Pat Ahern of Care Dimensions joins us to discuss several hospice-related issues affecting the home care industry.
Pat Ahern of Care Dimensions joins us for the eighth episode of the Talking Home Care Podcast. As the CEO of the largest and most experienced palliative care agency in the region, Pat’s an authority on palliative care, hospice, and related issues. In a conversation with Alliance Executive Director Pat Kelleher, Ahern discusses:
Palliative care’s role as a “midwife at the other end of life”;
Nurse recruitment and training; and
You may listen to the podcast by clicking the play button below, downloading it directly, or subscribing through iTunes or Google Play. (Length: 26 minutes; Size: 12 MB). If you enjoy it, please give us a five-star review so others can find it as well.
Guest: Patricia Ahern, joined Care Dimensions in 2017 as president and CEO. With more than 30 years of leadership in healthcare and an MBA, she has the clinical and strategic business skills, and a true passion for the mission, that enables her to provide Care Dimensions’s vision and leadership.
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.
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.
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.
In his first budget as governor, Charlie Baker’s administration made sizable shifts within Health and Human Services, which accounts for 53 percent of the overall budget proposal. These shifts were done without negatively impacting most provider rates, including home health services.
In a conference call with provider and advocacy organizations, Executive Office of Health and Human Services Secretary Marylou Sudders announced that there was a 5.6 percent growth over FY15 in the total EOHHS budget and that line items in the Elder Affairs accounts governing the Aging Service Access Point network saw a 2.1 percent increase overall. This includes the following highlights:
A nearly $5.6 million increase over FY15 spending in the Elder Enhanced Home Care Services Program.
Level funding for the Home Care Purchased Services line item ($106.6 million), which governs contracts with home care providers.
A reduction of $13.7 million in the MassHealth Senior Care Account that includes, among other things, the Senior Care Options or SCO program. On the call with Secretary Sudders, it was explained that this was an adjustment on caseloads after re-determinations.
A continued reduction ($68,360,305) in MassHealth Fee-for-Service payments to “meet projected need.”
An increase of $768,713,676 in MassHealth Managed Care spending.
Level funding of grants to councils on aging and to the elder nutrition program.
A nominal increase in spending over FY15 on Pediatric Palliative Care.
The following is a guest blog post from JoAnne Nowak MD who is Medical Director at Merrimack Valley Hospice. They are promoting a publication from the Massachusetts Department of Public Health, titled “Know Your Choices: A Guide for Patients with Serious Advancing Illness.” The guide is meant to help healthcare providers adhere to a new state regulation that requires they inform patients with advancing illnesses about their care options and choices. This publication, which Merrimack Valley Hospice has adapted this publication for their use, lists the Home Care Alliance of Massachusetts as a resource and the Alliance encourages further promotion and distribution.
As a hospice and palliative care physician, I know that decisions about end of life care are deeply personal, and based on individual values and beliefs. I’ve also seen first-hand how advance care planning can be an invaluable gift to those you love. Taking the time to talk with your family, close friends and your healthcare providers while you are in good health are all important steps in an advance care planning conversation.
In Massachusetts, a newly implemented regulation requires that all licensed hospitals, clinics, and long-term care facilities provide information about advance care planning, palliative care, hospice care, and other end of life care options to adults with serious illness. The goal is to help patients start the conversation and make their end of life care wishes clearly known.
To help you begin, the Massachusetts Department of Public Health recently created “Know Your Choices: A Guide for Patients with Serious Advancing Illness.” Merrimack Valley Hospice would like to make it easy for you to obtain this guide by making it available on our website because it contains important information about a variety of healthcare choices. For your free copy, go to http://www.homehealthfoundation.org/patients-resources. You can also call 978-552-4186 to receive a copy by mail.
It’s time for all of us to start the conversation.
JoAnne Nowak MD Medical Director, Merrimack Valley Hospice
Legislation supported by a coalition of health care organizations and advocacy groups, including the Home Care Alliance, that would improve consumer education and provider quality around palliative care has made it to the Governor’s desk on the last day of the 2013-2014 legislative session.
House Bill 4520 sponsored by Representative Chris Walsh, if signed into law by the Governor, would create a State Advisory Council on Palliative Care and Quality of Life. This interdisciplinary group would consult with and advise the Department of Public Health on matters related to the establishment, maintenance, operation and outcomes evaluation of palliative care initiatives in the Commonwealth.
The bill also seeks to establish a Palliative Care Consumer and Professional Information and Education Program that would look to maximize the effectiveness of palliative care initiatives in the Commonwealth by ensuring that comprehensive and accurate information and education about palliative care is available to the public, health care providers and health care facilities.
Additionally, the Massachusetts Department of Public Health would be charged with publishing on its web site, information and resources including links to external resources about palliative care for the public, health care providers, and health care facilities. This would include, but not be limited to, continuing education opportunities for health care providers; information about palliative care delivery in the home, primary, secondary, and tertiary environments; best practices for palliative care delivery; and consumer educational materials and referral information for palliative care, including hospice.
The American Cancer Society’s Cancer Action Network has led the charge on this effort, which Home Care Alliance has supported throughout the legislative process. The bill promotes the idea that palliative care is appropriate for patients with advanced illnesses or conditions that employ a team-based and patient-centered approach that takes into account a person’s emotional and mental well-being and strives to improve the quality of life for both patient and family.
A provision included in the state’s 2012 Health Care Cost Containment Law (Chapter 224) on palliative and end-of-life care options is being realized through a final regulation issued by the Department of Public Health.
It is now a patients legal right to receive information about palliative care and hospice from a facility as well as their full range of options for treatment, if the condition warrants either approach. Massachusetts hospitals, clinics and long-term care facilities are expected to comply.
The Home Care Alliance helped advocate for the inclusion of this provision in the law and also commented with several other provider groups and organizations at a public hearing when the regulations were proposed. At that time, the definition of palliative care in the proposed regulation was more in line with hospice services. The Alliance, among many other groups, expressed concern that palliative care is a team-based approach to an advanced illness, but not necessarily linked to the expected outcome of that illness as with hospice.
DPH has released a guide explaining the right to these options in several languages for consumers, a summary of what was changed from the proposed to the final regulation, and the regulation language itself. The list of resources can be viewed here on a DPH webpage.
The Home Care Alliance is a part of an MCCPCN task force that built the survey, which will be distributed to agencies via email form DPH. Agencies are strongly encouraged to take the time to respond. MCCPCN is under the Department of Public Health and a cover letter from Commissioner Cheryl Bartlett explains the reasoning and background to the survey as well as how it will help advance palliative care services.
Questions on this issue can be directed to James Fuccione at the Alliance.
The MA Department of Public Health recently released a set of draft regulations relative to a new requirement that – effective next year – will require hospitals and skilled nursing facilities to distribute information on palliative care and end of life care. Under the draft regulations, the facilities will be required:
Have a process to identify appropriate patients
Ensure that appropriate patients receive information
Distribute information about hospice and palliative care in a timely manner
Some HCA members have reviewed these draft regulations and believe that the draft definitions do not make a clear enough distinction between palliative care and hospice care almost using the terms interchangeably. There will be a public hearing on these rules in Boston on Nov 21st at 2 PM in the Public Health Council Room, Second Floor, Department of Public Health, 250 Washington Street, Boston.
The Alliance will be providing comments and encourages other members to do so, either in person or in writing. Electronic or written testimony can be submitted to: Reg.Testimony@state.ma.us as an attached Word document or as text within the body of an email and type “End-of-Life” in the subject line. All submissions must include the sender’s full name and address. The Department will post all electronic testimony that complies with these instructions on its website All testimony must be submitted by 5:00 p.m. on November 22, 2013.
Members are encouraged to also provide feedback to the Alliance for our testimony as well.
After years of advocacy and passing budget items with weak language that did not compel MassHealth to act, the Governor signed off on the $33.6 billion FY2014 state budget with a provision that recognizes home telehealth as a reimbursable service.
There is still plenty of work to be done with MassHealth, but passing the telehealth language in the budget is the furthest the Home Care Alliance has gone towards achieving reimbursement for an established service known to create efficiencies, improve care, and reduce costs.
The Alliance will be including a push for telehealth in comments on the state’s proposed home health regulation changes. Any agencies or advocates interested in commenting with HCA in an attempt to have the state include telehealth reimbursement in regulation to ensure its permanence should have a letter in to MassHealth by the July 26th deadline. Agencies can contact James Fuccione at the Alliance for details.
Also included in the the final budget is $1.5 million for the Pediatric Palliative Care Network, which serves the unmet physical, emotional, social and spiritual needs of children in Massachusetts with life-limiting illnesses. This is more than $670,000 of additional funding over previous budgets.
The Alliance would like to thank all the agencies and advocates who sent emails, made phone calls, met with legislators and otherwise supported telehealth and the pediatric palliative care funding. These items passing in the final budget represent a huge victory for home care and prove that persistent advocacy pays off.