1.

Executive Summary
Hospice of Michigan (HOM) provides Open Access to patients, their caregivers, and
families. Hospice patients typically have six months or less to live. Our Open Access
program provides end-of-life care to patients with terminal illness who: (1) do not qualify
for Medicaid, Medicare, or are without private insurance, and (2) whose diagnoses are
considered to be too costly to manage.
The Hospice of Michigan Open Access program allows us to serve the chronically ill and
their families regardless of their age, diagnosis, or ability to pay. Open Access services
include Charity Care, Quality of Life, and Grief Support. Hence, Open Access emphasizes
compassion at its corefor patients, their families, and caregivers during one of the most
difficult times in their lives.
With funding from Federal Mogul, HOM will be able to continue providing Open Access
hospice and palliative care to patients and their families. Hospice of Michigan projects
costs of approximately $1 million that the organization will absorbbeyond
reimbursements from Medicare, Medicaid, and insurance companiesin support of Open
Access patients in 2015.

2. Purpose of the Grant

Goal of the Program
For 35 years, our goal has remained unchanged: We will continue to provide hospice
services for everyone in our communities who needs and seeks our care irrespective of
their age, diagnosis, or ability to pay. The mission of Hospice of Michigan (HOM) is to
ensure quality-of-life, comfort and peace for patients, and to provide support for their
loved ones during their end-of-life experience. HOM strives to develop innovations for endof-life care and serve as a role model in hospice and palliative care.

Needs Statement
Today, the health care system is facing challenges due to an aging population, an
increasing number of people facing economic challenges, and a lack of coordination to
meet these demands. In its most recent report, the Institute of Medicine of the National
Academies focus on our increasingly burdened healthcare system, which effectively
hampers care delivery at the end-of-life stage.1 These burdens include barriers in access
to care that disadvantage certain groups; a mismatch between the services patients and
families need and the services they can obtain; and inadequate numbers of palliative care
specialists and too little palliative care knowledge among other clinicians who care for
individuals with serious advanced illness. 2
In response, there have been various
governmental agencies, interest groups, and end-of-life care organizations (such as
Hospice of Michigan) advocating not only for greater efficiency but also greater
effectiveness in service delivery in order to meet these challenges. At Hospice of
Michigan, we actively scan and analyze the unique needs and challenges in our

1 Institute of Medicine (2014). Dying in America: Improving Quality and Honoring Individual
Preferences Near the End of Life. Institute of Medicine. Washington, D.C.: The National Academics
Press. Report Brief, p 2.
2 Ibid.

environment, in order to develop best practicesensuring that our patients,

caregivers, and families receive superior care.
In their 2014 Facts and Figures publication, The National Hospice and Palliative Care
Organization reported a steady increase in the number of hospice patients, from 1.34
million patients in 2009 to 1.54 million patients in 2013. 3 This 15% increase for the
time period is significant in that it suggests a rapid rise in the number of patients
seeking hospice services. Although many patients qualify for Medicare, Medicaid, or
private insurance, many will also be in need of charity care, grief support, and qualityof-life assistance (i.e., Open Access).
Furthermore, patients continue to migrate away from the inpatient hospice care
model, choosing instead to receive care at their place of residencewhether it be a
nursing home, residential facility, or (primarily) at home. 4 Hospice of Michigan
forecasted this trend 15 years ago, thereby enabling the organization to send
specialized clinicians to patients wherever they call home, and to deploy essential
resources towards the hiring of Physicians, RNs, Social Workers, Hospice Aides,
Spiritual Care Advisors at the bedside, along with telephone support provided by RNs.
Through the hospice program, HOM's Open Access funds provide services for
individuals with terminal illnesses who require complex or costly care to live their final
months and days in comfort and dignitypatients for whom many other hospices in
Michigan cannot afford to provide comprehensive care. Over the past two decades,
there has been a significant increase in the number of patients and families choosing
hospice care. Yet as hospice care becomes more widely used, the hospice
reimbursement structure continues to fall short.

Many of our patients have no income, other than social security, pension,
and/or disability insurance, which may support their cost of living but
cannot cover medication and equipment expenses necessary to provide
patient comfort. Furthermore, Open Access ensures that care is provided
for individuals who do not qualify for Medicare or Medicaid, do not have
private insurance, or are underinsured. It is the mission of HOM to
provide comprehensive end-of-life palliative care for patients and their
families despite their inability to pay.
Program Description

Open Access enables Hospice of Michigan to provide services that are not reimbursed
such as Charity Care, Quality-of-Life, and Grief Support, as well as costs for
medications, equipment, and supplies that are needed to provide comfort to patients.
Open Access funds are used to serve individuals with terminal illnesses who require
complex or costly care to live their final months and days in comfort and dignity
primarily at the patients place of residence.
Hospice of Michigan is dedicated to enhancing the quality-of-life of those who are
living with a life-threatening illness and to providing grief support for their families. By
providing medical, emotional and spiritual care to terminally ill men, women, and

3 NHPCO (2014). Facts and Figures: Hospice Care in America. Alexandria, VA: National Hospice
and Palliative Care Organization. Print, p. 4.
4 Ibid, p. 6.
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children, Hospice of Michigan assists patients in achieving an optimal level of comfort,

dignity, and independence at the end of life. Hospice is care that seeks to comfort
rather than cure. Hospice of Michigan interdisciplinary teams include a physician,
regional nurse, social worker, hospice aide, counselors, spiritual care advisor and
volunteer depending upon the needs of the patient and family.
The care team develops an individual plan of
care for each hospice patient. Pain control is a
major goal of hospice care. Decreased pain
leads to easier breathing, better sleep, reduced
anxiety, and increased interest in life. The
hospice team manages that pain with various
medications, and they are always available to
assure comfort.
Un-Reimbursed Services
Un-reimbursed services that Hospice of
Michigan provides include charity care, grief
support services, and funds for quality-of-life.
Under-Reimbursed Services
Under-reimbursed
services
include
direct
patient care, medication, durable medical
equipment and supplies provided for a patient
with health care coverage which the Hospice
of Michigan care team includes in the patient's
care plan to ensure quality-of-life and comfort
but the insurer declines to cover. Nevertheless,
Hospice of Michigan provides services for
patients who require treatments and testing
procedures that are often not reimbursed (such
as dialysis, chemotherapy, radiation, CAT scans,
MRIs, transfusions, high-cost medications).

Program Timeline
= Ongoing
TIMELINE FOR OPEN
Activities
ACCESS FY 2015
Major Project
1st
2nd
3rd
4th
Components
Qtr.
Qtr.
Qtr.
Qtr.
Patient Admissions
Individualized Plan of
Care Consultations
Personalized Care
Recommendations for
Patients
Emotional and
Spiritual Support for
Patients, Caregivers,
and Family Members
Evaluation of Services
Staff Development and

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Hospice of Michigan
Provides
1. Individualized plan of care:
consultation, personalized
care recommendation.
2. Physical support: pain
management, symptom
control, personal care.
3. Emotional and spiritual
support: helping patients and
families cope.
4. Grief support: helping
families, friends and
community members cope
with loss.
5. Volunteer services:
providing respite care, doing
chores, listening.
6. Open access: helping all
terminally ill patients,
regardless of diagnosis and
ability to pay.

Education

Open Access Program Staff and Qualifications

Hospice of Michigan has a staff of 534 employees. Our Physicians, Registered Nurses,
Social Workers, Hospice Aides, and Spiritual Care Advisors work in interdisciplinary
teams throughout 57 counties in Michigans Lower Peninsula.
Michael Paletta, MD, FAAHPM
Vice President, Medical Affairs and Executive Director, Hospice of Michigan Institute
As Vice President of Medical Affairs, Dr. Paletta oversees 10 physicians across the state
delivering care to more than 1,400 patients each day. Dr. Paletta also guides policies
and protocols related to patient care. Since joining Hospice of Michigan in 1997, he has
seen the dramatic shift in acceptance of hospice and palliative care by patients facing
life-limiting illness, and the increase of services available to them.
In his role as Executive Director of the Hospice of Michigan Institute, Dr. Paletta leads a
team of researchers and educators developing programs that enhance care for
patients and families at this important time of life. Through the use of state-of-the-art
technology, the Institute has helped the Hospice of Michigan clinical staff increase the
time available to spend with patients and families. Dr. Paletta has led initiatives
related to the education of medical professionals on the importance of hospice and
palliative care, and raised awareness among legislators and the public on the benefits
of hospice care.

Community Support

Generous individual, corporate, and foundation donors have enthusiastically embraced

Hospice of Michigans ability to provide specialized services without regard for ability
to pay. HOM's Open Access programwhile financially challenging to the organization
greatly impacts uninsured or underinsured patients and their families during this
most difficult time in their lives.

3. Program Evaluation
Evaluation Plan

Hospice of Michigan (HOM) places great emphasis on program effectiveness and

performance to ensure quality, competent care to patients and families. Hospice of
Michigan is unique in that, unlike almost all other hospices in Michigan, the
organization has its own Organizational Quality and Service Excellence Division. This
department solicits feedback from surveys taken by patients and families at intervals
throughout care and after the patient's death. The Division also evaluates the care
plans and assessment notes of all patients on a regular basis and evaluates the
success of HOM's services through other internal protocols set by the Division.
Patient and family surveys include the National Hospice and Palliative Care
Organization's (NHPCO) Family Evaluation of Hospice Care (FEHC) survey. The FEHC is
a post-death survey designed to yield information that reflects the quality of hospice
care delivery from the perspective of family caregivers. HOM submits FEHC data to the
NHPCO and receives quarterly reports, which include HOM's individual results and
comparative state and national results.
In addition, performance is assessed regularly with regard to HOM's Strategic
Operation Plan which includes improving performance related to mission outreach,

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resource stewardship, teamwork, quality service, and sacred space. HOM is proud of
its success and will continue to serve all patients who need and seek our care.

The success of our programs can be measured in part by the results of

our FEHC survey responses from the 4th quarter of 2014, which include
the following:

90.7% of family respondents indicated that the patient received enough support
dealing with their feelings of anxiety or sadness.
90.4% of respondents indicated that the medicine received for the patient's pain was
the right amount.
94.6% of family respondents said that emotional support was provided to the family
prior to the patient's death; and 90.7% said that emotional support was provided after
the patients death.

Family members are also asked to provide additional comments in

regards to the care they received. Here is a sample of comments
received in 2014:

I could not have continued to care for my husband at home without the help of
Hospice of Michigan. He was put in a nursing home for only the last five days of his
life.
This was such a hard time for us and Hospice made this experience as smooth as
possible. They were all so caring and informative. The staff that answered the phones
were always thorough and compassionate. Thank you, thank you. We still meet with
Jackie and she is helping us through this time since our daughters death.
Your sensitivity to the needs of survivors was also very good.
We cannot express enough the gratitude we have to Hospice of Michigan. When we
were told that our dad was terminal with cancer we were all devastated. Our dad was a
man that never asked for anything and always did for himself, so when I asked him if I
could contact Hospice of Michigan it was hard for him to accept, but he finally agreed.
After the call was made Hospice of Michigan was there immediately. We were amazed
at the quick response that we received. They saw to it that all his needs that we felt
were necessary were met. We just couldn't believe how fast things were taken care of
and Dad kept saying, "You people are so good to me" and tears would come to his
eyes. We were lucky that Dad did not suffer a long, painful death, but when we had a
question or if we needed something Hospice was there. So we just wanted you all to
know how grateful we are to Hospice of Michigan.

4. Budget Narrative and Justification

While some HOM patients receive their care through Open Access, others may utilize
Open Access funds for only a portion of their care that is not reimbursed, such as
prescriptions, procedures, and comfort items.

Hospice of Michigan Open Access Budget

SummaryFY 2015
Charity Care
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$268,000

Grief Support

$734,000

Quality-of-Life Funds

$43,757

Total Open Access

$1,045,757

Definitions
Charity Care is a service for patients without any health care coverage or those who
have partial coverage but may need services, medication, or equipment that their
insurer declines to provide. When an individual has no health care coverage available,
support from generous community partners enables us to provide the medical and
support services the patient needs in order to have dignity and comfort at the end of
life.

Grief Support is an un-reimbursed service that is vital to the program and helps
individuals and families to grieve effectively. Services include individual and group
counseling, memorial services, follow-up contacts, and educational programs and
materials. These services are available free of charge to anyone in our communities.
Hospice of Michigan believes that our organization must serve everyone in our
communities who needs bereavement care -- whether or not they have had a loved
one as our patient.

Quality-of-Life funds provide patients with basic assistance such as comfort items
and utility bills, are another unreimbursed service which HOM offers patients. Typically
these expenses are related to their terminal diagnosis while receiving hospice care.
Many times, it is as simple as a fan to cool a patient during the warm summer months
or liquid nutrition supplements for a patient who is unable to chew or swallow food.

5. Organizational Information
Hospice of Michigan (HOM) is an independent, statewide, nonprofit hospice program
serving urban, suburban, and rural communities in 57 counties. For more than 35
years, Hospice of Michigan has been helping patients, families, and loved ones find
comfort, dignity and hope in the final chapter of life.
Hospice of Michigan utilizes a unique team-based approach in delivery of hospice care
to achieve an optimal level of comfort, dignity, and independence during the final
chapter of a patients life. Each team includes hospice professionals who specialize in
providing end-of-life palliative care. The care teams include medical directors (MD),
clinicians (RN), social worker grief support counselors (MSW), hospice aides, spiritual
care counselors, and hospice volunteers. Hospice medical clinicians are trained to
diagnose and provide advanced illness patients with pain management and symptom
relief. Social workers provide patients and their families with grief support and
counseling. Hospice Aides and volunteers assist patients with hygiene, feeding, and
invaluable companionship. Interdisciplinary Clinical Teams meet weekly to discuss
patient updates, status, and treatment plans.

Mission and Goals

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The mission of Hospice of Michigan is to ensure quality-of-life, comfort and peace for
patients and to provide support for their loved ones during their end-of-life experience.
HOM serves everyone in Michigan who needs and seeks care, regardless of diagnosis
or ability to pay. HOM strives to develop innovations for end-of-life care and serve as a
role model in hospice and palliative care.

Hospice of Michigan Is Different from Other Hospices

The hospice industry is comprised of private for-profit and non-profit care providers,
which differ in their philosophies towards patient care. In Michigan there are
approximately 150 hospices some of which are part of for-profit national chains that
are traded on the New York Stock Exchange.
The non-profit versus for-profit organizational distinction indicates a fundamental
difference in the priorities of hospice providers. For-profit hospices tend to prioritize
profit and returns to shareholders, whereas non-profits such as HOM prioritize quality
care for patients, family members, and loved ones, using resources to enhance
services.
Our nonprofit counterparts are newer and have less experience in the industry. They
exist as part of hospitals, nursing homes, and home health care agencies where
hospice may be a continuation of existing care. HOM (founded in 1980) is one of the
only non-profits that is free-standing and provides hospice and advanced illness
management services exclusively. We continue to distinguish ourselves by our active
commitment to our community and patients, caregivers, and family members by:
Raising awareness regarding end-of-life care issues;
Providing education to community members and health care professionals;
Advocating for patient and caregiver rights;
Working to impact legislation to improve care of the dying;
Negotiating for fair reimbursement and to manage lower health care costs;
Conducting research projects to advance the field of end-of-life care;
Offering special programs to underserved and disenfranchised populations;
Providing leadership to other organizations.

Collaborative Partners

Since July 2005, Hospice of Michigan has partnered with Wayne State University (WSU)
School of Medicine, the John D. Dingell Veterans Administration Medical Center (VAMC)
and the Detroit Medical Center (DMC) to conduct a training program for physicians in
hospice and palliative medicine. Hospice of Michigan has also collaborated with
Michigan State University College of Human Medicine in a similar Physician Fellowship
Program. These collaborations give every participating Physician Fellow a unique
comprehensive, community-based hospice and palliative care experience.

Exemplary Programs and Accomplishments

An industry leader at the local, state and national levels, Hospice of Michigan impacts
the hospice industry in significant ways. In the 1980s, HOM helped write regulations
that led to federal government coverage of hospice care. In the 1990s, HOM helped
carry out research programs that demonstrated hospice's cost-effectiveness and
benefits to family caregivers. Now, HOM is developing programs that will set the
standards for hospice care in the 21st Century. Following are a few examples:
The At HOMe Support Program
Hospice of Michigans At Home Support is an Advanced Illness Management
program designed to provide assistance for chronically ill patients and their

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family caregivers. Through At Home Support, patients and families receive all
supportive care services available in traditional hospice home care without the
requirement that patients discontinue active treatment.
The At Home Support program is a unique delivery model that is neither home
care nor hospice, but rather a home-based delivery model with an Advanced
Illness Management (AIM) focus. AIM strategies for patients and families provide
24/7 accessibility to staff, education and counseling for management of
advancing illness. Services are primarily delivered in the home by an
interdisciplinary team of registered nurses, social workers, and patient-family
assistants in collaboration with the patients primary care physician.

Research and Education Conducted within the Hospice of Michigan

Institute
Due to the generosity of philanthropist Maggie Allesee, Hospice of Michigan
established the Maggie Allesee Center for Innovation a nucleus for research,
education, quality improvement, and community outreach.
Through the Center, HOM educates physicians in hospice and palliative care
through the fellowship program, as well as, provides ongoing training in
palliative care for nurses, social workers, spiritual and bereavement counselors.
HOM has implemented new initiatives to support doctors, nurses, and hospice
aides to become certified in Hospice and Palliative Medicine.
The Center is the hub for initiatives aimed at improving care for people who are
terminally ill and providing support for their caregivers and families. The Center
also studies quality-of-life issues faced by older people, identifies ways they can
live fully, and educates them on how to plan for their own end-of-life care. HOM
offers programs to educate and empower the public to make advanced choices
about what kind of care they would like to receive.
Hospice of Michigans Pediatric Programs
Hospice of Michigan provides three unique programs focused on pediatric care.
This includes a Prenatal Program offering medical, emotional and spiritual
support to families anticipating life-threatening conditions for their unborn child.
HOM also supports a Pediatric Early Care (PEC) Program, which provides a range
of services to children and their families from infancy to age 21. This program
enables the family to continue to pursue curative treatment options while
receiving the support of our social workers. Finally, the Pediatric Hospice
Program provides care to children and comfort for families whose children are
facing end of life. HOM helps families make the best decisions for their children
when a cure is unlikely.
Leadership
Our organization works on a state and national level to develop standards and
common practices for the industry and to establish best practices for end-of-life
care. Many of our board members and administrators participate in state and
national government bodies within the industry. HOM currently has board
members, administrators, and directors who participate and provide leadership
in the following organizations:
The National Hospice Work Group (NHWG), including many specific forums
Michigan Hospice and Palliative Care Organization (MHPCO)

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 National Hospice and Palliative Care Organization (NHPCO)

The American Academy of Hospice and Palliative Medicine (AAHPM).
HOM is the only hospice in Michigan that is a member of the National Hospice
Work Group (NHWG)a professional coalition from some of the nations largest
and most innovative hospices. NHWG is committed to increasing access and
developing best practices for hospice and palliative care.

Accreditation
Hospice of Michigan is accredited by the Accreditation Commission for Health
Care (ACHC). ACHC currently accredits more than 300 hospice locations across
the U.S. and has held recognition by The Centers for Medicare and Medicaid
Services (CMS) as a national accrediting organization for its hospice program
since 2009. As an established industry leader in hospice accreditation, ACHC
has developed a unique consultative approach that focuses on patient care.
Accreditation by this organization recognizes that Hospice of Michigan meets
the shared goal of high quality and consumer-driven health care.
Choosing the right hospice to provide care for a loved one can be a very difficult
decision for any family. By choosing a provider that has achieved accreditation,
patients and caregivers can take comfort in knowing that it has demonstrated
its commitment to meeting rigorous national standards for quality and safety as
well as providing an exceptional level of care. ACHC offers nationally-recognized
accreditation services for hospice organizations that wish to participate in the
Medicare or Medicaid programs. The comprehensive set of accreditation
standards are written by industry experts to meet or exceed Medicare
Conditions of Participation as well as align with industry best practices.

6. Request for Support and Recognition

Hospice of Michigan respectfully requests $2,500 in support of Open Access in the fivecounty Federal Mogul area. In return for your generous contribution, Hospice of
Michigan will recognize Federal Mogul through HOM publications (such as our
Connections newsletter that is mailed twice annually to 16,000 individuals) and on
our website.
Hospice of Michigan respectfully requests your support to help offset these ongoing
expenses for the uninsured and underinsured patients in our Michigan communities.

7. Proposal Attachments
A. HOM IRS Determination Letter

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B. 2015 HOM Operating Budget

C. 2013 Consolidated Financial Statement
D. 2013 HOM Annual Report
E. 2012 HOM Institute Annual Report

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