Hospice and long-term partnerships work well with attention to details
Hospice and long-term partnerships work well with attention to details
Identify responsibilities and concerns up front
(Editor's note: This month we begin a two-month look at partnerships between hospice agencies and long-term care providers. This issue contains stories related to key issues to address in developing and maintaining relationships between hospice agencies and long-term care facilities, including potential legal risks as well as tips to strengthen relationships. Next month, we look at a hospice agency that has developed an inpatient hospice unit within a long-term care facility.)
Research indicates that 22% of nursing home clients who die in a long-term care facility receive hospice services, but approximately one-third of those patients are enrolled in hospice one to two weeks before death, which greatly reduces the benefits that they and their families received.1
Collaboration between hospice agencies and long-term care facilities can mean significant new growth opportunities for the hospice agency, as well as impressive enhancement of services and resources for the long-term care facility's clients and their families. To take advantage of the opportunities offered by collaboration, you must plan and manage these business relationships carefully, sources say.
While there is no federal requirement that nursing homes or assisted living facilities allow hospice agencies access to patients, there may be some states that define "resident rights" as including access to hospice, says Meg S.L. Pekarske, JD, an attorney with Reinhart Boerner Van Deuren in Madison, WI. Even in those states, a relationship with a hospice agency is elective, so developing a good relationship is important to a long-lasting collaboration, she adds.
"We have had a nursing home service line for over four years and an assisted living facility service line for three years," says Margo Post, administrative director for long-term care services at Tidewell Hospice and Palliative Care in Sarasota, FL. The hospice contracts with three nursing homes in four counties in the area and several assisted-living facilities, she says. "Our contracts are reviewed and renewed every two years or whenever there is a change in ownership of the long-term care facility," she adds.
The contract is very important, Post says. "It describes each facility's responsibilities for the patient's care as well as the procedure for referral to hospice," she says. A physician order is needed for referral to hospice, and then the patient is evaluated by a hospice case manager to determine if the patient meets the criteria for hospice, she explains. The contract also should spell out who provides certain supplies, equipment, and services to the hospice patient, she adds.
The difference between offering hospice services to a nursing home patient and a patient in a private home is the presence of the nursing home staff, says Post. "In a patient's home, we are teaching family members how to provide some care to the patient, but in the nursing home, we contract with the nursing home to provide some services," she says. "We have occupational and physical therapists on staff that can work with patients, but we try to use the nursing home's therapists whenever possible."
Demonstrate your confidence in the nursing home staff's ability to provide care, Post says. "We're in the nursing home to enhance services, not to take over the care of their patients," she adds.
State surveys of nursing homes have serious implications, and hospice staff members can help nursing homes with surveys that include hospice patients, says Pekarske. Hospice staff members can ensure that the care plan and documentation of patient care show that some issues, such as weight loss, are expected for a hospice patient, she explains. "Patient weight loss is a common reason for a citation, but if the documentation supports the weight loss as a normal progression for this particular patient, the nursing home is not cited," Pekarske says.
Post says her staff are present at all surveys. "Documentation of a hospice patient is very detailed, and surveyors typically review 100% of the chart for our patients," she says. Hospice staff can answer questions and provide information to the surveyor that can help the nursing home's survey go more smoothly, Post adds.
Respect facility culture
Showing respect for the long-term care facility's staff and culture is an important part of a good relationship, says Kelly Fischer, RN, SHPN, director of long-term partners at Hospice Care in Madison, WI.
"Each facility has a different personality or culture," she says. "I am constantly asking the director of nursing for feedback on our services and our staff who come into their facilities."
When a staff member who has not previously worked at a particular nursing home starts seeing patients at that facility, Fischer makes a point of calling the director of nursing after a few days to make sure that there are no concerns. "Some nursing homes are very elegant and formal, while other may be homey and laid back, so we try to match our staff members' personalities and demeanors to the facility," she explains. "I call the director of nursing to show our commitment to providing staff that reflects the same attributes of her staff."
As part of her follow-up with some facilities a few years ago, Fischer learned that one concern was the attire of the certified nursing assistants (CNA). "We now provide polo-type shirts with our company logo to our CNAs to wear on their visits," she says. This change improved the professional appearance of the CNAs and made it much easier for nursing home personnel to recognize them as hospice employees, she says. Even though all hospice staff members wear name badges, the "uniform" look simplifies identification, she adds.
Communication is also an issue that contributes to the success of the collaboration, says Fischer. "Because the nursing home or assisted living staff is providing personal services as part of their care of the patient, we wanted to make sure that everyone knew who did what and when," she says. A communications binder that has a calendar and room for notes about the patient is left in each hospice patient's room or in a location that the director of nursing specifies.
"The hospice staff member checks in with the front desk so the nursing home knows that he or she is there, then the staff member writes his or her name and discipline in the calendar in the patient's room," she says. In addition to listing a name, the hospice staff member also will describe what services were provided, she says. "This is very important for the CNAs so that the hospice and nursing home staffs don't duplicate services," she explains. For example, if a hospice CNA changes the patient's bed linens on Monday, the nursing home CNA who comes into the patient's room later on Monday will know that the bed linens don't need changing, she explains. Nursing home employees also use the communications binder to let hospice employees know what they did so that everyone's time is better used, she adds.
Hospice participation in the care plan meetings is also important, says Post. "We use one care plan that incorporates long-term care and hospice services," she says. Having one plan to drive the care is helpful because long-term care and hospice services are provided parallel to each other, not in isolation, Post says.
It was not easy to introduce a single care plan, but staff education for both staffs on the services that are designed to help the patient and the family increases acceptance, Post says. "It is also important to understand the conditions of participation for both organizations and reflect those requirements in the plan, and to design the plan on evidence-based practices that provide a high standard of care," she says.
Reference
1. Dobbs DJ, Hanson L, Zimmerman S, et al. Hospice attitudes among assisted living and nursing home administrators, and the long-term care hospice attitudes scale. J Palliat Med 2006; 9:1,388-1,400. n
Need More Information?
For more information about collaborating with long-term care facilities, contact:
- Kelly Fischer, RN, CHPN, Director of Long Term Partners, Hospice Care, 5395 E. Cheryl Parkway, Madison, WI 53711. Telephone: (800) 553-4289 or (608) 276-4660. Fax: (608) 276-4672. E-mail: [email protected].
- Meg S.L. Pekarske, JD, Attorney, Reinhart Boerner Van Deuren, 22 E. Mifflin St., Suite 600, Madison, WI 53703. Telephone: (608) 229-2216. Fax: (608) 229-2100. E-mail: [email protected].
- Margo Post, Administrative Director for Long Term Care Services, Tidewell Hospice and Palliative Care, 5955 Rand Blvd., Sarasota, FL 34238. Telephone: (941) 923-5822. E-mail: [email protected].
For more resources on collaboration between hospice and long-term care, go to the National Hospice and Palliative Care Organization web site for a report on the Nursing Home/Hospice Partnership. The free report contains examples of different types of collaboration and components of successful relationships. Go to www.nhpco.org and select "professional resources" then choose "Access, outreach and marketing" then select "Long term care."
(Editor's note: This month we begin a two-month look at partnerships between hospice agencies and long-term care providers. This issue contains stories related to key issues to address in developing and maintaining relationships between hospice agencies and long-term care facilities, including potential legal risks as well as tips to strengthen relationships. Next month, we look at a hospice agency that has developed an inpatient hospice unit within a long-term care facility.)Subscribe Now for Access
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