Inpatient hospice, nursing home situation is win-win
From financial drain to successful unit
(Editor's note: This is the second part of a two-part series on partnerships between hospice agencies and long-term care providers. Last month, we looked at the key issues to address in relationships that involve hospice employees visiting residents in long-term care facilities. This month, we look at a hospice agency that has developed an inpatient hospice unit within a long-term care facility.)
When the management at Rainbow Hospice in Park Ridge, IL, determined that the agency had reached a size and daily census that would support an inpatient hospice unit, they looked to current long-term care partners as potential landlords.
"Many inpatient hospice units are located in hospitals, but we wanted a different environment," explains Pat Ahern, chief executive officer of the hospice. "We didn't want our patients and their family members negotiating a hospital campus, and we didn't want them restricted by hospital visiting hours." By going to a facility other than a hospital, the hospice was able to create a warmer, more homelike environment, she says.
"We work with 85 long-term care facilities in our area, so we contacted them to see which ones might have the space we needed and be willing to lease it to us," explains Ahern. Requirements on Ahern's wish list included 7,000 square feet, the ability to convert the space into private suites for patients and their families, separate entrance for the unit, and close proximity to the home office to make it easy to manage the construction and startup of the unit, she says.
"We had one long-term care partner that was ideal," says Ahern. Not only did the nursing home have unused space, but they were experiencing a decline in occupied beds and were looking for a way to cover costs, she explains. The nursing home only is a five-minute drive from the hospice central office, and the facility's goals and patient care philosophy is a good match for the hospice, Ahern says.
Converting one wing
Because the nursing home was built with a number of wings, the hospice was able to rent one wing that previously housed 24 nursing home patients. It was able to convert it to 15 patient care suites along with a home-like reception and waiting area, and a hospice-specific entrance, says Ahern. "We paid for the renovation, and our rent includes dietary and housekeeping services, utilities, and parking," she says. Having a hospice entrance that is separate from the nursing home is important for the convenience of hospice families and for the privacy of nursing home residents, she adds.
Although services such as dietary and housekeeping are purchased from the nursing home, the inpatient hospice unit is staffed by hospice employees and all patient care is provided by hospice employees, Ahern says. "We have 17 employees for the hospice unit," she says. The staff consist of nurses, nursing aides, a physical therapist, and a music therapist, she says. "Three nurses came from our hospice agency, and others came from other hospice agencies," she says. "Inpatient hospice nursing is not for every hospice nurse because it is more intense." Working at the inpatient unit is voluntary, but staff members will float between the agency and the inpatient unit as needed based on census, she adds.
Start new service slowly
In the first three months of operation, the inpatient hospice has reached eight patients, says Ahern.
"We are intentionally building slowly," she says. "Every patient needs us to do this right, and we don't get a chance for 'do-overs.' We have to do it right the first time."
Patients admitted to the inpatient unit have experienced an exacerbation in symptoms that cannot be managed at home, says Ahern. Examples of reasons for admission to an inpatient hospice include increasing pain, agitation, or the inability of a frail spouse to provide care, she explains. "About one-half of our admissions come from patients we are seeing through our agency, and the other half are directly from the hospital," she says.
Hospital patients' families like the availability of an inpatient hospice because they often are afraid that the family member won't get the same level of care in a home setting as they can receive in a hospital, says Ahern. "Our unit is a win-win for the hospital and the family," she says. Not only does the hospital have an appropriate place to which patients can be discharged, but families are reassured by the inpatient setting, Ahern explains.
Hospice managers who are considering development of an inpatient hospice unit should keep a few things in mind to ensure a successful partnership, suggests Ahern. "Make sure that the mission and values of the other organization match your mission and values," she says. Ask to see their mission statement, discuss the results of their most recent state survey, and even look up their profile on the Nursing Home Compare web site, she suggests. (Editor's note: Go to www.medicare.gov, and select "Compare nursing homes in your area.")
Also, be very open about your plans and why you are proceeding the way you are, says Ahern. Long-term care facilities don't get reimbursed in exactly the same way hospices are reimbursed, so use your initial talks to educate potential partners, she suggests. "Share your business plan and talk about how your plans can complement or affect their business," Ahern says. "Be sure to cover all issues related to staffing, services, equipment, and the building in your conversations as well as your contract."
Even with thorough planning, there are glitches, admits Ahern. "We identified every possible need for families, patients, and staff members and thought we had addressed everything," she says. One of the issues addressed was parking, and both Ahern and the long-term care manager believed that there were plenty of parking places for families of both facilities' patients. Four spaces were designated for hospice visitors to make sure there were places close to the entrance for them, she says. Other visitors could use nursing home spaces as well, she adds.
"We quickly realized that we underestimated our need for parking when 40 family members arrived to visit our second patient," Ahern says with a laugh. "We worked with the nursing home to negotiate overflow parking space with a church that is located one block from the facility. We direct families to the overflow parking when the lot is full, and we've had no more problems."
Need More Information?
For more information about development of an inpatient hospice, contact:
- Pat Ahern, Chief Executive Officer, Rainbow Hospice, 444 N. Northwest Highway, Suite 145, Park Ridge, IL 60068. Telephone: (847) 685-9900. Fax: (847) 685-6390. E-mail: [email protected].
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