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Fill gaps in care: Partner with nonmedical agency
Look for one that has same goals, provides education
Hospice managers admit that the most reliable referral network is comprised of relationships developed with other providers in the community who can recommend hospice to appropriate patients. For this reason, hospices frequently develop relationships with hospitals, physician practices, home health agencies, and nursing homes.
Another ideal partnership that many hospices have discovered is with nonmedical caregiver agencies in the community.
"Frequently, our patients and families need care at a higher level than we can provide under Medicare rules, so we partner with a nonmedical caregiving agency that can provide staff support to the family," says Deborah Eby, executive director of VistaCare, a hospice in Reno, NV. "We chose to develop specific partnerships, so we are comfortable recommending another agency," she says.
A partnership, rather than just offering families a list of local nonmedical agencies, gives hospice managers an opportunity to make sure the nonmedical agency's philosophies and goals are in sync with the hospice's philosophies and goals, she explains. "We know the quality of care provided by the other agency, and we can educate the other staff about the differences in caring for a hospice patient compared to nonhospice patients," Eby says. Those differences include dealing with the emotional needs of patients and families, as well as the side effects of pain medications that hospice patients may take, she explains. "We are also able to develop a way to communicate between the two staffs so that our nurses and their aides stay up-to-date on the patient's condition," she adds.
Education is important, even for the manager of the nonmedical agency, admits Laurie Hamilton, franchise owner of Home Instead Senior Care in Harrisburg, PA. "I had always assumed that hospice volunteers stayed with families all day long, so I was surprised to learn that was not the case," she says. "Being able to offer nonmedical caregiver support at times when the hospice staff and volunteers were not present made partnerships between my agency and local hospices a perfect fit."
The nonmedical agency manager and staff do have to commit to additional training to care for hospice patients, points out Hamilton. "My staff members who provide care to hospice patients have learned how to care for a patient as he or she declines," she says. "They have also learned how to interact with the family and how to enhance the services provided by the hospice nurse and staff."
A nonmedical agency can enhance services to the family by providing extra support with the patient's personal needs, says Eby. "If my nursing staff believe that extra support is needed, the social worker visits the family to determine what level of support is needed and what financial resources they have," she says. If the family can pay for private care, the social worker refers them to nonmedical agencies with which the hospice partners. "The ultimate decision of who is hired is the family's decision, but we recommend agencies that we know and have worked with in the past because we trust their level of care," Eby adds.
Hamilton's entire staff, even those members who do not work with hospice patients, have learned enough about hospice care to be able to identify patients for whom they provide care who might be appropriate for hospice care. "When one of their long-time clients begins to deteriorate, the aides tell me about their concern, and I contact the family to offer to set up a meeting with a hospice representative," Hamilton says. If the hospice representative determines that the patient is medically appropriate for hospice care, he or she initiates the admission process and obtains physician approval.
Having a good partnership
A good partnership does require getting to know each other, says Eby. "You have to make sure that you can develop and maintain a good relationship that will enable you to work together to solve problems you may encounter with patients, families, and staff members," she says. "In addition to staff training sessions, we work with the agency to develop a method of communication between the two staffs," Eby says. The method depends on the individual agency, but the most common is a communication binder in which staff members from each agency write notes about the patient's condition, she says. The binder is kept in a central location such as the patient's room or the kitchen, she adds. A nonmedical aide might write a note about the patient's appetite, mental status, or activity level.
"We do define issues that require a call to the nurse as opposed to a note in the book," Eby says. "If a patient is constipated but the hospice nurse is not scheduled to visit for four more days, we instruct the aide to call the nurse rather than write a note, because constipation needs to be treated sooner than the nurse is scheduled to see the patient," she explains. Significantly altered mental status and increase in pain are other reasons to make a call, she adds.
Eby's hospice has partnered with a nonmedical agency for two years, and she is glad that she spent the time and effort to develop the partnership and provide the education to the other agency's staff. "This extra help has made a big difference for the families involved, because they can just spend time with their loved one rather than focusing only on providing care," she says. "For me, it's all about meeting the goals of the family; and, for some families, using a nonmedical caregiver is the way to meet their goals."
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