Los Angeles Times Series on End-of-Life Care

There is a great series of three articles on end-of-life care that appears in the Los Angeles Times. I was interviewed for the article, “Hospice care helps patients and loved ones” that ran in print January 25. The writers for the pieces spoke with many well known names in the field. There are some very poignant photographs that accompany the series as well.

Media attention to the range of issues involving care at the end-of-life are always important and this series, which is available on the LA Times website, will certainly provide a great deal of helpful information to those not familiar with some of the issues involved in care at the end of life.

“Hospice care helps patients and loved ones: More patients use the service for end-of-life care. But what is it? “
January 25, 2010

“Study: Doctors delay communicating end-of-life care issues with terminally ill patients “
January 25, 2010

“Choices at the end of life”
January 22, 2010

I was pleased to see that NHPCO's Caring Connections website, www.caringinfo.org, was offered as a resource for those looking for advance directives and information on advance care planning.

NHF Donates $15,000 for Haitian Earthquake Relief

$15,000 for Haitian Earthquake Relief

Usings funds from our Disaster Relief Fund, we were able to donate an initial $15,000 to Haitian earthquake relief. Three organizations doing on-the-ground work in Haiti have each received $5,000: Holy Angels Hospice, Partners in Health, and the Hôpital Albert Schweitzer (Albert Schweitzer Hospital). We invite you to donate directly to these organizatons or make a contribution to NHF's Disaster Relief Fund.

Just like everybody who has been watching the heartbreaking images from Haiti, NHF’s board and staff have reacted with horror and sadness to the tragedy unfolding in that nation,” said J. Donald Schumacher, President & CEO. “We were so grateful that past donations to the NHF Disaster Relief Fund allowed us to respond quickly with cash to these three fine organizations. It feels good to know we are doing something tangible to help in the wake of such devastation.”

Holy Angels Hospice & Orphanage is located in Port-au-Prince. Although much of the capital city has been destroyed, their facility is still standing. Holy Angels is in dire need of financial resources to ramp up service provision. Prior to the earthquake, they focused exclusively on caring for children. With the enormous need created by the earthquake, Holy Angels plans to expand their services.

Partners in Health (PIH) is a Boston-based international health agency that has been working in Haiti for more than 20 years. PIH works to bring modern medical care to poor communities in nine countries around the world. The work of PIH has three goals: to care for patients, to alleviate the root causes of disease in their communities, and to share lessons learned around the world. Right now in Haiti, one of PIH’s main goals is to help with pain relief. PIH has deep roots and a major presence in Haiti, particularly in the Central Plateau region that sits northeast of Port-au-Prince.

The Hôpital Albert Schweitzer (HAS) is located 42 miles outside of Port-au-Prince and escaped damage, although buildings even further away from the capital city were destroyed. According to the hospital director, the 120-bed hospital went over capacity within minutes following the earthquake and the staff of 200 immediately shifted into a mass casualty protocol. With so many of the injured arriving with broken or crushed bones, the x-ray machines and operating rooms are in constant use.

Knowing that the need for assistance is both immediate and long-term, NHF will monitor the situation in Haiti and make additional donations during the long period of rebuilding.

What Does the Future Care Continuum Look Like?

Create the future care continuum for those facing the end-of-life by lending your expertise to a conference devoted to creating a seamless system of care. Serve as faculty for the National Conference on Developing the Care Continuum: Innovative Models to Meet the Unique Care Needs of Patients/Families, in Boston, MA from August 5 – 7, 2010. National experts and local providers will gather in Boston to explore best practices and innovative models and your voice is needed. Submit a proposal for a 30, 60 or 90 minute session that demonstrates significant work and achievement in meeting one or more of the conference objectives and that features innovative program models, methods, strategies and approaches to care for children, adults and seniors in the last phase of life. The Call for Proposals is open through February 8 and will not be extended.

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

Hospice Objects to MedPAC Margin Projections and Reductions

(Alexandria, VA)—The National Hospice and Palliative Care Organization today urged the Medicare Payment Advisory Commission to adjust the community’s 2010 projected profit margins from 4.6 to 2.6 percent in order to more accurately reflect hospice’s unique, mandatory program costs of volunteer and bereavement services.

The Medicare (and Medicaid) hospice benefit includes all care related to the terminal illness, as well as requires programs to provide up to 13 months of bereavement services to the families and loved ones of the beneficiary after he or she dies. In addition, the Medicare hospice benefit requires that trained volunteers provide at least 5 percent of the patient care hours. These services are mandatory as detailed in the hospice conditions of participation, and this is unique to the hospice benefit.

“While other providers also may establish volunteer programs, and perhaps the cost of those programs are considered non-reimbursable costs on the Medicare cost report, we know of no other provider that is federally required to establish and maintain a volunteer program and to track and document the cost savings achieved,“ said NHPCO Vice President of Public Policy Jonathon Keyserling. “The costs of both volunteer and bereavement services must be included in the margin computation.Any other approach would ignore the financial reality of hospice programs bearing these mandatory costs.”

MedPAC staff projected hospice margins of 4.6 percent for 2010. NHPCO contends this figure overstates the actual margin being experienced by most hospice programs.

“The MedPAC staff previously noted that they estimated bereavement costs to be about 1.5 percent. Another cost for every hospice program is the cost of administering and tracking volunteer services, but these also are not considered in margin calculations. We estimate that the cost of volunteer services would be 0.5 percent. Therefore, the “true” margins of hospice programs, providing the range of required services under Medicare, would then be 4.6 percent minus 1.5 percent minus 0.5 percent yielding a ‘real’ margin of 2.6 percent,” Keyserling said.

The 2008 MedPAC projection for hospice margins was 3.4 percent. NHPCO argues that a 4.6 percent projection for 2010 indicates, mistakenly, that hospice margins are growing.

“The discrepancy in the numbers is an indication of a change in the calculation methodology, by excluding the costs of delivering statutorily mandated services, rather than pointing to the fact that hospice margins are actually shrinking. For MedPAC to recommend countering an erroneous growth in hospice margins by reducing the annual inflationary adjustment is absurd and potentially devastating to the hospice community,” Keyserling concluded.

NHPCO is committed to working with the MedPAC staff and Commissioners to address and resolve issues, both perceived and real, within the hospice community.

“We look forward to working with MedPAC staff and Commissioners to fully explore the available data before payment reform is implemented,” said NHPCO President and CEO J. Donald Schumacher. “NHPCO is also committed to a full discussion of the costs of care and a detailed analysis of the data elements that will be necessary for comprehensive data collection.”

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Media Contact:
Michele Matthews
Manager, Public Policy Communications
Direct: 703-837-3135
mmatthews@nhpco.org

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

New Legal Guide for the Seriously Ill

Legal Guide for the Seriously Ill Written by the American Bar Association

Guide Commissioned by NHPCO and Created by American Bar Association Commission on Law and Aging

(Alexandria, Va) -- The onset of a serious illness or injury can affect much more than a person’s health. Knowing what steps to take to get one’s financial and legal affairs in order is often vitally important not only to the affected individual, but to his or her loved ones as well.

The "Legal Guide for the Seriously Ill" -- a project by the American Bar Association Commission on Law and Aging commissioned by the National Hospice and Palliative Care Organization -- was designed for both the seriously ill individual and those caring for someone who is seriously ill. The guide explains “Seven Key Steps” in a brief, clear way while offering additional tips and resources for readers looking for more detailed information and guidance.

The recently released guide addresses societal issues that have gained prominent media attention in recent years, such as paying for health care, managing health and personal decisions, and patient rights. In addition, the Legal Guide for the Seriously Ill sheds light on recent legislative and regulatory changes, such as the recently enacted American Recovery and Reinvestment Act of 2009, which provides a 35 percent subsidy of the COBRA premium for up to nine months.

“The Legal Guide for the Seriously Ill is a great resource for anyone facing a serious illness. The book provides critical tools that help readers understand their options, make informed decisions, and minimize some of the anxiety they may be feeling about their financial and legal affairs at this stage of life,” said ABA President Carolyn Lamm.

J. Donald Schumacher, president and CEO of NHPCO added, “Hospice and palliative care organizations are frequently asked for information regarding end-of-life planning and decision-making. This guide will be a tremendous resource to them as well as faith communities, caregiver organizations, aging service providers, hospitals and others who work to support people living with a serious illness.

Ellen M. Klem, staff attorney of the ABA Commission on Law and the Aging, reminded readers that the book does not give legal advice, but will “arm readers with knowledge about the options they have during this difficult time.”

The views expressed in the book have not been approved by the House of Delegates or the Board of Governors of the American Bar Association and, accordingly, should not be construed as representing the policy of the ABA.

"Legal Guide for the Seriously Ill" is available online at the Caring Connections Web site.

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With nearly 400,000 members, the American Bar Association is the largest voluntary professional membership organization in the world. As the national voice of the legal profession, the ABA works to improve the administration of justice, promotes programs that assist lawyers and judges in their work, accredits law schools, provides continuing legal education, and works to build public understanding around the world of the importance of the rule of law.

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. NHPCO's Caring Connections provides free resources and information to help people make decisions about end-of-life care and services before a crisis. Learn more at caringinfo.org or by calling the HelpLine at 1-800-658-8898.

Media Contact:
Tina Lanier, ABA
Phone:202-662-1792
tlanier@staff.abanet.org

Or:

Jon Radulovic, NHPCO
Phone: 703-837-3139
jradulovic@nhpco.org

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

NHPCO Releases Updated Resource Manual

NHPCO Releases New Hospice Volunteer Resource Manual to Support Volunteer Programs and the Nation's 550,000 Hospice Volunteers

(Alexandria, Va) – The National Hospice and Palliative Care Organization reports that more than 550,000 individuals across the nation are giving of their time and talents as trained hospice volunteers. These volunteers contribute more than 25 million hours of service annually and reach 1.5 million patients and their family caregivers every year.

These figures, part of the NHPCO report Facts & Figures: Hospice Care in America were shared at NHPCO’s recent 6^th National Conference on Volunteerism and Family Caregiving held last weekend in Orlando, Fla.

As part of the conference events, NHPCO released the newly revised edition of The Hospice Volunteer Program Resource Manual.

Hospice organizations have a responsibility to ensure that volunteers are well trained and well cared for and this manual will contribute to those efforts.

“Hospice volunteers are individuals who have stepped forward to make a difference in the lives of other people in their communities and they are vital members of the hospice and palliative care interdisciplinary team,” said J. Donald Schumacher, NHPCO president and CEO.

“The help, kindness and support that patients and families receive from hospice volunteers often profoundly changes their experience at the end of life.”

The manual has been updated to reflect the 2008 hospice Conditions of Participation—the federal requirements that all hospices must meet—and includes fresh ideas on recruitment, retention, training, volunteer manager skills development, program development, and more.

The publication includes a CD-ROM that assists managers in personalizing a volunteer program that meets the specific needs of an organization. Materials that can be adapted include competency checklists, surveys, policies and procedures, visit logs, job descriptions, training outlines, and more.

To ensure that volunteers remain an integral part of hospice care, it is federally mandated that at least five percent of patient care hours be provided by trained volunteers. Providers must track and document this carefully.

When a hospice invests in establishing a fully-functioning volunteer support program, the five percent rule becomes a guidepost, instead of burden.

“I know it costs money to run a well-coordinated volunteer program, however, on every level the benefits exceed the costs. Volunteers and their gift of service can have a huge impact on both the quality of the care your organization provides and its bottom line. A well-trained, engaged volunteer who spends time with patients and families can pick up on changes or challenges before they become crises,” noted Schumacher.

The Hospice Volunteer Program Resource Manual (item #820114) is available from the NHPCO Marketplace and may be ordered online, nhpco.org/marketplace, by phone at 1-800-646-6460, or by downloading and returning theVolunteer Manual order form.

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

Wishing You a Peaceful Holiday Season

As the year comes to a close, I would like to thank each one of you, our members, who have offered so much support to NHPCO throughout this very busy year. There have been issues, large and small, that we have had to confront together and I think we’ve risen to the challenge time and time again.

I am so proud of the spirit of collaboration that is so palpable within our community. For this willingness to work together and support one another, I am indeed grateful.

During this holiday season, I encourage you to cherish time spent with your families and loved ones. On a personal note, this holiday season will be particularly poignant for me as I prepare to welcome my first grandchild.

We care for people on a daily basis, most often during one of life’s most challenging journeys. I hope that every one of you find the same peace and kindness that you so generously provide to the people you serve. Enjoy the special gifts found in quiet moments of reflection and in unexpected acts of kindness.

On behalf of the NHPCO board of directors, our staff and our affiliate organizations, I wish you a peaceful holiday season and a happy New Year!

Don

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