Indiana Hospice House profiled

The Abbie Hunt Bryce Home, a hospice house that offers free care for homeless and low-income hospice patients, along with several of its recent residents, gets profiled in a series of articles in the Indianapolis Star newspaper this month, highlighting their hard lives and the opportunities for healing that are offered in a Hospice House.

Opened in 2004 with 10 beds for hospices patients and two additional rooms for patients recovering from medical procedures who have no other safe place to go outside of the hospital, it is operated by Morning Light, Inc.. Morning Light fosters fosters nonprofit community services and programs in central Indiana for the terminally ill, seniors, and families of limited means in need of health, wellness or end of life care, including at the 35-unit Pennwood Place Apartments.

The Abbie Hunt Bryce Home includes private single rooms, kitchen facilities, living and family rooms, trained staff and volunteers, with medical care provided by community hospice teams.

Working with a University Medical Center

Hospice of Central Ohio in Newark is now working on a leased bed agreement with Wexner Medical Center at Ohio State University to open a 12-bed hospice unit inside the hospital. Minor revisions and resurfacing are underway to give the new hospice unit more of a homelike feel in its health facility setting, with opening planned for a few months from now.

“This is part of the hospital’s strategy for how to manage its seriously ill patients,” says the hospice’s President and CEO, Kerry Hamilton. “My conversations with OSU about hospice started 18 years ago, but something on their side changed recently. They’ve always acknowledged the value of hospice care, but new imperatives have driven them to consider new strategic approaches. If you are at OSU Wexner Medical Center and are dying and in need of hospice care, right now they have to send you someplace else. This collaboration will help to address that issue.”

Some of the imperatives putting pressures on academic medical centers include new payment models with a focus on bundled payment, coverage of populations, prevention of hospital readmissions and the like, Hamilton explains. “I believe it’s a big shift and OSU is one of the academic centers leading the charge. They put out a request for information tied to a plan for a demonstration in their system, but that concept was not tenable at that time.” OSU then looked at opening its own hospice unit, but for a myriad of reasons decided to contract with Hospice of Central Ohio, instead.

“We have identified that the anticipated complexity of these patients means higher staffing levels on our hospice unit, using RNs and advanced practice nurses and drawing upon social services from the hospital. These will be the most complex, difficult and medically involved patients of any partner that we work with,” he adds, involving for example left ventricular assistive devices, ventilators, total parenteral nutrition, and other assorted drips.

”At least in the beginning, length of stay will be very short as we work to evolve the culture in the hospital to allow for earlier referrals to hospice care based on trust and collaboration.” In the beginning most of the patients will be eligible for a general inpatient level of hospice care and will likely be billed at that level. The hospice is also building an endowment for uncompensated care on the unit and is in conversation with the medical center about some form of cost sharing for these complex hospice patients.

Viability for the Hospice House Model

We recently caught up with hospice consultant Sue Lyn Schramm, who led a preconference session on hospice facilities at the National Hospice and Palliative Care Organization Management and Leadership Conference in April and a similar one last year, described here, which explored the precipitous drop in utilization percentages for hospice general inpatient (GIP) care that has left many hospices with facilities scrambling to keep beds full.

“All of the challenges we talked about a year ago still apply,” Schramm said in summarizing this year’s NHPCO precon. “GIP days are lower, patients are more acute, and balancing the bottom line is difficult.” But the tone of the meeting was hopeful, she added. “There are lots of things people can do to manage their units, and I hope I gave them practical tips to use. Answers vary widely depending on your own unique local circumstances. I did not have a sense that it was a funeral for the Hospice House model. We’re in a very interesting time given the demographic trends. Demand for inpatient and residential hospice care can only go up.”

Schramm says some of her clients have waiting lists for their hospice facilities while others are looking to build or expand for competitive reasons or because their hospitals are asking for it. But the terminology is another challenge for the field. “Is Hospice House or home too warm and fuzzy a name to describe the actual experience of caring for acutely ill hospice patients referred for GIP (and qualifying for GIP-level coverage)? I think Hospice Houses can sell themselves short.”

But what is the right terminology for a hospice organization trying to provide residential-level care or a mix of residential and GIP? What do you think? (Read more about what Schramm has to say here.)

Larry Beresford, Editor & Publisher