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How Do You Train Your Hospice Volunteers?

By Barbara Karnes

I was thinking about hospice volunteer training. What makes a good training program? I am hearing stories about the lack of professional staff training for new hires, which led me to wonder about volunteer training. 

So - here are my thoughts for a hospice volunteer training program:

  1. At the first meeting of the training, have a discussion focusing on why the person wants to be a volunteer in the end of life arena. It is not an area most people are interested in, so why are they?
  2. When was their last experience with death? Often there can still be unresolved grief issues. I suggest that at least one year has passed since the death of a significant person in the potential volunteer’s life. Working with end of life patients may trigger their own memories and interfere with objectivity in giving help. (Note that steps 1 and 2 should come before the following steps. We need to see why they are drawn to this area before anything else. These steps may be the time that the prospective volunteer decides hospice volunteering is not the work for them. It is also the point at which the hospice coordinator decides it is not a good fit for the applicant.)
  3. Now explain the role of a volunteer. Go over what is expected and what is not acceptable. 
  4. Begin teaching the signs of approaching death. Go over what the signs will look like in the months, weeks, and hours before death. Particularly address how eating, sleep, socialization will change. Provide lecture-style teaching, take-home reading materials, and written assignments.
  5. Teach the basics of nutrition, skin care, pain management, and monitoring activity levels. Not because the volunteer will be doing care, but because they are the eyes of the professional staff and can report their observations.
  6. Teach effective and sensitive communication and active listening skills.
  7. Go over the specifics of dementia at end of life and how to interact with someone with the disease.
  8. The basics of grief are another important component of end of life training. Again, lecture and provide reading materials and written assignments.
  9. Offer guidance on self-care. Offer guidance on the importance of entering the patient/caregivers life as a support person, and how we don’t become personally involved. Lecture on creating a closure ritual, having a buddy system, and when and how to contact a bereavement coordinator for personal support should the need arise.
Convey the importance of attending monthly volunteer discussion groups. These groups are a coming together of active volunteers for conversation, support, and continuing education inservice.

I suggest The Final Act of LivingBy Your Side and the End of Life Guideline Series Bundle be required readingThese will provide a strong baseline in end of life knowledge. I also recommend these for medical professionals working in the end of life area.


New Gene Tests Can Predict if a Drug Will Work for a Patient

Medscape | By Sari Harrar

What if there were tests that could tell you whether the following drugs were a good match for your patients: Antidepressants, statins, painkillers, anticlotting medicines, chemotherapy agents, HIV treatments, organ transplant antirejection drugs, proton pump inhibitors for heartburn, and more?

That's quite a list. And that's pharmacogenetics, testing patients for genetic differences that affect how well a given drug will work for them and what kind of side effects to expect.

"About 9 out of 10 people will have a genetic difference in their DNA that can impact how they respond to common medications," said Emily J. Cicali, PharmD, a clinical associate at the University of Florida College of Pharmacy, Gainesville, Florida.

Cicali is the clinical director of UF Health's MyRx, a virtual program that gives Florida and New Jersey residents access to pharmacogenetic (PGx) tests plus expert interpretation by the health system's pharmacists. Genetic factors are thought to contribute to about 25% or more of inappropriate drug responses or adverse events, said Kristin Wiisanen, PharmD, dean of the College of Pharmacy at Rosalind Franklin University of Medicine and Science in North Chicago, Illinois.

"Pharmacogenetics helps consumers avoid drugs that may not work well for them or could cause serious adverse events. It's personalized medicine," Cicali said.

Through a cheek swab or blood sample, the MyRx program — and a growing number of health system programs, doctors' offices, and home tests available across the United States — gives consumers a window on inherited gene variants that can affect how their body activates, metabolizes, and clears away medications from a long list of widely used drugs…

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NAHC, NHPCO to Merge, Dombi to Retire

McKnight’s Home Care | By Adam Healy

The National Association for Home Care & Hospice and the National Hospice and Palliative Care Organization are on track to begin merging by July. In a related development, NAHC’s president William Dombi disclosed that he intends to retire by the end of 2024.

“Both boards have authorized an affiliation agreement; it’s fully drafted,” Ken Albert, chair of NAHC’s board of directors, told McKnight’s Home Care Daily Pulse in an interview. “We’re looking to transition July 1 of this year. The transition board has been selected. I’ll serve as chair of that transition board; [NHPCO board chair] Melinda Gruber will serve as vice chair. Board members have been identified, and then that next six months from July to December will kind of be the operational integration. We’re in the process of recruiting a new CEO right now, and then all the tech-side, the backend, office-end, that’s going on right now.”

Albert added that neither Bill Dombi or Ben Marcantonio, NHPCO’s chief executive officer, would be eligible to lead the new organization. However, Dombi may remain associated with the new organization in some capacity, he said.

“His title with [the new organization] is ‘president emeritus and of counsel,’” Albert said. “So he’ll continue to stay on as the new counsel for us and really in an advisory capacity with regard to the new organization as that transition is over in 2025.”

The current merger between NAHC and NHPCO represents the organizations’ fourth time attempting to combine. They have previously stated that a merger would help create a “unified voice” advocating on behalf of the home health, home care and hospice industries.

Dombi’s impact on the sector cannot be understated, Albert added.

“He’s contributed to the healthcare sector — particularly the post-acute, home health and hospice sector — for almost 40 years. It’s a huge part of who he is professionally,” he said. “Bill Dombi deserves to be celebrated for his contributions to the industry, and as the NAHC board winds down, we have an ad hoc committee that has been working to identify opportunities to acknowledge his contributions and celebrate him as NAHC winds down and becomes the new organization.”


Contradictory Policymaking Has Led To Costlier Care: The Future of Health Care Is In The Home

Home Health Care News | By Guest Contributor
The following is an op-ed submitted by: Ken Albert, CEO, Andwell Health Partners; David Causby, CEO, Gentiva; Marcylle Combs, CEO, MAC Legacy; Brent Korte, CEO, Frontpoint Health; John Olajide, CEO, Axxess; Billy Simione, Managing Principal, SimiTree; Jennifer Sheets, the former CEO of Interim HealthCare; Susan Ponder-Stansel, CEO, Alivia Care; David Totaro, Chief Government Affairs Officer, BAYADA; Sara Wilson, President & CEO, Home Assist Health; and Bryan Wolfe, the former CEO of Traditions Health

As the nation faces a debt ceiling of $34 trillion and climbing, it’s no surprise that the federal government is under pressure to find ways to cut program costs and crack down on overspending. 
What is surprising is that the program they continually target in budget cutbacks has an impressive record of saving the government billions: Medicare-certified home health care. 

Though home health care helps nearly 36 million 65+ and permanently disabled Americans recover at home and avoid costlier placements in institutions, the Centers for Medicare & Medicaid Services (CMS) has initiated deep cuts to the Medicare home health industry, totaling $25 billion in cuts over the next decade

Government-funded health care programs like Medicare, Medicaid and Medicare Advantage (MA) home health are closely connected in how they are financed. 
This is because Medicaid and Medicare Advantage have such insufficient funding to begin with, forcing providers to rely on Medicare to cover the shortfall to offset the costs incurred in treating patients under Medicaid and Medicare Advantage – a decade-old system that is severely flawed and requires all three programs to ride on the backs of one another for financial stability. 
The solution is two-fold: First, CMS must stop cutting Medicare home health care funding. Cutting funding year after year has only created turmoil in the very industry that is essential in providing stable, in-home care for vulnerable Americans. 
Second, CMS and the Medicare Payment Advisory Council (MedPAC) must seek to develop new policy approaches that account for Medicare’s cost-savings and support a sustainable funding model for Medicare, Medicaid and MA. This two-fold solution will ensure that purported federal efforts to save money and cut programs are not done so to the detriment of millions of seniors and adults with permanent disabilities. 
As funding cuts continue, the costs of business and operations increase, leaving home health providers forced to either cut wages, services and coverage areas or shut their doors altogether. This ultimately costs Medicare more money by pushing patients into costlier institutional settings while simultaneously risking health outcomes. 
Medicare home health patients have better health outcomes and are at less riskfor rehospitalization. Since COVID, we have seen a substantial shift in America’s future of health care as more evidence has shown home to be the safer and more comfortable setting. Without fixing the flawed system, vulnerable Americans won’t be able to access this option of care and our government will be forced to spend even more money. 
To put it into perspective:
It costs $2,010 per month to care for a patient at home for 30 days under home health care.
skilled nursing facility costs an astronomical $16,500 for that same care.
That’s a cost savings of approximately 88% for every patient diverted from a skilled nursing facility and cared for at home. Put another way, we can care for eight people at home for the cost of caring for one person in an institution…

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Nursing Home Groups File Lawsuit to Block CMS' Staffing Mandate

Fierce Healthcare | By Dave Muoio
Nursing home associations have filed a lawsuit in federal court seeking to block a controversial staffing policy the Biden administration says is necessary to protect facility residents.
The American Health Care Association, the Texas Health Care Association and the operators of three nursing facilities in Texas filed their complaint Thursday in the Northern District of Texas. It seeks to block a final rule, published in the federal registrar on May 10, that they argue exceeds the administration’s statutory authority.
“We had hoped it would not come to this; we repeatedly sought to work with the Administration on more productive ways to boost the nursing home workforce,” Mark Parkinson, President and CEO of AHCA, said in a release announcing the lawsuit. 
“Unfortunately, federal officials rushed this flawed policy through, ignoring the credible concerns of stakeholders and showing little regard for the negative impact it will have on our nursing home residents, staff and the larger healthcare system.”
The Centers for Medicare and Medicaid Services’ (CMS’) final rule requires facilities receiving Medicare and Medicaid funding to have a total nurse staffing standard of 3.48 hours per resident per day. It also outlines ratio requirements for registered nurses (0.55 hours per resident per day) and nurse aides (2.45 hours per resident per day), and a requirement for at least one registered nurse to be onsite 24 hours a day.
These and other requirements are set to be phased in over the coming years, with certain facilities like those in rural communities getting extra leeway.
AHCA and other industry groups have been against the requirements since they were proposed last year. They warned that the final rule would in effect reduce access to care due to nursing homes’ widespread workforce shortages and tight finances.
In an analysis released earlier this month AHCA and the National Center for Assisted Living, for instance, the groups wrote that the nursing home industry would need to hire an additional 102,000 nurses and nurse aids to come into compliance, a collective $6.5 billion per year added expense. They also warned that over 290,000 current residents of nursing homes could be displaced due to census reductions or full closures.
“Hundreds of thousands of seniors could be displaced from their nursing home; someone has to stand up for them, and that’s what we’re here to do,” Parkinson said…

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