Eli's Hospice Insider

Good communication, continuity prove essential.

Partnering with skilled nursing facilities (SNFs) to provide their residents with hospice care can bring benefits -- and headaches -- to both members of the partnership. But better communication and continuity of staff can help make these relationships even better.

Twenty-five percent of all deaths in America take place in nursing homes, but fewer that 20 percent of nursing homes offer end-of-life care. Your agency may be in a position to help change this, but it will take time and commitment.

A recent research report from the Institute for the Future of Aging Services (IFAS), the research division of the American Association of Homes and Services for the Aging (AAHSA), identified the lack of end of life services in nursing homes, the Washington, D.C.-based AAHSA said in a press release. The researchers found that nursing homes were more likely to participate in end-of-life programs if they provided specialty programs for hospice, pain management or dementia care.  The study also found a strong correlation between end of life program participation and staff training for services related to end of life care, according to the release.

"When it comes to end-of-life care, providing appropriate staff training may be the key to expanding program participation." Helaine Resnick, Ph.D., director of research at IFAS said in the release.

"Providers must consider the professional value EoL training and participation offers staff and more important, its personal value to the people they serve."

Nursing home/hospice partnerships can pose some challenges, but they also provide opportunities, says Peter Notarsefano, director of home and community based services for AAHSA.

Problem: Nursing home regulations can conflict with hospice regulations, Notarsefano says.

Solution: To combat the compliance disconnect, make certain you create a formal contract that spells out how the relationship will function in order to remain in compliance from both perspectives.

Good communication is the key to a successful partnership, says Priscilla Lynn, RN, supervisor of the SNF/hospice team for Lifetime Care in Rochester, N.Y. Keeping the staff assigned to each nursing home consistent helps with this, she says.

Tout Hospice Benefits

The benefits of a SNF/hospice relationship stretch beyond the residents. Consider the ways your services can have a positive impact in the nursing homes you work with. Hospice agency staff helps in the nursing facility by complementing the care provided by existing nursing home staff and by giving a different perspective, Notarsefano says. To make the most of this partnership, he recommends that hospice staff:

• Keep visits structured and planned;

• Check in at the beginning and end of each visit;

• Attend care planning meetings;

• Be on hand to answer questions during surveys;

• Attend orientation, in-services, and other nursing home training offerings;

• Know the facility's regulations for fires, disasters, do-not-resuscitate orders, and documentation

Training can go both ways. The in-service coordinator at Lifetime Care provides nursing home staff with a list of available in-services and helps set up the training programs so both day and evening staff can attend, Lynn says.

Cost benefit: Nursing homes must keep a careful eye on the bottom line, and providing end-of-life care to a Medicaid resident can be costly, Notarsefano says. The nursing home may view moving that resident on to the hospice benefit as a positive.

Marketing plus: The nursing home can use its hospice partnership as a marketing opportunity too, Notarsefano says. While the nursing home is charged with the entire spectrum of the resident's care while he is living in their facility, providing hospice services in the facility shows a deeper commitment. Highlighting the bereavement care that hospice can provide the family, as well as the spiritual, psycho-social, and physical care for the resident can be a selling point.

Provide hospice brochures to your SNF partners so they can be included in admission packets, suggests Lynn. Hospice care may not be on family's mind at first, but it can be helpful to mention the available service while driving home your common goal of compassion and care for the residents.

Staff care: Nursing facility staff also benefits from hospice care as they face grieving for the residents they care for.

Note: The IFAS research was published in the online version of the American Journal of Hospice and Palliative Care Medicine. The report is also available on the IFAS Web site, www.futureofaging.org.