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Rural hospice evaluates different options for future
PRN staff, increased fundraising to offset cuts
Finding a way to serve hospice patients who are spread over a 10,000 square mile area is challenging, especially when some staff members are driving as much as 60 miles one way to reach a patient's home.
Staff recruitment and retention, as well as increasing costs for driving those distances are a few of the reasons management at Prairie Haven Hospice in Scottsbluff, NE, are looking carefully at ideas and options to enhance their ability to serve patients in a cost-effective manner.
With small towns of 400 people or less located 50 miles or more apart, staff members are asked to drive great distances, admits Linda L. Rock, executive director of the hospice. "We can't hire staff members for every town but we are looking at a way to find nurses as needed in more towns," she says. She is looking at the possibility of hiring nurses who work at the four critical access hospitals in her service area to work on an as-needed basis in their hometowns. "They would be part-time employees of the hospice, but would only work when we have a patient in their area," she explains.
"Hiring people who live in or near some of the small towns will cut expenses such as mileage and reduce the driving distance for all employees," she says. Finding the right people will present its own challenges as will ensuring proper training and education, but in the long run, Rock sees this as a solution worth exploring.
The alternative to expanding staff with part-time nurses in different towns is to restrict the geographic area served by the hospice, says Rock. "This would be a very difficult decision to make and one that we would only make as a last resort," she admits. "There are no other providers in the area so people living in the areas we would not serve would have no access to hospice," she says.
The hospice is also looking for ways to increase income, says Rock. "We've done some fundraising in the past but we are going to look at increasing our efforts beyond our annual golf tournament and our memorial donations," she says. "Although memorial gifts are still given by patients' families and friends, the amounts given have decreased," she says. When planning fundraising events, Rock says she will be cognizant and respectful of other events planned by not-for-profit organizations in the community. "We have to realize that people in our community are being approached by many charities so we have to find a way to raise funds that doesn't negatively affect donors or other organizations," she adds.
The hospice's expertise in end-of-life care is another way the organization might add income, says Rock. "We have critical access hospitals in our area and one hospital administrator has commented that we could teach them how to provide better end-of-life care in the hospital," she says. Contracting with the hospital to provide staff education about end-of-life and palliative care would generate income and expand options for the community, she says. "One of the sad things we hear is that patients believe that they have to be a hospice patient to receive end-of-life care and if you don't have hospice, you get no care," she says. "Educating critical access hospital staffs would help us provide end-of-life care in other parts of the health care continuum."
Another last resort option that would be difficult to choose would be to combine services and staff with other hospices, says Rock. "We do have one hospice located 100 miles north of us and another 75 miles south," she says. Although no hospice wants to give up its own identity, these are difficult times, she points out. "No option is sacred or off limits now," she says. Hospice administrators need to be open to the possibility of combining with other organizations if necessary because as Rock says, "It's about survival, and if we don't survive, our friends and families in our communities will suffer."