9 Partnerships #8 – Hospice

Hospice is likely the most valuable partnership you can have and the one that will most dramatically enhance your residents’ longevity.

Hospice is likely the most valuable partnership you can have and the one that will most dramatically enhance your residents’ longevity.

People with fatal illnesses have been shown to live, on average, 29 days longer when they have hospice care. With the average length of stay for assisted living being around 18 months, that is a 5% increase in revenue.

Not only does it benefit your community, it provides huge benefits to the residents and family. It avoids another move; it allows residents to pass comfortably to their death in a homelike setting. It allows for a better time with loved ones in those last few days.

Making Hospice Work Right

1. You don’t want multiple hospices coming in your community. You only want to partner with one hospice. As with therapy and physician care, your residents must be able to choose their provider, but you want to limit the number of providers that are giving care in your facility.
2. Your hospice partner must provide you with consistent hospice staff. Ideally with enough hospice residents in your community and a single hospice partner, you will have hospice staff in your building everyday all day.

   For example: The way our hospice staffing works is that we generally assign one RN Case Manager to about every fifteen patients. Therefore, if a community has 15 hospice residents, the RN assigned to that community will show up there every single day.

   This is important because you want to have that hospice RN in your building any time there is a crisis situation. In our case, we have some communities that average 30 residents on hospice, which allows us to have a hospice RN in the community12 hours a day, 7 days a week rather than have 2 RNs 8 hours a day, 5 days a week.

3. It is also important that the hospice provides you adequate CAN’s.  In our communities  our hospices provide about ten hours of aide care per resident per week. And, our assisted living communities average 25% of their residents on hospice at any given time.

   For example: If you have 8 patients, it should be 80 hours. This allows you to have one hospice aide in your community for 12 hours every day of the week. By doing this, if one of your residents has a crisis, you don’t have to call them and have them drive to your facility, when they might live some distance away.

4. Your hospice partners also needs to have either their own hospice house or a contract with a skilled facility or hospital to do in-patient hospice care for those times when your residents are in crisis.

   For example: You have a resident that needs pain medication on an hourly basis. It shouldn’t be the responsibility of your staff to provide that extra care. When that occurs, the hospice should be prepared to transfer the patient out of your community for a few days. Unfortunately, many hospices will not want to do this because it is costly to them. They have to pay for the ambulance and the higher care level. But if you have the right hospice partner, you can demand that they provide this service when needed and appropriate.

5. Your hospice partner must be actively involved in the education of your staff. This allows your staff and hospice staff to work closely together in a way the benefits the resident and their family.
6. You want to make sure that the hospices you choose provides both a bereavement and volunteer program, not only to the family, but also to your staff. This should include, at a minimum, counseling, memorial services, and a chaplain who makes regular visits.

   Hospices are required by law to provide 5% of their work hours with volunteers, working with patients and/or their families. You should expect them to provide volunteers to help out in your community. They should provide you a volunteer schedule, so you know when those volunteers are coming in. Additionally, you want to make sure that those volunteers are educated about all the benefits your facility offers because those volunteers will then become effective sources of referrals.

7. You want a hospice that will help you identify hospice appropriate residents early. In surveys of our own communities, we have found that at any given time, 25% of our residents are on hospice and 50% of our residents in our dementia unit are on hospice; we believe this is optimal. This is essential to extending your resident’s longevity because, although national studies have shown that people who go on hospice early, on average, live 29 days longer; this is only true if residents go on hospice early, meaning about six months before they are expected to die.

Consistently we hear how meaningful our hospice partnership is for families and staff.

Scott