Hospice/Nursing Home Interface

Guidelines for Care Coordination for Hospice Patients Who Reside in Nursing Homes

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SECTION V - GUIDELINES FOR INSERVICE /
EDUCATION PLANNING

Clear communication of the basic components of the contract, the policies and protocols that guide care coordination, and understanding the key regulations that govern both providers is essential for a successful nursing home/hospice partnership.  Achieving quality outcomes for patients and their families should be the focus of all staff efforts.

Assuring effective participation by all levels of staff requires careful planning of the initial orientation following the establishment of a contract.  Ongoing educational efforts aimed at improving the efficiency and understanding of experienced and new staff is also essential.

Suggested content for these educational efforts are separated into "Initial Orientation" and "Ongoing Education."

Introducing the hospice concept to nursing home staff may be most effectively accomplished by using an interdisciplinary approach.  Representation from each of the core disciplines is ideal to establish trusting relationships and encourage professional interaction.  Recommendations for inclusion in the initial orientation process are listed below.

Note: It may be useful to group the topic areas according to individual roles of Nursing Home staff (i.e., meeting with business office and clerical staff separately from direct patient care staff to allow for questions and discussion specific to the expertise of the group).

• Discussion of hospice concept and philosophy, including patient’s entitlement.

• Informed consent and corresponding expectations/ accountabilities.

• Services available - delineation of benefits.

• Introduction of core team members/roles.

• Terminology - definition of terms as specified in the contract.

• How/when to notify hospice.

• On call availability.

• Discussion of mutual roles and responsibilities as outlined in the contract.

• Communication and collaboration relating to care planning, ongoing patient needs, family support and record maintenance.

  • Symptom management practices common for hospice patients.

  • Securing and processing of physician orders (including utilization of standing orders, if applicable).

  • Reimbursement scenarios.

  • Bereavement services available.

  • Location of resource materials such as a hospice manual with accompanying quick references.

  • DME, disposable supplies, oxygen, and ancillary services to be supplied by the hospice.

  • Provision of pharmacy services.

  • Clarifying the role of the hospice team in the nursing home needs to be balanced by a corresponding effort to educate hospice staff on the regulations and protocols of the nursing home.  Information to be included in this effort might include the following:

    • Tour of the facility, with introductions of key personnel, location of records, security system operation, and any information specific to the physical layout and daily routine.

    • Discussion of Resident Rights.

    • Life Safety Code, including fire/emergency procedures, exits, etc.

    • Key terminology - definition of terms, including terms specified in the contract.

    • Comprehensive assessment process and requirements.

    • Care planning process, including conferences, family involvement, etc.

    • Record keeping practices.

    • Infection control issues, especially including biohazard waste disposal, location of personal protective equipment and blood spill clean-up kit, etc.

    • Chemical/Physical restraints.

    • Medication management, including regulations governing use of psychotropic, "unnecessary medications", self-medication, etc.

    • Patient level of care reimbursement scenarios.

    • Pertinent facility policies (i.e., CPR, hydration, RN coverage, any policies that explore ethical issues).

Many hospices provide updates for their contracted nursing homes to review practical issues related to mutual roles and responsibilities.  This provides an opportunity for dialogue, problem solving, feedback, and recognition of the cooperative relationships and the impact this collaboration has on quality care for patient.  Suggested topics to include in these periodic updates.

• Pain control and other symptom management protocols commonly used for hospice patients.

• Loss, grief and bereavement care.

• Quality assurance/performance improvement study results and recommendations.

• Practical issues related to communication with physicians, management of orders, etc.

• Care plan coordination processes.

• Volunteer involvement and utilization.

• Review and discuss mutual roles and responsibilities as appropriate.

Some hospices hold regular conferences in the nursing home on a prearranged schedule to communicate patient related issues. . Others conduct occasional IDG meetings in the nursing home and encourage nursing home staff participation.

These suggestions, as well as the guidelines for initial orientation, are not intended to be all-inclusive.  Creative approaches that foster improved understanding and communication between the nursing home and hospice providers are encouraged.  The use of various "mediums" is helpful to have available in the nursing home for staff who are unable to attend scheduled inservices.  These might include audio/video tapes, self-learning modules, quick reference materials, and a manual containing pertinent hospice protocols/policies.

SECTION VI - CONCLUSION AND ACKNOWLEDGMENTS

These guidelines were developed for the purpose of promoting access to quality hospice care for eligible nursing home residents throughout Wisconsin.

The second edition is issued to offer updated guidelines that:

• Clarify contract considerations,

• Promote hospice care in the nursing home setting,

• Encourage constancy with the requirements that govern patient care as set forth in HFS 131, HFS 132, and federal regulations for hospices and nursing homes.

The measure of success for this collective effort is the question of access.  It is hoped that access to hospice care for nursing home residents may be protected and expanded through diligent efforts to maintain clear communication while striving to meet the unique needs of patients and their families. Collaboration is the key.

The contributions of the numerous individuals who have participated are gratefully acknowledged.  The shared commitment of the statewide nursing home and hospice providers has set the tone for continued success in this collaborative process.