“Hospice Helps Everyone” Message Reaching Latino Communities

The National Hospice and Palliative Care Organization’s “Moments of Life: Made Possible by Hospice” campaign has released a new video translated in Spanish and showcases the benefits of hospice care. “Un Baile Para Gloria” features Gloria, an 85 year-old Latina and former schoolteacher from Pueblo, Colorado, who suffers from COPD, a condition that confines her to her home. The video which was first produced in English, was translated to Spanish to use for outreach in the Latino community where hospice utilization is disproportionately low.

Gloria is cared for by Sangre de Cristo Hospice. The video features a special event her care team organized to honor her love of culture, music, dance, and prayer. Gloria’s care team honors her Latino heritage as well. One of Gloria’s caregivers, Carolina, is bilingual and speaks Spanish with Gloria during her visits. Carolina helps Gloria with her baths and showers. Having a caregiver who can speak to the patient in their native tongue can add ease to a situation that can be very stressful and uncomfortable.

“We are thrilled to release this video that highlights the benefits hospice can provide to all communities including the Latino population,” says NHPCO President and CEO, J. Donald Schumacher. “Many hospice providers serve diverse populations and it’s essential to understand each community’s end-of-life cultural beliefs and attitudes."

 According to Tarrah Schreiner, chief executive officer at Sangre de Cristo Hospice, many people on the team can speak Spanish.  Southern Colorado has a large Latino population and the organization services several Latino families like Gloria’s.

To support the work of hospice providers that service Latino communities, NHPCO’s Latino Outreach Guide is available online, free of charge. The guide outlines key principles and insights to help hospices better serve this diverse community.  

Gloria’s video is part of the “Moments of Life” public awareness campaign launched by NHPCO in 2014. The campaign features stories from hospices and palliative care programs across the United States of patients and families experiencing hospice and palliative care first hand. The “Moments of Life” website includes information in Spanish that helps explain hospice care and advance care planning. 

Gloria pictured with the Grupo Xochitl dance troop.

NHPCO Welcomes New Volunteer Section Leader to its National Council

NHPCO's National Council of Hospice and Palliative Professionals is pleased to introduce Stacy Groff, MNM, as the incoming Volunteer/Volunteer Management Section Leader.

Ms. Groff has served on the section’s steering committee since 2012 and has been a regular presenter at NHPCO conferences. Her presentations include Volunteer Mentors: A Key to Retention; Medicare Regulations for Hospice Volunteer Programs: Creating a Survey-Ready Program that Demonstrates Excellence; and Hospice Volunteer Leadership Development 101. Members of the section will recognize her voice from the many section chat’s she has hosted. In addition, Stacy contributed her expertise to the recently revised Hospice Volunteer Program Resource Manual.

Groff currently leads one of the largest volunteer programs in the country as the Director of Volunteer Services for Tidewell Hospice, which serves Manatee, Sarasota, Charlotte, and Desoto counties in Florida.

Outgoing Section Leader Sandi Huster says “I am very pleased that Stacy will be serving as our section leader and know that she and our outstanding steering committee members will continue to provide excellent service to the members of our profession.” Earlier this year Huster was chosen to be the next Chair of NHPCO’s National Council of Hospice and Palliative Professionals.  In that role, she will be on the board of NHPCO.

Ms. Groff and Ms. Huster will begin their three-year terms on January 1, 2017.

Stacy Groff, MNM

 

Birth of a New CoP for Medicare Hospice, Part 3

This is part three of a three part series focusing on the final rule for Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers (CMS-3178-F) for hospice providers.  This article will discuss the last two standards of this new Condition of participation (CoP) for hospice providers. 

The Communication Plan

The third standard in this new hospice CoP at §418.113 (c) requires a hospice to develop and maintain an emergency preparedness communication plan that that complies with Federal, State, and local laws and is reviewed and updated at least annually.  The communication plan outlines the names and contact information for hospice staff, contracted partners, and patient physicians as well as Federal, State, tribal, regional, and local emergency preparedness staff.  The plan must outline primary and secondary means for communication with hospice staff and Federal, State, tribal, regional, and local emergency management agencies to ensure optimal coordination of care and services during a disaster[i].

The communication plan must also delineate the process of how a hospice will share information and clinical documentation for patients under their care with other health care providers and Federal, State, tribal, regional, and local emergency management agencies to preserve continuity of care.  The release of patient information is critical in the event of patient evacuation and is permitted under 45 CFR 164.510(b)(1)(ii) which discusses when a covered entity may use or disclose protected health information without the written consent or authorization of an individual.  For hospices with an inpatient facility, this process would also include how information about a hospice's inpatient occupancy, needs, and its ability to provide assistance would be communicated to Federal, State, tribal, regional, and local emergency management agencies.  The process of patient information exchange during a disaster response serves as a means to discern the general condition and location of patients under a hospice facility's care[ii].

Training and Testing
The final standard in the CoP at §418.113(d) requires a hospice provider to develop and maintain an emergency preparedness training and testing program that is based on the emergency plan, policies and procedures, and the communication plan and is reviewed and updated at least annually.  Depending on the size of the hospice and their geographic location, elements in this part of the requirement may be the most difficult to implement. 

The training program:   The emergency preparedness training program must educate new staff, existing staff, and contracted partners about the emergency plan, policies and procedures, and communication plan consistent with their expected roles at least annually. As with all training, staff competency needs to be assessed and documentation of training needs to be maintained[iii].

Testing the program: A hospice must conduct two exercises to test their emergency plan at least annually.  One of the exercises requires ‘boots on the ground’ participation in a full-scale exercise that is community-based or individually facility-based.  The second exercise may include, but is not limited to a second full-scale exercise that is community-based or individually facility-based or a tabletop exercise that includes a group discussion led by a facilitator who utilizes a narrated, clinically-relevant emergency scenario, and a set of problem statements, designed to test an emergency plan.  The hospice must analyze their response to the exercise and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the hospice's emergency plan, as needed based on the outcomes of the exercises.  If the hospice activates their emergency plan related to an actual natural or man-made emergency, they are exempt from engaging in a community-based or individually facility-based full-scale exercise for 1 year following the actual event[iv].

A hospice may be part of a healthcare system which includes multiple separately certified healthcare facilities.  If this is the case, that system may opt to have a combined and integrated emergency preparedness program and the hospice may choose to participate in the healthcare system's coordinated emergency preparedness program. In this scenario, the integrated emergency preparedness program must demonstrate that each provider within the system actively participated in the development of the unified emergency preparedness program and that it was developed and maintained related to the unique conditions, patient populations, and services offered by each provider.  This approach to compliance would need to include all of the required elements outlined in the CoP (emergency plan, policies and procedures, communication plan, and training and testing)[v].

(Read part one and part two.)

Jennifer Kennedy, MA, BSN, RN, CHC
NHPCO Senior Director, Regulatory & Quality 

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[i] Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers; Final Rule. (2016, Sep16). Retrieved from https://www.gpo.gov/fdsys/pkg/FR-2016-09-16/pdf/2016-21404.pdf

[ii] Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers; Final Rule. (2016, Sep16). Retrieved from https://www.gpo.gov/fdsys/pkg/FR-2016-09-16/pdf/2016-21404.pdf

[iii] Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers; Final Rule. (2016, Sep16). Retrieved from https://www.gpo.gov/fdsys/pkg/FR-2016-09-16/pdf/2016-21404.pdf

[iv] Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers; Final Rule. (2016, Sep16). Retrieved from https://www.gpo.gov/fdsys/pkg/FR-2016-09-16/pdf/2016-21404.pdf

[v] Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers; Final Rule. (2016, Sep16). Retrieved from https://www.gpo.gov/fdsys/pkg/FR-2016-09-16/pdf/2016-21404.pdf

DEA prescription drug "Take Back Day"

On Saturday, October 22, from 10am to 2pm the Drug Enforcement Administration will give the public its 12th opportunity to rid their homes of potentially dangerous expired, unused, and unwanted prescription drugs. This is the 12th "Take Back Day" sponsored by the DEA over the past six years.

Consumers are invited to bring pills for disposal to a take back site in their area; find a take back site location. The DEA cannot accept liquids or needles or sharps, only pills or patches. The service is free and anonymous, no questions asked.

Last April, Americans turned in 447 tons (over 893,000 pounds) of prescription drugs at almost 5,400 sites operated by the DEA and more than 4,200 of its state and local law enforcement partners.  Overall, in its 11 previous Take Back events, DEA and its partners have taken in over 6.4 million pounds—about 3,200 tons—of pills.  

This initiative addresses a vital public safety and public health issue. Medicines that languish in home cabinets are highly susceptible to diversion, misuse, and abuse. Rates of prescription drug abuse in the U.S. are alarmingly high, as are the number of accidental poisonings and overdoses due to these drugs.  Studies show that a majority of abused prescription drugs are obtained from family and friends, including from the home medicine cabinet. In addition, Americans are now advised that their usual methods for disposing of unused medicines—flushing them down the toilet or throwing them in the trash—both pose potential safety and health hazards. 

For more information about the disposal of prescription drugs or about the October 22 Take Back Day event, go to the DEA Diversion website.

World Hospice and Palliative Care Day is October 8

At the NHPCO Management and Leadership Conference in this year, I had the opportunity to sit down with Dr. Paul Zebadia Mmbando, manager of the Evangelical Lutheran Church in Tanzania Palliative Care Program.  We met to discuss the positive impact that results from U.S. and international hospice and palliative care programs partnering to increase access to hospice and palliative care where the need great and resources few -- like his home country of Tanzania.  Part of our discussion shifted to the need for more palliative care training, including more training on prescribing pain medication, for healthcare professionals in Tanzania. As prepare for World Hospice and Palliative Care Day here at NHPCO, I can’t help but reflect back on my meeting with Dr. Mmbando. 

The theme for WHPCD is ‘Living and dying in pain: It doesn’t have to happen’. According to the Worldwide Hospice and Palliative Care Alliance, “75% of the world population does not have adequate access to controlled medications for pain relief,” and because of this, “millions of people suffer from pain which is avoidable and could be managed with proper access to the correct medications.  

This year’s WHPCD aims to educate the world on three barriers for access to pain relief:  restrictive regulations, poor education, and economic barriers. Dr. Mmbando mentioned each of these barriers in our discussion and was particularly focused on education. He explained to me that “opioid phobia” is a challenge among healthcare professionals who do not feel educated enough to provide pain medication or fear that it will lead to substance abuse. Up until 2011, only four facilities in Tanzania were allowed to prescribe morphine. Four facilities…it’s hard to comprehend.

Despite that sobering statistic, Dr. Mmbando remained positive. “Through our program we train people,” he said. “All of our facilities now have a member of the palliative care team who is able to prescribe morphine.” 

He went on to explain that many physicians, especially those who are not trained in palliative care, are still very cautious when it comes to prescribing morphine. “They still call it a drug of substance abuse,” he says. “It’s something that is rooted in the training that they have had.” 

There are measures being taken to address this barrier. WHPCA cites the following:

• Countries are now including palliative care education for medical and nursing students.  
• The Hospice Africa Uganda morphine initiators’ course at the Institute of Hospice and Palliative Care in Africa trains healthcare workers from all over Africa in how to safely prescribe and administer morphine.
• The University of Cape Town runs a Master’s course and Postgraduate Diploma in Palliative Medicine which use distance learning so that busy professionals can expand access to palliative care and pain management, as well as the research base on this topic.
• In Tajikistan a course on pain relief and palliative care is being developed for police professionals.

Dr. Mmbando feels that more partnerships between U.S. and African hospice and palliative care organizations, would help increase and improve the training for healthcare professionals. His trip to the U.S. was an opportunity to network with interested organizations to educate about the need for more partnerships in Tanzania. Through knowledge sharing and financial support, healthcare facilities would be better equipped to help their patients manage their pain. 

There are currently twelve active partnerships but there are eleven programs that need a U.S. partner. “It’s a bit of a challenge that there are still so many facilities that don’t have a partner,” says Dr. Mmbando.

World Hospice and Palliative Care Day is October 8. Please take the time to visit the WHPCA website and review the key messages that help support this vital day of awareness.

Amanda Bow
NHPCO, Director of Communications

Birth of a New CoP for Medicare Hospice, Part 2

Part two of the three-part series will focus on the first two standards of the final rule for Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers (CMS-3178-F) for hospice providers. 

The Emergency Plan

The first standard in this new hospice Condition of participation (CoP) at §418.113 (a) requires the hospice to develop and maintain an emergency preparedness program that complies with all of the outlined requirements and applicable Federal, State, and local emergency preparedness requirements and is reviewed/updated at least annually.  The basis of the plan rests on the completion and documentation of a facility-based and community-based risk assessment, utilizing an all-hazards approach. Based on the outcomes of this assessment, the hospice will identify strategies for addressing emergency events identified by the risk assessment, including the management of the effects of power outages, natural disasters, and other emergencies that would affect the hospice's ability to provide patient/ family care[i].

The hospice must also address their patient population by determining what type of services they can provide in during an emergency and how the services will be delivered and how continuity of operations will be maintained, including delegation of authority and development of a succession plan.  The hospice provider must also map out their process for coordinating and cooperating with local, tribal, regional, State, or Federal emergency preparedness officials' efforts with the aim of maintaining an integrated response during a disaster or emergency response situation.  The hospice must document their attempts to contact these officials and, when applicable, of their involvement in collaboration and coordination in planning[ii]. 

Hospice providers should check with their state for emergency preparedness resources such as hazard risk assessment tools and emergency plan templates.  There are also Federal risk assessment resources available from the Federal Emergency Management Agency (FEMA).  Ready.gov has a helpful risk assessment tool for providers to use to document their all hazards risk assessment outcomes.  

Policies and Procedures

The second standard of the new CoP at §418.113(b) requires a hospice provider to develop and implement emergency preparedness policies and procedures, based on the emergency plan, the facility-based and community-based risk assessment, the communication plan, and the training and testing program. The communication plan and training and testing program requirements will be discussed in Part three of this blog series. The hospice organization’s policies and procedures must be reviewed and updated at least annually just like the emergency plan.  There are minimal requirements for the policies and procedures including: 

• Processes for follow up with on-duty staff and patients to determine services that are needed, in the event that there is an interruption in services during or due to an emergency and how hospice staff will be used in emergency as well as other emergency staffing strategies.
• Measures to inform State and local officials about hospice patients in need of evacuation from their residences at any time due to an emergency situation based on the patient's medical and psychiatric condition and home environment.
• Structure and processes to preserve patient information and clinical documentation that is HIPAA security compliant and maintains access to records.
• The establishment of arrangements with other hospices and other providers to receive patients if there are limitations or interruption of hospice operations to maintain the continuity of services to patients[iii].

When §418.113 goes into effect in 2017, the current CoP requirements at §418.110 Condition of participation: Hospices that provide inpatient care directly, Standard: Physical environment will be eliminated.  The policies and procedures that are additional requirements for hospice-operated inpatient care facilities only must include the following: 

•  A process to shelter in place for patients, hospice employees who remain in the hospice.
• An evacuation plan from the hospice facility which includes consideration of care and treatment needs of evacuees; staff responsibilities; transportation; identification of evacuation site(s) and principle and alternate modes of communication with external sources for assistance.
• A plan to meet the sustenance need of hospice patients and staff including food, water, medical, and pharmaceutical supplies if they evacuate to an alternative site; the means to provide a temperature controlled environment to protect patient health and safety and for the safe and sanitary storage of provisions; emergency lighting, fire detection, alarms, and management; and sewage and waste disposal.
• Plan for functioning under a Federal 1135 waiver [iv] for the provision of patient care and treatment at an alternate care site identified by emergency management officials.
• Development of a system to track the location of hospice employees' on-duty and sheltered patients in the hospice's care during an emergency.

o   If the on-duty employees or sheltered patients are relocated during the emergency, the hospice must document the specific name and location of the receiving facility or other location[v].

The last two standards of this new CoP will be discussed in Part 3 of this blog series. (Read Part 1.)

Jennifer Kennedy, MA, BSN, RN, CHC
NHPCO Senior Director, Regulatory & Quality 

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[i] Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers; Final Rule. (2016, Sep16). Retrieved from https://www.gpo.gov/fdsys/pkg/FR-2016-09-16/pdf/2016-21404.pdf

[ii] Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers; Final Rule. (2016, Sep16). Retrieved from https://www.gpo.gov/fdsys/pkg/FR-2016-09-16/pdf/2016-21404.pdf

[iii] Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers; Final Rule. (2016, Sep16). Retrieved from https://www.gpo.gov/fdsys/pkg/FR-2016-09-16/pdf/2016-21404.pdf

[iv] Centers for Medicare and Medicaid Services. (2009, Nov 4). Retrieved from https://www.cms.gov/About-CMS/Agency-Information/H1N1/downloads/requestingawaiver101.pdf

[v] Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers; Final Rule. (2016, Sep16). Retrieved from https://www.gpo.gov/fdsys/pkg/FR-2016-09-16/pdf/2016-21404.pdf