Trustee letter for Nathan Adelson Hospice, June 1986

TRUSTEE LETTED MESSAGE FROM THE EXECUTIVE ADMINISTRATOR I've created this letter to help keep you in tune with current hospice and foundation activity and developments. Our large tabloid newsletter is only published quarterly and it is designed for wide public distribution (10,000). There are often many topics of trustee interest that would be inappropriate for a general audience. As a hospice and/or foundation trustee you will receive this letter monthly. Please call me directly if you desire additional information on any item or if you have any suggestions. There are 38 hospice and 62 foundation trustees with 20 people serving on both boards. The Nathan Adelson Hospice and Foundation's greatest-resource is in the strength of its trustees. Your involvement, is an essential element in the continuing success of the Nathan Adelson Hospice program. RECORD NUMBER OF Last month 43 patients were admitted to the HOSPICE ADMISSIONS Nathan Adelson Hospice acute care hospital. IN MAY Every admission is carefully screened to insure that each is medically appropriate. We estimate that 60 to 80 southern Nevada terminally ill patients may be appropriate for NAH hospital care at any given time. Our goal is to make the facility available to every appropriate acute patient. During the first four months of 1986 we projected 145 admissions. We fell short with 139. May's 43 admissions, which equalled our previous high (Oct. '85) brought us exactly in line with our five month projection of 182. Increased facility utilization is essential for the program's economic health but what is even more important is the fact that every new admission brings hospice acute care, team support and relief to another patient and family during their most difficult hours. HOSPICE HOME CARE The heart of hospice care is, of course, the CENSUS HOLDING home care program. That census has been rising AT 80+ steadily. We are now routinely providing hospice care in about 80 Clark County homes. With six full time, three contract and two part time nurses, the Monday morning home care conferences are flowing into the hallway. Even our full time nurses are sharing their desks. HOSPICE FACILITY The preceding paragraph regarding the Monday SPACE AT A morning home care conferences is only one example PREMIUM of the strain the NAH program growth has put on our facility. We have recently hired our third social worker. All three share an office designed for one. When intake interviews become personal or reguire confidentiality, the chaplain's office is being used which displaces pastoral and bereavement team members. We've got medical record storage (minimum legal standards), meeting room and a dozen other serious space shortage problems. The staff is to be commended for their positive attitude (we converted a broom closet into a nursing office in January). I'm working on a long range solution and I invite you to stop in to do a little brainstorming with me. The guality of our patient care remains uncompromised, but everything else is being taxed. I can sure use your help on this one. FREE HOSPICE In May our home care nurses made 97 "no charge" HOME CARE visits, bringing our free care home visit total to 596 for the first five months of 1986. We make "free" visits for indigent patients and in cases where guality hospice care requires it even though we know the "formula" used by the reimbursement source (Medicare or insurance) won't cover us. We are very careful to make sure that every visit is needed, but the patient's ability to pay is not a consideration. Our "free care" visits are a direct result of the ongoing private support provided by the NAH Foundation. HOSPICE FACTS Most NAH Patients Have Medicare Coverage: Approximately 66 % of our patients are over 65 and qualify for Medicare coverage. Private insurance covers 27% and Medicaid (SAMI) patients make up only 4% and "other" sources make up 3%. HOSPICE FACTS NAH Free Care: Private contributions in the (CONT.) form of tribute and gifts-in-memory along with NAH Foundation grants totalled $540,142.00 in 1985. Private funds are primarily used to provide total care for the indigent, to make up the difference between Medicare, Medicaid and/or insurance coverage and the actual cost of providing NAH quality care. NAH Facility Adjusts Its Rates: Our facility has been open for nearly three years. During that time we have almost doubled our services. Last year alone we reached 50% more terminal patients than the previous year. We have also increased facility nurse to patient ratios, salaries, supplies, contract services and operational, expenses have, of course, increased. Although all costs have increased we have not raised our rates. The NAH Executive Committee recognized the extra burden the situation has placed on our private resources and voted to raise our daily rate to $434. This still makes the hospice facility the least expensive acute care hospital in Las Vegas. Our average daily cost continues to be a little more than half that of the areas full service acute care hospitals. LITERALLY A If you've toured the facility during the last SIGN OF THE fourteen (14) months, you will probably recall TIMES the large white "case load display boards" we use to track our patients in the home care office. When people tour the facility the true scope of the program is not very evident until they stand in front of these display boards and see name after name, patient after patient, two columns running from ceiling to floor. Next to the patient's name we show our contacts: R.N., aide and volunteer visits, schedules and assignments. I usually make the home care office visit the last stop on the tour. The whole facility, the entire staff says "quality care" and the last stop shouts . . . "for everyone". (NOTE: We have now ordered a third display board. A board displays forty (40) patients, the new one should fill rapidly.) NAH FOUNDATION Nine months ago many of you heard about a little ASSISTS IN boy that the NAH was caring for. I'll call BURIAL OF him Tommy to preserve the family's privacy. SEVEN-YEAR OLD His family couldn't afford to pay for our care NAH FOUNDATION ASSISTS IN BURIAL OF SEVEN-YEAR OLD (CONT.) . . . in fact, their financial situation was so difficult that they couldn't afford funeral or burial costs. At that time we thought death was imminent and the NAH Foundation agreed to assist by covering Tommy's funeral expenses. Our care, while incredibly extensive does not usually extend to burial. In this case the knowledge that Tommy would receive a "proper burial" was an important part of the total plan of care for the surviving family members. Although the little boy remained comatose, he stabilized and was able to go home where his family cared for him with the assistance of a round-the-clock voluntary rotating team of NAH nurses. A few days ago Tommy died. The NAH Foundation, working with Davis Funeral Homes (who provided a lovely service at their cost) laid Tommy to rest. Hospice pediatric care is most stressful. A recent study put hospice pediatric physicians at the top of the emotional stress ladder. Many hospice staff and volunteers stepped forward to help out under these trying conditions. My sincere thanks go to them and to the foundation for its financial help. NAH CHIEF OF Dr. R.G. Gagliano, Chief of Staff at NAH, has STAFF HONORED been elected to Fellowship by the American College of Physicians. Election to Fellowship in the College signifies that a physician has been recognized by his colleagues as having attained a high level of medical scholarship and achievement in internal medicine. Fellowship means that the honoree is involved in the teaching of young doctors and medical students, has authored articles in medical journals, presented papers at medical meetings, and made other notable contributions to the advancement of medical science and practice. Congratulations Dr. Gagliano! FLETCHER JONES WILL DEDICATE NOVEMBER TO HOSPICE NAHF Trustee Jan Jones has committed to making November NAH month for Fletcher Jones Chevrolet. Ten dollars will be contributed to the hospice for every car sold in November. Congress has also decreed that November is again "National Hospice Month". In May 1985 Fletcher Jones dedicated the month to hospice and we received more than $4,000. We sincerely appreciate being remembered again in 1986. Our thanks to Jan and Fletcher Jones Chevrolet.