FOR-PROFIT AND NON-PROFIT HOSPICES

As hospice liaisons we are asked on a daily basis “are you a non-profit hospice?” After being asked this question day after day we thought what a great topic for our blog page. All of us at Front Range Hospice believe that knowledge is power, so visit our blog page frequently or like us on face book to get the answers to the questions you may have.

FOR-PROFIT AND NON-PROFIT HOSPICES

by Victor Montour

The Medicare Hospice benefit is a highly regulated program with very specific requirements that are monitored closely. This oversight is in part needed because approximately 90% of hospice patients are receiving services under their Medicare benefit.

Medicare pays all hospices a per diem rate, which is the dollar amount Medicare, has determined that will cover essentially all of the expenses related to the management of the patient’s care. This dollar amount varies from state-to-state and then from county-to-county. The rate is based on the location the care is provided not the location of the hospice office. There is no difference in the rate between for-profit or non-profit.

Perhaps the most significant difference between a non-profit hospice and for- profit hospice is that non-profits do not pay taxes. This is an exclusive quality of all non-profits no matter what the goals of that organization may be. A common misconception is that “non-profit” means monies are not exchanged or that the non-profit organization is run by volunteers, donations, and grant money. Some of this is true; however it is not completely true, as non-profits have employees that receive compensation. In the case of a non-profit hospice, Medicare pays them the exact same per diem that the for-profit hospices receive. They are just not taxed on that money due to how their business is structured. The taxes that are assessed to the for- profit hospices are paid to the county in which they are located; this money is then used to support local government, social programs, and special projects that benefit the community.

Every hospice must follow the guidelines that Medicare has designated, and every hospice is run differently and is special in its own way. This flexibility is an intricate part of the Medicare Hospice Regulations. There are regulations of what needs to be provided and there is flexibility in how this is provided. Beyond the Medicare criteria, every hospice has the ability to do things in their own special way. For example, aroma therapy, music and pet therapies are just some of the complementary therapies that a hospice may have to offer. You may find different complementary services throughout the other hospices of Colorado. It is these special extras that make each hospice unique and establishes a personal fit to those that are entering hospice. It is indeed these special “extras” that may help a person when they are deciding which hospice is right for themselves or their loved one.

When you really look at the differences between for-profit and non-profit hospice organizations, I believe you will see they really aren’t so different. Hospices, regardless of how they are organized, are here to help people live their lives with dignity and in comfort. They want to help the patient as well as the family, their caregivers, and their physicians. All hospice organizations follow the Conditions of Participation, have wonderful and caring staff members, and are prone to giving back to their community.

The major difference that really stands out is the one of personal choice. When you are choosing the hospice that is right for you, finding the organization that has the personal touches that appeal to you may be the motivating factor that you would want to consider.

Watch for our next blog – Front Range Hospice Non-Profit Memorial Fund

For more information call 303-957-3101 or 970-776-8080 or email us at info@frhospice.com

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Hospice Care in an Assisted Living Facility? Why Not?

Hospice Care in an Assisted Living Facility?  Why Not?
Written by Barbara Reed

Many people live fulfilling lives in Assisted Living communities. Their days include social events, dining, perhaps volunteer opportunities, and a measure of independence in their own apartments.    Many develop deep friendships with other residents and affection for the staff.  Families of residents often form a strong bond after seeing one another visiting family members on a regular basis.  In short – the time spent living in Assisted Living can be very rewarding for the resident and the family, and a deeply meaningful experience for the staff at the facility. So why would anyone want to change all these components just because a person qualifies for hospice?  When one’s health condition changes and a person can qualify for hospice care, most of the time that person can stay in the assisted living community – with additional support from the hospice team.  The hospice team works hand in hand with the community team, ensuring that the care plan created by hospice is manageable within the level of care that the assisted living community offers. This goes back to the core values of honoring the wishes of a patient and the family.

 

I’ve had an opportunity to see first-hand how this collaborative care can be so successful.  Before joining Front Range Hospice, I worked for over 8 years for a large assisted living provider.  I saw on a daily basis how complimentary these two disciplines can be……from the perspective of the assisted living community.  We all want the least restrictive, most independent environment for the resident.  The collaborative relationship between assisted living and hospice creates the best end of life quality for the resident and the family.  A referral for hospice care early in the resident’s disease process allows the two teams to develop strategy to maximize all of the ways hospice provides care.

 

I recall clearly a patient in her 40’s for which the assisted living community and Front Range Hospice provided amazing care.  She had no family living locally and she had been ill long enough that only her most loyal friends stayed in touch.  When I was first made aware of her situation, it was through a phone call from the case manager at the local hospital – looking for a good fit for her favorite patient.  I was able to show the case manager how closely the wellness team and Front Range Hospice work together. On the recommendation of the case manager, the patient moved into our community and became our resident.  As she began her decline, these two teams decided to host a tea party in her room – complete with china cups, tea pots, and sweets.  We took turns enjoying the company of our resident/patient and we were so happy to do this for her!  

September 7th – 13th is National Assisted Living Week – a time to honor the incredible work done every day by our Assisted Living partners. 

Please remember that a move from the familiar surroundings of home – whether someone lives in their own home or in an assisted living community – can be very stressful.  Front Range Hospice will work closely with the assisted living team to ensure the best possible care is given wherever the patient calls home.  It is essential to understand what care is needed now, and as the patient’s health declines – what the assisted living community, family, and patient should expect going forward.   Honest and open communication is the key to caring successfully for a hospice patient in an Assisted Living community.

If you are considering relocating a patient or a loved one from Assisted Living simply because that person qualifies for hospice, please consider the option to have that person stay in his or her home – surrounded by their familiar support systems and receiving  Legendary Care from Front Range Hospice.

 

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What Is A Hospice Nurse

What Is A Hospice Nurse

Outside its noisy along the houses on a street in the suburbs of Denver. But inside one tidy living room, all is quiet except for the sound of a woman’s raspy breathing. The patient is huddled in an easy chair under a handmade pink-and-blue afghan, a knit cap on her head and booties on her feet. Her cancer has returned with a vengeance and she has only a few weeks to live. A Front Range Hospice nurse kneels down beside her, listens to her breathing, and then checks her blood pressure. The nurse has already had oxygen tanks delivered to the home, the nurse shows family members how to work them, organizes the medicine, and assesses how her patient has been eating and sleeping. The nurse now takes a moment to connect one-on-one with her patient. The nurse wraps her hands around the woman’s hands and rubs them together to warm them. She looks into her eyes and asks softly, “are you feeling a little better today?”

Getting to know our patients and families, and helping them through the toughest time of their lives is what Front Range Hospice nurses appreciate most about being a hospice nurse. We don’t know of another place or position where we can do more for people.

The patients at Front Range Hospice have all been told that they have six months or less to live. Rather than continue with often-difficult or painful treatments that probably won’t extend their lives, they have decided to stop trying for a cure that most likely won’t come. Instead, with the help of hospice care, they’ll focus on comfort and living whatever they have left of their lives to the fullest — usually in their own home.

Being able to die at home is a major part of the appeal of hospice, but patients and family members may not see it that way at first. A lot of people still view hospice as giving up and letting the disease win. That’s why the decision to call in hospice care can be an incredibly difficult one for a family to make. Once they do, though, most patients and their families soon understand the value of having a team of dedicated professionals — including social workers, certified nursing assistance, chaplains, and nurses — work together to provide not only physical but also emotional and spiritual support.

When a nurse takes their first job in hospice care they have the same fears as anyone about hospice. A veteran nurse, who’d worked in operating rooms, expected it to be unbearably sad. But on her first day, she was surprised that the family members were relaxed and sharing funny stories about their dying father. There’s still happiness in the sadness of it. She realized that hospice is not just about death– it’s about life. The life of one’s past, present and future.

By spending time inside patients’ home the nurse gets to witness the blessings of a peaceful ending to life. The nurse may have seen family members resolve longstanding, hurtful disputes and be reunited. For some patients the victories have been smaller but equally profound: a visit to a hair salon or being able to sit outside on a nice day. But getting patients and their relatives to that place of peace and acceptance can be tough. Some families are divided or resistant to the idea of hospice. A family may ask the nurse to cover her badge and not mention hospice to the patent, thinking that if their grandmother saw the word hospice or heard it she’d give up and die.

Others may unnecessarily worry about drug addiction and won’t give their sick relative pain medicine when it’s needed. Some patients are afraid of taking morphine, thinking it will stop their breathing or make them feel out of it. “Did you take your pain medicine?” The nurse asks her patient, who is holding her rib cage in agony. The nurse squats beside the hesitant woman and assures her she’ll stay with her while she takes it, to make sure she’s okay. The patient is worried she’ll just sleep away the time she has left, but pain medicine often allows a person to feel better and actually do more. 

Many days Front Range Hospice nurses are busy juggling crises — one patient may have fallen down, another may be vomiting, and another is close to dying. Other days our nurses delicately navigate the fears of patients and families with their gentle, grounded spirits. During and after visiting patients our nurses find that people want to know the same things: how long they have left and what the final moments will be like. Some only want to know if the nurse can keep them calm and out of pain. They can. Others want details, so the nurse explains that after they stop eating and drinking, for example, they will become semi-comatose and just gradually slip away.

Some still wonder if they could be the rare person who survives. “Has there ever been a case where somebody walks away from this?” one 75-year-old grandfather asks the nurse hopefully. “I don’t know,” the nurse says after a moment. She explains that it’s hard to say with his kidney disease. “Live each day,” the nurse tells him. Then, noting his jokes about eating whatever he wants and having his daughter and wife wait on him, the nurse adds with a smile.

Because many people see hospice care as the end of hope, there are even some doctors who are reluctant to bring up the option. As a result, more than a third of hospice patients don’t start hospice care until they have just days left to live. Ironically, some patients who get hospice care live longer than those who don’t, studies show. But many wait until it’s nearly too late, and those people often sacrifice the chance for closure.

More often than we like the nurse gets a message: The man she’d just seen for the first time two hours earlier has already died. “Ooh,” the nurse says, letting out a long, frustrated sigh. The nurse knows what we could have done for him if we had more time — the same thing we all want for ourselves when our life is ending: a chance to have those last conversations, to be comfortable, at home, surrounded by loved ones.

That’s why the nurse tries to focus on what patients want and need. And when a terminally ill person hangs on longer than seems possible, nurses learn from experience that the patient may be waiting for something to be resolved. An example of this is a dying woman’s adult children are gathered at her bedside. One of the daughters, in particular, is heartbroken and distraught. The chaplain leads them in prayer and then the children, leaning on each other, leave the room. “Look, they’re together”, the nurse whispers to her patient. Sensing she is worried about them. “If you want, it’s okay to go. They’re going to be okay.” Within minutes, the patient dies with the nurse holding her hand.

“People are so afraid of how it’s going to end but when you’ve been there and held their hand and watched them take their last breath, you see that it’s a really powerful moment — powerful and peaceful.”

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Info@frhospice.com

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Balm for the Broken-Hearted: The Bereavement Program

Balm for the Broken-Hearted: The Bereavement Program
Jonathan C. Wretlind, M.Div
Chaplain and Bereavement Coordinator, Front Range Hospice

One of the great benefits of hospice care is the emotional support offered by chaplains, social workers, and the bereavement program. A well-organized bereavement program is crucial to providing the best care to hospice families. Hospice is not only about caring for the patient, but realizing that death of a loved-one impacts the entire family-system. Offering each family the opportunity to receive support for 13 months following a death, the bereavement coordinator “follows” family members by mail and phone in order to provide assistance to those who need it and are willing to receive help. It is a free benefit, and one that is often overlooked in presenting the benefits of hospice to family members considering hospice care for a loved-one.

One of the main goals of a bereavement program is to identify those individuals in a family that may need extra support, may experience “complicated grief”, and may need ongoing professional support through a referral to a local therapist or counselor. Complicated grief can be a serious psychological condition, and can mimic symptoms similar to Post-Traumatic Stress Disorder (PTSD), and is a form of secondary trauma itself. It may even lead to fully-developed PTSD, cause permanent brain damage, and even lead to suicide or homicide. Even “normal” grieving itself can result in depression, loss of productivity, or illness. It is because of this potential consequence of grief that Medicare requires the hospice program to provide bereavement services as part of the Conditions of Participation (CoP), even though it is non-reimbursed by Medicare/Medicaid.

The Bereavement Coordinator continually contacts family members who are in the bereavement program to “check-in” with them at predetermined intervals according to a plan-of-care based on an individuals’ risk for complicated grief. This is done through phone-calls, letters, or through support groups in order to continually assess which family members may need extra support in order to prevent complications due to grief. The plan-of-care may need to be altered depending on what is reported to the bereavement coordinator or bereavement program assistants or what other objective risk-factors (such as alcohol abuse, family dysfunction, lack of support system or suicidal ideation) are discovered through interaction with the bereaved individual. There are many factors which plays into an individual’s risk for complicated grief, and the bereavement coordinator along with hospice social-workers and chaplains record what is learned about the bereaved using a document called a Bereavement Assessment. This document is reviewed for each family member in the bereavement program on a regular basis by the psycho-social team, and modified if necessary.

Part of the bereavement program also includes grief counseling services through one-on-one counseling with a qualified counselor, or through group-sessions held throughout the year and conducted by the psycho-social team. Counseling may also be offered prior to the patient’s death if needed for family-members who are having difficulty with coping with “anticipated grief.” These are free benefits through our hospice program, and extremely beneficial to those willing to receive help. When a person is identified with a high-risk for complicated grieving and/or may be experiencing extremely poor coping, a referral may be made to a local counselor or therapist qualified to handle difficult cases of complicated grief. Also, family members who reside out of our service area may be referred to another grief program or counselor in their area.

I am proud to be part of Front Range Hospice’s bereavement program as both a chaplain and the bereavement coordinator, working with a team of top-notch bereavement assistants and volunteers. I have heard many stories and reports from our families of the legendary care that Front Range provides, and honored to be able to help the bereaved in their time of need.

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Speak Up

Speak Up

Front Range Hospice continues to maintain the highest standards of care set before us by the Joint Commission.. We would like to take this opportunity to introduce you the Joint Commissions Speak Up campaign. As a Joint Commission Accredited company Front Range Hospice supports this campaign and encourages everyone to familiarize themselves with the program. In an effort to help you understand this program Front Range Hospice is going to Speak Up about the program and get you started on the road of empowerment. When you finish reading this blog you will have a better understanding of the medications that may be used at Front Range hospice.

The Joint Commission has a hospice/palliative care education campaign as part of their award-winning Speak Up program. The Speak Up program urges people like you to take an active role in their own health care.

The basic framework of the Speak Up campaign urges patients and families to:
• Speak up if you have questions or concerns, and if you don’t understand, ask again. It’s your body and you have a right to know.
• Pay attention to the care you are receiving. Make sure you’re getting the right treatments and medications by the right health care professionals. Don’t assume anything.
• Educate yourself about your diagnosis, and your treatment plan.
• Ask a trusted family member or friend to be your advocate.
• Know what medications you take and why you take them. Medication errors are the most common health care errors.
• Use a hospice, hospital, clinic, or other type of health care organization that has undergone a rigorous on-site evaluation against established state-of-the-art quality and safety standards, such as that provided by The Joint Commission.
• Participate in all decisions about your treatment. You are the center of your health care team.

All of us at Front Range Hospice want to help you speak up. As mentioned above, medication errors are the most common mistake in healthcare. What better way to minimize these errors then to talk about medications.

When becoming a patient at Front Range Hospice you may hear from the Liaison or Nurse that a comfort pack will be delivered to your home. Your now wondering what’s a comfort pack and what do I do with it once it arrives?

Answer: The hospice comfort pack – is a prescribed set of medications that are kept in a patient’s home in the event of an emergency or onset of new symptoms. Having the medications already in your home will help the hospice team treat any distressing symptoms as quickly as possible in your home. Front Range Hospice strives to get and keep you as comfortable as possible.
The hospice comfort pack may be ordered and delivered to your home at the start of hospice care or anytime the RN Case Manager sees a possible need. The Front Range Hospice comfort pack contains medications for pain, anxiety, nausea, constipation.
Other medications may be included depending on the hospice diagnosis. For example, a patient with a brain tumor who is at risk for seizures may have valium suppositories included in the comfort pack.
The Front Range Hospice RN Case Manager will explain each medication to you including the purpose and correct way to administer it. In most cases the RN Case Manager will instruct their patients and families not to start any of the medications till they have consulted the RN Case manager. At this time the RN Case Manager will review the medication, why it is being used, how to administer it and the frequency it can be given.
If you have a true allergy to these or any medications it is important to share that information with the RN Case Manager. A true allergy occurs when your immune system reacts abnormally to a medication. A number of drugs can cause a drug allergy, including prescription and over-the-counter medications. The most common signs of a drug allergy are hives, rash or fever. You can have an allergic reaction to a drug anytime you take it, even if it caused no reaction in the past.
Most drug-related symptoms are not a true drug allergy and don’t involve the immune system. Drug allergy and non-allergic drug reactions are often confused because they can cause similar symptoms. Either type is called an adverse drug event and needs to be reported to the RN Case Manager. Some allergic and non-allergic drug reactions can be severe or life-threatening.
Lastly please remember to report to the RN Case Manager any herbal remedies you are taking. Herbal remedies can have a negative impact on the medications being prescribed by your physician.
Remember to SPEAK UP! Excellent end of life care is your right and it is dependent on you Speaking up and communicating with your health care team.
Front Range Hospice
Legendary Care.
info@frhospice.com

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As the Affordable Care Act shapes the future of patient care in the United States…

As the Affordable Care Act shapes the future of patient care in the United States, the issue of healthcare’s “revolving door,” or avoidable hospital readmissions, continues to take a front seat in the national conversation. Rehospitalization among Medicare beneficiaries has become a top priority for both policymakers and the Centers for Medicare and Medicaid Services (CMS) as hospitals feel added pressure to help patients remain at home.

Front Range Hospice is working hard at maintaining current relationships and developing strong relationships with the hospitals in our service territory. Front Range Hospice is the first hospice along the northern front range to track return to hospital rates along with other clinical data measures on patients receiving care through Front Range Hospice. Why do we track data you ask?
Nearly one in five Medicare beneficiaries is readmitted to the hospital within 30 days of release. As of this post Front Range Hospice has a zero percent return to hospital rate. Tracking this data allowed us to show our hospital partners how hard we work to support our patients and our hospital partners.

The CMS has taken on several initiatives to reduce readmissions – an important measure of patient care quality – from reporting hospital readmission rates and changing payment policies, to implementing shared savings programs in efforts to increase care coordination among post-acute care providers.

The biggest change, as part of the healthcare overhaul: Medicare began penalizing hospitals with high readmission rates for heart failure, heart attack, and pneumonia cases. In 2012 more than 2,000 hospitals received a reduction of up to one percent on their Medicare reimbursements. This penalty will increase to a maximum of two percent this year 2014, and three percent in 2015.
Because Front Range Hospice has developed chronic disease programs our staff is trained on how to manage chronic diseases like CHF and COPD in the home. Front Range Hospice nurses are able to better support the patient and family at home, reducing or eliminating the return to the hospital. Resulting in better family satisfaction and no penalties issued to the hospital.

Why Are Patients Returning to The Hospital?
There are some return trips to the hospital that are unavoidable – due to complications, new and unrelated problems, or anticipated steps of certain treatment plans. Some patients are also readmitted because they live in a region where hospitals are used more frequently as a place of care for illnesses.

Regardless of where patients reside, education and support are key factors in preventing readmissions to hospitals. We work hard to provide education to our patients and families with every interaction we have with them. The more education, the more comfortable the patient and family will feel, resulting in decreased or eliminating the trip to the ED or calling 911.

The Role of Hospice
Front Range Hospice is a leader in improving coordination of care between care settings and reducing avoidable hospital readmissions. Increasingly, hospitals are forming collaborative partnerships with hospice providers like Front Range Hospice, nursing homes and home care agencies to combat avoidable readmissions.

Front Range Hospice works closely with the hospitals, patients and families to identify care preferences, manage symptoms, and address clinical, emotional and spiritual needs through a team-oriented, interdisciplinary approach. This type of care allows patients to pick up the phone in a time of crisis and receive emergency medications at home, or a facility, without returning to the hospital.

Integrating hospice care services early in the hospital stay and making timely and appropriate hospice referrals can not only improve patient experiences, but address some of the most important issues faced by hospitals today: quality improvement, overcrowding in the ICU, increasing coordination of care, preventing complications, reducing costs – and ultimately, reducing return trips to the hospital in a patient’s final stages of life when comfort matters most.

-Victor Montour

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Honoring Veterans

As we celebrate the 4th of July Front Range Hospice asks that you pause to recognize the sacrifice from the millions of veterans in our Armed Forces. Since the Declaration of Independence was signed more than 200 years ago on July 4, 1776, our country has seen multiple wars – and called upon its sons, daughters, brothers, sisters, mothers and fathers to serve many times.

As our veterans age, they sometimes require special assistance beyond the typical senior citizen. Veterans may have physical wounds from battle injuries, or psychological wounds from being part of a war.

Even without service-specific wounds, veterans face the same diseases that we all do. World War II veterans are now all over 70, and many have cancer, dementia, chronic heart failure and other chronic or end of life diseases.

 

Like the rest of us, veterans need hospice care to guide them and their family through the end-of-life journey. These men and women deserve the best care available, and we are honored to serve them in their time of need.

 

It is never too late to honor and give a Veteran a hero’s welcome home. Front Range Hospice staff work hard to provide the last opportunity for Veterans to feel that their service was not in vain, and that they are appreciated. We do this with simple acts of gratitude at the end-of-life to make up for a lack of appreciation or recognition during the Veteran’s lifetime, especially for those Veterans who were never welcomed home or thanked for their service. Front Range Hospice will always, honor and recognize the Veterans we serve by providing;

 

Veterans with an opportunity to tell their stories.
Respecting Veterans’ service, their feelings, and any suggestions they might offer.
Thanking Veterans for their service to our country.
Providing a Veteran to Veteran volunteer program.
Showing our appreciation to the families of Veterans.
Always being sincere, caring, compassionate and ready and able to listen to what a Veteran or his or her family member has to share about the situation they are dealing with.
Being supportive and non-judgmental of our Veterans and always validating their feelings and concerns.
Being honest, sincere, caring and respectful.
Accept, without judgment, the Veteran as he/she is.
Being patient and listening.
Offering spiritual support for Veterans, family and friends.

Front Range Hospices asks that this 4th of July, stop and say THANK YOU to all of the service men and women who have made and continue to make the 4th of July possible. Without their sacrifice we wouldn’t be able to enjoy a day filled with family and friends or an evening filled with awesome fireworks.

 

Victor Montour
Hospice Liaison
Front Range Hospice
303-957-3101
Providing Legendary End of Life Care
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