Research Published by American Geriatric Society Suggests People Begin Hospice Too Late

New research published in the current issue of the Journal of the American Geriatrics Society states that individuals who access hospice care often do so too late to fully benefit from this holistic model of care. National Hospice and Palliative Care Organization, the oldest and largest leadership organization working on behalf of hospice and palliative care providers applauds the research and attention it brings to issues involving when to best access hospice care.

A team of researchers from the Yale University School of Medicine looked at hospice enrollment for decedents from a cohort of 754 persons aged 70 and older who were enrolled in a larger longitudinal study.  Of the 562 patients who died during the study, more than 40 percent utilized hospice care in the last year of life; however, the median time spent under the care of hospice was less than two weeks.

Study researchers wrote, "In summary, hospice services appear to be suitably targeted to older persons with the greatest needs at the end of life, although the short duration of hospice suggests that additional strategies are needed to better address the high burden of distressing symptoms and disability at the end of life.

NHPCO’s current Facts and Figures Report indicates that 34.5 percent of patients died or were discharged within seven days of admission. In fact, the report shows that 61.5 percent of patients received care for 29 days or less, which may prevent patients and family caregivers from taking full advantage of the full range of services that the hospice team can offer.

NHPCO stresses that hospice care is best suited for the final months of life, not just the final days.

Hospice is more than pain relief and symptom control. Hospice also provides emotional and spiritual support, training for family caregivers, and bereavement services to family for a year following the death of a loved one under hospice care.

Remarked Edo Banach, president and CEO of National Hospice and Palliative Care Organization, "Hospice and palliative care professionals have long known the importance of earlier access to the high-quality, interdisciplinary care that hospice makes available to those facing life-limiting illness.”

“Helping the public and the broader health care community – particularly physicians caring for patients with a non-cancer diagnosis – understand the many benefits of timely access to hospice care is an ongoing initiative at NHPCO. This study will certainly help raise important awareness and we offer our appreciation to the researches who have shared this important work,” Banach added.

Previous research has found that earlier access to hospice and palliative care services can prevent emergency department visits, hospitalizations, and stays in the intensive care unit – all of which can be distressing for those coping with serious and life-limiting illness.

Additionally, hospice works to help patients stay in the home if possible, which is the place that eight out of ten Americans would prefer to be at the end of life.

Timely access to hospice care can increase quality of life for patients and family caregivers. NHPCO suggests discussions of hospice care should take place earlier in the course of a serious illness, before hospice care might be necessary.

“Individuals must also ask their medical professions about hospice care and whether it’s appropriate and when the best time to think about accessing services should be,” explained Banach. “A question people can ask their physicians is: ‘Would you be surprised if I were to die within six months?’ – if the physician feels that this is a possibility, then a discussion about hospice should begin immediately.”

Resources to help people learn about hospice care are available on NHPCO’s CaringInfo.org website and via information, videos and tools from NHPCO’s public engagement campaign, Moments of Life: Made Possible by Hospice, at momentsoflife.org.

September 11: A Message from Edo Banach

It is hard to believe that it has been 16 years since the tragedy of September 11, 2001. As some of you know, I grew up in New York City and many friends and family were impacted by the tragic events of that day. I’m sure that lots of us have similar stories and memories. Many years later, I have the most vivid memories of how we pulled together as a country after that day. 

I’m further reminded of that as I see how we are pulling together in Texas, Florida and across the nation to deal with natural disasters. It is interesting to see how people of all walks of life can come together during these moments and then retreat back when the imminent danger subsides and memory fades.  

I’m proud to be working with and on behalf of a community that does not retreat—dealing with crisis, often personal crisis, is a part of our collective jobs. I think we have lots to teach the rest of the nation and world about how to stick with it and to continue to help each other get through the rough times that are inevitably thrown our way.  

Thanks for what you do every day.  

Edo

NHPCO Suggestions for Regulatory Relief

In response to a request from the U.S. House of Representatives Ways and Means Committee, the National Hospice and Palliative Care Organization has submitted a series of recommendations (PDF) that would provide regulatory relief to hospice providers. 

The recommendations were developed by the NHPCO regulatory committee and echo concerns raised in NHPCO’s comments to the Centers for Medicare and Medicaid Services regarding the FY 2018 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements; Proposed Rule. 

In summary, NHPCO highlighted areas where Congress and CMS could reduce regulatory burden around payment policy, staffing requirements, audits, and data collection and reporting.  NHPCO also called for Congress to enact legislation that would loosen requirements around Face-to-Face, and allow both Rural Health Clinicians and Physician Assistants to serve as the hospice attending physician. 

NHPCO President and CEO Edo Banach wrote in the letter to Congress, “In recent years, hospices have been faced with substantially increased regulatory burdens, based on new regulations and sub-regulatory guidance, changes required by hospice payment reform, additional quality reporting obligations, and increased audit activity. While some of these changes are positive, hospices report that they are facing many regulatory burdens that take valuable staff time away from patients and are not increasing the quality of care provided.”

NHPCO leadership, staff, and members are eager to work with Congress on these issues, as well as other policy changes that will ensure that all Medicare beneficiaries can access the high-quality, compassionate end-of-life care offered by hospice providers across the nation.

The Hurricane Disaster in Texas

The scope of the natural disaster in Texas is overwhelming. NHPCO has heard from a number of members throughout the country asking about ways to best support our hospice and palliative care colleagues in regions of Texas who are coping with the ongoing devastation of Hurricane Harvey and the continuing rains and flooding.

First, NHPCO extends thoughts and prayers to all those affected by this natural disaster.  We know that hospice and palliative care professionals are continuing to care for patients and family members despite flooding, blocked roads, power outages, property damage and personal loss. As the full impact of the situation unfolds, we stress the importance of safety as our colleagues face the brunt of this disaster.

During times of such disasters, it is essential that concerned individuals recognize the importance of following the direction of first responders and the agencies that are on the ground addressing the most critical needs. In these initial hours – and as the impact of flooding continues – we must heed the advice of emergency management systems that are responding as designed.

As with previous events of this nature, NHPCO traditionally coordinates with state associations to respond in the most effective manner; we have found that state associations best know the needs and priorities of providers in affected regions. Our leadership is working to contact our colleagues at the Texas & New Mexico Hospice Organization based in Austin.  We will learn more about the best ways to support our colleagues and providers in the region in the days and weeks ahead.

One way we have supported providers in areas affected by tragedies such as this is through the National Hospice Foundation (NHF) Disaster Relief Fund. This fund was specifically established to aid the hospice community when disaster overwhelms regularly-available resources. We have found that financial donations are one of the most helpful ways to address needs in the imminent wake of destruction.  NHPCO and NHF will be collecting donations through the fund and giving to the Texas & New Mexico Hospice Organization to use in the ways that will be most beneficial. We welcome your support of the NHF Disaster Relief Fund; to donate, please visit the NHF donation page online. 

Tragedy and loss are part of our world. Yet amid the wreckage and destruction, hope can be found. By surviving disasters, such as the hurricane and flooding that we are watching unfold in Texas, people recognize that they are part of a greater community, a community built upon our shared humanity. Ultimately, tragedy can show people they have more resiliency and strength then they realized. Neighbors help neighbors. Communities come together to rebuild. It becomes clear that survival is possible. While we cannot stop the forces of Mother Nature, we learn that the care and support of family and friends is essential.

National Hospice and Palliative Care Organization
August 28, 2017

 

Edo Banach Responds to Kaiser Health News

There is no question that the U.S. is coping with an opioid epidemic of overwhelming proportions. Unfortunately, the article from Kaiser Health News published in The Washington Post, “Dying at home in pain doesn’t keep relatives from stealing the pills,” unfairly points to the hospice community’s role in exacerbating this national crisis.  That could not be further from the truth.  Hospices take seriously their obligation to maintain the health and safety of patients and their loved ones.  Hospices have an obligation to the community and the patient to be sure that the medications are used appropriately, which includes careful monitoring of the patient’s pain and the family and home situation. However, hospices – and those who work for them – generally do not have the authority to confiscate or destroy unused opoids or other pills.   

As the author states, “The U.S. Drug Enforcement Administration encourages hospice staff to help families destroy leftover medications, but the agency forbids those staff members from destroying the meds themselves unless that is allowed by state law.”  I think it’s important to be perfectly clear, in most states, hospice professionals cannot touch the medications of a patient who has died – they belong to the family.  At the same time, Federal regulations require hospice professionals to go over the federal drug disposal guidelines with family caregivers, but hospice professionals are prohibited from taking a more active role in disposing or removing medications from the home.

Some states have taken action to put more control in the hands of the hospice professionals, but NHPCO supports a national policy and uniform set of practices.  To this end, NHPCO has already drafted legislation and has been working with Congress to expand the ability of hospice professionals to take a more active role in helping families dispose of these drugs.

Hospice professionals are trained in engaging with families about these medications – this includes addressing concerns of diversion or theft. Certainly, there are situations where a hospice professional failed, but such an instance should not be used to describe the entire provider community in this country. The 2013 study out of Virginia cited in the article, which reflects the practices of 23 hospices in Virginia, ultimately lead to training and resources made available throughout the state and country.

The author’s assertion that “hospices may go years without inspection” is not accurate. Legislation passed in 2014 (the IMPACT Act of 2014), strongly supported by the hospice community, requires hospices to be surveyed at least every three years. The hospice community has long worked with regulators to ensure high standards of practice, compliance and safety in the field. 

Drug diversion by friends, family members and caregivers must be addressed. However, readers of this article who may have a loved one in hospice – or be under the care of hospice themselves – should not be frightened by medications used to relieve suffering. If a patient or family has any concerns, please reach out to the hospice team providing care.

Not only are hospices working to do the right thing for patients and families, but they also working to ensure that the pain and suffering of dying Americans is properly addressed.  And no professionals are better trained to do this than those working in hospice and palliative care.

The Interdisciplinary Thought Behind IDC 2017

By Joan Harrold, MD, MPH, FACP, FAAHPM
Medical Director/Vice President of Medical Services
Hospice & Community Care, Lancaster, PA
Chair of NHPCO’s Professional Education Committee

In selecting the content for the 2017 Interdisciplinary Conference, we’ve pulled together an incredible group of people from the field of hospice and palliative care to answer some of the questions that are especially difficult for many programs. How to approach chronic pain in cancer survivors (especially in hospice when cancer is not an active diagnosis)?  How to manage addiction issues? What do studies really say about cannabis use? The IDC17 will offer variety of different sessions that really matter how we deliver care to people. 

While I know that it can be a sacrifice for programs to send people to an onsite educational program like this, it is incredibly valuable for both the individuals who attend and for the organizations that send them. First, an onsite program can gather many more people from different disciplines, cover a broader range of session topics, and offer many more presenters—all in a very short period of time. So while it may seem like it takes more time and money, it’s actually very efficient. Even more so if you plan beforehand to have your staff come home with handouts, other resources, and information to share with their colleagues.  The education shouldn’t stop with a handful of staff who attend the conference in person. 

Second, people who gather “in person” have the opportunity to follow up on what they learn.  Not just the questions you might ask during a presentation, but even more in depth conversation following a session. I’ve presented NHPCO webinars and been happy to answer questions that were emailed afterwards. I can often help more, however, when someone approaches in person and says, “I’m doing something like that, and I want to pick your brain.” You can often make time for a concentrated conversation about what matters to that person right then and there.

I think we can be a little blasé about “networking” at conferences and the benefits that offers. However, it goes beyond meeting other people from other places and having a good time; it’s actually taking the educational elements and figuring out very quickly how they apply to your program. Taking resources that matter to you. Having an intensive conversation with a presenter—or other attendee—about issues that really matter to your program. And if people go with this idea in mind, that they’re going to bring information back, it really can enrich their program.  

One of the things we’ve done for years at my organization is divvy up the sessions before the conference begins. After all, this is not like swimming after eating—you don’t need a buddy at every session! If you send three people and they’re all attending different sessions, they can come home with much more information than you would get in the same amount of time listening to webinars or reading articles. And this is an interdisciplinary conference, it’s not just for one discipline. It’s not just the docs; it’s not just the nurses. The psycho-social, spiritual, bereavement staff, volunteers, regulatory and quality professionals and interdisciplinary team leaders are such an integral part of our teams. They need to get the same kind of experience and bring it back. I think this is incredibly valuable way to learn. 

I’m so proud of the work that NHPCO’s professional education committee and conference planning committee members have done to create this very special event, the 2017 Interdisciplinary Conference. I hope many people from across the field will join us in San Diego this September.
 

2017 Interdisciplinary Conference:
Strengthen Your Organization: Care, Compliance, Quality
San Diego Marriott Marquis and Marina, San Diego, CA
Education Programs and Preconference Seminars: September 16-17, 2017
Main Conference: September 18-20, 2017

Register today – team discounts available.

(Look for a special registration discount on Monday & Tuesday, August 21 & 21 only!)