I hear it every day from the leaders in the not-for-profit hospice world: We’re losing ground. Caught between a rock – reduced federal dollars – and a hard place – the crushing proliferation of regulations – hospice leaders are adopting a bunker mentality, hunkering down to provide the basics to those in their care, while forced to let go of many of the extra services that bring comfort and meaning to their final days. It looks grim – yet I can’t help but feel like we’ve been here before.
There weren’t a lot of resources for us at the start of the hospice movement – and no Federal money for hospice – but there was enthusiasm, and partnership within the communities we served. We cobbled together alliances, trained volunteers, worked with what we had, and made life better for dying people and their loved ones.
When I look at where we are today, what occurs to me is this: What might we be able to accomplish, if we more...
I was touring a hospice care center when the smell of freshly baked chocolate chip cookies drew me to the kitchen, where I found a group of girls from the local high school. They told me that once a week they come to bake cookies for the families and patients in the care center. What a terrific way to enable young people to express their budding instincts to serve – and to create ardent ambassadors for hospice in the community.
When I’m assessing a hospice program, one key measure of quality is the number of active volunteers and their level of involvement. How many volunteers do you have? What kind of things do the volunteers do for hospice? How long have they been volunteering? As we move forward in this new world of hospice and health care reform, volunteers are going to have an even greater impact on the lives of people who are facing serious illness and death.
What kind of person is likely to volunteer at a hospice? Most often, volunteers will be...
Image Above: Acting Administrator of CMS Andy Slavitt and C-TAC Board Co-Chair Tom Koutsoumpas
Is hospice a commodity? Is it a payment system for the dying? Is it only for the final days of life? Is it only about giving morphine until a patient is no longer in pain?
Last week I attended the National Summit of the Coalition to Transform Advanced Care (C-TAC) in Washington DC. The speakers were Congressmen and Senators, health care leaders and insurers, pastors, and seriously ill people, and the Acting Administrator of Medicare/Medicaid and the Secretary of Veterans Affairs; all people interested in making the care that serves those in their final years of life as compassionate and creative as possible.
While the meeting had outstanding speakers, what struck me was that most of these dedicated, intelligent and caring people think that we need a "new model of care" for people with advanced illness and hospice was hardly mentioned. They described this model...
For most people, death is something that happens at the periphery of their lives – but some of us choose to make it the focus of our careers. I knew early on I wanted to care for the sick, but my path to caring for the dying was more circuitous.
As a kid I was given a book on how to take a pulse. I loved learning to feel the beat under the skin on my wrist. I asked for the “Visible Woman” for my 10th birthday and to my delight she was delivered, complete with the optional pregnancy parts. My path was set; after high school, I decided to get an AA degree and then transfer to University of Florida for my Bachelors Degree in Nursing.
My first real job as a RN was on a medical surgical floor in the local hospital where I had the responsibility of caring for patients following surgery. One of my patients was Mr. Green, who’d had surgery for lung cancer and was in and out of the hospital. In those days there was little to be done for people with...
Image Above: Laure Carmichael at her 100th birthday party at Haven Hospice
Leland Kaiser said it well: “Great compassion and unconditional love can change the world; they are the only things that can”. I’d like to share with you the stories of two people whose donations of time, influence and money, along with great compassion and unconditional love, changed our community and left a legacy.
Retired bank teller Laura Carmichael had no children; widowed at 65, she was know for her legendary thank you notes, she clipped out the photos of brides in the newspaper and mailed them to the newlyweds, she drove the same Buick for nearly 20 years, and sent a crisp $1 dollar bill to every child chosen as “Student of the Month” at the local elementary schools. Generosity was in her bones.
Laura lived near the local hospital where she volunteered and was on their board of directors and on the hospice board where I was Executive Director. When we began...
Do you see the future as one of shortage, lack, and ever-harsher governmental funding reductions? Or are you focused on an abundant future filled with new opportunities and innovative ways for people to engage and contribute? Let’s talk about how we can create that abundant future through development strategies that will enhance your organizations.
How can we in hospice management create a robust culture of care in our organizations? In the past I consulted with a hospice run by an autocratic leader who really didn’t want to know what the staff thought or cared about; his big concern was his bottom line, not his front lines. How is staff likely to respond to leadership solely focused on dollars and cents, even at the expense of their mission of care? Not well, in my experience, because it’s so at odds with the animating ideals of hospice itself, and of the people who go into this work.
That’s why it’s critical to create a corporate culture that supports our work and our people – and that culture begins with transparency and trust.
Here are 5 ways to improve your hospice’s culture of care, and better support your mission:
In hospice, your only product is service, and nothing is more important to that than proper staffing. No matter how powerful your mission statement is or how beautiful your facility, your people have to be service-oriented and fully committed to the work. Hospice doesn’t run on a nine-to-five, five-day week; it’s 24/7, and we can never be less than our best. We deal daily with the dying and the grieving, and that means that everyone, from the social worker to the nurses’ aide to the bookkeeper, has to be emotionally stable and mature enough to handle that.
What do you look for in a potential hire? My first priority in doing executive searches for clients today is the same as it was when I was hiring as an hospice Executive Director; I look for people who have a belief in something greater than themselves. I don’t mean religion necessarily, but faith in goodness, faith in humankind, faith in the rightness of the universe. People who...
How hospice has changed since the movement began! Back at the beginning, there was no competition, because there wasn’t any money. But today competition is fierce, and requires that we as leaders re-imagine and upgrade our relationships with our clients, our communities, our donors and our referrers. Beyond offering superb care, delivered consistently, and unfailingly going above and beyond what is expected, how can you stand out from other providers in your market?
Last time, I offered up the first five of these ten ways to thrive in an increasingly competitive market; here are five more.
1. Know what your community really wants. Often hospices offer programs they think are important but which may not really meet the needs of their community. Great organizations get to know intimately what their customers want. That means spending time talking with patients and families, not just sending out a survey.
2. Know what your referrers...