lawsuits are expensive to defend, and some result in very high-dollar losses. That’s whyliability insurance coverage is so important. Glatfelter Healthcare Practice is administeredby Glatfelter Insurance Group, a national agency. We work closely with your insuranceagent to provide competitive proposals and friendly service for special businesses like yours.
Remember, before you can take care of others, you have to take care of yourself.
Insurance for Hospices and Home Health Care Agencies� Professional Liability� General Liability� Directors & Officers Liability� Property Insurance� Non-owned Auto Liability
800-233-1957 www.GlatfelterHealthcarePractice.com
Administered by Glatfelter Underwriting Services, Inc.a/k/a Glatfelter Insurance Services in CA, MN, NV, TX, and UT and Glatfelter Brokerage Services in NY
Advertisem
ent
HEALTHCARE CONSULTANTS
Advertisem
ent
Award Winners:
The Denver Hospice Denver, CO
Calvary Hospital Hertzberg Palliative Care InstituteMount Sinai Medical Center, New York, NY
UnityPoint HealthIowa and Illinois
Since 2000, the American Hospital Association (AHA) has presented the prestigious Circle of Life Award™ to honor innovation in palliative and end-of-life care.
This year, the AHA recognized eight organizations — with three receiving awards and four receiving citations of honor. While the honorees represent different sectors of healthcare — hospices, academic medical centers, and regional and national healthcare systems — they each have demonstrated exemplary skill in actively creating and championing palliative care throughout the care continuum.
Seven of the eight organizations honored this year are NHPCO members! To learn about their innovative work, see the 2013 Circle of Award booklet or visit AHA/Circle of Life Award Winners.
Citation Winners:
Gundersen Health System La Crosse, WI
Hospice and Palliative Care Program, Department of Veterans Affairs Washington, DC
Hospice of Dayton Dayton, OH
Nathan Adelson Hospice Las Vegas, NV
North Shore University Hospital Palliative Care Program Manhasset, NY
Circle of Life Award: 2013 Honorees
18 NHPCO NewsLine
NHPCO and affiliate, the National Hospice Foundation, are proud sponsors of this award.
Front row (l to r): James H. Hinton, AHA chair-elect; Bob Trine, Gundersen Health System; Martha Twaddle, Circle of Life Award Committee chair; Scott T. Shreve, Department of Veterans Affairs; John Mastrojohn, NHPCO. Back row (l to r): Dana Lustbader, North Shore-LIJ Health System; Kent Anderson, Hospice of Dayton; Bev Sloan, The Denver Hospice; Sally Welsh, the Alliance for Excellence in Hospice and Palliative Nursing and the HPNA; Angela Hult, Cambia Health Foundation; Holly Yang, Scripps Mercy Hospital and AAHPM board member; R. Sean Morrison, Hertzberg Palliative Care Institute; Janlee Wong, NASW (CA Chapter); and Lori Bishop, UnityPoint Health (IA and IL). Not pictured: Diane Smith, Nathan Adelson Hospice.
NHPCO NewsLine 19
Hospice Quality
Reporting – A Look
Back at the First YearBy Susan Zimmerman,
with Sherry Agado, Ellen Martin, Laurie
West, and Lynn Wilson
W hile data collection for the Comfortable Dying Measure (aka
NQF #0209) and the structural measure will be discontinued in CY2014 (see note below), members of the NCHPP QAPI Section felt it would still be very instructive to review some of the challenges and successes that hospices have experienced over the past year — for one important reason: The processes that must be established and followed for any measure — including those in the new Hospice Item Set — are essentially the same:
• Needed data elements must be identified and care processes reviewed to ensure the elements can be generated;
• Documentation processes must be reviewed to make sure the required data are being recorded; and
• A system must be put in place to retrieve the required data from the clinical record.
Of course, this is sometimes easier said then done. So in this article, we share feedback from QAPI professionals on implementation of the first-year requirements.
First, a Review of the Requirements
Medicare-certified hospices were required to begin collecting data by October 1, 2012 on the Comfortable Dying Measure (aka NQF #0209), and a Structural Measure.
From the NCHPP QAPI Section*
* The National Council of Hospice and Palliative Professionals (NCHPP) is comprised of 15 discipline-specific
sections that represent the staff and volunteers who work for NHPCO provider-members. To learn more about
this NCHPP Section, visit the NHPCO website.
New CY2014 Requirements
The FY2014 Hospice Wage Index Final Rule, which CMS released on August 2, 2013, included new requirements for quality reporting, beginning in CY2014.
The new requirements call for implementation of a “Hospice Item Set (HIS)” which is comprised of seven NQF-endorsed measures.
Please see the NHPCO Regulatory Alert (8/6/13) for additional information.
20 NHPCO NewsLine
continued on next page
The Comfortable Dying Measure is an outcome measure that reflects hospices’ performance related to initial pain management. Data generation for the measure is done through two questions asked of patients.
The first question (“Are you uncomfortable because of pain?”) must be asked at the initial pain assessment following hospice admission. If the patient answers ‘yes,’ then a second question must be asked within 48 hours of the initial assessment (“Was your pain brought to a comfortable level within 48 hours of the start of hospice care?”). Note too that patients must be at least 18 years of age and able to self-report (with no language barrier) in order to be eligible for this measure.
To meet the requirements of the Structural Measure, hospices had to make certain that their QAPI programs included at least three patient-care related performance measures. Examples of data sources for patient-care related measures include questions from the NHPCO Family Evaluation of Hospice Care (FEHC) survey; documentation of advance directives; and patient safety indicators such as medication errors and falls.
Data for quarter four of 2012 had to be reported to CMS by April 1, 2013, and data for CY2013 must be reported to CMS by April 1, 2014.
So What Did We Learn?
On Preparing for Implementation…
“Begin early. As soon as CMS released the requirements for the first year of reporting back in August of 2011, we began a process of over-communication to staff regarding the new expectations,” says Lynn Wilson, the quality improvement specialist at The Community Hospice in Rennselaer, New York. “We emphasized the reasoning behind the selection of the measure through a brief lesson for all employees on what NQF is, what it does, and how it endorses measures. Educating all employees and not just the interdisciplinary team helped us build an ‘all-in’ culture within the organization.”
Ellen Martin, director of quality at Hospice Austin in Austin, Texas, went one step further. “Because we thought initially that this measure might end up being publicly reported, we educated our leadership team and board members about the measure — both the specifications and how we planned to be compliant.”
Beginning early also allows time to make adjustments and improvements. At Suncoast Hospice, staff began collecting
We emphasized
the reasoning behind
the measure through
a brief lesson for
all employees
NHPCO NewsLine 21
data for the Comfortable Dying Measure one year in advance of the requirement. According to Laurie West, its director of quality and service excellence, “Once we began looking at the actual data, there were identifiable opportunities. For example, staff were not documenting on the correct form – something that we could correct before the requirement went into effect.”
Carefully reviewing the specifications of each measure (or, in the case of the Hospice Item Set, the specifications of each data element) is the first step in implementing any new data collection and reporting process. “The first thing we did was to study the measure specifications to understand the requirements,” says Ellen Martin. “Before any tools or processes can be developed, it is important to understand the restrictions and parameters of each data element and its prescribed responses as it relates to data collection.”
It’s also important to understand the significance and interrelatedness of each data element for measure calculation and, ultimately, for reporting. A
complete comprehension of the data elements and calculations means the development of accurate tools and processes from the get-go, and can prevent the headaches of training and retraining staff.
On Developing Data Collection Tools…
Once the measures and data elements are fully understood, the next step is to begin developing the tools and processes that will aid in the collection and reporting of data. Critical to this process is a close relationship with your information technology department and your electronic medical record (EMR) software vendor.
It is important to determine upfront if your EMR vendor will be incorporating the new data elements or if your software allows for in-house customization.
At Suncoast Hospice, staff had the ability to make the adjustments themselves. “Our first step was to adjust our EMR and then begin the training of all clinical staff on the process and documentation, says Laurie West.” We needed to ‘hard-wire’ practices to ensure the retrieval of the data elements required for quality reporting.”
continued from previous page
22 NHPCO NewsLine
Hospice of Austin followed a similar approach. “To document the initial question at admission, we added a field in the initial admission assessment and developed a form to document the patient’s response to the follow-up question,” says Ellen Martin. “We wanted all the documentation in the EMR so that we could retrieve the data for reporting later.”
Some hospices found that a hybrid system of data capture worked the best for them. Sherry Agado, CQI-RN at Infinity Hospice Care of Las Vegas, notes that her organization created an electronic referral form that provides the nursing team with immediate information about the newly admitted patients’ verbal responses to the Comfortable Dying Measure.
On Processes and Protocols…
In addition to data collection tools, processes and protocols needed to be developed. Laurie West of Suncoast Hospice found that linking the data collection process to principles of good patient care were the key to helping her staff adopt the new protocol.
“We knew there would be an adjustment period, but had no doubt our team would be successful by continually focusing on identified best practice principles to ensure their patients’ pain would be
brought to a comfortable level within 48 hours.”
Sherry Agado agrees: “The Comfortable Dying Measure is a top priority at Infinity Hospice Care not only because we have to submit these reports to CMS, but also because quickly managing pain for our patients eases their suffering and helps reduce the family’s emotional load and stress.”
The education and training that accompanies the implementation of new measures can take many forms. At The Community Hospice, a brief, focused training session was made available to all interdisciplinary members about how to document the new data elements using EMR. The organization also allowed staff a short period of amnesty at the beginning. “We piloted the data collection process for several weeks, with the promise that the data collected during that timeframe would not be used on any reports,” explains Lynn Wilson. The organization began formally tracking data after this trial period.
Infinity Hospice placed particular focus on the orientation of new staff. “The Comfortable Dying Measure is initially introduced during orientation training to all new staff,” says Sherry Agado.
We piloted the
data collection process
for several weeks…
continued on next page
NHPCO NewsLine 23
continued from previous page
continued on page 26
24 NHPCO NewsLine
“An understanding of how to document the patient’s answers appropriately on the initial nursing assessment and the follow-up reporting on the nurse visit record is a ‘must know’ nursing competency for all nurse new-hires.”
With all new protocols come challenges. Ellen Martin reflects on several of the issues that surfaced during the implementation phase at Hospice of Austin. “We found out early that follow-up on the weekend was a challenge. We have a busy on-call team and didn’t want to add additional duties to their workload, so we identified one person who would be responsible for making weekend follow-up calls or visits. We also learned that frequent data analysis was critical. For example, we noticed early on that we were missing initial assessment data on a few patients. Investigation revealed these patients were direct admits to the inpatient facility, so we realized we needed to add the initial admission assessment question to the inpatient forms.”
The team at Hospice of Austin also developed a method for making sure that patients who were admitted to home care, but were quickly moved to an
inpatient setting, did not get passed over. These were difficult situations because they happened so infrequently; however, over time, they were able analyze the causes of missing data and improve their process to account for all situations that resulted in missing data.
Ongoing Monitoring and Communication are Also Key
Throughout the first year of implementation, processes and protocols were continuously monitored to assure accuracy and completeness of the data. Ellen Martin and Sherry Agado each found that daily monitoring was the most effective way to stay on top of the process and identify opportunities for improvement.
“Our department utilizes a tracking tool daily that monitors each patient’s eligibility, assessment of pain on admission, and the timeframe that it took the nurse to manage the patient’s pain,” says Agado.
At Hospice Austin, Ellen Martin says that staff developed a report that is run each morning from the EMR that lists the patients who’ve answered yes to the first measure question and the date that their follow-up is due. This
NHPCO NewsLine 25
GSA AnnualScientific MeetingNOVEMBER 20–24, 2013Sheraton New Orleans • New Orleans Marriott
This Continuing Educational activity is jointly sponsored by The Annenberg Center for Health Sciences at Eisenhower and The Gerontological Society of America.
Optimal AgingThrough Research
GroundbreakinG research. international audience.
inspirinG atmosphere. a dedication to excellence.
register today at geron.org/2013
Pre-Conference Workshops Featuring:
Palliative and End-of-Life Care: An End-of-Life Nursing Education Consortium Geriatric Curriculum Workshop
Transformations in the Field of Palliative Care
View all pre-conference workshops at geron.org/2013
Earn Up to 29.5 Credits Continuing education credits will be available for physicians (AMA Category 1), nurses (ANCC-COA), licensed clinical social workers (NASW), and psychologists (APA).
Professional participants may be eligible to receive up to 29.5 credits depending on their profession and the sessions that they attend.
continued from page 24
26 NHPCO NewsLine
report is then emailed to all team leaders daily so they know who to contact for follow-up.
Ongoing communication is also vital. At Infinity Hospice Care, clinical managers work side-by-side with the continuous quality improvement department to make sure that each and every patient who is experiencing pain is attended to promptly and appropriately. As Laurie West so aptly puts it, “Communication continues to be a focus ─through the sharing of results each month and by remembering to celebrate accomplishments with the staff.”
In Summary
So what successful principles have we now learned that we can apply to implementation of the Hospice Item Set (HIS)?
• Begin now. Review the available information in order to gain a full understanding of HIS data requirements. [As an important first step, review the NHPCO Regulatory Alert that summarizes the CY2014 requirements. Note too that more detailed information will follow from CMS, including free software for the HIS, as well as issuing
guidance and training materials.)
• Think through the processes that are needed to generate, document, and retrieve the required data:
- Your Care Processes: Can the data be captured and generated through your current care processes? If not, what changes are needed to allow for their capture?
- Your Documentation Processes: Make sure the data elements can/will be recorded.
- Your Retrieval Processes: Make sure you have a system in place to retrieve the required data from the clinical record for submission to CMS.
• Don’t wait until the required start date of CY2014, but begin collecting and analyzing data as soon as possible. [Note, however, that hospices must continue to collect data on the Comfortable Dying and Structural Measures through December 31, 2013 — and must submit data on these measures no later than April 1, 2014.)
• Contact your EMR vendor to find out how it plans to support the current and new requirements.
• Develop a general process plan for implementation.
• Maintain open and continuous communication and education of staff.
• Monitor implementation continuously to avoid costly setbacks and inaccurate data.
Implementation of the HIS and the seven measures will of course pose significant challenges for all of us. Fortunately, we have learned much during this first year of quality reporting — knowledge that can help us address these new requirements all that more effectively.
Sue Zimmerman is a product manager for Deyta, LLC. She is also a member of the NHPCO Quality and Standards Committee and section leader for the NCHPP Quality Assessment and Performance Improvement Section
NHPCO NewsLine 27
The HAN Advocacy Intensive
Agrace*Akron Children’s Hospice Palliative
Care CenterAlive Hospice
Arkansas Hospice*AseraCare Hospice Barnabas Health*Bristol Hospice Capital Caring*
CareFirst*Caris Healthcare
Carolinas Center for Hospice & End of Life Care
Catholic HospiceCatskill Area Hospice
Center for Hospice Care*Centra Hospice
Central Hospice of the HillsCentral Wyoming Hospice &
Transitions*Cima Hospice
Circle of Life HospiceCoastal Hospice and Palliative CareCommunity Health and Counseling
ServicesCommunity Home Health &
HospiceCommunity Hospice
Community Hospice of Tuscarawas, Stark and Carroll Counties*
Community Hospices of DC and MD
Community Mercy HospiceCovenant Hospice*Delaware Hospice*Embrace HospiceEvercare Hospice
EvergreenHealth*Faith Hospice
Family LifeCare*Florida Hospice & Palliative Care
Association*Franciscan Hospice and Palliative
CareGaston Hospice-Robin
Johnson HouseGentiva*
Georgia Hospice and Palliative Care Organization*
Gilchrist Hospice Care*Good Shepherd Hospice
Haven HospiceHeartland Home Health Care and
Hospice*Heartland Hospice*
Home & Hospice Care of Rhode Island
Home Health and Hospice Care (NH)
Hope Hospice and Community Services (FL)*
Hope Hospice and Community Services (MA)
Horizon Hospice & Palliative CareHosparus
Hospice Advantage *Hospice and Community Care
Hospice and Palliative Care Federation of Massachusetts *Hospice and Palliative Care Inc
Hospice at Home *Hospice Austin *
Hospice Care Network Hospice Care of South Carolina *
Hospice Compassus *
Hospice for All Seasons Hospice Life Care
Hospice of Central Ohio *Hospice of Central Pennsylvania
Hospice of Dayton Hospice of Jefferson County Hospice of McDowell County
Hospice of Michigan *Hospice of Orange & Sullivan
Counties *Hospice of Rockingham County,
Inc. Hospice of Siouxland *
Hospice of Southwest Virginia Hospice of the Bluegrass *
Hospice of the Carolina Foothills Hospice of the Chesapeake *Hospice of the Panhandle *
Hospice of the Prairie Hospice of the Red River Valley *
Hospice of the Twin Cities Hospice of the Western Reserve
Hospice of Wake County *Hospice of Washington
Hospice of Washington County *Hospice of Western Kentucky *
Hospice Services, Inc. *Hospice Visions *
Jewish Social Services Association Joseph Richey Hospice
Lifepath Hospice *Mercy Hospice (KS) Mercy Hospice (SC) Meridian At Home
Midland Care Connection *Midwest Care Alliance *
Montgomery Hospice *Namaste Hospice
Nathan Adelson Hospice *National Hospice Work Group
New Jersey Hospice and Palliative Care Organization *NorthCare Hospice *
Our Hospice of South Central Indiana
Outcome Resources Overlook Hospice Services
Pennyroyal Hospice Prairie Haven Hospice *
Providence Hospice QPC Hospice LLC
Rainbow Hospice and Palliative Care *
Saint Agnes Hospice Samaritan Healthcare and Hospice
Seasons Hospice *Silverado Hospice Skirball Hospice *
Spartanburg Regional Hospice and Palliative Care
Suncoast Hospice Sutter Care At Home Hospice Texas & New Mexico Hospice
Organization *Treasure Coast Hospice TRU Community Care
Unity Point Health Visiting Nurse Service of New York *
VITAS *VNA Hospice Care (MA)
Wissahickon Hospice Washington State Hospice & Palliative Care Organization *
NHPCO and the Hospice Action Network would like to thank the following programs for sending attendees to the 2013 Advocacy Intensive on July 29th and 30th. We thank these programs and organizations for their ongoing commitment to preserving and protecting access to end-of-life care in the United States.
The Hospice Action Network’s mission is to advocate, with one voice, for policies that ensure the best care
for patients and families facing the end of life. We simply cannot do this without the support of the hospice
community, especially those hospices listed above. *Denotes a hospice program that has sent attendees in both 2012 and 2013.
HAN would also like to recognize Outcome Resources for their support
of the Advocacy Intensive
A 2013 Circle of Life Honoree
The Hospice and Palliative Care Program of the Department of Veterans Affairs has received a 2013 Circle of Life Citation of Honor in recognition of its many achievements — including the We Honor Veterans program. (See page 18 to learn more about the Award.)
New Report Documents Achievements of WHV Partners
Hospices nationwide have demonstrated amazing support of the We Honor Veterans (WHV) program since NHPCO launched it in September 2010, in partnership with the Department of Veterans Affairs.
Today, more than 1,900 hospices have enrolled as WHV partners. But perhaps more importantly, these hospices are using the WHV tools and resources to improve the care they provide to Veterans and their families — and give them the recognition they deserve for their service.
A beautiful new 20-page report, recently published by NHPCO, spotlights this inspiring work, along with the program’s growth over the past three years and its future plans.
To download a copy, visit the We Honor Veterans website.
Enroll Too — and Receive a Commemorative Poster!
Consider joining your colleagues by also enrolling in the WHV program. While there are four WHV Partner Levels — based on a hospice program’s demonstrated work in serving Veterans — the first step is to become a Recruit.
The WHV website provides full details, but there are really just two simple steps to become a Recruit:
1. Review the following two documents with your organization’s CEO and senior leadership: (1) WHV Campaign Facts, and (2) WHV Overview and Commitment form.
2. Complete the WHV Partner Commitment form and return it to NHPCO.
On approval of your completed commitment form, NHPCO will send you a confirmation email and your organization’s name will be listed in the online WHV Partner Directory. And, if you enroll by October 1, 2013, NHPCO will also send you a commemorative poster (shown on the opposite page).
Enroll today by visiting the We Honor Veterans website.
28 NHPCO NewsLine
Short Takes
NHPCO NewsLine 29
Enroll your hospice to be a WHV Partner by October 1 and receive a FREE WHV Poster (as shown)! Learn more and sign up at:
www.WeHonorVeterans.org/Enroll
Short Takes continued from previous page
Reminder: LIVE Without Pain at September’s CTC
With funding support from Purdue Pharma, LP, a preconference session on “Advanced Pain Management” will be presented on September 25 (from 1:30 to 4:30 p.m.) by Dr. Russell Portenoy of New York’s Beth Israel Medical Center. To learn more, visit 2013 Clinical Team Conference.
LIVE Without Pain: Free Resources for Pain Awareness Month
September is “Pain Awareness Month,” an excellent time to remind referral sources and consumers of your expertise in pain management.
To help raise awareness, use some of these free resources, developed as part of the LIVE Without Pain consumer campaign funded by Purdue Pharma, LP.
Display Ad — Ready to Personalize
A display ad to promote pain awareness is available in three sizes (full-page, half-page and poster-size), with space available for your organization logo and/or contact information. There are also two versions, one bearing the “Pain Awareness Month” banner (shown on the opposite page), and an evergreen version (without the banner). Visit www.nhpco.org/outreach.
Banners for Your Social Media
Facebook and Twitter banners have also been created for use in your social media. Visit www.nhpco.org/outreach.
Tip Sheets
You can also share the following four tip sheets with consumers to help them understand the many aspects of pain and support loved ones who may be in pain:
• Physical Pain at End of Life • Understanding Pain for Improved Quality of Life• Caring for Someone in Pain• Pain at the End of Life – Common Questions
You can make as many copies as you wish. Or you can purchase multiple copies through NHPCO’s Custom-Print Marketplace — with the option of adding your organization logo and a message.
• To download a copy of each tip sheet, visit LIVE Without Pain > Resources on the Caring Connections website.
• To order personalized copies, visit Custom-print Marketplace. (If you are a first-time user, you must register first and will then receive an immediate email confirmation with your access information.)
To learn more about LIVE Without Pain, visit www.caringinfo.org/pain.
Facebook Banner
30 NHPCO NewsLine
NHPCO NewsLine 31
Without Pain
P A I N A W A R E N E S S M O N T H • S E P T E M B E R 2 0 1 3
DON’T SUFFER
IN SILENCE.
When you are in pain, it’s hard to focus on anything
else. Physical pain can take away peace of mind,
comfort, enjoyment and most of all hope. Learning
what you can do to manage your pain can help you
focus on other parts of your life and enjoy your days.
Learn more about dealing with pain at caringinfo.org/pain
32 NHPCO NewsLine
Member News and Notes
HNSGB Hospice Aide Receives Gift of Compassion
The Third Annual Lane-Butler Gift of Compassion was awarded to Dale Lemure, an aide with Hospice of the North Shore & Greater Boston (HNSGB). Nominated by
her peers, Dale was cited for her great care and compassion with hospice patients and families.
The Lane-Butler Gift of Compassion is given annually to a HNSGB hospice aide, in honor of the late-hospice paitent, David Lane, and his
hospice aide, John Butler. The gift is made possible by the generosity of David Lane’s wife, Lynn Lane, and their family and friends.
ACS CAN Reports That Few States Meet Palliative Care Benchmark
According to a new report, just published by the American Cancer Society Cancer Action Network (ACS CAN), only four states have effective strategies in place to improve access to and knowledge of palliative care services. The ACS CAN awarded top scores to Connecticut, Maryland, Massachusetts, and Rhode Island, using a scoring system that combines grades from the Center to Advance Palliative Care’s national palliative care report card with actions on model legislation. The six states on the low end of the scoring range were Alabama, Alaska, Arkansas, Delaware, Mississippi, and Oklahoma. The full report can be accessed online.
Barbara Ivanko Named President/CEO of Family Hospice and Palliative Care
Barbara Ivanko joined Family Hospice and Palliative Care as president/CEO, effective August 1.
A social worker by background, Ivanko has been involved in the hospice industry since 2000. Most recently, she served as chief operating officer for
Spectrum Health, Inc., the parent organization of Hospice of Palm Beach County, where she had also worked as chief operating officer.
The Elizabeth Hospice Honored for Its Community Work
The Elizabeth Hospice, based in Escondido, CA, has received two awards that reflect its commitment to the community:
Its Center for Compassionate Care has been chosen as the 2013 “Community Organization of the Year” by the Escondido Chamber of Commerce for its grief support programs in North San Diego County. Last year, 522 youth from 18 different elementary, middle and high schools participated in the program, with eight of the grief support groups offered in the Escondido Unified School District.
The organization was also one of just two organizations that received the “Nonprofit of the Year” Award from the San Diego North Chamber of Commerce. It was recognized for improving the quality of life in greater San Diego County and partnering with the business community to achieve their missions.
Front/center: Dale Lemure; Back/left to right: Antonia Sierra; John
Butler; and Lynn Lane.
Have News to Share?
Add Us to Your Media
Distribution List:
NHPCO NewsLine 33
HFA ‘Living With Grief Program’ Focuses on Improving Care for Veterans
NHPCO recently hosted a screening of the Hospice Foundation of America program, “Living With Grief: Improving Care for Veterans,” that was attended by staff from the Department of Veterans Affairs and the HFA, as well as We Honor Veterans (WHV) partners from Maryland and Virginia.
HFA senior program officer, Lisa Veglahn, gave an introduction to the program which featured panelists familiar to many WHV partners and a video roll-in of NHPCO president/CEO, Don Schumacher. Gwynn Sullivan and Rebecca Trout of NHPCO’s WHV team also gave an update on WHV partner recruitment. (There are now more than 1,900 hospices which have enrolled in We Honor Veterans. See page 28 to learn more.)
From left to right: Rebecca Trout, NHPCO; Lisa Veglahn, HFA; and Chris Cody and Lauren Klepac, Department of Veterans Affairs.
Further Reading
A Hospice Provider’s Guide to Live Discharges, NewsLine (September 2012).
Hospice Discharge, Revocation, and Change of Hospice (November 2012). This is a pocket-size guide available through NHPCO Marketplace for $11.95.
1 CMS Medicare Benefit Policy Manual (Chapter 9): Coverage of Hospice Services Under Hospital Insurance: 20.2 - Election, Revocation, and Change of Hospice.
2 CMS Medicare Claims Processing Manual (Chapter 11): Processing Hospice Claims: 30.3-Data Required on the Institutional Claim to Medicare Contractor
34 NHPCO NewsLine
T he federal hospice regulations allow a patient to transfer from one
hospice provider to another (i.e., to “change the designated hospice”) once during each benefit period.
The decision to transfer to another hospice provider is the right of the patient or his/her representative under the Medicare Hospice Benefit. It is not considered a revocation of the election of hospice services and, thus, the patient remains in the same benefit period. Note too that hospice providers may not refuse to transfer a patient or have a “no transfer” policy in place in their organization.1
To transfer to another hospice provider, the patient or his/her representative must file a signed statement with the hospice from which the patient has received care as well as with the newly designated hospice.
The signed statement must include the name of the hospice from which the patient has received care; the name of the hospice from which the patient plans to receive
care; and the date the change will be effective.1 If there will be a significant break in service during the transfer, a discharge is recommended versus a transfer.
Suggestions for a Smooth Transfer
• Communicate with the receiving hospice as soon as possible to coordinate the transfer date and share necessary information about the patient.
• Share the following documents with the receiving hospice: signed transfer statement from the patient/representative; signed notice of hospice election statement from the patient/representative; current certification materials, including the face-to-face attestation for the current benefit period as applicable; and advance directive documents and/or the DNR.
• Code the transfer correctly: For transfers to another hospice provider, use discharge status code 50 or 51; the claim does not terminate the patient’s current hospice benefit period. The receiving hospice must also submit a transfer notice of election (type of bill 8xC) after the transfer has occurred, and the beneficiary’s hospice benefit is not affected.2
Change of Designated Hospice: Revisiting the Regs
Tip of the Month
National Hospice and Palliative Care Organization’s2013 Virtual Conference - November 4th-8th, 2013
Loss, Grief and BereavementHelping Patients, Families and Communities
Join NHPCO and hospice and palliative care professionals committed to holistic care of those at the end of life for a national virtual learning opportunity exclusively focused on the loss, grief and bereavement needs of patients, families and communities. The experiences and many ways loss permeates, impacts, infl uences and defi nes the end-of-life experience will comprise the innovative and cutting-edge content of this learning opportunity.
This online event will offer all the benefi ts of an in-person conference without the added time and expense of travel:
• Live-broadcast plenary sessions featuring national speakers• Concurrent sessions • Ignite sessions (Quick, succinct and “to the point” presentations) • Networking opportunities• Exhibit hall featuring national vendors
Mark the dates on your calendar and prepare to join colleagues from across the country in this unprecedented learning event!
SAVE THE DATE
Visit us at http://www.nhpco.org/education
Full Page In House Virtual Con Ad
to go hereNational Hospice and Palliative Care Organization’s2013 Virtual Conference - November 4th-8th, 2013
Loss, Grief and BereavementHelping Patients, Families and Communities
Join NHPCO and hospice and palliative care professionals committed to holistic care of those at the end of life for a national virtual learning opportunity exclusively focused on the loss, grief and bereavement needs of patients, families and communities. The experiences and many ways loss permeates, impacts, infl uences and defi nes the end-of-life experience will comprise the innovative and cutting-edge content of this learning opportunity.
This online event will offer all the benefi ts of an in-person conference without the added time and expense of travel:
• Live-broadcast plenary sessions featuring national speakers• Concurrent sessions • Ignite sessions (Quick, succinct and “to the point” presentations) • Networking opportunities• Exhibit hall featuring national vendors
Mark the dates on your calendar and prepare to join colleagues from across the country in this unprecedented learning event!
SAVE THE DATE
Visit us at http://www.nhpco.org/education
Videos Worth Watching
NewsLine is a publication of the National Hospice and Palliative Care Organization
Vice President, Communications . . . . . . . . . . . . . . . . . . . . .Jon Radulovic Editor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sue Canuteson Advertising Inquiries . . . . . . . . . . . . . . . . . . Grace Zupancic, 703/837-3134 Membership Inquiries . . . . . . . . . . . . . . . . . . . . . . . . . . . 800/646-6460
Copyright © 2012, NHPCO and its licensors. All rights reserved. NHPCO does not endorse the products and services advertised in this publication.
All past issues of NewsLine are posted online: www.nhpco.org/newsline.
1731 King Street, Suite 100Alexandria, VA 22314703/837-1500 www.nhpco.org • www.caringinfo.org
Affiliates:
Links to Some Resources on the NHPCO Website
Quality and Regulatory
Quality Reporting Requirements
QAPI Resources
Regulatory Center Home Page
Fraud and Abuse
Past Regulatory Alerts and
Roundups
Staffing Guidelines
Standards of Practice
State-specific Resources
Quality Partners
Self-Assessment System
Outreach
2013–14 Outreach Materials
LIVE Without Pain Resources
Resources to Reach
the Underserved
Professional Education
Education Home Page
2013 Monthly Webinars
End-of-Life Online
Pediatric Palliative Care
Publications
Past issues of weekly NewsBriefs
Past issues of monthly NewsLine
Past issues of ChiPPS Newsletter
NHPCO’s Hospice Action Network has been collecting stories — or video testimonials — of personal hospice experiences to help members of Congress understand the value of hospice care, but also posts them on the HAN website.
So this month, NewsLine spotlights not just one video, but many — from hospice advocates and staff who put a camera on themselves to share their hospice story. Visit the HAN website now to hear from Tasha in Illinois, Kim in Nebraska, and many others.
Consider sharing your own story too. HAN makes it very easy to do from your own backyard. To learn more, email the team at [email protected].