Eli's Hospice Insider

Innovative programs pay off in publicity.

The Centers for Medicare & Medicaid (CMS) requires hospice providers to offer bereavement services, but it doesn't give much guidance as to what this entails -- or how it should be funded. Before you writeoff the potential of these service, take note that offering a wide-array of programs for the grieving may actually pay off for your agency. Here's how.

Offer a Variety of Services

CMS instructs hospice providers to offer an organized program of bereavement services under the supervision of a qualified professional. Beyond that, providers are mainly left to figure out on their own what sort of care to provide, so each agency takes a different approach.

Theo Munson, MPH, manager of bereavement services for Lifetime Care/Hospice in Rochester, N.Y. says her agency benefits from providing a "smorgasbord" of bereavement care.

Try this: Each family or caregiver who has used Lifetime Care's hospice services gets a mailer after their loved one has passed away. The bereavement care team then follows up with calls to those who need more attention, Munson says. Professional home visitors predict which primary caregivers will have a challenging bereavement. Those who exhibit risk factors or who have simply expressed distressing thoughts like "everyone will leave in a few weeks" receive follow-up calls from staff that worked with them.

This initial contact benefits the hospice provider by giving a chance to receive service improvement suggestions and to address any dissatisfaction caregivers may have had with hospice services, Munson says.

Lifetime Care also offers open drop-in support group programs which are targeted at those experiencing a particular kind of loss, including:

• grieving parents who have lost a child

• children who have lost parents

• young widows and widowers

• a daytime group for seniors.

The agency also recently added a support groups for those affected by suicide. These programs aren't just for those who have used Lifetime Care's hospice services -- they are available to the whole community.

This openness has benefitted Lifetime Care by serving as a "rainmaker" and builds a stream of referrals for the agency from those who might one day need their services. Participants in one of the bereavement groups are more likely to look to Lifetime Care should they require home health services, Munson says. Support groups also provide a source of volunteers and inspire memorial gifts from their members.

The mutual support these groups offer has a power that nothing else does, Munson says. Lifetime Care home health aides even have a bereavement group of their own. Michele Allman, LMSW,  bereavement coordinator for Visiting Nurse Service and Palliative Care in Webster, N.Y. says her agency just began offering support groups this year after recognizing a need in the community. Grieving people need a place to go, she says.

Helpful: Some agencies use volunteers to run their groups because they see the potential for cost savings, but Lifetime care pays their group leaders, says Munson. Leaders are required to do record keeping, provide extra help to those who need it, and take responsibility for keys to meeting spaces in churches. Paid volunteers may also have less emotional involvement than those who have experienced a loss themselves, she says.

Other traditional bereavement program offerings include remembrance ceremonies and lectures. Lifetime Care also offers innovative programs such as a mall walking group for widows and widowers, nature walks, programs on grief gardening, stress management techniques, and a grief journaling course. These workshops can serve as outside revenue streams and create a "face" for marketing and publicity efforts for hospice services, Munson says.

Social gatherings for the grieving are also a big hit. Becoming widowed is a social blow, and these programs help the grieving develop new social contacts, Munson says.

Isolated Grievers Get Help, Too Some hospices offer bereavement correspondence programs with a monthly mailing of grief education content. These mailers offer things to think about as you grieve, discuss normal grief processes, address sleep issues, and manage depression. This approach is good for those with no vehicle who couldn't make it out to support groups, and for those who would rather deal with their grief privately, Munson says.

Our culture is quick to prescribe medicine or to advise grieving people to hurry up and move on, Munson  says. Bereavement services give people the space to say "I'm still struggling."

"It's good preventative medicine -- so many people tell us 'you've saved my life,'" she says.