NHPCO Meets with CMS Administrator Seema Verma

Written by Judi Lund Person, Vice President, Regulatory and Compliance

On Wednesday, December 13, NHPCO’s President and CEO Edo Banach and I attended a productive meeting with CMS Administrator Seema Verma. Hospice Action Network board members Mark Murray, a hospice provider in South Bend, Indiana in Seema Verma’s home state, and Angie Sells, from AseraCare, a multi-state hospice provider attended the meeting as well and eloquently represented the hospice provider voice. The planned agenda for our meeting with Administrator Verma included a quick review on facts about hospice, our response to the Centers for Medicare and Medicaid Innovation (CMMI) request for information and progress on the Medicare Care Choices Model (MCCM), the impact on hospice when Medicaid managed care is in place, and concerns related to  Hospice Compare.

Pictured at the NHPCO office pre-meeting are NHPCO Vice President of Regulatory and Compliance Judi Lund Person, AseraCare President Angie Sells, NHPCO President & CEO Edo Banach, and Center for Hospice Care President & CEO Mark Murray.

On Wednesday afternoon, we made our way to the Hubert Humphrey building in downtown DC to meet with Administrator Verma.  She was joined by five members of the CMS staff, representing both the Center for Medicare and the Center for Medicare and Medicaid Innovation.  We began with a few quick data facts about hospice but quickly moved to a robust discussion about innovation, where we shared why the hospice and palliative care patient-centered approach is exactly in line with the Administrator’s goals for patient-centered care.  Verma was particularly interested in how hospices can be involved with patients earlier in their disease process, and we discussed the need for care navigation and coordination and how hospices are already involved in that process.

The meeting with Administrator Verma (center) was productive and informative.

We also had a discussion about the MCCM and talked about some of the limitations of the model, as well as what the learning has been.  We commented that the supportive services offered in the MCCM model are exactly what many patients need before they elect hospice.  Our hope is to build on that learning as we consider additional models.     

It was clear from our discussions that innovation is a high priority issue for the Administrator.  Our visit highlighted the skills and experiences of hospice providers to participate in models for seriously ill patients and develop new models to ensure that patients and their families have the care and supportive services they need.  We agreed to continue our discussions with Administrator Verma and CMS staff at the meeting. It was a productive and useful meeting, and we look forward to continuing to build upon the strong working relationship between NHPCO and CMS. 

One Cause, Two Continents: Commit to a new friend in Africa

NHPCO's affiliate organization, FHSSA, counts its partnership initiative among its most valuable programs. The organization (originally known as the Foundation for Hospices in Sub-Saharan Africa) has successfully created more than 90 partnerships between US hospice programs and organizations providing care in 15 different African nations. Partners provide technical assistance, support and friendship. They are working collaboratively to expand access to hospice and palliative care services in sub-Saharan Africa, a region where the need is great and resources are few.

Yet, more than 20 African palliative care programs in 11 African nations are anxiously waiting to be matched with a US hospice program. It is estimated that these 20 African care providers serve more than 13,200 patients and 66,000 family members.

To meet this need, FHSSA has launched the campaign, One Cause, Two Continents: Commit to a new friend in Africa, at a special event in San Diego celebrating current partners.

In recognizing the accomplishments of current FHSSA partners, it was noted that in 2010 alone, partners in this country:

• Sent $450,000 to African partners;
• Donated $122,000 in medicines and supplies;
• Supported nearly 3,000 staff and 4,000 volunteers who served 60,000 patients and 300,000 family members in African communities.

“Our current partners say over and over that becoming a partner was transformative for each staff member involved as well as for their program as a whole,” said J. Donald Schumacher, FHSSA president and CEO.

“By committing to a partnership in Africa a hospice in this country has the opportunity to broaden its vision of compassion, further its reach in the community it serves, and help a community in Africa,” Schumacher added.

For more information about the One Cause, Two Continents campaign, visit the FHSSA website.

FHSSA shares an article about the benefits of partnering that’s available online (PDF).

Hospices interested in partnering should contact:
Erinn Nanney
703-647-6684

Don Schumacher Comments on Recent Media Focus

A Message from NHPCO President and CEO

J. Donald Schumacher
July 22, 2011

Recent attention in the media has turned a bright spotlight on purported problems in hospice. Only yesterday, NHPCO issued a Regulatory Alert summarizing information put out by the OIG, focused on hospice care in the nursing home, as several previous OIG reports have done. Then, this morning, an article by a Bloomberg News reporter brought much of the same OIG information out again in a more sensationalized, investigative fashion.

First and foremost, NHPCO strongly believes in the value of hospice care as the highest-quality care for patients and family caregivers struggling with serious and life-limiting illness. Furthermore, it is NHPCO’s belief that the overwhelming majority of U.S. hospices are committed to a shared vision to bring the best that humankind can offer to all those individuals facing serious illness, death and grief. Within that vision, however, is the duty of each provider to do the best job possible to ensure that every single patient day of care is within all regulatory and legal limits. NHPCO will not support any provider who fails to strive for the highest level of compliance and practice.

What we do is not easy. We share a sacred covenant with those we serve. In addition to bringing expert care, compassion and dignity to the dying and their family caregivers, we manage multifaceted organizations that are a significant part of the complex American healthcare system. The accomplishments we have made over the past forty years in changing the way we care for the dying is to be celebrated.

NHPCO statistics show more than 1.5 million dying American receive care every year – and this extends beyond Medicare beneficiaries to people of all ages, with an ever increasing number of complex illnesses. NHPCO’s comprehensive survey, the Family Evaluation of Hospice Care, shows 94% of family caregivers surveyed rated care as “very good to excellent.” Additionally, this research shows that if you ask 100 people who’ve had hospice care for a loved one if they’d recommend it to someone else, 98 of them are going to say yes. There are no professionals or volunteers better equipped to meet the unique needs of the dying than those found in the American hospice and palliative care community.

In recent years we have also improved our ability to serve people across all care settings and have made advances in reaching populations where hospice is underutilized. In the decades where we have made such progress, our model of care and the work of the interdisciplinary team has had a positive impact on many other sectors of healthcare.

I am so very proud to represent you and the hundreds of thousands dedicated individuals committed to caring for the dying and their family caregivers. These are the messages I consistently carry to the media and the public. And while it’s difficult to see my words not conveyed fully in the media, that does not diminish my faith in the work we are doing to raise awareness of the high quality care that the overwhelming majority of people receive. Our work at the national, state and local level with the media results in a constant stream of positive news stories and feature pieces that are published in every corner of the country (a selection of which we link in NewsBriefs each week). That said, it is unfortunate that negatively focused articles can lead to confusion and fear among the public, which in some cases may be an added barrier to care when it’s needed most.

Legally, we are not able to comment on specific lawsuits, nor can we talk about individual patient or employee situations. However we can and will continue our work helping providers ensure that the care at the bedside not only meets, but exceeds current regulations and standards.

Long before recent media attention, NHPCO has been committed to increasing quality and helping providers continuously improve performance. This includes:

• Calling for more consistent and timely regulatory oversight and surveys;
• Launching NHPCO’s innovative Quality Partners program;
• Developing a self-assessment program built on the ten foundation blocks of quality;
• Increasing the number of outcome measurement and data collection tools that are free to our members;
• Creating the most extensive set of compliance and regulatory tools and resources available in the hospice community for current regulatory requirements: From face-to-face and changes in the cost report, to the requirements reflected in the historic revision to the CMS hospice regulations, including the Medicare Hospice Conditions of Participation;
• Providing expert regulatory and compliance guidance to the field;
• Revising the landmark publication, Standards of Practice for Hospice Providers, to reflect the most up-to-date regulatory guidelines;
• Offering professional development opportunities onsite and via the Internet that bring expert training in a multitude of formats;
• Sharing best practices and allowing the nation’s hospice community to network and learn from one another in conferences, forums, e-groups, and more.

NHPCO is committed to serving the entire hospice and palliative care community. Among our membership are programs large and small, urban and rural, nonprofit and for-profit, government owned and faith-based, single site and multi-site, the variations go on, and this diversity enriches our organization and the field. Despite these differences our commitment to caring and excellence is the same.

In my thirty-five years as a hospice and palliative care leader (as a CEO and now in my role leading NHPCO and its affiliates) I’ve met thousands, of hospice professionals (both paid and volunteer) who share a commitment to excellence. To a person, they share the same beliefs – that the dying and their family caregivers deserve the very best care that humankind has to offer them. These passion-driven professionals bring compassion and dignity to people when fears are many and hope seems out of reach.

I hope you share these words of encouragement with your staff, volunteers, board members and supporters.

We will continue our ongoing work at NHPCO to reach out and inform, educate, advocate and build awareness about the quality care you provide.

Finally, let me reaffirm the work of NHPCO and assure you that we stand with you to make a difference in the lives of people who need the support and caring we provide.

J. Donald Schumacher, PsyD
President and CEO

For more information visit, http://www.nhpco.org

"Hospices are Serving a Critical Need" in Kaiser Health News

NHPCO's Don Schumacher writes in Kaiser Health News about the benefits and value of hospice care. He stresses the importance of quality end-of-life care and calls for well-informed discussions. Schumacher's article begins:

"As Congress works to come to terms with the economic challenges facing our nation, it's inevitable that discussions focus on health care. With an estimated one third of Medicare spending going towards care of beneficiaries in the last year of life, attention has understandably turned to the rising costs of hospice care. Hospice is the leading provider of palliative care services for those facing serious and life-limiting illness."

Read the full piece on the Kaiser Health News website. http://www.kaiserhealthnews.org/Columns/2011/July/070511schumacher.aspx

NHPCO Draws Providers’ Attention to Article in New York Times

NHPCO members may have seen the article from Kaiser Health News that was posted on the New York Times website yesterday and appears in print in the Health & Science section today, "Concerns about costs rise with hospices' use."

NHPCO wanted to let members know that President/CEO Don Schumacher wrote a letter to the editor reminding the NY Times that growth in hospice over the past decade reflects our caring more compassionately for the dying in this country. He also made the point that NHPCO has been calling for more federal oversight of hospice for many years.

The NY Times blog page, New Old Age, welcomes comments from readers. Please feel free to share any thoughts you might have through the comment section of the New Old Age blog. An insightful comment was posted on the New Old Age blog that NHPCO would like to draw provider's attention to. An individual wrote: "I'm so thankful that this article was published, because we weren't aware that hospice care was available for end stage Alzheimers. We want to do everything we can to honor my mother's wish that she die in her own home, but if things become impossible,,,well it gives me great comfort to know there is another option."

To many of us, so close to issues that involve the field, it can be easy to forget that many members of the public are concerned about issues as they affect them in a personal way. Even challenging news articles can provide valuable information about hospice that is important to the public.

In addition to Don's letter to the editor, we are submitting an op-ed to the NY Times that we hope will get serious consideration.

Additionally, the Public Policy team has put together some specific talking points they are sharing with legislators and their staffs on Capitol Hill who may have concern or confusion resulting from this article.

We wanted to assure members that NHPCO has been actively responding following the release of this article.

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Why a National Center for Care at the End of Life?

Last April, at NHPCO’s Management and Leadership Conference, we rolled out the public phase of the National Hospice Foundation’s Capital Campaign for the National Center for Care at the End of Life. Some of you may already be aware of this important investment for the future of end-of-life care in this county. In fact, we’ve already raised $2.4 million of our $10 million goal, so things are off to a great start.

You may ask, “Why do we need a national center for end-of-life care?” Well, it has never been more important that we, as the nation’s hospice and palliative care community, have a permanent presence advancing our shared vision for care at the end of life. It is estimated that 70 million Americans will need hospice and palliative care services in the next 20 years, so what we do matters. As our nation grapples with challenges of healthcare delivery and costs, the need for us to strategically advocate for the dying has never been greater.

This Campaign will help ensure that we have a permanent home where skilled professionals can come together to accomplish the transformational work of care and compassion at the bedside.

The Cornerstone for Advancing Care and Compassion

The Washington-metropolitan area is a city of buildings that serve as “go to” destinations representing many organizations and causes. The National Center for Care at the End of Life will be the “go to” place dedicated to advancing and ensuring that high-quality care is available to everyone in need at life’s end.

I was moved by the enthusiasm that MLC attendees showed toward our Campaign. We have already finalized several naming opportunities for individuals and organizations that want to be a part of the National Center. If you or your colleagues need more information on how to be a part of the Campaign, visit the National Hospice Foundation website or contact the NHF team at 703-516-4928.

Providers, volunteers and supporters are all an important part of the hospice and palliative care community, and for that I am thankful.

I hope you’ll consider how you can become involved in supporting the National Center for Care at the End of Life.

Position Statement on Ethical Marketing Practices Released by National Hospice and Palliative Care Organization

(Alexandria, Va) – A position statement and commentary, Hospice and Palliative Care: Ethical Marketing Practices, has been released by the National Hospice and Palliative Care Organization. Approved by the NHPCO board of directors, this document reinforces the need for hospice and palliative care providers to utilize ethical marketing practices, which in turn, will ensure trust and support among those being served.

Ethical behavior exemplifies the foundational hospice values of service, respect, excellence, collaboration and stewardship. These values can both inspire and challenge end-of-life professionals as they promote services available in the community.

“Hospice and palliative care providers are caring for individuals and families who may be particularly vulnerable as they cope with serious and life-limiting illness. The highest ethical practices and standards are necessary from every single provider in the industry – with no exceptions,” said J. Donald Schumacher, NHPCO president and CEO.

“This position statement will help providers to establish accountability for sound ethical practices as they engage in marketing efforts and business development,” he added.

NHPCO’s position statement focuses on six key components:
1. Access to Care
2. Competition
3. Customer Service Excellence and Boundaries
4. Hospice and Palliative Care Organizations as Referral Sources
5. New Trends in Marketing and Communication
6. Traditional Media Marketing

NHPCO strongly believes that sound ethical practices are an essential component of quality.
The statement stresses that responsive admissions systems and personnel that meet patients’ and referral sources’ needs are hallmarks of service excellence. NHPCO further states that marketing practices should be evaluated and monitored frequently to avoid unethical decisions and behaviors.

NHPCO hopes the document serves as a catalyst for dialogue within and among organizations that provide hospice and palliative care—a dialogue that will support and reinforce ethical standards of practice.

Developed by the NHPCO Ethics Committee, Hospice and Palliative Care: Ethical Marketing Practices (PDF) is available on the NHPCO website.

# # #

Contact:
Jon Radulovic
Vice President, Communications
703-837-3139
jradulovic@nhpco.org

NHPCO's other position statements are available on the NHPCO website.

A Member of NHPCO’s Leadership Team Shares Thoughts on Death(ly) Panels

I spent Memorial Day Weekend with a group of Cub Scouts ranging in age from six to 11. My son, who is eleven, was excited to be “crossing the bridge” from Cub Scouts to Boy Scouts. The formal ritual, which involved his Den leader saying some nice words about his growth and older Boy Scouts welcoming him to their midst, was an important milestone in my son’s life. He isn’t a little kid any more, he’s a teenager. I have no idea when that happened.

Nor do I know the specific moment when I became the adult caregiver of my mother, who turns 80 this year and has been in good physical and mental shape for years. Yet it hasn’t been easy. The death of her two sisters within six months of one another and two knee replacements surgeries of her own during those difficult months left her exhausted as well as emotionally and physically frail. I flew to Florida to visit her in the facility where she is receiving rehab, arranged for non-medical aides to help her when she moved back home and spent a few days with her so she wouldn’t be alone. This was an important milestone for me as an adult daughter. My responsibility level has increased and there really isn’t any going back.

As adults we experience multiple milestones – planned and unplanned – that mark our progression through life. One day we are happily single and the next we’re in a committed relationship. We’re childless and then become parents in a few short months. We are healthy and the next day we’re told we have a potentially life-limiting illness. It all happens so fast and there’s little we can do to slow down this inevitable march onward, through life’s stages.

We can’t stop it, even though many people try to slow down the aging process through surgery, exercise, nutrition or just plain denial. We can save money for our kids’ education. We can put money away for retirement. But eventually we’re all going to face the fact that we’re all mortal. Even as aware as we all are that we will die some day, we do little to plan for it.

When there is a healthcare crisis, which happens to so many people, we are unprepared, as are our families. We haven’t thought about the type of care we want or don’t want. We haven’t selected someone to speak for us if we can’t talk to the doctors ourselves. We haven’t told anyone whether we would or would not want to be kept alive through medical interventions if the chance of recovery was slim. We haven’t planned properly to make sure we are in control during what might be the last phase of our life.

My son is now memorizing all the Boy Scout pledges, laws and mottos in preparation for his first meeting. To me the most important one, besides “do a good turn every day,” is the one that is best known and yet universally most ignored – “be prepared.”

You can’t avoid the last milestone in life. Hopefully you won’t face it for many years to come. But it will happen, in some shape or form, to all of us. Take a lesson from my son, be prepared. Download a free advance directive, read it through and talk about with your doctor and family members, sign it and give copies to folks who will need it during a crisis. Take control of the phase of your life before that milestone creeps up on you and catches you unprepared.

GUEST BLOGGER: Kathy Brandt, MS, the Senior Vice President, Office of Education and Engagement at the National Hospice and Palliative Care Organization, is a passionate believer in the need to plan for, talk about, and document end-of-life care wishes, and the proud mother of an amazing eleven year Boy Scout.

Dartmouth Atlas Report

US End-of-Life Care Changing: While Medicare Patients are Spending Less Time in Hospital, Those Admitted Receive More Intensive Care

Chronically ill Medicare patients spent fewer days in the hospital and received more hospice care in 2007 than they did in 2003, but at the same time there was an increase in the intensity of care for patients who were hospitalized, according to the Dartmouth Atlas Project report "Trends and Variation in End-of-Life Care for Medicare Beneficiaries with Severe Chronic Illness."

"It may be possible to reduce spending, while also improving the quality of care, by ensuring that patient preferences are more closely followed," said David C. Goodman, M.D., M.S., lead author and co-principal investigator.

Download the full report in PDF from Dartmouth Atlas website.

NHPCO Congratulates “We Honor Veterans” Grant Recipients for 2011

(Alexandria, Va) – Five hospice organizations from across the nation have been chosen as grant recipients in the third year of the National Hospice and Palliative Care Organization’s Reaching Out grants program. The grantees are:

• Guardian Hospice – Franklin, Tennessee
• Hope Hospice & Palliative Care – Medford, Wisconsin
• Hospice of Central Iowa – West Des Moines
• Mercy Hospice – Roseburg, Oregon
• Mountain Hospice – Belington, West Virginia

Funded through a contract with the Department of Veterans Affairs, the Reaching Out grants were created to support innovative programs committed to increasing access to hospice and palliative care for rural and homeless Veterans.

“These grants serve a two-fold purpose,” said J. Donald Schumacher, NHPCO president and CEO. “They support specific, community-based programs and the lessons learned will help the VA in discovering new ways to reach veterans who are homeless or living in rural areas and in need of quality care as they near the end of life.”

Throughout 2011, grantees will be implementing outreach models in their communities designed to expand and increase the quality of care and services provided to Veterans coping with life-limiting illness.

The models guiding the work to be done in 2011 were originally developed by Reaching Out grantees in 2009 and 2010. The 18 grantees who were part of year one and two of the Reaching Out grants program focused on establishing partnerships between community hospices and VA facilities – all with the ultimate goal of increasing access and improving quality of care for Veterans.

In addition to the distinguished organizations receiving grant awards this year, work continues by the organizations that were 2010 Reaching Out grant recipients: Arkansas Hospice, Inc.; California Hospice Foundation; Delaware Hospice, Inc.; Hospice of the Bluegrass; Hospice of Chattanooga, Inc.; and LINK of Hampton Roads, Inc.

Grant reviewers from the field evaluated forty proposals submitted to NHPCO.

“All of us at NHPCO and the VA appreciate the enthusiastic response to the Reaching Out program and we thank our current and previous grantees for their continuing dedication to serving Veterans", added Schumacher.

As part of the initiative to reach more Veterans in need of hospice and palliative care, NHPCO in collaboration with the VA created the We Honor Veterans website (www.WeHonorVeterans.org) offering information and resources for organizations interested in better serving Veterans at the end of life.

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Media Contact:
Jon Radulovic, 703-837-3139 or jradulovic@nhpco.org.
Emil Zuberbueler, 703-647-6687 or ezuberbueler@nhpco.org.

NHPCO is the oldest and largest nonprofit membership organization representing hospice and palliative care programs and professionals in the United States. NHPCO’s mission is to lead and mobilize social change for improved care at the end of life, www.nhpco.org.

We Honor Veterans, a program of NHPCO in collaboration with the Department of Veterans Affairs, provides educational tools and resources that promote Veteran-centric educational activities, increases organizational capacity to serve Veterans, supports development of strategic partnerships, and increases access and improve quality, www.WeHonorVeterans.org

Hospice Community Disappointed in Administration’s Decision and Reminds All Americans of the Value of Advance Care Planning

(Alexandria, Va) – “We are surprised that the Administration has decided to reverse the decision to include voluntary advance care planning consultations as part of a Medicare beneficiaries’ annual wellness exam,” remarked J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization.

Despite this action, NHPCO strongly encourages all Americans to think about their wishes for care at the end of life and engage in advance care planning. This includes having discussions with healthcare providers and family members, completing an advance directive (which includes a living will and healthcare proxy), and making sure their loved ones understand their wishes.

“Frankly, we are somewhat disappointed that the regulatory guideline making this part of the annual Medicare exam and compensating the physician for taking time to talk about personal preferences has become such a political issue,” continued Schumacher. “It's simply about educating patients about the types of decisions they might need to consider in future healthcare situations, and then supporting them as they make their own choices based on their values, beliefs and preferences.”

The opportunity for this voluntary consultation with a physician has been part of the “welcome to Medicare” exam since 2008.

Research has shown that patients who discuss their care options when facing a serious or life-limiting illness report a higher quality of life, less hospitalizations and fewer visits to the emergency department. Family caregivers have also been shown to benefit from discussions held between physicians and patients.

Far too often, patients and their families are forced to make decisions in times of crisis; these voluntary advance care planning consultations would have facilitated informed conversations prior to the onset of an illness or medical crisis.

“Death and dying can be a difficult topic for people to deal with – this includes politicians crafting legislation, healthcare providers caring for patients, and people who may be confronting a serious illness. But as hard as this can be, it’s far more difficult for a patient and family to face a medical crisis without a prior understanding of an individual’s wishes and how quality of life might be addressed. Knowing a loved one has engaged in discussions with a knowledgeable physician can bring comfort to patients and families—and that can be quite a gift at a challenging time,” Schumacher said. “Having this option spelled out in Medicare regulations would have raised awareness of advance care planning and potentially opened the door for valuable conversations.”

NHPCO emphasizes that advance care planning is not about discontinuing treatment, saving money, or having someone else make decisions for you; it’s about making sure your wishes are known and then honored, regardless of whether you choose every medical intervention available, discontinue non-productive treatments, or something in between.

There is concern among hospice providers that the debate about this regulation and last year’s “death panel” rumors will cause additional confusion to members of the public and make them even more suspicious of advance care planning.

Hospice and palliative care providers are skilled in helping people understand issues of importance when facing a serious or life-limiting illness and can be important resources for those looking to learn more or make their wishes known.

NHPCO’s Caring Connections offers information on care at the end of life and provides free, state-specific living will and healthcare proxy forms: Visit www.caringinfo.org or call the HelpLine at 1-800-658-8898.

Things we are grateful for this year

For three years running now, many of us bloggers have participated in what we’ve called a “blog rally” to promote Engage With Grace [www.engagewithgrace.org] – a movement

aimed at making sure all of us understand, communicate, and have honored our end-of-life wishes.

The rally is timed to coincide with a weekend when most of us are with the very people with whom we should be having these unbelievably important conversations – our closest friends and family.

At the heart of Engage With Grace are five questions designed to get the conversation about end-of-life started. We’ve included them at the end of this post. They’re not easy questions, but they are important – and believe it or not, most people find they actually enjoy discussing their answers with loved ones. The key is having the conversation before it’s too late.

This past year has done so much to support our mission to get more and more people talking about their end-of-life wishes. We’ve heard stories with happy endings … and stories with endings that could’ve (and should’ve) been better. We’ve stared down political opposition. We’ve supported each other’s efforts. And we’ve helped make this a topic of national importance.

So in the spirit of the upcoming Thanksgiving weekend, we’d like to highlight some things for which we’re grateful.

Thank you to Atul Gawande for writing such a fiercely intelligent and compelling piece on “letting go” [http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande]– it is a work of art, and a must read.

Thank you to whomever perpetuated the myth of “death panels” for putting a fine point on all the things we don’t stand for, and in the process, shining a light on the right we all have to live our lives with intent – right through to the end.

Thank you to TEDMED [http://www.thehealthcareblog.com/the_health_care_blog/2010/10/engage-with-grace.html] for letting us share our story and our vision.

And of course, thank you to everyone who has taken this topic so seriously, and to all who have done so much to spread the word, including sharing The One Slide.

Don't Wait to Talk About Hospice

With Release of PBS FrontlineSeries and Dartmouth Atlas Report, NHPCO Reminds People of the Importance of Advance Care Planning

(Alexandria, Va) – An intimate journey into the edge of life is how this evening’s episode of the PBS series Frontline has been described. Frontline’s "Facing Death" will air this evening (11/23/10) at 9:00pm on most PBS stations.

In this groundbreaking film, doctors, patients and families at one of New York’s biggest hospitals speak with remarkable candor about the increasingly difficult choices people are making at the end of life: when to remove a breathing tube in the ICU; when to continue treatment for patients with aggressive blood cancers; when to perform a surgery; and when to call for hospice.

This follows the release of a report from the Dartmouth Atlas Project looking at care for patients with advanced cancer at the end of life that identified gaps between patient wishes and care received.

The National Hospice and Palliative Care Organization urges members of the public to learn about advance care planning and discuss wishes with family members.

“It’s an all too common situation. A family is at the bedside of a loved one who is seriously ill and nearing the end of life,” remarked J. Donald Schumacher, NHPCO president and CEO. “Each member of the family has a different idea of what should be done and what the patient would have wanted.”

Far too many people wait until they are in the midst of a health care crisis before thinking about what options are available or what care they or their loved ones would have wanted. Hospice professionals deal with these challenging situations every day – that’s what they are trained to do.

When a family is coping with a serious illness and a cure is no longer possible, hospice provides the type of care most people say they want at the end of life: comfort and dignity. Considered to be the model for high-quality, compassionate care for people with a life-limiting illness, hospice care includes expert medical care, pain management, and emotional and spiritual support. Care is provided by an inter-disciplinary team of professionals and trained volunteers. The wishes of the patient and family are always at the center of care.

Most hospice care is provided in the home – where the majority of Americans have said they would want to be at this time. Care is also provided in nursing homes, assisted living facilities, and hospice centers.

Care is paid for by Medicare, Medicaid, and most private insurance plans and HMOs.

The National Hospice and Palliative Care Organization reports that more than 1.56 million people received care from our nation’s hospices last year.

Hospice providers can help with information about care options and choices and ensure you live as fully as possible throughout your entire life. They will make sure your loved ones receive support as well.

One of the best ways to make sure you and your loved ones benefit fully from hospice, should you ever need this care, is to talk about it before it becomes an issue.

For more information on advance care planning and hospice, visit NHPCO’s Caring Connections at caringinfo.org or call the HelpLine at 1-800-658-8898.

Caring Connections is one of the recommended resources included with the education tools PBS has made available online for “Facing Death.”

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Contact:
Jon Radulovic
NHPCO, Vice President of Communications
Ph: 703-837-3139
jradulovic@nhpco.org

Dartmouth Atlas Report Identifies Gap between Patient Wishes and Care Received

NHPCO Commends Dartmouth Atlas Project and Calls on Hospitals to Increase Access to Hospice Care

(Alexandria, Va) – A new report released today from the Dartmouth Atlas Project showing that individuals in some areas of the country are far less likely to receive comfort care in accordance with their wishes and has drawn the attention of the nation’s hospice and palliative care community.

This first-ever report from the Dartmouth Atlas Project on cancer care at the end of life, found that across the US, about 29 percent of patients with advanced cancer died in a hospital between 2003 and 2007. And in 50 academic medical centers, fewer than half of these patients received hospice care.

Furthermore, the study authors state that many patients are aggressively treated with curative therapies they may not want, and, “for frail elderly patients, and any patient with advanced cancer, these treatments have limited or no benefit.”

“The Dartmouth Atlas Project is to be commended for undertaking this thorough examination of end-of-life care for Medicare beneficiaries with advance cancer,” said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization. “While the findings of variation in care are not necessarily a surprise, one of the key messages that I take away from this report is the critical need for hospitals and all healthcare professionals to ensure that all patients are informed earlier about the course of an illness and the range of options available – options that include hospice and palliative care.”

The likelihood that a Medicare patient with advanced cancer will die with the support of hospice care, or in the hospital without hospice, varies markedly depending on where he or she lives and receives care. The percent of cancer patients dying in a hospital varied threefold among patients receiving most of their care at academic medical centers.

“It’s important to recognize that this report is not a negative comment on care in our nation’s hospitals or among academic medical centers, rather, it’s a much needed reminder that healthcare professionals must work to help patients and families understand where the course of their illness may take them. And, when cure is not possible, it is our duty to offer the robust benefits that the hospice team can provide,” added Schumacher.

Hospice care provides coordinated care delivered by a team of interdisciplinary professionals that are trained to address the special needs a person has at the end of life. The hospice team provides pain and symptom relief as well as emotional and spiritual support for the patient and the family.

More than 1.56 million Americans received care from the nation’s hospices last year. However, 34 percent of patients died or were discharged in seven days or less – too short a time to take full advantage of all of the services available under hospice, including support for family caregivers.

“In more than 30 years of running hospice programs, the most frequent comment I would hear from patients and families was why they didn’t learn about hospice care earlier,” Schumacher noted.

For several years, NHPCO’s Caring Connections has been providing healthcare professionals and consumers with information about care options and caregiving when facing serious or life-limiting illness. Information to help patients and family caregivers understand the benefits of hospice care, speak with physicians about care, or learn about advance care planning is available free of charge from NHPCO’s Caring Connections at www.CaringInfo.org or by calling the HelpLine at 1-800-658-8898.

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The Dartmouth Atlas Project is run by the Dartmouth Institute for Health Policy and Clinical Practice and principally funded by the Robert Wood Johnson Foundation. A link to the full study can be found at www.dartmouthatlas.org.

NHPCO is the oldest and largest nonprofit membership organization representing hospice and palliative care programs and professionals in the United States. NHPCO’s mission is to lead and mobilize social change for improved care at the end of life, www.nhpco.org.

Contact:
Jon Radulovic
NHPCO, Vice President of Communications
Ph: 703-837-3139
jradulovic@nhpco.org

November 2010 Palliative Care Grand Rounds

The 2010 November Palliative Care Grand Rounds (PCGR), highlighting blog post focusing on hospice, palliative care and grief matters, is being hosted this month by Compassion & Choices Blog. Check it out today!

The views expressed in the Palliative Care Grand Rounds are the sole responsibility of the authors of each blog highlighted and does not necessarily reflect the views of NHPCO, this blog or its editors.

It's never too late to say 'thank you' to our nation's Veterans: even at the end of life

A Message from J. Donald Schumacher, PsyD
President/CEO
National Hospice and Palliative Care Organization

Americans across the country celebrate Veterans Day on November 11, a special day to salute the men and women who have bravely served our country in the military.

These fellow Americans have made profound sacrifices in defense of freedom and they deserve our heartfelt thanks and appreciation. Honoring our nation’s Veterans includes supporting them throughout their entire lives, especially at the end.

As our nation marks Veterans Day 2010, the National Hospice and Palliative Care Organization deepens its commitment to increase Veterans’ access to the compassionate, high quality care available from the nation’s hospice and palliative care providers.

NHPCO has been a long-time supporter of the valuable work being done by the Department of Veterans Affairs to bring palliative care services to VA Medical Centers and the communities they serve.

This past month, NHPCO in collaboration with the VA, took a great step forward to help healthcare providers better serve Veterans at life’s end by launching the website www.WeHonorVeterans.org, the centerpiece of the new We Honor Veterans campaign. This campaign will help those who provide care at the end of life, better understand the unique needs of our nation’s Veterans.

But there is something that every American can do to honor and serve our Veterans – and that is to say, “thank you.” Not just on November 11 but all year long.

Ask your friends, neighbors, coworkers and others in your community whether they have served in the military (you may be surprised how many have)—and thank those who have served for their sacrifice.

A generation of World War II and Korean War Veterans are facing end-of-life care decisions now, and they are quickly being followed by younger Vietnam War Veterans, many of whom are confronting serious illnesses at an even earlier age.

It surprises many Americans to learn that every day, 1,800 Veterans die. That’s more than 680,000 Veterans every year – or 25 percent of all the people who die in this country annually.

The liberty that we, as US citizens, enjoy comes at a price paid by these valiant men and women. Let each of us make sure we do our part to recognize and support them throughout their lives.

If you know a Veteran who is in need of the special care hospice and palliative care brings to people facing serious and life-limiting illness, please reach out and help them learn more about care options. Information is available from NHPCO’s Caring Connections at www.caringinfo.org or by calling the HelpLine at 1-800-658-8898.

To all our nation’s Veterans, thank you.

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Don's 2010 November Video Update

For more information visit, http://www.nhpco.org

Schumacher Quoted in Oncology Times

NHPCO's Don Schumacher is quoted in an article in Oncology Times, "Helping Prevent Suicide in Cancer Patients," (September 25, 2010 issue). The article by Robert Carlson begins:

"Oncologists who say they've never had a patient commit suicide simply might not know. The patient who doesn't return for treatment or reportedly died of an accidental drug overdose could have decided, in their suffering, that life was not worth living."

Dr. Schumacher offers some insight from his 30 years of running a hospice program. This is an informative article for oncologists and other healthcare providers.

Read the article online! What are you thoughts?