Report on the Massachusetts Serious Illness Coalition

The MA Serious Illness Coalition pushes to bring awareness and focus on end-of-life issues.

“It is my goal that every nursing school in MA embrace that a nursing student must see a dying patient with the same fervor that they embrace that every nurse must see a baby being born.”
— Susan Lysaght Hurley, PhD, RN
Director of Research, Care Dimensions, Inc

Last week, the Massachusetts Serious Illness Coalition hosted its annual meeting welcoming more than 100 attendees to the JFK Library in Boston. The message from the Coalition’s leadership – as articulated by Blue Cross Blue Shield MA President and CEO – is that “the momentum is building.” From the Coalition’s beginnings less than five years ago, Dreyfus has focused on a long-term strategy to achieve the Coalition’s six goals. These include the ideas that everyone in Massachusetts 18 years or older has a designated health care decision-maker and that all Massachusetts clinicians have appropriate training to communicate comfortably with patients around advanced care planning and serious illness. Dreyfus has likened the work to that done in years past on smoking and on car seats, where steady force and public messaging achieved near-universal changes in public thinking.

The progress on clinician education – from a provider association perspective – is perhaps the most engaging and encouraging news. Dr Atul Gwande, as eloquent as ever, declared that the work to date has shown that: “People have priorities in life beyond just surviving, but you must ask them. Suffering happens when care doesn’t match our priorities.”

In addition to a public education campaign about engaging in advanced care planning conversations, Dr. Gwande announced that the Coalition is in talks with all four Massachusetts medical schools about a cooperative effort to require training of med students in serious illness communication as a graduation requirement.

But it was Dr, Hurley’s remarks that struck home for the home health and hospice agencies in the Coalition. In addition to the above comment, Dr. Hurley spoke of being a young nurse “totally unprepared as to how to talk to the dying.” Along with her subcommittee co-chair Anne Marie Barron of Simmons College, she is working on recommendations on core competencies for nursing education related to serious illness care. These are to be presented in the near future to the Massachusetts Association of Colleges of Nursing. What a great achievement that would be!

For those following the Coalition’s work, these may also be of interest:

  1. End Games, an Academy Award-nominated short documentary on hospice and palliative care executive produced by Shoshana Ungerleider, MD. It premiered at Sundance Film Festival in 2018 and was acquired by Netflix.

2. The Coalition’s public message research and draft public facing marketing approaches.

Commendable progress!

Return to www.thinkhomecare.org.

Celebrate Nurses Week

Next week is National Nurses week. It is a time to celebrate the dedication, caring and overall contributions of those who choose nursing as their profession.

The Home Care Alliance would like to share your nursing human interest stories next week across our various social media platforms, whether it’s a shout out to a team or a staff member.

Email Megan Fournier at mfournier@thinkhomecare.org to tell us why you love home care & hospice nurses – OR – share our post below and comment why!

Celebrate Nurses Week 2

State Palliative Care Report Published, Work Group Seeks New Members

Last year, the state of Massachusetts’ Palliative Care Work Group commissioned the JSI Research & Training Institute to conduct a statewide and regional assessment on palliative care. In addition to reviewing the quality of palliative care in various settings, the report examined both accessibility and the factors that affect it. The work group, which is housed in MA Department of Public Health’s Comprehensive Cancer and Prevention Control Network, recently published the report. It examines availability of various models of care (e.g., hospital vs community-based), and the intersection of access and reimbursement, as well as public misconceptions and the need for more education. The report looks at access to care on a regional basis and includes an interactive map of identified palliative care services.

Screenshot of the report’s interactive map.

HCA of MA has also identified distinct palliative care programs on our consumer pages. Our online directory now includes a specific category for palliative care, and lists a total of eleven agencies that responded with information about palliative care to our recent survey.

As this work progresses, the state’s Palliative Care Work Group is looking for additional members to help provide consistent messaging about palliative care across the state. The next Work Group meeting will be Thursday, October 19, 2017, 11 AM – 1 PM at the American Cancer Society in Framingham.

Please email Colleen Bayard, cbayard@thinkhomecare.org if you would like to join the work group.

Return to www.thinkhomecare.org.

Portraits of CareGiving – Enter Now!

To celebrate November as National Home  Care Month, the Home Care Alliance wants to put your picture up in the MA Statehouse!   So get out your iPhones and even — if you’d like — your selfie sticks, and send us a photograph of a day or a moment in your home care life!  The photographs will hang the first week in November,  and we hope they will tell in pictures a story of what you do every day across the entire Commonwealth to support those who are often invisible to elected officials and other parts of the health care system.

So get creative with it and let us show them what you do!

Find all of the details here.

Return to www.thinkhomecare.org.

Alliance Quoted in Article on Worker Training, Background Checks

James Fuccione, former Director of Legislative and Public Affairs for the Home Care Alliance, was extensively quoted in an article in the Springfield Republican today.  The article, “Personal care attendants have less training, checks than other home care workers,” by Shira Schoenberg, Statehouse reporter for the Republican, compares background checks and training requirements for workers in the state Personal Care Attendant program with workers employed by home care agencies that provide services under the Executive Office of Elder Affairs home care program.

Proposed Changes Prep Mass. for Nurse Delegation

The Massachusetts Board of Registration in Nursing (BORN) has released proposed regulations that sets guidelines for, among other activities, delegation by nurses to “unlicensed personnel.” These guidelines are NOT a change in the nursing scope of practice around medication delegation, which requires a law  approved by the legislature and signed by the Governor.

The BORN is merely aiming to establish a nurse delegation framework inclusive of much more specificity in areas such as training, supervision and documentation should nurse delegation practices become allowable in Massachusetts.

The proposed regulations also protect nurses by setting criteria for delegation that includes the following:

  • Ensuring that the delegating nurse would not bear any responsibility for any deviation by the unlicensed personnel from the nursing directive, instruction, or plan of care.
  • Formalizes the nurse’s role in knowing what is within the ability of the unlicensed personnel to carry out and what can be delegated that would not require judgment or assessment by the unlicensed personnel.
  • The final decision to delegate is made by the nurse and not the employing healthcare provider.
  • The employing healthcare provider must have the competencies of the unlicensed personnel documented for each nursing activity along with periodic validation of those abilities.
  • The nurse can determine at any time that an activity can no longer be delegated based on the health status of the patient, the unlicensed personnel’s performance of the activity, or any other reason the nurse believes would jeopardize the health and safety of the patient.

The proposed regulation follows years of discussion and a BORN subcommittee report on the state’s readiness for potential changes to nursing practice.

One of the possible changes is a longstanding policy priority of the Home Care Alliance, which is to allow home health care nurses to delegate certain medication administration tasks to a trained and certified home health aide. The HCA has dubbed the proposed policy as the “Nurse Delegation Bill.”

This bill will not pass in the current legislative session that ends with the New Year in 2017, but the HCA plans to continue pursuing a change that would allow – not mandate – that home health and home care agencies can implement proper training and procedures to maximize the efficiency of their direct care staff.

It should be noted that this bill includes protections, such as the fact that delegation is limited to medications which are NOT controlled substances and are administered in the following methods:

  • Oral
  • Ophthalmic
  • Otic
  • Topical
  • Internasal
  • Transdermal
  • Suppository
  • prefilled auto-injectables designed for self-administration
  • Products which are administered by inhalation.

The legislation states that “delegation of intramuscular, subcutaneous, intradermal, intraosseous or intravenous administration of medication shall not be permitted.”

Although the Alliance has comments and suggestions for the BORN’s proposed regulations, HCA fully supports the move to ensure the state is prepared for laws that promote nurses practicing at the top of their licenses. The Alliance appreciates the BORN’s thoughtful approach that further solidifies the importance of nurses in healthcare delivery.

The BORN will hold a public hearing on October 4th and will accept written comments until October 11th.

Return to www.thinkhomecare.org.

Boston Globe’s ‘Salute to Nurses’ Recognizes Home Care

Home care had a prominent place in this year’s “Salute to Nurses,” a special section published every year in the Boston Globe recognizing the work of nurses in every health care setting.

The compassionate and high-quality care of nurses from several home care agencies were recognized, including CareGroup Parmenter Home Care & Hospice, Comfort Home Care, Emerson Hospital Home Care, Hallmark Health VNA & Hospice, and Home Health VNA. Many more stories from patients, their families and nurse colleagues highlighted cases where a nurse from a setting other than home care arranged for post-acute services or follow-up in some way.

Although it wasn’t from a traditional home care agency, another article was dedicated to Allison Neff, a  nurse in Boston Medical Center’s “Elders Living at Home” Program. The article explains:

Neff joined the Elders Living at Home Program, which prevents homelessness among seniors, in 2008. Her job is to conduct home visits to ELAHP patients who don’t qualify for visiting nurse services provided by the state, but who need assistance with some aspect of their health. Many of her patients are at imminent risk of losing their housing, or were homeless and are now transitioning into housing.

The Home Care Alliance will be recognizing all levels of home care staff at the annual Innovation Showcase & Star Awards on June 14th. Clinicians, aides, managers, physicians and other home care champions can be nominated for recognition at the event’s website.

Return to www.thinkhomecare.org.