In The News

Supporting Hospice Caregivers - and their Daily Encounters with Death

Barbara Karnes, RN

Dear Barbara, What are ways to provide support to hospice staff (RN's, CNA's, SW's, CP's) who see death on a nearly daily basis? What actions would be meaningful in an industry where death is an integral part of our lives?

Working with end of life in the medical field often leaves us feeling like outliers. The medical model is designed to fix people. Working with dying generally isn’t addressed in training. (It’s getting better in our medical schools but we’ve still got a long way to go.)

Because of this lack of education, it is up to the individual hospices to provide training. It isn’t enough to send a new employee to shadow for a week and then give them a caseload of patients. Forget a whole caseload, they're not going to be ready for even one patient. 

The agency must provide education to each employee on the signs of approaching death, what to look for, and what to do. Teach conversation skills, listening skills, medication and pain management skills. These are not skills generally focused on in medical or nursing schools. Social work and chaplaincy programs tend to focus more on communication and listening skills. So be sure to include the entire team in all facets of the education the agency is giving.

Next, teach them how to take care of themselves. Develop a closure ritual so they can move forward following each death. Daily or weekly journaling is helpful.

Create a buddy system. Each employee is teamed with another to call, talk and unload following any stressful situation. A buddy is a listener, someone to share concerns with and an “it goes no further” support person.

It’s not enough to tell staff they can talk with the agency social workers or chaplains or their supervisor if they are having a problem. Staff generally will not talk with administration for fear of looking weak or having people they work with think they are having challenges. 

Even though everyone dies at some point, we as a society tend to view death as bad, fearsome, something to be avoided. For those people who fill the important and often avoided job of the caregiver at end of life, their needs for well-being are unique. Agencies need to be responsive to those special needs.

 

DOL Issues Final Rule on Independent Contractors, Effective March 11

SESCO Management Consultants

The U.S. Department of Labor (DOL) has issued a final rule to clarify who is an independent contractor under the Fair Labor Standards Act (FLSA).

The final rule also rescinds a 2021 rule in which two core factors—control over the work and opportunity for profit or loss—carried greater weight in determining the status of independent contractors. The 2021 rule, which is still in effect, made it easier for employers to classify workers as independent contractors, rather than as employees.

The final rule will take effect on March 11, 2024.

The final rule returns to a more employee-friendly standard. Under the final rule, employers would use a totality-of-the-circumstances analysis, in which all of the factors do not have a predetermined weight. The six factors the DOL would look at are:

Opportunity for profit or loss. If a worker can set or negotiate his pay, accept or decline jobs, choose the order or time of performance, engage in marketing to expand the business, and hire others, purchase materials or otherwise invest in the business, the worker is more likely to be an independent contractor. However, deciding to do more work or accept more jobs is not indicative of contractor status. It is unclear how the ability to "accept or decline jobs" indicates contractor status, while the decision to "take more jobs" does not.

Investments by the worker and the employer. Investments that are "capital or entrepreneurial" in nature, such as those increasing the worker's ability to do different types or more work, reducing costs or extending market reach are indicative of contractor status. However, investing in tools to do the job indicates employee status. It is not clear how this factor would be applied in jobs that do not require any significant investment beyond a computer and internet connection. This factor also embraces the idea that the worker's level of investment should be compared to the business' investments. The utility of the relative-comparison factor is at best unclear and at worst illogical, as nearly every business will have invested more overall than any individual worker, and it would change the nature of the employment relationship based not on the worker's activities or the work done, but simply on the size of the business engaging the worker.

Degree of permanence of the work relationship. When the working relationship is indefinite or continuous, it indicates employee status. When the work is definite in duration, nonexclusive, project-based, or sporadic "based on" the worker providing services to other businesses, it is indicative of contractor status. When the work is project-based or sporadic for some other reason (such as the nature of the business), then it does not indicate contractor status.

Nature and degree of control. This factor looks at various indicia of control over the work and the economic aspects of the relationship. Importantly, control that is merely reserved, but not exercised, still counts as "control." Also notable is the DOL's statement that control exercised to ensure compliance with "legal obligations, safety standards, or contractual or customer service standards may be indicative of control." Prohibiting a subcontractor from engaging in unlawful discrimination, requiring it to follow safety rules or flowing down compliance clauses, would therefore appear to undermine contractor status.

Extent to which the work performed is an integral part of the employer's business. This factor weighs in favor of employee status when the work is "critical, necessary, or central to the employer's principal business." It is unclear what role a contractor could play that would not be "critical, necessary, or central to the employer's business." For instance, external accounting and marketing functions, both historically areas for independent contractors, would seem to be both "critical" and "necessary."

Skill and initiative. This factor looks at whether the worker uses "specialized skills" in performing the work, and whether those skills "contribute to business-like initiative." Being highly skilled in the substance of a particular field (such as engineering, journalism, or hospitality) does not seem to be the kind of "skill" contemplated. Rather, skill in running an independent business is what matters.

The DOL then includes a catch-all provision stating that additional factors may be relevant "if the factors in some way indicate whether the worker is in business for themself, as opposed to being economically dependent on the employer for work."

[Department of Labor’s updated Independent Contractor test As the March 11 effective date approaches, the DOL has issued FAQs offering guidance]

If employers have any questions or concerns, we recommend they contact SESCO Management Services to ensure compliance. For assistance, contact them at 423-764-4127 or by email at [email protected]

 

Speaker Johnson in Pressure Cooker as Partial Shutdown Deadline Nears

The Hill | By Emily Brooks and Al Waver
 
Pressure is ratcheting up on Speaker Mike Johnson (R-La.) as he returns to work this week aiming to push through a government funding deal to avoid a shutdown that could hurt the GOP in an election year. 
 
Johnson faces major risks as he seeks to solidify the first major legislative deal of his tenure, including those from conservatives who say Republicans should be willing to shut down the government to secure the southern border.
 
“There’s incredible pressure on Speaker Johnson to step up as the highest-ranking Republican in Congress and get a deal that can pass. The last guy lost his job trying to do it,” one Senate GOP aide told The Hill, referring to former Speaker Kevin McCarthy’s (R-Calif.) ouster in October after he cut a deal to temporarily fund the government. 
 
Johnson and Democratic leaders announced a deal on topline spending numbers on Sunday, largely modeled after a debt limit deal that McCarthy struck with the White House last year that prompted months of rebellion from hardline conservatives — but that Johnson said secured included new offsets.
 
The new Speaker, like McCarthy, has a tiny majority that seems only to be shrinking. With House Majority Leader Steve Scalise (R-La.) out for cancer treatment until next month, it means losing just three GOP lawmakers on any vote forces Johnson to rely on Democratic lawmakers to pass major legislation.
 
There are some differences in play when it comes to Johnson and McCarthy.
 
While McCarthy had trust issues and damaged relations with a host of conservatives in his conference, Johnson is in more of a grace period with his members that gives him more leeway.
And unlike McCarthy, he is also working in an election year where Republicans want to avoid mistakes that would make it harder for them to hold on to and build their House majority in the fall. Republicans are eyeing full control of Washington as their odds for picking up the Senate grow and as polls show former President Trump with an edge on President Biden.  
 
Rep. Dave Joyce (R-Ohio), a House GOP appropriations cardinal, stressed that appropriators think a shutdown is “a bad idea.”
 
“When we shut down, it costs us $60 million a day,” Joyce said.
 
Under a two-tiered funding extension that Johnson spearheaded in order to avoid a single massive omnibus spending bill, part of government funding runs out on Jan. 19, and the rest runs out two weeks later on Feb. 2. 
 
That leaves little time for Johnson to get the deal into legislative bill text form and usher it through the House in face of the GOP opposition…

Read Full Article

 

Take Action: Congress Should Use Hospice Funds for Hospice Needs!

As negotiations to fund the government continue, Congress must reject cuts to the Medicare hospice benefit. If Congress chooses to extend a faulty hospice aggregate payment cap formula, nearly $1 billion in funds will be taken from hospice care and spent elsewhere. 

As the population rapidly ages, Congress should be focusing funds on improving access to hospice care, not using hospice as a piggybank for other priorities!

The National Hospice and Palliative Care Organization (NHPCO), LeadingAge, the National Association for Home Care & Hospice (NAHC), and the National Partnership for Healthcare and Hospice Innovation (NPHI) are united in their opposition to the use of hospice dollars to exclusively fund non-hospice priorities. 

Share this action with your networks with the hashtag #HospiceAction!

Take action today! Click Act Now!

 

Report: Home Health Spending in October Continued to Outpace Other Healthcare Segments

McKnight’s Home Care | By Adam Healy
 
Year-over-year healthcare spending was fastest within the home health sector for the third straight month, according to a Health Sector Economic Indicators brief for October by nonprofit research and consulting firm Altarum.
 
Healthcare spending overall grew 6% year over year during October 2023, representing 17.4% of the national gross domestic product, according to the report. At the same time, consumers’ utilization of healthcare services has continued to outpace the price of those services. The Health Care Price Index estimated a 2.9% year-over-year increase in November, while utilization grew by 4.8%
 
Home health and personal care again dominated spending growth. October saw a 2.9% rise in personal care spending, driven by utilization rates rather than price increases. The fastest-growing category was home healthcare, which saw a 13.5% increase year-over-year. Prices for home health services were also among the fastest-growing at a rate of 4.3%.
 
The healthcare industry overall added 76,800 jobs in November, which tied July 2023 for the most jobs added in a month compared to the previous year. This constituted roughly 35% of all the jobs added to the United States economy during the month, which added just under 199,000. Still, economywide job growth in November — 199,000 — fell behind the 12-month average of 232,600. Unemployment dropped slightly to 3.7%.
 
Nursing and residential care facilities brought in the most new workers, with 17,300 jobs added in November. Nursing homes followed with 5,700 new jobs…

Read Full Article

 
<< first < Prev 31 32 33 34 35 36 37 38 39 40 Next > last >>

Page 40 of 357