Complete Story
02/25/2010
Hospice E-News Volume 15, Issue 8 February 26, 2010
- JOB OPPORTUNITIES
- AUTHOR EXAMINES INTERDISCIPLINARY STAFFING PATTERNS IN FOR-PROFIT AND NONPROFIT HOSPICES
- RESEARCH & RESOURCE NOTES
- HOSPICE NOTES
- MUSIC THERAPY NOTES
- OTHER NOTES
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AUTHOR EXAMINES INTERDISCIPLINARY STAFFING PATTERNS IN FOR-PROFIT AND NONPROFIT HOSPICES
"Interdisciplinary Staffing Patterns: Do For-Profit and Nonprofit Hospices Differ?," in the current Journal of Palliative Medicine, uses the 2006 Medicare Provider of Services (POS) survey to evaluate staffing patterns in hospices. The study defined interdisciplinary staff as "having at least 1 full-time equivalent (FTE) staff in each of 4 disciplines ascertained by the survey: physician, nursing, psychosocial, and home health aide, and by the professional mix of staff within each discipline."
Ownership of hospices was classified as either for-profit (46.9%) or nonprofit (43.0%), with a small minority classed separately as governmental hospices (10.1%). The study also took into account the age of the hospices, which allowed for examining "differences among the very new hospices, the somewhat older hospices, and the most well-established hospices," a distinction the authors believed important "given the recent expansion of the for-profit sector of the hospice industry."
The results showed "substantial variation" in the staffing patterns by hospice ownership type. The authors say, "We find that for-profit compared to nonprofit hospices on average employed a less professionalized mix of nurses and of psychosocial staff counselors. As hypothesized, for-profit hospices had proportionally fewer registered nurses per nursing FTEs, proportionally fewer medical social workers per psychosocial FTE, and proportionally fewer clinicians per total FTEs. The findings regarding fewer volunteers per total staff in for-profit hospice was also consistent with our hypothesis."
The authors add, "What was less expected was the increased odds of for-profit compared with nonprofit hospices having a full range of disciplines among paid staff. The difference did not exist when counting both paid and volunteer staff, and was explained in large part by the more common use of volunteer versus paid physicians in nonprofit hospices compared with for-profit hospices. Previous work has shown that for-profit hospices are more likely to be affiliated with a chain and therefore, it is plausible that being part of larger operation allows them to spread the costs of paid physicians FTEs more efficiently. The current state of knowledge on the impact of integrating volunteer physicians into the hospice care team is limited, and future studies should examine this pattern in light of the full complement of an interdisciplinary team."
According to the article, there were no differences by ownership between older and younger hospices, but the authors say their "power to detect such differences as significant was limited." They note that they could not examine the presence of clergy because the information is not included in the POS data. They also "could not adjust for hospice size or market-based competition in labor supply or patient demand, and it is possible that market features would be important in determining staffing patterns. Nevertheless, it is not clear that such market features would differ by ownership type and we did adjust for geographical location."
In conclusion, the article says, "From these national data, it appears that hospices do not differ in the existence of a full range of interdisciplinary staff if both paid and volunteer staff members are counted, but nonetheless do differ in the professional mix of the staff within the various disciplines. Having more professionalized staff with more advanced educational and licensure backgrounds has been found in acute care to be associated with better patient outcomes, although such studies have not been conducted in the context of hospice care. Our study has identified new and significant ownership-related differences within the hospice industry. Future studies are needed to characterize the impact of these differences for patients and their families." (Journal of Palliative Medicine, 2010;13(3))
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RESEARCH & RESOURCE NOTES
- "Impact of Writing ‘Comfort Measures Only' Orders in a Community Teaching Hospital" compared end-of-life care for patients who did and did not have "comfort measures only" orders, and "evaluated whether standards for palliative medicine were met." The retrospective chart review found no significant differences between the groups in medications, treatments, or notation of symptoms, except that nausea and vomiting were more common in those without CMO orders. The CMO group had opioids "more significantly available," and antibiotics and routine lab work were less common for that group. The authors conclude, "CMO orders alone were insufficient for redirecting changes in care at the end-of-life." (Journal of Palliative Medicine, 2010;13(3)
- "Use of the Stages of Change Transtheoretical Model in End-of-Life Planning Conversations," in the Journal of Palliative Medicine, discusses the use of the Stages of Change (SOC) model to initiate end-of-life planning discussions. The model was used in a controlled trial of an Advanced Illness Care Coordination Program, which is "designed to assist patients and families to optimally manage life with an advanced illness." (Journal of Palliative Medicine, 2010;13(3);
- "Results from the National Hospice Volunteer Training Survey," in the current Journal of Palliative Medicine, reports on an online survey for the Hospice Volunteer Association and Hospice Educators Affirming Life Project. The results show that most volunteers work in patient care, and most agencies require a commitment of four hours per week for a year. Volunteer training costs an average of $14,303 per year. Important curriculum topics are communication and family support. (Journal of Palliative Medicine, 2010;13(3)
- "Improving Social Work in Intensive Care Unit Palliative Care: Results of a Quality Improvement Intervention," reports on the effects of the intervention on three outcomes" "(1) families' satisfaction with social work, (2) social workers' reported palliative and supportive activities, and (3) social workers' satisfaction with meeting family needs." The results showed no increase in social worker satisfaction or family ratings of social workers after the intervention. Increased family satisfaction with social work was reported with "increased social worker experience and smaller social work caseload." The researchers say, "Future studies will need more powerful interventions or more sensitive outcome measures to document improvements in family-assessed outcomes." (Journal of Palliative Medicine, 2010;13(3)
- "A Respiratory Distress Observation Scale for Patients Unable to Self-Report Dyspnea," in the current Journal of Palliative Medicine, reports that the Respiratory Distress Observation Scale (RDOS) "performed well when tested with terminally ill patients who were at risk for respiratory distress, most of whom could not self-report dyspnea." The authors call the scale "simple to use; scoring takes less than 5 minutes," and add that it is "sensitive to detect changes over time and measure response to treatment." (Journal of Palliative Medicine, 2010;13(3)
- A study from the Johns Hopkins Bloomberg School of Public Health's Department of Health Policy and Management found that two-thirds of respondents to a survey did not have advance directives in place. While nearly two-thirds of respondents did have preferences about the kind of medical care they would want, the reasons they gave for not having one included lack of familiarity with them, and feeling either too healthy or too young to need one. Forty percent said they would like to get information on medical directives from their physician, but only 12% of those who had one got the information from their doctor. (The Medical News, 2/18)
- "Center to Advance Palliative Care Palliative Care Clinical Care and Customer Satisfaction Metrics Consensus Recommendations" reports on a CAPC consensus panel which developed "specific clinical and customer metrics that programs should track." Clinical metrics include "daily assessment of physical/psychological/spiritual symptoms by a symptom assessment tool; establishment of patient-centered goals of care; support to patient/family caregivers; and management of transitions across care sites." Customer metrics are "patient/family satisfaction, and referring clinician satisfaction."(Journal of Palliative Medicine, 2010;13(2):179-184)
HOSPICE NOTES
- Howard Gleckman, Senior Research Associate at the Urban Institute, says that hospice enrollments are declining, and it's not clear why. He writes, "Some hospice officials blame both a bad economy and Medicare rules that unintentionally discourage doctors from referring all but those who are about to die. ... The poor economy may also be driving doctors to hold on to patients longer." A spokesman for the Center for Hospice and Palliative Care in South Bend, Indiana, said that 8% of last year's referrals died before admission, and 20% more died within 48 hours. According to Gleckman, "Those last-minute decisions put enormous financial pressure on hospices and make it impossible for patients to get the full benefit of end-of-life care." (Kaiser Health News, 2/18)
- Marie Trottier, disability coordinator at Harvard University, is trying to establish a regional Hospice House that "incorporates hospice services in a hospital environment." Click here to read the full article. (The Harvard Gazette, 2/21)
MUSIC THERAPY NOTES
- A literature review of "all randomized and quasi-randomized controlled trials that compared music interventions and standard care with standard care alone or combined with other therapies in any care setting with a diagnosis of advanced life-limiting illness being treated with palliative intent and with a life expectancy of less than two years" found "no strong evidence" for beneficial effects of music on pain or anxiety. The authors conclude, "A limited number of studies suggest there may be a benefit of music therapy on the quality of life of people in end-of-life care. However, the results stem from studies with a high risk of bias. More research is needed." (Cochrane Database of Systematic Reviews, 2010)
- Peter Roberts, a music thanatologist, worked with the people at Musicmakers Kits to develop a harp that could be used by patients. Matt Edwards, who works at Musicmakers, said, "He wanted something that was smooth, round, and easy to hold, with no sharp edges, so it could easily go into a hospital bed or a wheel chair." They designed the Reverie Harp, small and egg-shaped, which has a "harmonized scale on which it's impossible to play a bad note." The harp now outsells all other instruments made by musicmakers, and is popular with music therapists. See www.harpkit.com for more information and a link to a presentation about the instrument. (St. Croix Valley Local News, 2/19)
OTHER NOTES
- The reviewer of "American VI: Ain't No Grave," Johnny Cash's last album, calls it "Cash's hospice record." Click here to read the full article. (The Los Angeles Times, 2/21)
- Embark Health, Inc. has announced its Advance Directive Solution, a paid membership program which will donate a percentage of the enrollment fee to a worthy healthcare cause. Click here to read the full article. More information is available at www.embarkhealth.com/ADS. (PR Newswire, 2/18)
- Murray Dubin, former reporter for The Philadelphia Inquirer, writes about his grief after his 92-year-old mother died. He says, "A friend told me what I could expect. He said it would be like standing on the beach and letting the waves hit you. Most just splash on your legs, but sometimes, without warning, a big one comes and knocks you down. You get up, and then sometime, you're never sure when, another whopper plows into you." Dubin and his mother had talked about her last wishes, and he encourages readers to do the same. He writes, "I'm not sure how instructive my experience is, but if you haven't had a ‘dying' conversation with your parents, take the time to do it. Parents, your adult children may be uncomfortable bringing the topic up - so you do it." (The Philadelphia Inquirer, 2/21)
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