Netsmart CareThreads
Netsmart CareThreads

Episode · 1 month ago

Back to the Future of Hospice Care

ABOUT THIS EPISODE

Despite its frequent buzzword reference today, “person-centered care” is rooted firmly and deeply in hospice care. 

The future of healthcare lies in replicating what hospice care is really about -- serving the whole person by an interdisciplinary team who believes in care without barriers.

In this episode of Netsmart CareThreads, Samira Beckwith, President and CEO at Hope Healthcare , unpacks what it means and why it’s so important for hospices to go back to the future. 

Join us as we discuss:

  • How hospice can serve as a beacon for other areas of medicine
  • Why we must get away from saying “end-of-life-care”
  • What it means to go back to the future with hospice care
  • Why Americans think death is optional
  • The effect of value-based payment models

This discussion was taken from our show Netsmart CareThreads. If you want to hear more episodes like this one, check us out on Apple Podcasts

If you don’t use Apple Podcasts, you can find every episode here

Listening on a desktop & can’t see the links? Just search for Netsmart CareThreads in your favorite podcast player.

Welcome in that smart care, threads, apodcast were human services and post to cute leaders across the health carecontinuum, come together to discuss industry trends, challenges andopportunities. Listen as we uncover real stories about how to innovate andimprove the quality of care to the communities we serve. Let's get intothe show. My name is Tom Herzog and I'm your host. Today I serve as a chiefoperating officer for nets. Martin, I'm excited to introduce our guest. Today'sMara, back with President in CEO of Florida based hope, hospice through herleadership. The organization grew from a hospice caring for a fewer than onehundred patients a day to a comprehensive community based healthcare system with the daily sensitised, four thousand hospice pout of care paysimpediti patients some of is found, is a founding member of the NationalPartnership for health care and hospice, also known as in P H I and was recentlynamed its new board. Chair Somera, has also served as a chair Ferson for boththe National Hospites and Powaton Carrot Organization and the NationalHouse of his foundation. She has provided expert testimony before the USHouse. traditionary committee and the US Senate Special Committee on Agingand has received numerous awards, including the Mnie Women of DistinctionAward. So we thank you for joining me today and I couldn't be more excited aswe talk about a topic that is more pertinent than I can think of in mylifetime in a good way, it's really risen to a level of conversation thateveryone now is aware of integrated care or whole person care and has anunderstanding that we need to have an approach for that. The topic fortoday's episode is how Hosma can shape the future of health care. Will I'mpack Mars most pressing concerns facing...

...the hospice community, address the newvalue based payment models and discuss what needs to change to improve theperception of what hospice and powder care really offers? And I guess I'llbegin with that in our with my first question. So thank you for joiningappreciate it we're going to have a fun time year and on. My first question isduring kind of the chat and leading up to this you had mention. We need to goback to the future of hospites. Can you tell us what that means and yourthoughts around that like Tom? Thank you so much for theopportunity to be here with you today. I really appreciate it and lookingforward to our conversation, yeah what I mean I talk about going back to thefuture. It's a fair said being a part at the beginning of the hustis movementin this country, not the hustis industry, but what it was that wereally wanted to achieve person center chair, providing for the person and thefamily really helping to dessiner care caring for people after the lastbereavement, so is uncomfort when cure is not possible. Those are ourunderlying principles and now those seem to be the underlying principles ofall these new ideas coming out, you know advanced illness care, pallativecare, and so, instead of being pushed to brink of death care as hospicesreally being pushed to and being considered more of a commodity, Ibelieve that our future lives in people understanding. What has this carereally is about and going back to those beginning underlying principles and ourcommitment to caring for people, and that's what I mean by that? I'm gonnaask you about a word that I think it...

...would be good for some of the folks inour audience are going to be new to some of the terminology. So when yousay death care that has a certain, I think connotation even stigma around itand something that we're trying to combat in regardless to some of theperspectives in there. Can you speak a little more to that? I can know itreally statens me and concerns me when I hear people talk about pastes thingand of life care when I hear about hastas taking care of the dying. Ofcourse we do that. However, when we started out- and thanks just meSaunders- you know her famous quote- I'm been a paraphrase it. It reallytalks about. She talked about, and we've corporated the idea of helpingpeople to live as folly as possible to the time that they have t when they arefacing a life threatening illness when they're in their tin chapter of life,they're closing stage of life, and so we need to get back to the thought thatwe're helping people to live as fully as possible, the time that they haveand when it is time for that dying phase. Maybe days or weeks, you knowwe'll keep them comfortable, and so that is why you know. In a sense, nobody wants tohear the h word, because people don't mind hearing about Pallative Care,advanced illness, serious person, care, primary care coordinated here, becauseonly in America do people think that death is optional, and that is why wehave to get people thinking of the hospice differently. And I think onethank you for saying that, because I think the best way for us to addressthese is just to be able to talk to them. And I mean I think, death careforces and focuses. The conversation is...

...where it needs to be, and I think oneof the things I've really grown appreciative of over the years is whilethere is a specific focus on the patient. If you will it's also a greathelp in aid to those around that person to the family, members and friends, andso much of the work that you do that I think often isn't considered until youfound yourself there that the help that you provide goes beyond just thatperson. It's the other people and family members who are helping supportthat person as well, and I think, when people consider this notion aroundholistic care whole person care is. We need to be very mindful of everythingthat happens in the phases of life. So I guess I would ask you what are someof the encouraging things that you're seeing that bring? You hope that we'readdressing some of those challenges and what are some of the things that westill need to tackle and get better at a to you're. Absolutely on point aboutthe fact that even the person who is at the end of life, who has this illnessthat will be there a terminal, prognosis and their time. One of theteams to say worry that is not to be a burden on their family and you knowthey care about their family and the legacy that they're going to lead. Sothat's why being able to to really walk with them during this period of time isso important and I believe there is some incurred. There are encouragingscience. You know there are some Thrutch, but there is also someopportunities and one of the opportunities it's encouraging is thefact that there is a recognition of the cat that we have to shake the healthcare system in this chase of life for the person and that opportunity comeswith the discussion about advanced...

...illness, ter powder care, seriousillness person care. You know it's a threat that it's also an opportunity,because now there's conversation around what is the best care for people duringthis period of time with the best care? There can also be the right care at theright time at the right cost for our system. No hospice is really one of the few health ter providersthat can really need that triple ane at the right care at the right time at theright cost for the system, and so we can help them be a part of continuingthat conversation. So that's the opportunity and the threatat the same time. Well, I'm going to use that to Segati next question aroundthe triplane, the right, the right care at the right time at the right cost,aets that sometimes a good conversation. It's also the hard conversation becausecost absolutely is at the episode or of the conversations that we're having inevery community across this country and we're really. This is my hope- and thisis one of the things that I think the hospice communities do a great job atteaching us. This is really about persons, Central Care, not paymentcentury care, and for so long our health care system has been verypayment. But when we're looking at quality of life, we're looking at wellbeing, it is around this notion of what can we do well for the person. So withthat, I really feel like we're at a really critical junction in thehealthcare delivery system. Today there are so many value based payment systemsand really resetting the entire health care space going on right now, how doyou think the launch of these new value base payment models, particularly theMedicare and Manah Hosma Carvin- will affect non profit providers that I issuch a critical question that we're all...

...talking about and we're all looking at,and we want to be a part of this conversations with C M s with CCM Iwith the payers, so that the system can be adjusted in a way that actuallymeets that triple, because it's also a threat to the future. It could be thatwould be bid and with resetting of the system get there might be the thoughtof doing less, providing less care so that people feel like they're gettingsome cure, but not getting as much care as they really deserve to have and itthey have available to them now under the hospice benefit. So I believe it'sreally important for Phi for others and P and O to an HP co not for othersought to come together and to have the conversation about what is truly neededin the future when it comes to be bid, for example, for these other paymentsystems, because it could be that less cure is going to be acceptable. How youan example of that now, what has happened in some states like Medicaidmanaged care is that the actual medicate managed chair program, whichis now become a barrier people being able to access us this tar earlier andthe same thing could happen with some of these new pained models and unlessthere is built into the system, the right quality indicators to be surethat people can access as this early enough, then I think what we'll have isa delusion of hospice care, and I think...

...that's a really valid here to seehappen to one of the I was going to say comments. We are most often from fatmembers. I think you know what I'm going to say. I wish we would haveknown about hearty. That is probably the most common timent that we havefrom family members. So unless these new systems developing systems worktogether to assure early access, I think we're going to continue to seerightify percent of hostis patients median life of care being under twoweeks. So you've got my mind, spinning on several threads here, so I'm goingto pull on a couple of them, because I want to go down on impact those Icouldn't agree with you more in regards to the common comment from familymembers is. I wish I would have known about this sooner and I think you saidearlier someone in America that we don't think we're going to die. So wewait until the last possible moment and then there's these incredible,wonderful, beautiful organizations that can help family members in that personat such a critical time. I guess what are some of the things that we all needto continue to be doing to drive awareness around us. Are there thingsthat you're, seeing that that's becoming more known, or is there moreaction that providers or organizations, or even businesses such as ourselves,need to be doing to really make people aware of this, so that it isn't such alast minute thought or it's more responsive than reactive, in which somany times, people find themselves in a in the very beginning, many of uspioneers and going to refer to some of us that want to transform the cultureso that people would be more open and understanding about the opportunitiesat the final stage of life, and so now...

...everything that we can do to have moreopen conversation is very helpful to help people to plan and to understandwhat the options are for themselves and for their family members, and I thinkthat is going to require everyone coming together. As you said,businesses, regulatory organizations, legislation, Hustis and otherorganizations, health care systems, I think for health care providers to quit,trying to make the most funny that they can and to think about what's best forthe people in their health care system. I think it really requires a resettingof so many systems to be able to achieve that goal, and I also believethat petiit comes down to reimbursement and to regulations and de LegislationYeah. I think you know I I think if I were to sumthat one thought is, we need to be more intentional around it and morecollaborative around it. I know from an employer's standpoint: it's not a topic.We often talk about, and should we should? We have that conversation hasjust helping create not only awareness, but people develop a game plan if youwill for when that time comes out. If, as you said earlier right, I used tosay, if an now, I won't say that any more when that time comes in what wecan do, I guess I'm going to pull on the other thread that you took thisconversation around some of the payment reforming those thing. So I'm aprovider out there and I see the CO system changing its I'm certain. Idon't feel like. I have a voice sort of see it at the table. What would you sayto those providers to help them be more proactive around that piece? What canthey do right now to ensure that they have a seat at the table? Has Itsecosystem is being reshaped right...

...before us? That is so important because it wouldbe shaped around us if we're not at the table? Yeah conversation, my friendplanes EES, to say with this is an old phrase. You know if you're not at thetable, you're on the menu, and so you know, I think it that that iscritically important to to join working a say. O Shins, like Phi, now look athow we can have a voice to a worm with other organizations. Your stateorganizations, other national megatons. I mentioned N H, p, Co and Anon to haveconversations about worth the common good. Now I know, there's also a lot ofcompetition and there are competitive forces out there. However, we want hasis to be a part of that future. So where can we work together? I thinkit's really important, because I really believe that we have to workwith SMS and we have to change some of the regulations. We have the modern DOTmodernize to host this benefit and we have to change some of the way that we talked about hospice. Sohave you last question on this topic or last sum question on this topic,because you look ahead two three five years from now: Where do you see thingsgoing from payment reform? If you will, where do you think things are going tofinally evolved to well coved kind of stop some of the conversations Y intime of kind of help? The conversations the people can guess you know of closeand Personal Yeah News every day and people are maybe more aware of the factthat if you don't plan, then you know youdon't have the opportunity to have any control to think there is no silverlingin over. That may be an opportunity to have more discussion and we need tohave very direct conversation with cms.

You know I like a lot of CMS, becausegay have not modernized the benefit or head say gay, you know it's people inSamas, the intuition. They have not really looked at how to help peoplehave the conversation and to, for example, I'm going to give one example. Why do we continue with the sixth month?That's arbitrary and people have to sign a form that says I know I'm goingto die within six months and then I'm giving up curative care come on. Youknow, let's look at, you know how people can hear the message, and so weall have to find a way to work together to open up that conversation. Well,that sounds very pragmatic and I think we in our country and communities rightnow a challenge with very pragmatic thoughts and ideas, and I think maybesome of the most disruptive things is exactly what you just probat pointedout. Is We need to be able to address those very, I think, simple, obviousthings in order to move forward, so I really appreciate you bringing up thatwas one of the ones that I had top of mind. You already beat me to it and Ihope that those things continue to above and change, and I think on thatSMA. I agree with you. I think Ovid is Braden acceleration in while there's alot of negative in daunting from it, as we continue to navigate our way and Ithink there's more time ahead of us. I also agree there's opportunity and it'screated this acceleration if you will and maybe of potential andpossibilities- and I think if we look at hospitis and power of carats, itfeels like it's becoming more and more crowded, increasingly more competitive,especially with so many mergers. Acquisitions Partnerships anddaffiliations. I guess my question that...

I would love to hear and I think godswould love the ear from your perspective is how can non profithospices different, ate themselves from such so so much change and what appearsto be a very crop growing crowdin community O my heart is with mission andcommunity based legacy programs, and you know to most of us bear atforclosed organizations in our communities and in many communities thehustis space is becoming very crouded. So I believe it's so important for us, with a our mission, oriented auspices,to remind the community about our roots. Our Beginnings, how we've been therefrom the very beginning, and also how we promised, are vow to be there forthe future and how we are integrated into the fabric in the community andall that we do in all that we all for. We have to help people to understandthat all posture is really local. It may be competitive, but at the end ofthe day, was coming to care for your loved one, our loved ones at thebedside and who it's been part of the tunity. Who are your neighbors? Ourneighbors are church members and being there for them today, and it willcontinue be a part of their care for the future. So I think we need toremind people about local and eaten continued to be local for the future. Ilove that I love and I'm going to borrow that tag line. Healthcare islocal, couldn't agree more and in some ways I think those are the roots weregetting back to, and while there are some change there are someopportunities of were we have more extensibility or access than we've everhad before with Telo technology and the...

...primary care of the acute part of carethat there is, as also this there's this notion or me that people want toconnect and build relationships with people. They know, especially in someof the most meaningful and challenging times in our life, and I couldn't agreewith you more in in many ways you all have been the compass for all of us inthese communities and I guess I'm going to use that to sec way to the nextquestion, and that is workforce challenges and shortages are as greatas we've ever seen. I know they're keeping many hospice leaders awake andnight, and the pandemic seems to only as it caused more of that. If you will,how are you working through or thinking about this challenges? Are you doingthings different, or is it just a season that we're in would love to hearyour thoughts as many leaders in all communities are faced with thischallenge yeah? I wish it was a season and not a climate change, no, becauseI'm really concerned about work force and have been very concerned about iteven before the pandemic, and we really have instituted a number of differentprograms to offering scholarships for people from the community to become CNAto go to different nursing schools. We developrelationships with all of the universities and colleges and schoolsin our community so that we can have people rotate through our organizationand who have many different settings are different programs with medstudents coming through, so we can help to educate and to give people that up.We should now or more about their options until we have many of thoseprograms at the same time. So does...

...everybody else now the local hospitalsand the other facilities. So we've tried to also collaborate with them sothat we can collaborate within our communities that we serve to enticemore people to pomp to health care, to become caregivers, and I'm veryconcerned about that for the future. So I think it's par Cabratown with othersto entice people to pump to be a part of a future health tour safety atcommunities that we serve. So I guess on that same topic. I would ask youyour thoughts on. If what would you say to that student who is graduatingschool or in the middle school thinking about going into this creer field orthat person looking or considering wanting to make a queer change intothis community? What would be your encouragement as to why they shouldconsider it and what difference that they can make? If they would choosethis very noble profession for most of our people, we really shootas a calling. So we have instituted metropass and pre separate program sothat we can accept new grads from many different fields, whether that we tysinAprens, also nurses, some CNAS so fork. So we can really help them to develop,and we feel so that it becomes a choice. The first choice to make a differencefor people, and that is what we really stress, is being able to spend the timewith people in our care and their family members, so that we can helpthem during this period of time to live as fully as possible. I think thatthat's the point that we try to make with them is we're going to allow youthe time to make a difference, and I think that's, I think, you're commonand my daughter recently...

...graduated from college and my sonsabout to go to college in the conversations we've been having and asthey are looking at what they want to go do, and I said you know what thereis nothing better than if you can go, pursue an opportunity to make adifference, because what will be remembered in life won't be these midmetrics or statistics or some of those things. But when you were able to bethere for a person in a time of need, when you were able to work with othersto do something that helped someone for the better or for the good. As you said,and I would encourage anyone out there thinking about this. This is somethingthat isn't often promoted. I love hearing what you're doing that aroundthis collaboration and just bringing this awareness for people to considerit, because I think one of the best ways for us just to address the workfor shortages, to underscore the opportunity to answer that, calling ifyou will in the opportunity to make a difference, so I'm going to bring thisin for landing. I just have a couple more things in the one that I wouldlike to ask. You is think about that person. WHO's listening to this podcastright now seems overwhelming, maybe discouraged challenge they may bedealing with staff shortages right now. Maybe they're part of this stappin itand it doesn't seem like the hours ever and or they're they're trying to addressshort paws and revenues or margin, and what's one word, one thought or onestory that you would share to inspire them as they look forward to encouragethem in all of us as we think about the path before us. Well, you know thereare many days for it. It is discouraging, or can we still seemoverwhelming, and you know I always stop and think about the family. Memberthe person who was in our care- and let us know, let me know that we made adifference for them or that we're...

...making a difference for them, and that keeps me going is kept megoing for many years now. When I think about that difference that we make forpeople in the fact that if we weren't helping to lead person let center tear,then it wouldn't have happened in this country. I think we have shaped thefuture. Astis has shaped the future and that we can continue to shape thefuture. By being a part of this conversation, and so you know, I thinkabout you, know never giving up and you know being a part of that future. Ilove how you said bad and I think sometimes we all get consumed with.What's on the wind Shell and we need to post, we need to look up and lookaround and see the good that is happening and, while amazing dotting inthe movement, sometimes when we bring context to the conversation- and Iwould agree with you and my thanks and appreciation- has a has a son as ahusband friend, father has a worker and colleague you, you and the entirecommunity are leading us to person Centra care and we are all going toleave a better health care system than we found it. For me, that's what keepsme going is I don't have the opportunity to work directly with withit in the work that so many of you do, but I get to support you get to help when hopefully, we partner,together on shaking in an ecosystem better than we found it. I wanted thankyou for the conversation and before I wrap up here. If our listeners wantedto reach out to you or I had more questions or learn more about you andthe organization, how how would they do that? But let me thank you for theconversation I certainly enjoyed. Being part of the conversation today, Ienjoyed getting to know you better to and and your comments and I'm very open.If s someone wants to connect with me...

...on Lincoln or Somera Duck back with, ithope, HC s Du or you know pretty easy to find. So someone has a comment orwould like to ask a question: I'm open to continue the conversation. This hasbeen my passion, my calling for many years, and I look forward to continuingwell, thank you and thank you to all the providers out there and thank youfor joining our podcast today. It's our intent and hope that we bring just reallife, pragmatic conversations, and we talked about both the challenges andthe opportunities as we look forward and today's conversation so permanentto where we find ourselves, because if we're going to move continue ourmovement towards integrated care, whole person, care person, central care thatcan't happen without the hospice community at the table, we must censeattoday collaborate. We must connect and be intentional in those efforts, andwhen we do some amazing things can happen, and we talked about that justfrom. What's changed within the community around the payments andworkforce challenges, but also things that we can do as we go forward? So ifyou enjoyed today's podcast, please take a moment: has you give responsesor a share or ratings? It encourages other listeners, and if you have atopic or some one day, do you think we should talk to please share that withus and for today that's a rap. Thank you, some Matt for joining. Weappreciate everyone who listens and the contributions, comments and feedbackhave a great rest of the day at net smart. We understand thechallenges facing provider organizations. Our team will help younavigate changing value, based care models with solutions and services thatmake person centered care or reality will equip you with technology andservices that provide holistic, real time. Views of Care Histories thatinform better decision. They it and better outcomes visit us today at nTsom net smart serving you, so you can...

...serve others thanks for listening tothe net smart care, threads podcast through collaboration and conversation,we can work together to make health care more connected than ever beforeand better support. The communities we serve to ensure you never miss anepisode. Please subscribe to the show in your favorite podcast player, if youuse apple, podcast, we'd love for you to give us a quick rating for the showjust have the number of stars that you think the podcast deserves until nexttime. I.

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