Meeting minutes and supporting documents for the Nathan Adelson Board of Directors meeting, February 27, 1979

MINUTES MEETING OF THE NATHAN ADELSON MEMORIAL HOSPICE BOARD OF DIRECTORS DATE: CALL TO ORDER: ATTENDING: February 27, 1979 4:00 P.M. Members of the Board of Directors: Merv Adelson Pearl Adelson A1 Benedict Eli Boyer David Brandsness Irwin Buchalter Anthony J. Carter, M.D. Thalia Dondero Charles Kilduff, M.D. Committee Co-Chairmen, Guests and Staff: Irwin Molasky Susan Molasky Owen Peck, M.D. Allard Roen Muriel Stevens Ken Sullivan E. Parry Thomas Richard Thomas Gail Adelson Sharon Brandsness Judy Denny Dr. Ted Koff Ernest Libman Marydean Martin Willis Russell, M.D. Jerry Trenberth Chris Broderick, Review-Journal CHAIRMAN'S REMARKS: Irwin Molasky thanked those in attendance, briefly reviewing the importance of the hospice movement. He emphasized that the hospice goal is to provide the dying patient with every opportunity to live as full a life as possible. Each person in attendance was introduced. COMMITTEE REPORTS: Program Development Committee. Dr. Willis Russell and Eli Boyer highlighted the activities of the Program Development Committee. Dr. Russell distributed a written report (see attached) which succinctly outlined the program issues that had been resolved. 1. The hospice will contract to use the established home health agencies, including Sunrise Hospital's and the Clark County Health Department. The Committee had reached this conclusion after care-ful consideration, recognizing that there may be some disadvantages. There must be no misunder-standing of the fact that once the patient has Page 2 entered the Nathan Adelson Hospice system, that system is fully responsible for every rspect of care identified with the hospice progrc . Home health is an imperative aspect of care. By reaching the decision to provide home health care visits through arrangement and contract with existing home health agencies, we are presuming the ability of the hospice staff to guarantee the quality and standard of care and that continuity will be possible and assured. The two home health programs in existence are understandably not now in a position to render the level of hospice care expected. Both programs are unquestionably well run; neither, however, is adapted to the special needs and requirements of the hospice patient. The County, recognizing this fact, is already taking steps to build in the capacity for hospice care as has Sunrise Hospital. The decision of contract for home health services is predicated on the value of avoiding duplication of existing resources and broadening the referral base of the hospice program. The wisdom of this determination will have to be continually assessed in the light of performance. The hospice will have to be prepared to provide direct home health services at any point that it is apparent that a cooperative arrangement limits the ability to serve the patient. The members of the Board of Directors expressed concern that this approach of contracting would not be workable. Problems of coordination would be recurring. Dr. Kilduff pointed out that hospice patients would be such a small part of the home health programs' total patient load that they would not receive the level of attention and interest expected. Dr. Russell and Dr. Koff pointed out that both programs had to be viewed in terms of the changes that would occur in anticipation of accepting hospice patients; that is, adding new staff with the special interest and credentials required. Again,,it was emphasized that the Nathan Adelson Hospice would be responsible and that our staff would have to continually monitor the process. In fact, the hospice staff would expect to be involved in the recruitment of the hospice person-nel to the associated with either home health program. 2. Volunteer screening and recruitment program will be initiated. The success of the volunteer program will depend upon the most careful screening of interested applicants to assure their suitability. 3. Hospice care will be available to individuals other than those dying due to cancer and the admission criteria will be to accept those patients with a probable life expectancy of less than six months. Page 3 4 The hospice should begin with construction of a 20- bed unit with the immediate capacity to add an addit-ional 20 beds. Site selection and design should anticipate the opportunity for expansion for an additional 40 beds. 5. The question of the mix and number of beds per unit has not been resolved. However, it has been determined that private suites must be available and that all units are to be designed to facilitate ease of visiting by family and friends. 6. If it is assumed the hospice will not be in the immediate vicinity of Sunrise Hospital, with whatever educational areas are available, then the hospice must be built to include adequate educational areas. In making this deter-mination, the Committee believes that legitimate demands will be made to use the hospice as an important educa-tional experience for the professionals and the general public. This assumption initiated a good deal of discussion. A number of board members have been under the impression that it was at least desirable, if not necessary, to place the hospice immediately adjacent to the hospital. They felt that this would allow avoiding duplication of essential services and assure that the patient had quick access to life-supporting systems. Dr. Russell and others pointed out that the advantages of close location were almost non-existent if the patient had to be transported by vehicle. Once in a vehicle, immediate access was frankly not that imperative. As far as avoiding dupli-cation is concerned, the hospice patient would neither benefit from nor need the extensive technology associated with an acute hospital. Correspondingly, it was pointed out that by the hospice not being too close to the hospi-tal, it would be easier to emphasize its unique and important differences from the traditional hospital environ-ment. There also seemed to the Committee to be apparent practical reasons to think in terms of locations other than those immediately surrounding the hospital; fore-most being land availability, congestion and the desira-bility of avoiding intense commercial activity. In the discussion of location, Ken Sullivan proposed that serious consideration be given to the University area. It seemed the program described and the nature of hospice as an important educational resource would make such a location ideal. Dr. Russell and Dr. Koff answered a number of general questions dealing with the hospice program. Eli Boyer pointed out that as this program takes shape, he will then be in a position to be helpful in providing essential capital and operating projections. By mid- March, he should be able to begin working on the preparation of a financial feasibility report. Page 4 Architectural, Design and Site Selection Committee. Sharon Brandsness indicated that she and tf other Committee'Co-Chairmen have been in contact to begin preliminary discussions of site selection. Their final recommendations, of course, depend upon a thorough understanding of the hospice program which is under development. However, in anticipation of certain of the apparent conclusions, a number of working assumptions were possible. She then described an image of the hospice from the premise of a facility that would be totally non-institutional, emphasizing as tasteful a home-like environment as possible. - Privacy would be essential; the design challenge being to create this sort of setting while at the same time, assuring the easy availability of the medical care required. Her vision of the hospice anticipates the need for adequate acreage to allow for growth as well as a tranquil exterior environment. There was immediate recognition that the hospice envisioned would be costly to construct. It was pointed out that what Sharon Brandsness was describing was the optimum; there certainly were compromises. Each alternative from the most modest functional to the most elaborate will be developed in terms of capital and operating costs. It will then be up to the Board of Directors to determine the scope and character of the . facility. That decision can only be made when there is far more information on the opportunities for contri-butions and philanthropic support. There was general discussion of the need for this sort of detailed information. The Board must also know of all sources of reimbursement for care and any national policy that may alter hospice reimbursement. The above is especially important in light of the determination that all people, regardless of economic circumstances, are to be eligible for hospice care where needed. The Program Development Committee and consulting staff have reached the point where they are able to project pro-viding this degree of detail within the next six weeks. Legislative Committee. E. Libman reported that the hospice could be built and operated under existing Nevada law. It would, however, be both difficult and limiting to establish the sort of hospice program intended under these circumstances. There-fore, a legislative strategy has been prepared based- upon amending existing licensure statute to include as simple a definition of hospice as possible. Renny Ashleman is now actively working toward achieving this legislative result. He reports no obstacles to date. Page 5 Community Relations and Fund Raising Committee. Muriel Stevens distributed a written report to the Board of Directors (copy attached). She outlined the intensive profile of activities intended by the committee. She was impressed by the- enthusiastic response she received in selecting committee members. The goal of the committee's effort is to make Las Vegas aware of the importance of having the Nathan Adelson Memorial Hospice; to show that, in fact, a hospice can bring a whole community together in many ways, such as its being used by all hospitals and care facilities and volunteer service by community members. The core of the committee's efforts will be to teach Las Vegans that the hospice movement is, in essence, a humane concern for the dying and their loved ones in a world that sometimes is too technical, too efficient and too uncomfortable with the fact that dying is a part of life. The committee will strive to convey the message that hospice is dedicated to preserving the dignity, integrity and personal choices of the patient, and to providing care and control of pain, as well as physical, psychosocial and spiritual support for the patient and his family. Nominating Committee. Muriel Stevens reported that the Nominating Committee had recommended for the Nathan Adelson Memorial Hospice that the following individuals serve on the Board of Directors: Pearl Adelson Merv Adelson Donald Baepler A1 Benedict Eli Boyer, C.P.A. David Brandsness Irwin Buchalter Anthony J. Carter, M.D. Don Digilio Thaiia Dondero Hank Greenspun Charles Kilduff, M.D. Jerome Mack Irwin Molasky Susan Molasky Michael O'Callaghan Owen C. Peck, M.D. Lee Rich Allard Roen ? Art Smith William K. Stephan, M.D. Muriel Stevens Ken Sullivan E. Parry Thomas Richard Thomas David Zenoff I was so moved, seconded and unanimously approved. Page 6 Muriel Stevens reported that the Nominating Committee recommended that.the following individuals e elected officers of the Nathan Adelson Memorial Hospice: Pearl Adelson, Chairman Merv Adelson, Co-Chairman Irwin Molasky, Co-Chairman Eli Boyer, Secretary-Treasurer It was so moved, seconded and unanimously agreed upon. ADJOURNMENT: The meeting was adjourned at 6:15 P.M. Ernest W. Libman February 27, 1979 Sunrise Hospital IVledical Center TO: Steering Committee of the Nathan Adelson Memorial Hospice FROM: The Program Development Committee. The Committee has considered the functional uses of the hospice utilizing the hospice concept, that is, a program to assist the dying patient and his family whether the individual is at home or in a facility. We have visited one hospice program and will visit others. To begin with, we encourage a hospice team within the Home Health Care services in Clark County, a hospice team for each Home Health Care service. Experience can be gained while the facility is being constructed. Program flexibility can be maintained as information is gathered which is peculiar to Clark County and the Las Vegas Valley. Specifically, we believe that one hospice team member should be hired for the Sunrise Hospital Home Health Care team as soon as feasible and placed on that Home Health Care team payroll. The Committee members will participate in selecting this individual as needed. We cons-idered the questions from Dr. Koff. We do not believe that a comprehensive, all inclusive Home Health program should immiriate from the free standing hospice if the Home Health Care Services implement their hospice team(s). We emphasize that members of the Nathan Adelson Memorial Hospice would riot ordinari ly be members of the hospice'team for Home Health Care. The Committee endorses the recruitment and screening of volunteers for the hospice team of the Home Health Care program as these volunteers can work for a Home Health Care program or in the Nathan Adelson hospice. The Committee agrees that admission to NAMH should be offered io individuals other than those dying due of cancer. For the moment, the Committee concurs that admissions to the Nathan Adelson Hospice should be restricted to indiv-iduals who have a probable life expectancy of less than 6 months. This restriction is related to third party reimbursement and may aide the family and patient in preparing for death. February 27, 1979 Page -2- The Committee has considered the numbers of beds and is in reement with opening a 20 bed unit expanding to 20 and making plans for another ^0 bed expansion. The building should be specifically designed so that family and close or intimate friends may be involved in the care of the patient. The Committee believes that privacy should be available for individuals who wish it, but that shared accommodations should also be available. We are, at the moment, undecided as to whether those accommodations should or.should not include two or four beds. Given the realities of available money and site selection, we endorse the concept of an area in which the hospice occupants and their families occupy and one which is for visitors (not family), hospice staff and other non-care giving duties. Education of general medical community legislators, volunteers and the community at large should begin once the guidelines for the Home Health Care hospice program have been established. A number of prominent exper-ienced physicians in this field are available for speaking engagements in Las Vegas. In the near future the Nathan Adelson Memorial Hospice should select and hire a project director who should have approximately one year to work with the various committees to see that the facility is constructed properly. Willis M. Kusseil, uo-thairman, For the Committee: Jerome Blankinship Eli Boyer, Co-Chairman Constance J. Edwards Gerald Farino la Saundra Jack Ruth Jay Lyle Luman WMR:ne TO: Irwin Molasky, Chairman Steering Committee FROM: Muriel Stevens and Susan Molasky, Co-Chairpersons Community Relations and Fund Raising Committee SUBJECT: Progress Report February 27, 1979 COMMITTEE MEMBERS: Maureen Vinnik, Georgia Mind!in, Harold Erickson, Bea Levinson and Marydean Martin Media Contacts Media people are being contacted on a one-to-one basis. We are introducing them to the hospice concept and asking for their support. The response thus far has been that of positive interest. ? Indications are they will do what-ever they can to assist. Resource Material Center A resource material center is being planned at the U.N.L.V. library. A section of the library is being made avilable to house books, brochures and articles pertaining to the hospice movement. These materials will be available to anyone in the community who has need of them. Information Program Format A program format has been outlined for lectures to be given to service,and social groups. The lecture format includes: 1. A short, positive definition and history of the hospice movement. 2. Participation by the audience through use of the "Life Cycle of Experience" worksheet. This will serve to get them personally involved. "Life Cycle" shows through personal experience how important the family and friend support group of the patient are -- and how the hospice program educates and maintains this group as an integral part of its treatment. 3. On January 9, I attended a seminar sponsored by the Institute of Hospice Care at Millbrae, California. An outstanding slide presentation produced by Dr. Beau Bohart was shown. Dr. Bohart is associated with the Boulder, Colorado Hospice. The slides depict the atmosphere of the hospice and especially the staff interaction with the home-care patients. We are planning to adapt this presentation to fit our needs. 4. A question and answer period. Page 2 GOAL The goal of these lectures is to make Las Vegas aware of the importance of having the Nathan Adelson Memorial Hospice. To show that, in fact, a hospice can bring a whole community together in many ways, such as its being used by all hospitals and care facilities and volunteer service by community members. The core of all our efforts will be to teach Las Vegans that the hospice move-ment is in essence a humane concern for the dying and their loved ones in a world that sometimes is too technical, too efficient and too uncomfortable with the fact that dying is a part of life. We will strive to convey the mess that hospice is dedicated to preserving the dignity, integrity and personal choices of the patient, and to providing care and control of pain, physical,, psychosocial and spiritual support for the patient and family.