Adding life to days even when

days cannot be added to lives

The Future of Hospice: Presented by Danielle Gajewski

Background

Hospice provides expert medical care, pain management, and

emotional and spiritual support. Support is provided to the
patients loved ones as well.

Hospice care is a physician directed, nurse-coordinated,

interdisciplinary team approach to patient care available 24
hours a day, seven days a week.

Do not wish to prolong life, but live as fully as possible with the
remaining time.

Hospice Care

Eligibility

must choose the hospice benefit by completing and signing an

election form

must be certified as terminally ill with a prognosis of 6 months or

less to live.

give up curative treatment

What does hospice cover?

Manages the patients pain and symptoms

Assists the patient with the emotional, psychosocial and spiritual

aspects of dying

Provides needed drugs, medical supplies, and equipment

Delivers special services

Makes short-term inpatient care available

Provides bereavement care and counseling

History of Hospice

Cicely Saunders, an Anglican nurse and social worker,

established the first hospice in 1967

The last stages of life should not be seen as defeat, but as lifes
fulfillment.

1982 Congress established the Medicare hospice benefit.

Demographics

Demographics

Demographics

Demographics

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Problems with Hospice

Hospices are infrequently and unevenly policed

All must be licensed by their states but oversight varies

Three organizations provide accreditation for hospices:

*The Joint Commission

*The Accreditation Commission for Health Care Inc. (ACHC)
*The Community Health Accreditation Program (CHAP).
Sixty percent of hospices are not accredited.

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Findings

http://projects.huffingtonpost.com/projects/hospice-inc/database

The average U.S. hospice has not undergone a full certification

inspection in more than 3.5 years

759 hospices that havent been inspected in more than 6 years

Over a recent three-year span, 55 percent of all U.S. hospices

were cited for a violation. 20 providers that were cited for more
than 70 violations each during that time.

https://data.illinois.gov/Public-Health/IDPH-HospiceDirectory/8px3-6r9b

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Hospices with the most violations

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Most Common Violations

Failure by doctor or interdisciplinary review group to update a

patient's plan of care at least every 15 days, as required.

Any type of plan of care violation, including not customizing a

course of treatment to meet the needs of a specific patient.

Failing to consult with the hospice's interdisciplinary group, which

includes a doctor, nurse and social worker, when charting a
course of care for a patient.

Failing to include a doctor affiliated with the hospice on the

interdisciplinary group.

Failing to manage or document patient pain and symptoms.

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Most Common Violations

Failing to document that a hospice's governing body or

administrator is properly managing the organization.

Failing to document or ensure hospice aides regularly check on

patients.

Failing to measure patient progress and health.

Failing to document that hospice staff are visiting patients

frequently enough, as prescribed by the plan of care.

Failing to maintain complete patient records.

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Examples of violations

Accent Hospice Care- inspectors found that medical staff failed to

intervene to protect a 78-year-old patient who said her husband
was trying to kill her. Accent failed to call law enforcement or
adult protective services.

Inspectors found that a nurse had withheld medication to treat

seizures and panic attacks because she suspected that a relative
was stealing the drugs.

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Penalties

Hospices can avoid punishment by submitting correction plans.

In the time between the violation and the follow-up visit, the
hospice can continue to care for patients.

Despite the promises of reform, some hospices are cited months

or years later for the same violations.

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Why should you care?

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Venue

State Level- Illinois

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Vehicle- Hospice Program

Licensing Act

(210 ILCS 60/6)(from Ch. 111 1/2, par. 6106)

Sec. 6.Inspections.
(a) Prior to the issuance of a license, or renewal thereof, the
Department may inspect the hospice program for compliance with the
standards established pursuant to this Act.

Each plan of correction shall include:

1)A description of the specific corrective action the hospice program is

taking, or plans to take, to abate, eliminate, or correct the violation cited
in the Notice.
2)A description of the steps that will be taken to avoid future occurrences
of the same and similar violations and the parties responsible for the
correction.
3)A specific date by which the corrective action will be completed.

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Policy Action Plan

Mandatory inspection for ALL hospices in Illinois minimum of

once every two years.

IF a hospice fails:

-They have ten days to submit a plan of correction. The

Department has 10 days to approve or deny the plan. The
Department MUST then conduct a follow up inspection.

Hospices must pay for the inspection fee.

To compare, nursing homes in Illinois are required at least every

15 months.

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Policy Champions- Senate

Pamela J. Althoff (R)

Tim Bivins (R)

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House of Representatives

Patrick J. Verschoore (D)

Carol Sente (D)

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Stakeholders- Governmental

Illinois Department of Public Health

Illinois Department of Health and Human Services

Illinois Department on Aging

Centers for Medicare & Medicaid Services

National Center on Elder Abuse

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Stakeholders- Non-governmental

Patients

Family members

Caregivers

Volunteers

Individuals in the community

Physicians

Hospice staff (nurses, administrative secretaries, director of

organization, volunteer coordinator, marketing director, chaplains,
bereavement counselors,social workers, and interns)

Hospice board members

Insurance companies

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Non-gov continued

National Hospice and Palliative Care Organization

National Association for Home Care & Hospice (NAHC)

Illinois Hospice and Palliative Care Organization

American Academy of Hospice and Palliative Medicine

The National Hospice Work Group (NHWG)

Hospice Foundation of America

The National Partnership for Hospice Innovation

Illinois Homecare and Hospice Council

Hospice Care of America

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Non-gov continued

Hospice Education Institute

American Board of Hospice and Palliative Medicine (ABHPM)

Hospice and Palliative Nurses Association

Social Work Hospice and Palliative Care Network

Home Care and Hospice Financial Managers Association (HHFMA)

Hospice Volunteer Association

American Society of Health-System Pharmacists (ASHP)

Foundation for End-of-Life Care

Childrens Hospice & Palliative Care Coalition (CHPCC)

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Non-gov continued

American Pain Society

Children's Hospice International

Growth House, Inc.

International Association for Hospice and Palliative Care

American Medical Association, Institute for Ethics

National Alliance for Hospice Access

Chicago End-of-Life Care Coalition (CECC)

Life Quality Institute

Americans for Better Care of the Dying (ABCD)

National Prison Hospice Association

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References

Adams, A. B. (1984), Dilemmas of hospice: A critical look at its problems. CA: A Cancer Journal for
Clinicians, 34:183190. doi:10.3322/canjclin.34.4.183

Althoff, P. (2012).About pamela althoff.Retrieved 2/27, 2016, from

http://www.senatoralthoff.com/About/Biography.aspx

Bivins, T. (2012).About senator bivins.Retrieved 2/28, 2016, fromhttp://

bivins.senategop.org/About/Biography.aspx

Centers for Medicare and Medicaid Services. (2013).Medicare hospice data.Retrieved 2/10,
2016, fromhttps://
www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/Medicare_Hospice_Data.html

Comprehensive hospice and palliative care.(2013). Retrieved 2/15, 2016, from

http://chpchospice.com/

Hallman, B. (2015).Hospice, inc.Retrieved 2/25, 2016, from

http://projects.huffingtonpost.com/hospice-inc

IDPH hospice directory.(2016). Retrieved 2/28, 2016, from

https://data.illinois.gov/Public-Health/IDPH-Hospice-Directory/8px3-6r9b

Illinois compiled statutes- hospice program licensing act.(2016). Retrieved 2/15, 2016, from
http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1228&ChapterID=21

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References Continued

Keating, Dan & Tan, Shelly. (2014).Consumer guide to hospice.Retrieved

2/23, 2016, from
http://www.washingtonpost.com/wp-srv/special/business/hospice-quality/

National Hospice and Palliative Care Organization. (2015).History of hospice

care.Retrieved 2/20, 2016, fromhttp://www.nhpco.org/history-hospice-care

Ortman, J., Velkoff, V., & Hogan, H. (2014). An aging nation: The older
population in the united states.

Rep. patrick J. verschoore.(2015). Retrieved 2/19, 2016, fromhttp://

www.housedem.state.il.us/members/verschoorep/

Sente, C. (2015).About carol.Retrieved 2/10, 2016, from

http://www.repsente.com/

Will ferrell.(2015). Retrieved 2/18, 2016, from

http://www.troll.me/2013/08/02/will-ferrell-ricky-bobby/did-you-know-98-of-uswill-die-at-some-point-in-our-lives/

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