Newsletter Hospice & Palliative Care: A World of Dignity ... · Hospice & Palliative Care: A World of Dignity for All, con’t. In its most basic form, maintaining patient dignity

Inside

Trauma Informed Care................ 3

Free WHV Training ...................... 4

Kudos Corner .............................. 5

Telehealth Benefits ..................... 6

HPNA Position Statement ........... 7

Parental EOL Needs .................... 8

Tidbits ......................................... 10-11

CHAPCA News ............................. 12

Calendar ..................................... 13

Hospice & Palliative Care: A World of Dignity for All

CHAPCA Message for the Field

The first six months of 2020 have been turbulent. The pandemic and resulting economic crisis have created an atmosphere of

loss and uncertainty. Stress on our country’s healthcare workers and system continue. Including Hospice and Palliative Care

providers here in California.

The pandemic has created an environment in which people feel a loss of autonomy. A loss of making health care choices for

themselves and loved ones. A loss of empowerment. Most of all they feel a loss of their dignity. A sense of personal dignity is

essential to a person’s wellbeing. People need to feel valued and respected. It can be as simple as employing the “Golden Rule,”

a principle of many religions and cultures: Do unto others as you would have them do unto you.

Dignity is the cornerstone of hospice and palliative care. The philosophy of hospice and palliative care is built around respecting

the patient and their wishes, providing each individual with the highest quality of life for however many days they have

remaining. Maintaining patient dignity at end-of- life is paramount.

As members of a hospice and palliative care team, the most important thing that you can do to help a patient maintain dignity

at the end of life is to remember you are caring for an individual with unique needs, experiences, and desires. Everyone wants

to be treated with respect. Having the added support of hospice can help increase patient dignity by ensuring the patient

receives the respectful clinical, personal, emotional and spiritual care that they need.

Hospice Quality Reporting Program:

COVID-19 PHE

A tip sheet (PDF) on the Hospice Quality Reporting Program (HQRP): COVID-19

Public Health Emergency (PHE) is available. This tip sheet provides guidance on

quality data submissions starting on July 1, 2020, now that the temporary exemp-

tions from the COVID-19 PHE ended.

Visit the HQRP Requirements and Best Practices webpage for more information.

July 2020 Volume 12, Issue 7

Newsletter

Con’t pg 2

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4847835/https://www.cms.gov/files/document/hqrpcovid-19-phetipsheetjuly-2020508-compliant.pdfhttps://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/HQRP-Requirements-and-Best-Practices

2 July 2020

Hospice & Palliative Care: A World of Dignity for All, con’t. In its most basic form, maintaining patient dignity boils down to treating the individuals in your care the way you would

like to be treated, much like the Golden Rule. When patients are treated with respect, it creates a greater sense of trust

and wellbeing.

The Hospice & Palliative Care Approach to Maintaining Dignity Hospice and palliative care team members follow these guidelines to ensure that each patient is treated with respect and

dignity:

• Speak to the patient directly. Introduce yourself to the patient when you meet them. Never speak about a patient in

the third person if they are in the room.

• Speak respectfully to and about the patient. Speak without jargon and in terms that a patient can understand. At the

same time, do not patronize or speak down to a patient. Practice patience and empathy. Do not make jokes about the

patient even if you think they are out of earshot. Answer patients honestly to build trust and take time to listen to

their concerns.

• Ask how the patient would like to be cared for. For example, when brushing a patient’s hair, ask how they like their

hair parted. Explain what you will be doing before you do it – especially if you will be touching the patient. Remember

that what is routine for you may be a new experience for the patient.

• Protect the patient’s physical privacy. Maintain patient dignity by ensuring they remain covered while providing care.

When giving a bath, keep the patient covered with a blanket or towel, uncovering only the section of the body you are

currently washing.

• Protect the patient’s personal information. Do not gossip or share personal information about the patient or family

beyond what is necessary for members of the care team. It is a privilege to be invited into a patient’s life.

• Assist the patient with personal grooming. Go beyond the basics to help patients retain pride in their appearance.

Trim whiskers brush the patient’s hair or help the patient get dressed. For individuals who found great satisfaction in

their sense of style throughout their lives, pride in appearance is essential to their self-

respect.

• Create a respectful atmosphere. Maintain patient dignity at end-of-life by estab-

lishing a peaceful atmosphere in their final hours. Keep the patient comfortable. Play

soft music to set the mood. Ensure the patient’s religious needs are being met. Contin-

ue to speak to the patient even if they are no longer responsive. Assume they can still

hear you as the sense of hearing is one of the last senses to go.

The California Hospice and Palliative Care Association provides extensive education,

tools, resources and services to ensure that team members deliver the best care

possible with dignity. Membership opens access to those resources and compliance

issues. As a contributor or advocate you can help improve quality hospice and palliative

care services.

Sincerely,

CHAPCA President and CEO

CHAPCA STAFF

Shelia Clark

President & CEO

Sarah Dorricott

Director of Membership

Programs and Services

Courtney Rineman

Membership Outreach

Coordinator

CHAPCA

P.O. Box 340698

Sacramento, CA 95834

PH: 916.925.3770

FX: 916.925.3780

www.calhospice.org

http://calhospice.org/

July 2020 3

In June, CHAPCA announced that we were presented a grant provided by We Honor

Veterans and the Dept. of Veterans Affairs, to promote the Trauma Informed Care

Initiative for Veterans on Hospice. The focus of this grant seeks to improve the care

of Veterans on hospice that have been impacted by trauma. The three main goals is

to expand access to the VA Palliative Tele mental health expertise for veterans on

hospice in their homes, to share the VA's expertise through the PTSD program and to

train the community hospice staff in the care of veterans on hospice.

CHAPCA has implemented a few things to help hospice providers access the tools and

resources that are available. We encourage you and you staff to take advantage of

these resources so that we can ensure that our Veterans are receiving the care they

deserve.

Visit our Trauma Informed Care Initiative Resource Page CHAPCA has created a page devoted to the Trauma Informed Care Initiative on our website which contains information on how to

be a We Honor Veterans partner and earn your stars, how to participate in the initiative, a summary of the assessment tools that are

available, direct links to access the PTSD Consultation program, FREE education and helpful links to educate you and your staff on

trauma that effects Veterans and much more.

Join us for a FREE Live Q&A session with Dr. Quan Tran, MD. in August CHAPCA has invited Dr. Quan Tran and his team to provide a panel Q&A session for members to talk about Trauma Informed Care.

Dr. Quy Tran is staff physician at the VA Northern CA Health Care System. This is a great opportunity to bring your questions to a

team of physicians. More details will be available soon from CHAPCA!

Trauma Informed Care Initiative

Earn your stars by completing a quick survey

Are you a We Honor Veterans partner? If so, your agency can participate in a survey to support our efforts to collect data for congressional reporting. Participants will be provided a completion certificate that can be submitted with your activity report. The survey is just a few questions and takes less than five minutes to complete.

Click HERE to complete the survey. Additionally, if you would like to participate in our weekly surveys, please visit our Trauma Informed Care web page and click on Data Assessment and complete the 3 surveys to track the veterans that are being screened and are testing positive for PTSD, Moral Injury and/or Suicidality. If you are a We Honor Veterans Community Partner, you may use the completion certificate that you will receive to earn your stars and increase your levels.

• Trauma Informed Care Initiative - Agencies Adopting Protocols

• Trauma Informed Care Initiative - Number of Veterans Screened

• Trauma Informed Care Initiative - Positive Domains

Visit our Trauma Informed Care Page.

https://chpca.memberclicks.net/whv-trauma-informed-care-initiativehttps://chpca.memberclicks.net/index.php?option=com_mcform&view=ngforms&id=2051056https://www.calhospice.org/whv-trauma-informed-care-initiative#dataassessmenthttps://chpca.memberclicks.net/index.php?option=com_mcform&view=ngforms&id=2051124https://chpca.memberclicks.net/index.php?option=com_mcform&view=ngforms&id=2051128https://chpca.memberclicks.net/index.php?option=com_mcform&view=ngforms&id=2051129https://chpca.memberclicks.net/whv-trauma-informed-care-initiative

We Honor Veterans provides a training resource called VHA TRAIN which provides a comprehensive catalog of public health

training opportunities. Everything on VHA TRAIN is free and open to non-VA staff.

Though trauma comes in many forms, the focus of this initiative focuses on three forms of trauma that effects Veterans: PTSD,

Moral Injury and Suicidality. CHAPCA recommends starting with the following webinars:

Community Hospices- Posttraumatic Stress Disorder in Vietnam Veterans Recording Post-traumatic Stress Disorder (PTSD) affects many Veterans of the Vietnam War, and can complicate their quality of life and

relationships with families and health care providers. This live knowledge-based presentation will define PTSD, it’s causes and

symptoms, and how this may manifest at the end of life. A number of treatment options for PTSD specific to those under hospice

are will be presented. The similarities and differences between PTSD and other conditions will be discussed.

Register Here

Class Description

Suicide Prevention for Vietnam Veterans This live knowledge-based presentation will help to prepare hospice providers and other healthcare teams to identify signs of

suicidal thoughts and behavior among Veterans. Appropriate suicide assessment tools for identifying high risk Veterans will be

described. Options for intervention and care will be discussed, both within the VA and externally.

Register Here

Class Description

Community Hospices- Moral Injury in Vietnam Veterans This webinar will define the concept of Moral Injury (MI) to healthcare teams and how it affects some Veterans of the Vietnam

War. How to identify symptoms of Moral Injury, especially in the last weeks to months of life, will be described. Treatment

options, particularly those that are viable in the home setting and utilized by hospice and other healthcare professionals, will

be discussed. The similarities and differences between Post Traumatic Stress Disorder (PTSD) and Moral Injury will also be

presented. This can also apply to other Veterans.

Register Here

Class Description

4 July 2020

Download and Print the FREE Assessment Tools and Kits on PSTD

Proper assessment of trauma exposure and PTSD is best accomplished with validated measures. You will be provided

information on a variety of measures assessing trauma and PTSD. These measures are intended for use by qualified mental

health professionals and researchers. Be sure to utilize these assessment tools and best practices in your own agency:

• Measures authored by National Center staff are available in PDF format to download on the specific measure pages

or by request from the Center as noted.

• Measures developed outside of the National Center can be requested via contact information on the page for the

specific measure.

• A comprehensive list of all measures offered.

Utilize the FREE We Honor Veterans Training Available to Providers

https://vha.train.org/vha/course/1086813/https://chpca.memberclicks.net/assets/docs/PTSD%20Webinar%20Info.docxhttps://vha.train.org/vha/course/1086808/https://chpca.memberclicks.net/assets/docs/Suicide%20Prevention%20Webinar%20Info.docxhttps://vha.train.org/vha/course/1086811/https://chpca.memberclicks.net/assets/docs/Moral%20Injury%20Webinar%20Info.docxhttps://www.ptsd.va.gov/professional/assessment/list_measures.asp

July 2020 5

CHAPCA Kudos Corner: Featuring Music Therapists

CHACPA Announces New Partnership

Music therapists at VITAS® Healthcare, like Brad Steiger (in photo

at C), dedicate themselves to lifting spirits and fostering hope.

When the COVID-19 pandemic put a halt to in-person visits and

performances, music therapists began “window visits” with pa-

tients in SNFs and ALFs to keep sharing their mission and keep

people dancing whenever possible.

From songs at Balboa Nursing and Rehabilitation Center in the

San Diego area to courtyard concerts at Brookdale Gardens in

Tarzana, the music brings residents “a sense of mental well-

being after months of dealing with social distancing,” said

Michael MacDonald, VITAS director of market development for

San Fernando.

Music can also be a fun outlet and source of professional camaraderie, as shown in the Nurses Week musical tribute

from Brad Steiger, VITAS music therapist in Sacramento. Steiger and his colleagues have worked hard to “continue

providing enriching and engaging services for our patients and the communities where they live so we can establish

strong connections and address the social, emotional, and spiritual needs of those we serve during this time of uncer-

tainty and social isolation.”

Danny Garcia Jr., MT-BC (pictured at R), a Music Therapist and Bereavement

Specialist for Season’s Hospice Los Angeles Program, connects through the

gift of song.

“I have worked as a music therapist in many different clinical settings and

populations, and hospice care is by far the setting that best aligns with my

personal and professional philosophy of MT as a holistic, non-invasive, and

essential part of the interdisciplinary group. Seasons is an organization that

not only recognizes the power that music therapy has at this time in a

patient’s life, they make it an elemental part of the patient’s care team.

Seasons goes above and beyond for each patient to ensure that every part

of the dying process is addressed and transitioned smoothly, to give every

patient a death with dignity.”

The California Hospice and Palliative Care Association (CHAPCA) and Axxess are pleased to announce a partnership between the two organizations which will benefit CHAPCA members, who provide hospice and palliative care services in California. As a partner of CHAPCA, Axxess will provide education for providers that are both timely and FREE! Be sure to visit their Associate Partnership webpage for discounts, upcoming webinars and hospice products and ser-vices for CHAPCA member providers. Stay tuned – the first webinar will be scheduled for August!

https://youtu.be/6WPDKz5yQ4shttps://chpca.memberclicks.net/axxess-hospice

As the pandemic surged in U.S. cities, palliative care teams have been called on to provide end-of-life support for COVID-19

patients. Necessitated by safe distancing measures, much of this support was conducted by phone and video call alternatives.

In many cases, these kinds of communications can add to the palliative care experience, rather than take away, physicians report

in an article published on the website, Wired.

For example, the palliative care team at Mount Sinai found itself with more patients than it could support, so they set up a phone line to help reach everyone in need. Palliative care doctors Claire Ankuda and Chris Woodrell began the phone line, taking alternating 12-hour shifts. They served 900 patients in four weeks. Ankuda and Woodrell found that the phone calls were an effective mode for the serious conversations they were having with patients. Patients called in with concerns about symptoms, such as needing help breathing. People also called for help with loneliness, anxiety, and help making difficult care decisions. Ankuda also mentions benefits of having family members on calls, especially over video. Video calls eliminate issues of distance and allow more family members than usual to participate.

Many other palliative care physicians are echoing Ankuda and Woodrell’s excitement about tele-health. Eric Widera, Geriatrician

at the University of California San Francisco says he was worried about trying tele-health during the pandemic. His concerns

faded once he made his first call. “When you’re one on one with that family member—it feels really familiar, and it feels like I’ve

been doing it for a long time,” he says.

Michael Fratkin has practiced tele-health in rural Northern California for five years. He doesn’t plan to return to in-person visits

and isn’t concerned about connectivity issues, which some physicians cite as a concern. He says he would rather help arrange

the installation of connection-improving devices for his patients, regardless of cost. “If we avoid one emergency department visit

by managing a set of symptoms early and at home, we’re killing it on the numbers game,” Fratkin says.

6 July 2020

CMS/Treasury/Labor Announces Mandates for Coverage and Payment for COVID-19 Tests

The Trump administration announced on June 23, 2020, that insurers are not required to cover COVID-19 tests that employers

may mandate as they bring employees back to work. The guidance, jointly issued by CMS/Treasury and Labor, clarifies that

the law only applies to tests that are deemed “medically appropriate” by a health care provider, according to an article that

was published in Modern Healthcare on June 24 (a subscription is required to access this article).

Note, in particular, that in Question 5 (page 6 of the guidance) it specifically states that general workplace health and safety

screening and public health surveillance is beyond the scope of the coverage mandates in those laws. This has implications

for whether and when third party payers will cover COVID-19 tests and other services, and will be relevant to hospice and

palliative care providers who are either conducting such testing of employees, or whose employees are required to be tested

in order to access hospice patients in certain facilities.

NHPCO reports that some states have issued “directives” that state mandated testing of nursing home employees is

“medically necessary” and must be covered by state-regulated insurance plans. It is unknown at this time where those

mandates will end up in light of this guidance.

Palliative Care Doctors Find Benefits to Telehealth during Pandemic

https://www.wired.com/story/when-doctors-and-patients-talk-about-death-over-zoom/https://www.cms.gov/files/document/FFCRA-Part-43-FAQs.pdfhttps://www.modernhealthcare.com/payment/trump-administration-says-insurers-hook-back-work-covid-19-tests?utm_source=modern-healthcare-covid-19-coverage&utm_medium=email&utm_campaign=20200623&utm_content=article1-readmore

July 2020 7

News & Updates from CMS

HPNA Releases Position Statement on Medically Administered Nutrition and Hydration

CMS Extends Medicare Care Choices Model One More Year

A one-year extension of the Medicare Care Choices Model (MCCM) has been announced by the CMS Innovation

Center. The extension adds one calendar year, moving the end date to December 31, 2021. Participating hospice

providers will be able to continue enrolling patients through June 30, 2021, and provide services through

December 31, 2021.

The model is meant to “increase access to supportive care services provided by hospice,” “improve quality of life

and patient/family satisfaction,” and “inform new payment systems for the Medicare and Medicaid programs,” CMS

explains. The model targets dually eligible beneficiaries who have elected the hospice benefit within 30 days before

enrolling in the MCCM. “Under the model, participating hospices will provide services that are currently available

under the Medicare hospice benefit for routine home care and respite levels of care, but cannot be separately billed

under Medicare Parts A, B, and D,” says CMS. Currently, 82 hospices are participating in MCCM.

In a public statement, NHPCO President and CEO Edo Banach said, “We urge CMS to build upon this successful

demonstration in future years by offering even greater choice to patients suffering from serious illness, many of

whom are in need of interdisciplinary, person-centered care prior to qualifying for the hospice benefit.”

New ABN Form Released

The ABN, Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget

(OMB) for renewal. The use of the renewed form with the expiration date of 06/30/2023 will be mandatory on

8/31/2020. The ABN form and instructions may be found in the download section of the CMS website.

The Hospice and Palliative Nurses Association recently released a position statement on medically administered nutrition and hydration (MANH). In it, HPNA asserts that it is “medically, ethically, and legally acceptable for patients with serious illness or their surrogate decision-makers to choose to initiate, withhold, or withdraw” MANH. The HPNA statement delves into some of the background information that holds up their position.

In the statement, HPNA outlines several responsibilities of hospice and palliative nurses of MANH in clinical practice. These healthcare workers must ensure “patient autonomy”; “education regarding benefits and burdens of interven-tions”; and “informed decision-making based on the patient’s clinical condition, goals, values, beliefs, culture, ethnicity, and religion.” They must further ensure that discussions are guided by informed ethics, that decisions are aligned with any advance care documents, and that there is support of the decision from the interdisciplinary care team, the patient, and the family.

Education about MANH is essential. Hospice and palliative care nurses must receive instruction regarding MANH. MANH education must specify that it’s considered a medical intervention, affirm that some cultures and religions consider the treatment necessary for providing a basic human right of sustenance, and cover expected natural trajectories of illnesses and how food and water affects these progressions.

Find the MANH statement on the HPNA website’s position statement page

https://innovation.cms.gov/innovation-models/medicare-care-choiceshttps://www.nhpco.org/cms-announces-one-year-extension-of-medicare-care-choices-model/https://www.cms.gov/Medicare/Medicare-General-Information/BNI/ABNhttps://advancingexpertcare.org/position-statements/

The first qualitative study to explore the views of parents and families during end-of-life (EOL) care for children with cancer is providing insights into what families need during this painful time, as well as the policy changes and programs that could help overcome barriers to spending time with a dying child.

In an article, Bereaved Parents' Views on End-of-Life Care for Children with Cancer: Quality Marker Implications, research that was conducted by Dr. Emily Johnston and colleagues from Jacob's Heart Children's Cancer Support Services, Lucile Packard Children's Hospital Stanford, University of Washington School of Medicine, and the Univer-sity of Alabama at Birmingham, was published in the May 2020 issue of Cancer, the journal of the American Cancer Society.

Led by Dr. Johnston, the study was conducted through one-on-one interviews with bereaved parents on their perceptions of "quality markers" at the end of life. The trusted relationships and support provided by Jacob's Heart throughout the research process helped parents feel safe about sharing their experiences.

Among the research team's findings:

• Most families prefer a natural home death for their child instead of at a hospital, except when there was inadequate home support or concerns about how a child's siblings would react to a home death.

• Families reported wanting the option to continue anti-cancer therapy through end-of-life.

• Hospital visitation policies and financial strain were major barriers to families spending time with their child at end-of-life.

• Families were often underprepared for the events surrounding their child's death and funeral arrangements.

• Families reported feeling a sense of "abandonment" by their clinical teams after the death of their child.

8 July 2020

Study Explores Parental Needs During End-of-Life Care for Children with Cancer

NHPCO Calls for Extension to Public Health Emergency

In a letter sent to HHS Secretary Alex M. Azar on June 26, 2020, the National Hospice and Palliative Care Organization

called for an extension of the Public Health Emergency past the current expiration date of July 25, 2020.

In the request, NHPCO stressed that essential support can be given to hospices and palliative care providers under and

extension of the emergency declaration. Through the Public Health Emergency and national emergency measures, hos-

pices and palliative care providers have been able to adapt to the challenges of the COVID-19 crisis and continue ensur-

ing care to vulnerable patients.

If the Public Health Emergency were to end too soon, NHPCO expects negative consequences. Essential hospice tele-

health visits, allowed through the CARES Act, may no longer be permitted. Section 1135 waivers would expire, doing

away with further flexibilities which have facilitated continuation of care during the pandemic. The PPE shortage in hos-

pice care would still go unresolved before the emergency declaration is lifted. And the shortage of COVID-19 tests in

hospice and palliative care would also remain unresolved.

“Challenges associated with COVID-19 will continue to impact how patients receive care, and we ask that you continue

to support the capacity of hospice and palliative care providers to serve Americans in need,” wrote NHPCO.

The letter to Secretary Azar is available on the NHPCO website.

https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.32935http://www.nhpco.org/wp-content/uploads/NHPCO_Letter_Secretary_Azar_PHE_Extension_062620.pdf

July 2020 9

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Amazon will donate 0.5% of your purchases to CHAPCA automatically! Simply follow these instructions to turn on AmazonSmile.

1. Open the Amazon Shopping app on your device

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https://www.achc.org/

Tidbits Palliative Care

10 July 2020

Tidbits Hospice Care All hospice providers are encouraged to participate in

National Data Set. The National Data Set, a project of

NHPCO, is a unique collection of information from hospice

providers on staffing, volunteer, and bereavement ser-

vices. Sharing your program’s information helps NHPCO

update existing resources, create new resources, and

advocate with policy makers and regulators on behalf of

the provider community. Hospice organizations need not

be a member of NHPCO to submit data to the National

Data Set. All NDS participants will receive the National

Report for free and will be entered in a raffle for two free

passes to NHPCO’s 2020 Virtual Conference or Virtual

Interdisciplinary Conference. Providers with questions

about the NDS are encouraged to contact NHPCO staff at

[email protected]. Deadline to participate in NDS data col-

lection is August 30, 2020. – MORE

MedPAC June Report is released. The Medicare Payment

Advisory Commission released its June 2020 Report to the

Congress: Medicare and the Health Care Delivery System.

The seven chapters of the report include considerations

of “realizing the promise of value-based payment in Medi-

care, an agenda for change;” “challenges in maintaining

and increasing savings from accountable care organiza-

tions;” “replacing the Medicare Advantage quality bonus

program”; and many other topics. No policy changes to

hospice care are suggested in this

report. – MORE

NHPCO releases pediatric hospice and palliative care

video. The new video, “My Support, My Hospice: Na-

than’s Story,” shares the experience of 21-month-old Na-

than Pitillo and his parents Greg and Becky. Nathan was

born with microcephaly and diagnosed with a rare brain

disorder lissencephaly. Right after he was born, he began

hospice treatment with Hospice and Palliative Care Buffa-

lo, where his condition stabilized; he was then moved to

palliative care at home. Nathan’s parents describe pediat-

ric hospice as “incredibly important.” Becky Pitillo says “I

think it empowers you as a parent, you know the diagno-

sis, but having somebody there to walk you through eve-

rything gives you the strength to work through it and give

him the best life that he can have.” – MORE

Study on LGBT experience in hospice is published in JPM. A recent study published by the Journal of Palliative Medi-cine (JPM) examines “inadequate, disrespectful, and abu-sive care” of LGBT patients and their families in hospice care. LGBT patients report fear that they will not receive adequate, equal, or safe treatment if they are fully open about their sexual and gender identities. They have con-cerns that their partners and family members will not be included or taken seriously. Researchers say that staff training and advocacy should work to ensure more re-spectful and inclusive care. – MORE

Delivering Difficult News in COVID-19 Era. In Harvard

Business Review, palliative care physician Jessica L. Israel

discusses delivering difficult news to family members and

patients during the COVID-19 crisis. Though communica-

tion around tough news often comes with the territory in

palliative medicine, the pandemic has cut off many of the

normal routes for such conversations. In response, Israel

and her colleagues established a “Goals of Care Conversa-

tion Team” for fielding COVID-19 support phone calls at

Jersey City Medical Center and four other hospitals in

their system. “The urgent need we have to discover our

patients’ wishes during a public health emergency under-

scores the importance of knowing our patients’ goals as a

critical component of everyday high-quality health care,”

Israel says. “Our telephone service made it possible to

spend more time discussing those goals with families than

overwhelmed frontline physicians could have.” The

important lesson that Israel takes away from this experi-

ence is that palliative care teams need to expand their

efforts to know all of their patients’ goals of care. Her

team at Jersey City Medical Center is now working to

establish these kinds of conversations as a primary care

best practice. – MORE

https://www.nhpco.org/ndshttp://medpac.gov/docs/default-source/reports/jun20_reporttocongress_sec.pdfhttp://www.nhpco.org/nhpco-releases-video-about-the-value-of-pediatric-hospice-palliative-care/http://www.liebertpub.com/doi/10.1089/jpm.2019.0542https://hbr.org/2020/06/delivering-grim-news-to-covid-19-patients-families

Relaunch of Tipping Point Challenged. The Center to Advance Palliative Care announced the relaunch of the John A. Hartford Foundation Tipping Point Challenge. Winning organizations will be working for innovation in one of three areas: “Building Skills Among Nonpalliative Care Specialties and Disciplines: Improving communica-tion skills and/or pain and symptom management skills among all specialists treating CHF, COPD, and cancer;” “Improving Systematic Access to Specialty Palliative Care;” or “Reaching the Patients in Need: Implementing a population health approach to identify and address patients with serious illness and unmet needs.” Sign-up is available from June 2020 through March 2021. – MORE Potential Benefits of Cannabis. A recent study published

by the Journal of Palliative Medicine examines the poten-

tial benefits of medical marijuana for cancer-related

symptoms. The study reviewed Edmonton Symptom As-

sessment System (ESAS) reported pain symptoms in

medical charts of patients who used medical marijuana

and those who did not. Dosages of opioids for pain man-

agement are examined alongside marijuana use. More

favorable outcomes were seen in patients using medical

marijuana across categories of pain management, emo-

tional symptoms, and opioid dosage adjustments. Mari-

juana use “improved oncology patients’ ESAS scores de-

spite opioid dose reductions and should be considered a

viable adjuvant therapy for palliative management,” re-

searchers conclude. – MORE

Lack of clarity in physician communications can be a

problem. An article in Physician’s Weekly says physicians

may fail to inform patients when they are transitioning

them from curative to palliative care treatment, accord-

ing to the Blue Faery Liver Cancer Association. These

physicians may also be likely to avoid discussing end-of-

life options with patients, which can reduce quality of life

and leave bereaved family members with unnecessary

medical debt. “Physicians should make end-of-life plan-

ning and clear articulation of the options for palliative

care part of their standard operating procedures for pa-

tients who are terminal,” say article authors Andrea J.

Wilson and Matthew Loxton of Blue Faery Liver Cancer

Association. – MORE

Catholic Priests in Boston Receive Special Training. In

Boston, a task force of 21 Catholic priests are undergoing

specific safety training in order to deliver last rites to

Catholic patients dying of COVID-19, The New York Times

reports. “A century ago, priests were ‘answering sick calls

night and day,’ one Catholic newspaper reported at the

time. Now nurses and doctors, not spiritual leaders or

families, are most likely to be death’s witnesses,” accord-

ing to the article in NYT. – MORE

Robots helping doctors at risk. In Maryland, special ro-

bots are helping at-risk doctors carry out telehealth vis-

its, free of concerns of COVID-19 exposure. “The robots

allow us to get to the bedside virtually without putting

the physicians or other health care workers at risk of

being infected,” critical care physician at the University

of Maryland School of Medicine Dr. Neal Reynolds ex-

plains. “We wanted to keep health care workers working

if they could.” They hope to continue expanding the use

of the robots by making them available to palliative care

teams and pastoral services. – MORE

Berwick writes of “moral determinants of health.” Don-ald Berwick, MD, MPP, Institute for Healthcare Improve-ment, pens a “Viewpoint” essay for JAMA in which he examines the “moral determinants of health.” In it, he suggests that social determinants of poor health and shorter life expectancy could be addressed if either taxes were raised to fund social programs or health expendi-tures were shifted to prioritize social determinants of poor health. He challenges healthcare institutions, physi-cians, and nurses to call for “US ratification of the basic human rights treaties and conventions of the interna-tional community.” He calls for health care to be a basic human right. – MORE

NEJM on Innovations for MA patients. An article in the

New England Journal of Medicine highlights innovations

to care delivery that could better meet Medicare Ad-

vantage patient needs and reduce spending. Included in

this proposed model is engaging community as in-home

health care workers; improving capability of patients;

and leveraging telemediated behavioral health specialists

to improve communication around health care goals. The

full article is available to subscribers. – MORE

July 2020 11

Tidbits Other Notes

http://www.wfmz.com/news/pr_newswire/pr_newswire_health/center-to-advance-palliative-care-launches-new-round-of-the-tipping-point-challenge-to-change/article_d6676e15-a6fc-5246-817a-87f0058c6562.htmlhttp://www.liebertpub.com/doi/10.1089/jpm.2019.0374http://www.physiciansweekly.com/the-prognosis-problem-talking-with-patients-about-end-of-life-decisions/http://www.nytimes.com/interactive/2020/06/06/us/coronavirus-priests-last-rites.htmlhttps://wtop.com/maryland/2020/06/how-robots-are-helping-at-risk-caregivers-continue-to-work-with-covid-19-patients/https://jamanetwork.com/journals/jama/fullarticle/2767353https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0290

CHAPCA is partnering with NHPCO on these Virtual Conferences

What does this mean for CHAPCA members? Your membership with CHAPCA will allow you and your staff to register at the discounted rate for attendance to the

2020 Virtual Conference, July 22 & 23, and the Virtual Interdisciplinary Conference, October 12—30.

Visit the National Hospice and Palliative Care Organization Associate Partnership webpage for more information on the

schedule, educational agenda, faculty, and registration links.

12 July 2020

CHAPCA Job Boutique

Have you visited our Job Boutique? The CHAPCA Job Boutique is a free member benefit and will allow you to post your

agency’s job openings on our public forum. Members are welcome to post a 30, 60, or 90 day listing or upgrade to a

Premium advertisement. CHAPCA will be promoting this benefit regularly! Posting a job is just three simple steps.

Click here to visit the Job Boutique for full instructions.

Most Recent Openings:

• Director of Patient Care Services /Patient Care Administrator – Irvine, CA

• Hospice Administrator – San Diego, CA

• Site Visitor – Washington, DC

• RN Case Manager, Sacramento, CA

CHAPCA’s Annual Conference and Exposition is going VIRTUAL!

CHAPCA will be moving our 2020 Annual Conference to a virtual platform. More details on the event will be coming

soon! We are currently looking for presenters! If you or someone in your agency/company is interested in hosting a

virtual workshop, please submit an application for a proposal by July 31, 2020. Each workshop will be 60 minutes with

a 15 minutes Q&A session. Don’t miss the chance to be part of this CHAPCA event.

Call for Presenters —Topics to be considered:

• Community-Based Palliative Care

• Leadership | Motivating Your Team

• Hospice and Palliative Care Pain and Symptom Management

• Back Office Operations

• Quality Best Practices

• Regulatory Best Practices

• Other-CHAPCA will consider all proposals

https://chpca.memberclicks.net/national-hospice-and-palliative-care-organizationhttps://chpca.mcjobboard.net/jobshttps://chpca.memberclicks.net/index.php?option=com_mcform&view=ngforms&id=2047613

New in 2020, CHAPCA has added LIVE webinars that are FREE to CHAPCA

members. Check the event calendar on our website for a current schedule. Register through our Event Calendar on calhospice.org.

Upcoming FREE Live Webinars:

• July 16 - Best Practices Infection Control | Working Together | Assisted Liv-

ing and Hospice, presented by Josh Allen and Sheila Clark.

• July 21 - Exempt vs. Non-Exempt Employees, presented by Heffernan

Consulting

Hospice and Home Care Webinar Network – CHAPCA members receive a reduced

price on over 50 webinar topics. The 2020 webinar schedule with registration

links is online. Upcoming webinars:

• July 15 - Marketing & Community Outreach for Fall 2020: Challenges & Op-

portunities for Hospice & Palliative Care

• July 16 - From Referral to Admission: Secret Ingredient to Compliant Growth

• July 23 - The Denial Myth: Skillfully Working with Real or Perceived Denial

• July 30 - Navigating the Hospital Partnership Part 1

• July 30 - Navigating the Hospital Partnership Part 2

Conferences & Events

2020 Virtual Conference: A Focus on Quality - July 22-23, hosted by AAHPM,

HPNA, and NHPCO.

Weatherbee Resources Regulatory Bootcamp - December 14-16, 2020.

Calendar of Educational Events

CHAPCA Board of Directors

Board Chair

Suzi Johnson

Vice President

Sharp Hospice Care

San Diego, CA

Denyse Ashlock

Director of Patient Care Services,

Hospice of the Foothills

Grass Valley, CA

Rebecca Burnett

CEO, Hospice of San Joaquin

Stockton, CA

Paul Huante

President, Horizon Oxygen and

Medical Equipment, Inc.

Anaheim, CA

Jan Jones

CEO, The Elizabeth Hospice

Escondido, CA

Cristi Keith

COO, Continuum Care Hospice

North Bay, Petaluma, CA

Sharon Lutz

Executive Director,

Hospice of the North Coast

Carlsbad, CA

Sue Malter

Regional VP, Seasons Hospice &

Palliative Care

Sacramento, CA

Peggy Pettit

Executive VP, VITAS Healthcare,

California locations

Debbie Robson

Vice President, Salus Hospice

Irvine, CA

Joseph Rogers

CEO, Hospice of Humboldt

Eureka, CA

July 2020 13

Acknowledgment

Thank you to Hospice News Network for contributions to this issue of the CHAPCA

newsletter. Hospice Analytics is the national sponsor of Hospice News Network for

2020. Hospice Analytics is an information sharing research organization whose

mission is to improve hospice utilization and access to quality end-of-life care. For

additional information, please call Dr. Cordt Kassner, CEO, at 719-209-1237 or see

www.HospiceAnalytics.com.