Transcript Diane Jones and Kelly Schneider - Nebraska Hospice and Palliative

Nebraska Hospice-Veteran
Partnership
2007 Annual Meeting
Feb 23, 2007
Content
• Hospice-Veteran partnership Program
– Status of HVP Program
– National Collaboration
– NHPCO’s Veterans Advisory Council (VAC)
Update
• State Veterans Home Project
– State Veterans Homes Data and Demographics
– Survey, Focus Group and Interviews Findings
– Next Steps
• Resources
The HVP Map
• Established (green) HVPs
(33 states)
– Steering Committee, and
– Regular meetings and
– Activities initiated
• Emerging (orange) HVPs
(8 states)
– Leaders identified , or
– Interest expressed, or
– Planning initiated
• Pre-contemplative (pink)
(9 states)
– Little activity
Hawaii: Green
Washington, DC: Green
Alaska: Pink
There is some HVP
activity in every VISN
Strategies for Success
• Acknowledge and respect all interest
positions and cultural differences
– WIIFM factor
– Language of organization
– Rules, regulations and SOP
– Perceptions
Understanding Differences
VA
Hospice
Culture
Quasi-military Nurse-led grassroots
movement
Role
Provider and
Payer
Provider
Funding
Fixed
appropriation
and budget
Entitlement - Medicare/
Medicaid hospice benefit;
3rd party reimbursement
Accountability Congress
Governing Body, CMS,
Fiscal Intermediaries and
State
National Collaboration
• VA Field Advisory Council
– Led by Dr. Scott Shreve
– Family Satisfaction, Bereavement and State
Veterans Homes
• NHPCO National Veterans Advisory Council
– Chaired by Kandyce Powell
– Membership mirrors Hospice-Veteran Partnerships
• Council of States
– Led by Donna Bales
– Promoting Hospice-Veteran Partnerships with state
hospice organizations
Veterans Advisory Council
• Policy and Advocacy Workgroup
–
–
–
–
VA Purchased Hospice Care
VA/Medicare Hospice Benefit Interface
VA Physician - Community Hospice Interface
Hospice - Nursing Home Interface
• Access and Outreach Workgroup
– VA 101 Toolkit
– Veteran Volunteer Training Manual
– HVP Listserv ([email protected])
• Data and Outcomes Workgroup
– Veteran/military status
– Veteran-specific family satisfaction survey
VA Hospice and Palliative Care
Veterans Home Workgroup
• National web-based survey (completed)
– 58 of 119 State Home administrators and
managers responded (48%)
• Focus group (completed)
– 19 State Home administrators and managers
attended
• Interviews (ongoing)
– 15 administrators and their staff participated
State Veterans Homes
Data and Demographics
• Veteran deaths
– > 6,000 veteran deaths in State Veterans
Homes each year
– 20% average mortality rate
• Length of stay variable
– Demographics of patient population
– Eligibility criteria
– Size of facility and focus of services
SVH Web-based Survey
• Availability of HPC services
– Few SVH have designated hospice beds
– Many SVH contract with community
hospices
• What works
– Pain and symptom management
– Bereavement support to families
– Overall quality of hospice care
SVH Web-based Survey
• What could work better?
– Support to SVH staff
– Meeting unique needs of veterans
– Communication between SVH and hospice
• What are some of the challenges?
– SVH staff limited understanding of the Medicare
Hospice Benefit
– Hospice prognosis requirements and treatment
limitations
Focus Group
• Availability of HPC services
– Confirmed that more SVH contract with
community hospices than provide care directly
• What’s working
– Expertise in pain and symptom management
– Bereavement for families and SVH staff
• What could work better
– Communication and coordination
– Hospice understanding the unique needs of
veterans
– Physician to physician communication
Focus Group
• What can hospices do to help SVHs?
– Provide hospice and palliative care
education and training for SVH staff
– Know about PTSD and other unique care
needs of veterans
– Be able to navigate the systems of care
and services for veterans
• What can VA do to help SVHs?
– Good question!
Interviews
• Availability of HPC services
– Provided directly or contracts with
community hospices
– Rate of hospice referrals variable
– Triggers for hospice referrals variable
Interviews
• What works with Hospices?
– Pain and symptom management
– Immediate access to hospice services
– Consistent staff and services
– Patient, family and SVH staff benefit
– Hospice staff visibility within SVH
– Hospice is responsive to requests for
community resource information
Interviews
• What could work better?
– Lack of knowledge about veterans’ issues
– Medications (receiving, packaging)
– Communication, interaction with hospice
staff
– Patient and family education
Next Steps
• Encourage VA hospice and palliative care
staff to interface with SVH staff
– Hospice and palliative care education and
training
– Resource for consultation, information and
collaboration
• Encourage community hospices to
– Learn more about the systems of care and
services for veterans
– Learn more about veterans’ and their unique
end-of-life issues
– Communicate more effectively with SVH staff
Resources
• Hospice-Veteran Partnership Toolkit (on NHPCO’s
Veterans’ Webpage)
– www.nhpco.org/veterans
• Military History Card
– www.va.gov/oaa
• Wounded Warriors: Their Last Battle
– email [email protected]
• VA Hospice and Palliative Care
– www.va.gov/GeriatricsSHG/page.cfm?pg=65
• National Association of State Veterans Homes
– www.nasvh.org
• List of SVH Websites
– www.va.gov/statedva.htm