Outreach efforts pay off for award-winning hospice
Programs expand services beyond traditional audiences
Working outside the box to provide services that don't always fit the definition of home health or hospice is a trademark of Kansas City Hospice and Palliative Care in Kansas City, MO. The hospice's innovative approach to meeting community needs is one of the reasons it was one of three program honored with a 2010 American Hospital Association Circle of Life Award. (See resource box for information on award.)
Three programs that focus on reaching non-traditional hospice audiences were cited as reasons for the hospice's recognition: an outreach program for the African-American community, outpatient services and consultations in community oncology clinic, and a counseling program for community members whose grief exceeds hospice parameters.
Increasing the number of African-American patients from less than 8% to almost 14% in fewer than two years is the result of the minority outreach program at Kansas City Hospice and Palliative Care. "It was harder than I thought it would be to get this program going, but I've learned a lot in the process," says Brenda Sanders, LOM, minority community outreach liaison and educator for the hospice.
"When we started the program, I went to all of the obvious places to market the service," she says. Churches, social service organizations, hospitals, clinics, physicians, and local universities were the first places she went to offer to speak to members or students, she says. "I found that healthcare people needed the most education about hospice and what it can offer," she says.
She also found that churches, a central focus of many African-American communities, were more difficult to approach than she realized. "They don't know where I fit into their agenda," she explains. "I like to say that everyone wants to go to heaven, but no one wants to die."
Prayer groups, some Sunday school classes, and prayer breakfasts were the groups to which she presented the most, she says.
Understanding the cultural beliefs that lead people to avoid talking about hospice is important in an outreach effort, Sanders says. "Family is important, so it is critical to point out that hospice is not planning to replace any member of the family. Instead we are there to help, to give respite, and to support," she says. "I emphasize that I know they want the best quality of life for their family member and hospice services can reduce pain and increase comfort."
Her marketing efforts don't stop at community presentations. "I also appear on various local radio shows and write a column about grief, depression, and mental health issues for the local newspaper," says Sanders. "I also speak with African American physicians because they have the same misperceptions about hospice as the general African American population," she says. Many African-Americans believe that hospice care is less than adequate and hospice patients are lonely and in pain at the time of death.1 She adds, "They appreciate finding out the resources that are available to their patients."
Other one-on-one conversations that Sanders finds effective are with managers of assisted living and skilled nursing facilities. "Personal conversations take time and energy, but it is the best way to develop relationships that result in referrals," she adds.
Presence in oncology clinic spurs service
Talking with oncology patients about the benefits of palliative care and hospice can be difficult, time-consuming conversations, but physicians at Kansas City Hospice and Palliative Care have the opportunity to do so at a community cancer clinic.
Ann Allegre, MD, director of medical programs at the hospice, says, "We were approached by physicians from a large oncology group about an opportunity to offer palliative care services to their patients early in their treatment for cancer."
Allegre and another hospice physician are in the oncologists' clinic one afternoon each week to meet with patients and provide palliative care consultations. "I see about two to three patients each week," she says. "I've had mixed results with the patients I see."
Some patients are open to the idea of palliative medicine, but others are more focused on active treatment and not ready to think about other possibilities, she says. "Patients who are receiving their second or third type of treatment are more open to palliative care discussions than patients undergoing their first round of treatment," says Allegre. Patients who agree to talk with Allegre generally are open about their concerns and appreciate her discussion of end-of-life issues as well as palliative care, she says. "I've helped families complete do-not-resuscitate orders as well as advanced directives," she says. Allegre has also referred patients and their families to the hospice's home palliative care team when appropriate.
Although the ultimate goal of the program is to get patients admitted into hospice care sooner rather than later, Allegre measures success in smaller steps. "We've had a number of patients from the oncology clinic that have entered our hospice program as a result of meeting us in the clinic, but we are still trying to encourage earlier admission," she says.
There are several challenges as well as benefits to working in the oncology clinic, says Allegre. "It is helpful to be in the clinic because patients and family members are more comfortable meeting me at a location with which they are familiar," she explains. "They also appreciate having someone to talk with about issues that are not always easy to discuss with their oncologist."
Physician perceptions are a challenge, admits Allegre. "Old habits die hard, and oncologists have bonded with their patients in a long-term fight against cancer," she explains. "It is difficult for a physician to say that it might be time to stop active treatment."
Allegre's presence in the clinic helps physicians because she can talk directly with them to get their opinions and talk through options for the family. "We can make sure we are saying the same thing to the family, and I can handle the difficult part of the conversation if they prefer," she adds.
Mental health program focus: depression
Talking with seniors about depression as a result of their losses is another difficult conversation handled by the staff of Passages, the hospice's community counseling program.
"I started the program in 2006 after I noticed that a large number of our patients in hospice care had actually been suffering from undiagnosed and untreated depression for many years," says Stevie Shuchart, LSCSW, LCSW, CSW-G, director of the program. "These seniors just assumed that depression was a normal part of growing older, and they were not likely to seek help."
Offering the counseling services was a natural extension of the grief and bereavement counseling provided by the agency, says Shuchart. "Hospice grief counseling is limited to 13 months for Medicare reimbursement, but there are families that require a longer period of time to address their grief as well as any depression that they were experiencing before their loved one's death," she says. Reaching out to people who have not been associated with the hospice also makes sense because it is one way to demonstrate the full range of services a hospice can provide, she adds.
Shuchart's services are billed to her clients' insurance coverage or Medicare if they are covered for mental health counseling. "Because the hospice is a not-for-profit and does offer free care, I can see patients who cannot pay," she adds.
Community presentations on grief as well as end-of-life issues are one source of referrals for Passages and the hospice, says Shuchart. "I've also developed good relationships with several assisted living and skilled nursing facilities," she says.
Seniors are her largest audience because, as a group, they experience more loss, says Shuchart. "There are the obvious losses of a spouse, a sibling, or a good friend, but there are also secondary losses that are not as apparent as a cause of depression," she says. "Being told that they can't drive themselves anymore is a huge loss, especially for men, that often causes depression."
Other losses that contribute to depression include losing a long-time home when seniors can no longer live on their own or losing social groups when the move takes them to another area, she adds.
Although she describes her program as "a work in progress," Shuchart says that any hospice planning to offer a non-traditional mental health program should be prepared to spend time marketing it, often on a one-on-one basis. "This is not a typical program offered by hospice, so it does take time to get the word out," she says. "The good news is that I've now had enough clients that word-of-mouth marketing is bringing me new clients."
Reference
1. Taxis JC. Attitudes, values, and questions of African Americans regarding participation in hospice programs. J Hospice Pall Nurs 2006;8:77-85.
SOURCE/RESOURCE
For more information about programs at Kansas City Hospice and Palliative Care Services, contact:
Kenyon Anderson, PR Specialist, Kansas City, MO. Phone: (816) 276-2632. E-mail: [email protected].
The American Hospital Association (AHA) Circle of Life Award honors innovative programs in palliative and end-of-life care. A selection committee that includes leaders from medicine, nursing, social work, and health administration reviews nominations. For more information about the award, go to www.aha.org/circleoflife.
Working outside the box to provide services that don't always fit the definition of home health or hospice is a trademark of Kansas City Hospice and Palliative Care in Kansas City, MO. The hospice's innovative approach to meeting community needs is one of the reasons it was one of three program honored with a 2010 American Hospital Association Circle of Life Award.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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