Why the American Healthcare System Needs Hospice Nurses NORENE MOSTKOFF, MBA
s you read about the new healthcare models, they are all about improved care, improved health, and reduced cost—the “triple aim.” To achieve the triple aim, the current thinking is a need for more and better care coordination. Care coordination is talked about as almost a new disruptive innovation. Just as the iPod changed the way we listen to music in 2001, care coordination has taken the healthcare world by storm. Hospice nurses have been providing coordinated care for decades at a lower cost per patient and have been doing it extremely well. According to Medicare, “The goal of coordinated care is to make sure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.” Hospice nurses do this and more. What if healthcare, especially for the chronically ill, could be provided the way we deliver hospice services—with an interdisciplinary team that is led by a registered nurse (RN) case manager? Here are a few lessons the system can learn from hospice nurses:
A
February 2015
1. Treat the patient and his or her support system as the unit of care. Hospice goes beyond the idea of “patientcentered care” to address family needs as well. Imagine you are taking care of your 75-year-old mother while working full-time and raising your own children. What you
2. Have an RN in charge of managing the patient’s care. A hospice nurse is smart, self-directed, and has a deep understanding of not only end-stage illnesses but also their comorbidities. Under the advisement of physicians, hospice nurses help reduce duplication of tests,
Hospice nurses have been providing coordinated care for decades at a lower cost per patient and have been doing it extremely well. need is an army of experts to come to your home to show you how to give mom her medications, teach you how to assist her in ambulating, prepare you for her changing care needs, help you elect insurance coverage, bring together your squabbling siblings, and simply offer support and understanding. That’s what hospice does—it addresses the patient’s care needs and supports the family. Addressing the needs of family caregivers enables them to better support those of their loved ones. New healthcare models striving to enhance care while enabling individuals to age in place can take their cues from hospice’s approach.
avoid medication interactions, and empower patients by providing them with customized education. Today’s healthcare models should look to hospice nursing in addressing patient care coordination, blending the specialized expertise of a geriatric nurse with the skill of a public health nurse. 3. Hold a periodic interdisciplinary group (IDG) meeting. Working as the case manager under the advisement of the physician, hospice nurses work toward agreement on the plan of care among all care team members who contribute perspectives from a variety of disciplines. A hospice IDG meeting is the ideal blend of
Home Healthcare Now
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
117
Three million baby boomers will reach retirement age every year for the next 20 years, and during the next decade, the demand for geriatric nurses will grow between 19% and 26%. customized care, efficiency, and collaboration. Every opinion is valued and every discipline has an equal seat at the table. It can lead to improved quality of life for patients and their families and fosters an environment of innovative problem-solving among team members. 4. Care for the patient’s physical, emotional, and spiritual well-being. As we look to improve healthcare, we cannot ignore the emotional and spiritual needs of the patient and their contribution to the patient’s overall health. These needs are built into the hospice care model. A critical component of the hospice admission is the assessment from both the nurse and the social worker. Each addresses specific needs and works with the family to develop a plan of care that addresses psychosocial and spiritual support in addition to pain and symptom management. Led by the nurse, the hospice team supports person-centered care— from providing education to alleviate anxiety of the unexpected to supporting spiritual concerns to mediating family conflict to making final wishes realities. In a study published in the March 2007 issue of the Journal of Pain and Symptom Management, hospice patients lived 29 days
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longer than did nonhospice patients. We attribute this statistic to offering patients a sense of autonomy and hope that many have lost throughout the disease care process. We must change our focus to the patient’s overall health rather than the disease. 5. Bring the care to the patient. Hospice nurses go to the patients to meet them where they live. At the patient’s own residence, nurses can assess safety and social support. Bringing care to the patients supports their independence, keeps families together, and combines efficiency and compassion with the latest in healthcare technology. Recently, one of our nurses actually made her visits to her patient’s place of business, per his request. Although visiting a patient at work may not be a usual site of care delivery,
this patient, a lifelong carrepair enthusiast, requested that we come to his business because staying on the job was an important part of his life. To prepare for our nation’s aging population, we must offer care coordination that is efficient, creative, and smart. Three million baby boomers will reach retirement age every year for the next 20 years; and during the next decade, the demand for geriatric nurses will grow between 19% and 26%. The good news is that we do not have to recreate the wheel to develop a smart model of coordinated care for our nation’s chronically ill and aging. Best practices, cues for cost savings, and opportunities for cross coordination already exist. If you do not believe me, just ask a hospice nurse. Norene Mostkoff, MBA, is the President and Chief Executive Officer, HCI Care Service and Visiting Nurse Services of Iowa, West Des Moines, Iowa. The author declares no conflicts of interest. Address for correspondence: Norene Mostkoff, MBA, 2910 Westown Parkway, Suite 200, West Des Moines, IA 50266 ([email protected]). DOI: 10.1097/NHH.0000000000000189
home
HEALTHCARE now welcomes reader feedback! Send your thoughts and comments to:
Maureen Anthony, Editor [email protected]
www.homehealthcarenow.org
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
s you read about the new healthcare models, they are all about improved care, improved health, and reduced cost—the “triple aim.” To achieve the triple aim, the current thinking is a need for more and better care coordination. Care coordination is talked about as almost a new disruptive innovation. Just as the iPod changed the way we listen to music in 2001, care coordination has taken the healthcare world by storm. Hospice nurses have been providing coordinated care for decades at a lower cost per patient and have been doing it extremely well. According to Medicare, “The goal of coordinated care is to make sure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.” Hospice nurses do this and more. What if healthcare, especially for the chronically ill, could be provided the way we deliver hospice services—with an interdisciplinary team that is led by a registered nurse (RN) case manager? Here are a few lessons the system can learn from hospice nurses:
A
February 2015
1. Treat the patient and his or her support system as the unit of care. Hospice goes beyond the idea of “patientcentered care” to address family needs as well. Imagine you are taking care of your 75-year-old mother while working full-time and raising your own children. What you
2. Have an RN in charge of managing the patient’s care. A hospice nurse is smart, self-directed, and has a deep understanding of not only end-stage illnesses but also their comorbidities. Under the advisement of physicians, hospice nurses help reduce duplication of tests,
Hospice nurses have been providing coordinated care for decades at a lower cost per patient and have been doing it extremely well. need is an army of experts to come to your home to show you how to give mom her medications, teach you how to assist her in ambulating, prepare you for her changing care needs, help you elect insurance coverage, bring together your squabbling siblings, and simply offer support and understanding. That’s what hospice does—it addresses the patient’s care needs and supports the family. Addressing the needs of family caregivers enables them to better support those of their loved ones. New healthcare models striving to enhance care while enabling individuals to age in place can take their cues from hospice’s approach.
avoid medication interactions, and empower patients by providing them with customized education. Today’s healthcare models should look to hospice nursing in addressing patient care coordination, blending the specialized expertise of a geriatric nurse with the skill of a public health nurse. 3. Hold a periodic interdisciplinary group (IDG) meeting. Working as the case manager under the advisement of the physician, hospice nurses work toward agreement on the plan of care among all care team members who contribute perspectives from a variety of disciplines. A hospice IDG meeting is the ideal blend of
Home Healthcare Now
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
117
Three million baby boomers will reach retirement age every year for the next 20 years, and during the next decade, the demand for geriatric nurses will grow between 19% and 26%. customized care, efficiency, and collaboration. Every opinion is valued and every discipline has an equal seat at the table. It can lead to improved quality of life for patients and their families and fosters an environment of innovative problem-solving among team members. 4. Care for the patient’s physical, emotional, and spiritual well-being. As we look to improve healthcare, we cannot ignore the emotional and spiritual needs of the patient and their contribution to the patient’s overall health. These needs are built into the hospice care model. A critical component of the hospice admission is the assessment from both the nurse and the social worker. Each addresses specific needs and works with the family to develop a plan of care that addresses psychosocial and spiritual support in addition to pain and symptom management. Led by the nurse, the hospice team supports person-centered care— from providing education to alleviate anxiety of the unexpected to supporting spiritual concerns to mediating family conflict to making final wishes realities. In a study published in the March 2007 issue of the Journal of Pain and Symptom Management, hospice patients lived 29 days
118
Volume 33
|
Number 2
longer than did nonhospice patients. We attribute this statistic to offering patients a sense of autonomy and hope that many have lost throughout the disease care process. We must change our focus to the patient’s overall health rather than the disease. 5. Bring the care to the patient. Hospice nurses go to the patients to meet them where they live. At the patient’s own residence, nurses can assess safety and social support. Bringing care to the patients supports their independence, keeps families together, and combines efficiency and compassion with the latest in healthcare technology. Recently, one of our nurses actually made her visits to her patient’s place of business, per his request. Although visiting a patient at work may not be a usual site of care delivery,
this patient, a lifelong carrepair enthusiast, requested that we come to his business because staying on the job was an important part of his life. To prepare for our nation’s aging population, we must offer care coordination that is efficient, creative, and smart. Three million baby boomers will reach retirement age every year for the next 20 years; and during the next decade, the demand for geriatric nurses will grow between 19% and 26%. The good news is that we do not have to recreate the wheel to develop a smart model of coordinated care for our nation’s chronically ill and aging. Best practices, cues for cost savings, and opportunities for cross coordination already exist. If you do not believe me, just ask a hospice nurse. Norene Mostkoff, MBA, is the President and Chief Executive Officer, HCI Care Service and Visiting Nurse Services of Iowa, West Des Moines, Iowa. The author declares no conflicts of interest. Address for correspondence: Norene Mostkoff, MBA, 2910 Westown Parkway, Suite 200, West Des Moines, IA 50266 ([email protected]). DOI: 10.1097/NHH.0000000000000189
home
HEALTHCARE now welcomes reader feedback! Send your thoughts and comments to:
Maureen Anthony, Editor [email protected]
www.homehealthcarenow.org
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
