Illuminate
Hospice Roles and Responsibilities: Tips on Managing Care in Your Community
December 17, 2024Nearly two million Americans use hospice services every year, and the number is growing. More people, including practitioners, are seeing the value of hospice care as a way to provide comfort and support for individuals at the end of life.
These services can be provided in senior living communities, enabling residents to get the care they need without leaving their homes. Incorporating hospice on site also benefits communities in several ways, including:
• A hospice aide can help with personal care, freeing up community staff
• If available, a volunteer can come in and read to patients or simply provide companionship for an added layer of support
• Many symptoms that cause senior living residents to be sent to the hospital, such as fever, can be managed with routine level hospice care, reducing hospital visits
5 Steps to Ensuring Resident Access to Hospice in Your Community
As your community welcomes hospice into your buildings, it’s important to have a process in place for talking with residents about end-of-life care and how they can access it in your community. Here are five suggestions for these conversations.
1. Realize that talking about hospice and end of life is uncomfortable for many people, including physicians and other practitioners. It is important for residents and their families to know there is help for them when someone is nearing the end of life. However, they may not be ready to accept or address the situation. If someone makes it clear they don’t want to talk about the topic, it is appropriate and acceptable to take astep back, give them time to adjust to the situation, and come back later. At the same time, practitioners and others may not be comfortable having these sensitive conversations. Let them know it’s okay to request some training or guidance.
2. Let residents know that hospice is covered under Medicare. This care is reimbursed when a physician determines that a patient has a life-expectancy of six months or less or remains clinically appropriate. “This is a benefit that’s available for everyone who has Medicare,” said Jamie O’Neill, director of patient relations and network at Serenity Hospice Care. “However, each hospice provider has its own services, so it is important to match the organization with the resident’s needs. For instance, some offer pet therapy, which can be very important for animal lovers.”
3. Hospice isn’t mandatory. Residents can meet with a hospice nurse or other professional, who can make recommendations based on the person’s needs, interests, and preferences. They may also want to talk to other hospice service providers such as an organization’s social worker or chaplain. However, they can decline hospice services if they don’t feel ready or interested. O’Neill stressed that residents can change their mind and accept hospice care later if they want. She noted, “A resident or their family can decide to opt out. They can always check in later and say, ‘It’s been six months, and I think I need some additional support now.’”
4. Recognize that some people ‘graduate’ from hospice. Sometimes people actually improve enough to get off hospice. However, the hospice team will work with the senior living community to make sure they have everything they need to keep the resident comfortable and functioning to the highest degree possible.
5. Don’t forget about families. O’Neill said, “I always reach out to the family just to introduce myself and answer any questions. I also make sure they’re okay with us going out and doing an evaluation. I let them know they are welcome to be present if they would like to be.” She added, “If the family’s not there, we always have the nurse call them afterwards with an update on how the admission went and to make sure there are no follow up questions. The nurse also can share information such as what DME or other supplies they may be ordering.
Effective Vendor Management
When you offer outside hospice vendors to provide care to residents in your community, it’s important to understand the roles and responsibilities of each practitioner.
First and foremost, the senior living community continues to be the primary care provider with the hospice vendor delivering supplemental support. That means hospice should respect your community’s rules and collaborate with your staff to provide the best care. Your community will also want to get to know each hospice organization to optimize your working relationship, including:
• What they offer
• Who you call and how quickly they can get to your community when needed
• Their communication protocols
• How they will share documentation
• How to best address any issues that arise to prevent similar situations in the future
A community’s pharmacy provider is another vendor you’ll need to coordinate with when a resident is on hospice. Residents often take medications for issues such as pain, fever, infection, anxiety, and sleep disturbances. Many senior living communities have their own pharmacy or a preferred provider as do a number of hospice providers. Whatever the source of prescriptions, the pharmacist can help ensure the resident is getting the right medications, help prevent side effects or adverse events, address polypharmacy and medication optimization, and provide education for residents and staff alike.
Communication Is Key
Hospice can allow residents to have the quality of life and comfort they deserve when living with an incurable illness. But to best meet patient needs, communication is key. “I always describe the relationship between my senior living communities and myself as like a partnership or marriage. We are in constant communication. When we discover that someone is appropriate for hospice and we reach out to them, we also communicate with the community so they know what’s happening,” said O’Neill, “And before one of our nurses leaves the community after an admission, they will always check in with the community’s wellness director or other team leader and go over everything we put in our binder and other details.”
How and when to communicate depends to some degree on how the hospice organization and its team function. “In some of the communities I work in, I will generate an email thread with all the key players to let them when our nurse will be onsite and what is happening with the residents we’re seeing. I also send out daily and weekly aide schedules so they know who will be in their buildings and when,” said O’Neill. She added, “I always like to suggest a monthly communication meeting just to get to know key players in the communities and let them meet the hospice team. This also helps ensure that we’re not missing any possible opportunities to provide additional support emotionally, spiritually, or clinically for the residents we have on service.
”Two-way communication ensures that no one on either end is blindsided by a family calling with questions or concerns. “We want to make sure everyone is on the same page,” O’Neill offered.