Using Hospice to Extend Resident Lives

There is more to hospice care than you may know.

Essentially every skilled nursing community uses the services of a hospice, but too often they are not used to the maximum benefit of residents and the community. Here are the four strategies for your hospice partnership:

Strategy 1: Determine the need for hospice

Here’s how you calculate how many hospice patients you have in your building. You take the number of long-term residents you have in the building and divide it by their Average Length of Stay (ALOS) in months. Then multiply that by six to calculate the number of months someone should be on hospice. You should assume that if your staff is assessing correctly your long-term residents should have six months on hospice care. In our buildings we have about 40 long-term residents and the ALOS is 12 months. So we take 40 divided by 12 and then multiply by 6 and we get 20. So we can expect to have an average of 20 hospice patient in our buildings.  

Palliative care prolongs life. On average residents receiving hospice care can be expected to live 30 days longer than those undergoing aggressive end of life care. That means you can expect your ALOS of long-term patients to increase after you begin to utilize hospice.

Strategy 2: Select one hospice provider as your primary partner

For your staff and patients to truly experience the benefits of hospice you will want to have hospice nursing assistants who work full time inside your building. This means that they are there when you need the extra help. To do that you must work with one primary hospice provider because if you have two or three hospice providers they will not have enough patients to provide you with the hours you require.

Strategy 3: Require the hospice to provide an interdisciplinary team

First you should request nursing assistant care for approximately 10 hours per patient per week, and you want them to be in your building seven days a week from 7:00 AM to 7:00 PM. For example in our buildings where we have 20 hospice patients we receive about 10 hours of care per patient a week from our hospice. That means we have 200 hours of hospice care in our building per week delivered by five full time CNAs. We request at least two CNAs per day to work 7:00 AM to 7:00 PM.  You don’t need six people in your building from Monday through Friday from 7:00 AM to 3:00 PM, but that’s the way most hospices will schedule because that is what the CNAs prefer. You want to make sure your CNAs are there when you need them.

Next let’s take a look at the rest of your interdisciplinary team. For example if you have a primary hospice partner and 20 hospice patients in your building you will be able to require your hospice partner to provide:

• An additional RN in the building 40 hours a week

• 20 additional hours of SW

• 15 hours of chaplain services

• 15 hours of volunteers

• And two additional CNAs in the building 7:00 AM -7:00PM seven days a week

• You will have a total of 290 additional work hours a week in the building or 7.25 FTEs.

And all of this at no cost to you!

Strategy 4:  Provide GIP  

You cannot use hospice staff to take the place of your current staff to save on staffing costs; however, hospice can positively impact your profitability through the use of GIP.  GIP means general inpatient care for hospice patients who need continuous registered nurse care, supervision, or oversight. Whenever your staff is doing a lot more work for a hospice patient, particularly your nursing staff, you need to question your hospice provider to see if that patient is GIP eligible. If they are, the hospice can pay you $500 a day for providing that level of care.

And if you’ve got a hospice provider that doesn’t have a hospice house where they can send their in-community patients to do GIP, you can increase your census by providing GIP in your buildings.

In most hospice patient populations about 4 percent will be on GIP at any given time. That means if you’ve got a hospice provider in town that cares for 100 patients then you can expect that four patients should be on GIP a day, and if those patients were cared for in your building the hospice could pay you $500 per patient per day.