Trustee letter for Nathan Adelson Hospice, October 1986

October TRUSTEE LETTER THE HEALING Hospice was, and is, an alternative to death SPIRIT OF in an institutional setting, but hospice is HOSPICE also much more. This month marks the beginning of my third year as NAH1s Executive Administrator and I've learned a lot. I've watched and participated in hospice's healing spirit. Families have been reassembled, thousands of individuals have been supported and strengthened and hundreds of patients have been made more comfortable as they faced their last days. Hospice works because it helps to heal individual relationships and families that have been deeply wounded or torn apart by this emotional, physical and spiritual stress that comes from battling a terminal illness. Hospice isn't "a place to go and die". It isn't a place at all. Hospice is people helping people to face death with courage and dignity and love. Hospice care is based upon unconditional giving and unconditional loving. After two solid-years of daily hospice I've come to truly believe the axiom, "What you give is what you receive", is a basic law of nature. Hospice service is its own reward. NAH RECORDS PROGRAM'S FIRST "BREAK EVEN" MONTH IN ITS SIX YEAR HISTORY September operating revenue covered all costs, including free care and debt service. The facility's admissions were high (37) and the average length of stay was low (7.6 days). Our physicians worked very closely with us this last month and did some terrific patient/family counseling that helped the hospice tremendously. Even though hospice is home care, our beautiful facility sometimes convinces families that they don't want their loved one to return to the home setting after their acute symptom is controlled. We then must turn to the physician to assist us in explaining our facility's limited role in the overall hospice program and that our home care team is the essence of hospice. Our doctors' active support makes all the difference in the worId. MORE THAN HALF OF OUR HOME HEALTH VISITS ARE FREE CARE We bill Medicare and the few private insurance companies that have hospice benefits, but these sources inevitably do not provide enough coverage for adequate hospice care. We are caring for about 80 terminal patients in their homes at any given time. Our first six months indicate that we will make approximately 6,000 home visits in 1986. Thanks to our trustee support and donor backing we go when we are needed and we do whatever we can . . . the result is that 52% of our visits are for free. There is no other home care agency like ours. Our "free" or non-reimbursable visits, will account for approximately $139,000 in 1986. HOW & WHY THE HOSPICE FACILITY BECAME AN ACUTE SPECIALTY HOSPITAL More than 1700 hospice programs have developed during the 10 year old American Hospice Movement. Less than a dozen have in-patient units. Our program is generally acknowledged as one of, if not, the finest in the nation. Yet we still have a few major hurdles to clear to make the hospice all that its founders envisioned seven years ago. During the NAH1s first three years it was only a home care program, without a hospice facility to back it up. A little more than three years ago our Swenson Street facility opened. It was meant to be a non-acute, glorious, home-like building that would be used for patient and family stays of two weeks or less, to provide symptom control and respite for those few patients who needed temporary in-patient relief from pain, dehydration or family stress. Unfortunately, the Medicare reimbursement system that existed during the facility's planning was scrapped just as the building was opened. The new Medicare reimbursement system neglected to provide for hospice in-patient care. The cost of constructing the world's most beautiful and well designed hospice was considerable. With only 20 beds and no other alternatives available, the in-patient unit became licensed as an acute care specialty hospital to survive economically. THE FACILITY: OUR GREAT ASSET AND OUR GREAT CHALLENGE From the very beginning, we've never turned anyone away because they couldn't afford to pay. We never intended to have an acute care hospice facility, but the program had to play the cards as they were dealt. The building had to maximize the reimbursement possibilities from each bed. With acute licensure came 19 admitting criteria that limited our ability THE FACILITY: OUR GREAT ASSET AND OUR GREAT CHALLENGE (CONT.) to accepting only those patients meeting one or more of the criteria. This was never part of the original vision. In many cases the criteria proved to be anti-hospice. Hospice is, in part, an alternative to terminal acute care which tends to be to invasive, like intubation (tube feeding, morphine drips, etc.) yet the facility's economic survival required acute reimbursement status and tremendous on-going private contributions Most of our primary referring physicians understood and grudgingly accepted the reality, but all of us - physicians, patients, family, nurses, administrators, found ourselves in daily conflict with the acute care rules imposed upon us. THE HOSPICE IS BECOMING ALL IT WAS MEANT TO BE The following seven point plan was introduced to the medical staff and it was unanimously approved. We have been working for months to reduce our operating overhead (without sacrificing our quality of care). As we position ourselves to move this facility from acute to true hospice. Our primary physicians have been working closely with us to achieve our goal by carefully utilizing the facility to keep us going under our present structure and license. Special thanks must go to our Medical Director, Dick Weisner; Chief-of-Staff, Bob Gagliano; oncologists, Joe Quagliana, N. Nagy, Peter Graze, Paul Michael, and Ed Kingsley. HOSPICE DEVELOPMENT PLAN 1. Cut all expenses not directly related to patient and family care. This was necessary to drop our operating overhead to prepare the way for elimination of acute facility status. The overhead has been reduced by nearly $30,000 a month. That's as far as it can go without-reducing the 10:1 nurse hour per patient day ratio. 2. Revise home health to drop overhead by shifting emphasis toward volunteers and more LPN's and aides (currently underway). 3. Strengthen (triple) volunteer support (now in the planning stage). We have already hired an additional half-time volunteer coordinator and we will be creating more training sessions with more variety in "types" of volunteers and job descriptions. 4. Develop a lower cost in-patient alternative in the form of a nursing home, with a hospice dedicated section (10 beds). The hospice SNF is to be manned by nurses trained in our program, but the nurse hour ratio will probably be at / THE HOSPICE IS BECOMING ALL IT WAS MEANT TO BE (CONT.) the 4:1 level supplemented by volunteers. We are currently negotiating for this component. 5. The NAH has now made Hospice Medicare Benefit certification its number one priority. Patients participating in the benefit are on a per diem reimbursement basis, which takes them out of the acute/DRG category. We are targeting January 1st for certification. We plan to move the facility into the benefit in increments - one quad at a time. If all goes well for patient, physician and program, we will expand available "hospice benefit" beds accordingly. We need physician guidance and assistance as we proceed to insure that every consideration is being given to making physician participation as attractive as possible. 6. We are also targeting early 1987 for Joint Commission on Accreditation of Hospitals hospice accreditation. 7. All of this leads to our final objective, which is to establish Nevada hospice home care and facility licensure. We would then have the facility licensed as a hospice (not acute, not a nursing home, but a hospice!). We could set our own rates and guidelines and our utilization would no longer be deterred by acute criteria. TRUSTEES AND FRIENDS HELPING HOSPICE Foundation Trustees Dr. Ted Jacobs and Dr. Elias Ghanem are planning to travel to Denver to attend two key workshops at the annual National Hospice Organization's conference in November. The workshops are presented by one of NHO's founders, Don Gaetz, and they focus on hospice survival in the rapidly changing medical reimbursement-landscape. I sincerely appreciate their willingness to help this administration chart the strongest possible course for NAH1s future. Herb Kaufman and Renny Ashelman each responded to last month's call for assistance in creating a nursing home component as part of NAH's loop of care. Both have terrific ideas which are currently being explored. Jerry Kring had some suggestions concerning the new and rather dramatic penetration of Health Maintenance Organizations (HMOs) into the Medicare population. About 65% of our patients are Medicare. Jerry also contributed 50 tickets to the hospice staff and volunteers to the UNLV/N. Texas State November 1st football game on behalf of Humana Plus. Marydean Martin has been helping the hospice with publicity work and Robin Joyce has been writing some news releases for us. Muriel Stevens found a way to mention us in a recent column. Mike Mavros talked with the TRUSTEES right people and we now have 400 yards of new AND FRIENDS carpeting being donated to replace the worn HELPING carpet in the "Country Kitchen" living area HOSPICE (B quad) and cover the home health annex floorspace, (CONT.) Phil Keever of Mil liken Carpets made the commitment. Mike says wall paper is his next objective. HOSPICE BECOMES The hospice has become a smoke free facility. A SMOKE FREE Staff members are allowed to smoke only in designated FACILITY smoking areas and are encouraged to help each other quit smoking altogether. In Los Angeles recently smoking was banned by the County Board of Supervisors in six public hospitals and 47 public health clinics. One county supervisor put it this way, "It is absolutely idiotic to be having surgery for lung cancer and have the doctors and nurses smoking out in the halls." UNLV/FULLERTON FOOTBALL TICKETS FROM DR. MAXSON UNLV President Bob Maxson made 200 UNLV/Fullerton football tickets available to the Nathan Adelson Hospice family. Thank you Bob! Many of our staff, volunteers and friends attended and certainly enjoyed the second half. Dr. Maxson's unwaivering support for our program is deeply appreciated by all of us and with Bob at the University and his R.N. wife, Sylvia, here with us, the Nathan Adelson Hospice program has two very important Maxsons helping us help the terminally ill. CELEBRATE NOVEMBER AS NATIONAL HOSPICE MONTH For the third consecutive year, President Reagan and congress have declared November as National Hospice month. The slogan this year is, "Hospice - a special kind of caring". The NAH has now helped nearly 2000 families. Celebrate National Hospice Month with a contribution to the hospice. PROFILE OF A recent review of our patients showed that AN NAH the composite NAH patient is male (58%); has PATIENT partial Medicare coverage (65%); is 66 years old; will stay in our home care program 53 days receiving 9.53 skilled nursing visits, 15 aide visit's and 12 volunteer visits. HOSPICE HOME CARE & THE NAH FOUNDATION HAVE A NEW HOME The hospice home care team is joining the foundation in the refurbished 2,100 sq. ft. annex during the first week of November. Home care is the heart of hospice with an average daily patient census of 78. Leroy Gamble almost single handedly prepared the way, working on his own time attending to thousands of construction and cosmetic details to make this important move possible. We long ago outgrew the office space in the facility, with nurses and socialworkers doubling up on desks in very cramped space. The annex also allowed Foundation Director, Tom Kenefick and his secretary, Sherrie Rogge, to give up the donated office space in the Park Place Shopping Center and "come home" to the hospice grounds is located on the northern the back parking lot hospice in-patient unit, the same. Hospice home Foundation: 796-3166. on Swenson. The annex property boundary with separating it from the The phone lines remain care: 796-3163. NAH Stop by for a look, NAHF EXECUTIVE COMMITTEE RECOMMENDS FUND DEVELOPMENT AREAS The NAHF Executive Committee met on September 30, 1986, in the NAH activity room. The committee toured the hospice and stopped in to visit with patients and family members. The NAHF Executive Committee recommended two key areas of private fund development: 1) Selling our 80,000 L.V. Access Books. The foundation still has approximately $170,000 invested in the completed guide books which were intended for bulk convention sales. The committee made the sales of the books its number one priority; 2) Annual giving concentration on the tax advantage of gifts made before December 31, 1986. THREE EMPLOYEE CONTRIBUTION PLANS TO CONTRIBUTE TO THE NAH NAH has been selected to participate in three local employee contributing campaigns. The E.G. & G. Energy Measurement's G.O. (Give Once) campaign; the Reynold's Electric REECO Drive; and District 2053/7-Eleven contribution club. The employees of these companies will contribute over $300,000 to be distributed among selected charitable organizations in southern Nevada. Our selection by these companies speaks highly of our broad community support. We are proud and honored to be so chosen. ISSUE NO. 5, OCTOBER 1986 TELEPHONE: 733-0320