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National Healthcare Decisions Day

Honoring Care Decisions Event

In Honor of National Health Care Decision Day, April 16th, NHHPCO invited Senator Shaheen, Senator Hassan, Congresswoman Ann McLane Kuster and Congresswoman Carol Shea-Porter to attend events hosted by healthcare and hospice organizations to discuss Advanced Care Planning.

An event held on Monday April 17th at Dartmouth Hitchcock - Nashua called Honoring Care Decisions was attended by Staff member Meredith Shevitz, Special Assistant for Policy & Projects, from Senator Hassan's office.

The 90 minute session was facilitated by Terri Desrochers, RN, Dartmouth Hitchcock, Honoring Care Decisions Program Coordinator. It included an overview of the purpose of advanced care planning, the individual considerations that are important when making these decisions and an explanation of the legal forms for New Hampshire. The Honoring Care Decisions Program is offered monthly in several statewide locations.

NHHPCO Participates in Annual Advance Directive Survey

NHHPCO also took part in a NH Health Care Decisions Coalition project to determine how many patients in our state report having completed Advanced Directives.

For the past few years, NH hospitals and hospice providers have been asked to complete one day audits of their patient records. Results indicate that roughly one third of hospital-based patients complete advanced directives, which is in line with the national average.

This year Hospice providers report 67% of patients have advanced directives on admission to hospice, in contrast to 85 - 90 % in past years. Since this is not the trend we want to see, I would love your thoughts on why this might be.

In addition to basic advanced directive forms, this year's survey of hospice providers show 63% of patients have a portable DNR on admission and 63% had a POLST form in place. These are greatly improved percentages from 2016!

We thank those who participated!

Members Tour the Manchester VA Medical Center

On March 30th, NHHPCO members met with the Palliative Care Team at the VA Medical Center in Manchester for a tour of their six bed unit.

NHHPCO Members visit VA Medical Center in Manchester

We had time for conversation and questions, which will go a long way to help us give the best care possible for the Veterans in our state who depend on both of our services when needing end of life care.

Our ongoing efforts for collaboration between hospice teams and VA staff is welcomed by all. Care of the patient and family is our primary concern and many wonderful and heartwarming initiatives are provided to Veterans by Hospice staff and by VA staff.

We thank Dr. Ritamarie Moscala and Rev. Gary Rolph for their leadership and efforts to bring us all together.

2017 NH Top Docs Lauded


Congratulations to the following Hospice & Palliative Care "2017 Top Doctors" listed in the April edition of New Hampshire magazine!

  • Lisa Leinau, M.D., Chesire / DHK, Hospice Med. Director, Home Healthcare Hospice & Community Services, Keene
  • Sarah MacDuffie, D.O., The Edgewood Centre, Portsmouth Regional Hospital Palliative Care Program
  • Don McDonah, M.D., St. Joseph Hospital Palliative Care

Baudet Appointed to NHPCO Quality & Standards Committee

Congratulations to NHHPCO Board Chair, Andrea Patrick-Baudet, RN, CHPN, CHPCA, Hospice Director, Cornerstone VNA, who was selected to serve on the NHPCO Quality & Standards Committee for the next two years.

This committee is responsible for promoting quality end-of-life care including systematic ongoing review and revision of the Standards document to ensure compliance with regulations and best practices. The committee also assists in developing performance measures and QAPI program support materials. New Hampshire will surely benefit from Andrea's participation in this important work.


Laramie Appointed to NH Board of Nursing

Central New Hampshire VNA & Hospice is proud to announce that Hospice Director and Chief Clinical Nurse Jennifer Laramie RN has been appointed to sit on the New Hampshire Board of Nursing.

The purpose of the Board is to safeguard life, health, and the public welfare of the people of this state and to protect the people of the state of New Hampshire from the unauthorized, unqualified, and improper application of services by individuals in the practice of nursing. Jennifer Laramie has worked at Central New Hampshire VNA & Hospice for 12 years and says, "I really enjoy taking care of people...the patients are what keep me coming back every day."  She is excited about representing RNs on the Board of Nursing and looks forward to serving on the Board for the next three years.


For more information view the press release.


News from NHPCO

New CEO

NHPCO announced that its board of directors has selected Edo Banach, JD, as the organization's next president and chief executive officer, effective February 22, 2017. Banach will succeed J. Donald Schumacher, PsyD, who has led the organization since 2002. Read more about the new appointment here.

Letter to Trump

2017 promised to be an interesting and busy one, no matter who became President of the US. In this letter, current NHPCO President and CEO J. Donald Schumacher outlines key issues concerning hospice and palliative care, and asks President Trump what he will do to help ensure that the nation's frailest and most vulnerable populations - those with serious and life-limiting illness - are able to access the care they want and deserve.

NHPCO Podcasts

Have you seen the new NHPCO Podcasts? Feel free to share these with staff. The most popular one to date is Episode # 7, 5% Volunteer Requirement.


Representing You on Capitol Hill

Nearly 250 hospice advocates gathered on Capitol Hill this past July for the annual Advocacy Intensive of the Hospice Action Network and the National Hospice and Palliative Care Organization.

New Hampshire was well represented by Janice McDermott, NHHPCO Exec. Director, Beth Slepian, CRVNA President/CEO, Laurie Farmer, CRVNA VP of Hospice Services and Niambia Mercado, Senior Graduate Student at Antioch University. Meetings were held with staffers at the offices of Senators Shaheen and Ayotte as well as Congresswoman Kuster and Congressman Guinta. We were able to convey special thanks to Sen. Shaheen via her Legislative Correspondent, Eric Waskowicz for sponsoring the Rural Access to Hospice Act [S 2786] - see below. Please send your thanks if you have an opportunity to connect with her or her staff.

Advocates provided lawmakers with information about three policy issues that could affect the hospice community:

  • Personalize Your Care Act of 2016 [HR 5555], which allows individuals with chronic and advanced illness to receive both conventional, curative treatments along with hospice and palliative care services.
  • Rural Access to Hospice Act [S 2786], which addresses statutory barriers that restrict some patients' primary care physician from becoming their attending physician during hospice care.
  • Care Planning Act [S 1549], which creates a new Medicare benefit for care planning services offered by a hospice-like interdisciplinary team.

In addition to the in-person advocacy action, supporters around the country were encouraged to participate virtually by contacting elected officials in an outreach effort coordinated by Hospice Action Network's Virtual Hill Day. Visit NHPCO's website for more information.


Honoring Marie Kirn

Community Members and Hospice and Palliative Care Professionals in the Upper Valley came together on October 6th to honor Marie Kirn as she prepares to retire to Maine.

Marie is a founding member of the hospice movement in NH and a true grassroots champion for social change. She raised money for hospice by packing churches in the 1980s to hear about death and dying. A fierce advocate for hospice since those early days, Marie has the rare quality of being as inspirational and compassionate for the human condition as she is practical about the need to fundraise to make services available for our community members.

In tandem with developing hospice services in the Monadnock Region, Marie joined with hospice directors in our state to form what is now NH Hospice and Palliative Care Organization. She signed the application to be incorporated by our state and was Executive Director of then NH Hospice Organization from 1993-1994. Marie has gone on to lead larger organizations and has been instrumental in the development of Palliative Care services at DHMC, including finding partners to fund the soon to be built palliative care center on the Lebanon campus. We owe much to Marie Kirn and wish her all the best in her new home!


Hospices Urged to Engage in Legislative Action

NAHC recently called hospices to legislative action, and the Corridor Group issued a summary of the NAHC position. Congress will recess in August, and hospices are urged to use this time to connect with their leaders. Among the issues that hospice leaders are urged to encourage lawmakers to take action on are:

  • Rescind or rework the face-to-face physician encounter requirement, and overturn claims denials related to this.
  • Refuse the attempts to include hospice within the Medicare Advantage Benefit package. Empower PA's to operate as attending physicians for hospice.
  • Safeguard the Medicare Hospice Benefit.
  • Deny any attempt to cut federal funding for Medicaid.

The NAHC article includes links to background information, talking points, and sample messages for each issue.


NHHPCO Member Receives Governor's Volunteerism Award

On Tuesday 24 May, Volunteer NH, in partnership with the Governor's office, hosted the Annual Governor's Conference on Volunteerism at NHTI in Concord. Each year during the conference, the Governor's Outstanding Volunteer Manager of the Year Award is presented to honor volunteer administrators and salute their excellence in leadership and management of volunteers in New Hampshire. This year, Governor Maggie Hassan presented the award to Home Health & Hospice Care volunteer manager Tanya Prather.

Tanya is the foundation of the volunteer program at Home Health & Hospice Care. She manages over 250 volunteers and provides an intensive 33-hour hospice training course 2-3 times a year for new volunteers that wish to work directly with patients and their families.

Home Health & Hospice Care patients are offered unique programs such as pet therapy, Reiki, and bedside music that help connect patients and families to what gives them joy and peace, even in difficult times. Through these programs and other services, Tanya helps her volunteers to focus not only on the physical aspects of a patient's illness, but the whole person on the hospice journey. Please join us in congratulating Tanya on receiving this prestigious award!

Thanks to Hospice Volunteers

"You sit with people who are dying and you don't get paid? Why would you want to do that?"

Image CC Jonas Boni: Rapprochment


Have you ever heard something similar from a hospice patient or family member that you have visited? It is a familiar refrain that highlights the fact that many people would not be comfortable doing what hospice volunteers provide for support. Whether it is driving someone to a doctor's appointment, sitting vigil at the bedside or leading a bereavement support group, hospice volunteers give invaluable time and compassion to families at a critical point in time. It is work that feeds the soul and brings unexpected moments of joy.

The National Hospice and Palliative Care Organization (NHPCO) estimates that in 2014, 430,000 hospice volunteers provided 19 million hours of service. NHPCO reports that most volunteers were assisting with direct support (60.8%), 20.2% provided clinical care support, and 19.1% provided general support. In 2014, 5.2% of all clinical staff hours were provided by volunteers. The typical hospice volunteer devoted 46.3 hours of service over the course of the year and patient care volunteers made an average of 201 visits to hospice patients.

The Windows Within Project dedicates its work to all the hospice patients and families who have been our wisest and most generous teachers, providing wonderful stories and quotes from hospice volunteers on their website.

In honor of National Volunteer Week (April 10-16) NHHPCO extends sincere thanks and gratitude to the many hospice volunteers giving time to families in New Hampshire as well as the hospice volunteer managers who make it happen!

"I see and ponder that space between birth and death,
trying to make sure I live every day better than the last."
- Tony Diana, Hospice Volunteer
The Windows Within Project


POLST Expands throughout NH

A class of 20 health professionals participated in POLST Facilitator training on March 30, bringing the total to over 300 people who have completed the POLST Community Facilitator Respecting Choices Last Acts Program in the past three years.

Participants' disciplines included medicine nursing and social work, and represented hospitals, hospices, home care, long-term care and the NH Department of Corrections. Participant were recruited from organizations that have demonstrated a commitment to an implementation strategy.

The NH Healthcare Decisions Coalition is in the process of developing a NH POLST Facilitator education program that will be offered this fall. The program will be based on content available from the National POLST Paradigm with a NH focus. It will require some preparation work and a full day of on-site, interactive learning for participants.

POLST in NH has expanded statewide in the past three years and we have been invited to apply to be an 'Endorsed Program' through the National POLST Paradigm. This review process will take place over the summer.

Information about POLST in NH is available on the Foundation for Healthy Communities website.


PAS Survey Results are in

Senate Bill 426 proposes to "establish an end-of-life choices study commission". This legislation has just been passed/adopted by the Senate Health and Human Services Committee. It moves on to the House Judiciary Committee in a few weeks. If this passes into law, the mission of this committee is to "investigate the positive and negative effects of legislation in states that have enacted aid in dying laws". NHHPCO would have one of the 11 seats on the commission.

Similar versions of this bill have been proposed in many other states over the past two years. In an effort to understand the views of our members, we have been offering a brief survey. After discussion by our board of directors, NHHPCO is neither supporting or opposing this legislation.

Results currently indicate that:

  • Most prefer to refer to it as 'physician assisted suicide'.
  • 60% of survey participants are personally in favor of legalizing PAS, whereas 48% are professionally in favor of it.
  • Just over 19% have changed their opinion on the subject in the past few years.

Thanks to those of you who have already taken our short survey. There is still time to weigh in on this important issue. You can also listen to NHPR's The Exchange, Debating Physician-Assisted Suicide: The Risks vs The Right to Choose.


Advanced Directives Survey

In honor of National Health Care Decisions Day, NHHPCO took part in a NH Health Care Decisions Coalition project to determine how many patients in our state report having completed Advanced Directives.

For the past few years, NH hospitals and hospice providers have been asked to complete one day audits of their patient records. Results indicate that roughly one third of hospital-based patients complete advanced directives, which is in line with the national average.

Hospice providers report 88% of patients have advanced directives on admission to hospice, a number which increases to 90% once a person receives hospice-based care.

In addition to basic advanced directive forms, this year's survey of hospice providers show 36% of patients have a portable DNR on admission and 6% had a POLST form in place.


NHHPCO Responds to the Statewide Opioid Crisis

NHHPCO members and New Hampshire residents in general are very aware that there is a growing problem in our state. It is on the news, in our communities and a reality for our hospice and palliative care providers. Our patients may have a history of addiction, a family member or caregiver may have a current addiction and sometimes a healthcare organization employee is living with addiction.

As a result of the NHHPCO Fall Conference panel discussion “Medication Management - Safe Transitions in Care” a working group has been formed under the leadership of Phil Lawson, MD, to review the work of the state Drug Task Force and resulting emergency rules to protect access to pain medication for patients receiving palliative care and hospice while also reducing the opportunities for diversion. The balance of preserving access to opioid treatment for patients when needed, as well as looking at best practice to reduce drug abuse and diversion is their goal. Phil and colleagues have submitted recommendations to the NH Medical Society and the state task group working on new rules for opioid prescribing.

Please let us know if you are interested in joining this group by contacting Janice McDermott at jmcdermott@nhhpco.org

NHHPCO is also partnering with the NH Comprehensive Cancer Collaboration’s Quality of Life Task Force to assess the current practice in our state to improve outcomes for cancer patients who report unmanaged pain. A $1,000 grant has been awarded to create a patient and provider education tool to raise awareness of evidence based non-pharmacological pain management techniques. The QOL Task Force co-chairs are Janice McDermott, NHHPCO and Chris Howard, Oncology Resource Coordinator Elliot Regional Cancer Center and members include representatives from cancer centers statewide.


Is NH Ready for TC?

Therapeutic Cannabis has been on the agenda of several recent NHHPCO meetings. The four designated distribution sites are due to open by late March 2016, and will be located in Merrimack, Dover, Plymouth and Lebanon.

To be eligible, a person must have a qualifying condition and a qualifying symptom. The Physician's role is to fill out a document stating that the patient meets the criteria to receive TC. The patient will then receive a card that will allow them to purchase TC from one of the distribution centers. Details and documents can be found at the NH DHHS website.

NHHPCO thanks Jill Hunter, APRN, FNP-BC, ACHPN, who serves on the NH Therapeutic Cannabis Advisory Council for providing this information as well as attending two of our meetings.


Hyder House Reopens

Hyder Family Hospice, considered by many to be a "home away from home", officially announced it is reopening at the end of July, 2015. The hospice house was forced to shut in 2014 after its former owner, Amedisys Home Health Services, ran into financial issues.

Operating under Strafford Country's ownership as a nonprofit and being on county-owned land has provided several cost-cutting measures. Additionally, the hospice will now offer open admission - meaning guests who are working through any hospice provider may be eligible to stay there.

"We're not here to make a profit," said George Maglaras, chairman of the Strafford County Commission. "This is about dying with dignity. We're here to provide a needed service to people."

The hospice house will begin by opening one wing, but Maglaras is confident every bed will be full within two months.

"To me, there's no greater gift you can give someone than to help them leave this world," said Liz George, a member of Hyder family.


VNA Hospice of VT/NH Announces Partnership with Dartmouth-Hitchcock

Congratulations to the Visiting Nurse and Hospice for Vermont and New Hampshire, which announced the pursuit of "a formal affiliate relationship" with Dartmouth-Hitchcock on June 29, 2015.

The affiliation was formed to avoid unnecessary hospitalizations, streamline patient transitions from home to hospital and improve inpatient symptom management services through "joint development of the new Dartmouth-Hitchcock Center for Hospice and Palliative Care," according to a press release.

Jeanne McLaughlin, VNH's chief executive, said that a formal agreement could be finalized in the fall.

Dartmouth-Hitchcock, which operates Mary Hitchcock Memorial Hospital and Dartmouth-Hitchcock Clinic, had more than 8,800 employees and posted $1.6 billion in revenue in the fiscal year that ended June 30, 2014. VNH posted $21.3 million in revenue in 2013, when it employed 278 people delivering "home and community-based health and hospice services."

The hospital's planned palliative care center is expected to be located on Lahaye Drive, south of Dartmouth-Hitchcock Medical Center's main complex. Dartmouth-Hitchcock anticipates a 2017 opening for the $20.5 million palliative care facility, which would allow the hospital to move patients into a more comfortable setting and provide patients with life-threatening illnesses and complex medical needs with the type of care that they and their families want.

Read the press release for complete details.


Beacon Hospice is NH's First Level 4 Hospice

Beacon Hospice, an Amedisys company in Portsmouth, has announced that it is the first hospice in New Hampshire to achieve Level 4 status with the We Honor Veterans Program.

We Honor Veterans is a national initiative sponsored by the National Hospice and Palliative Care Organization (NHPCO) to better serve veterans who are receiving end-of-life care. Veterans often carry experiences from their service that present unique challenges, and unfortunately, many of them may not know about or have access to hospice or palliative care. NHPCO's We Honor Veterans program provides hospices across the country tools and resources that allow them to access veteran-specific educational resources for their staff.

For more on this program and a list of other NHHPCO member rankings visit our Veterans page.

Well done on this important achievement!


Charles Mills Appointed Elliot Physician of the Year

Congratulations to Charles S. Mills, MD who has just been appointed Elliot Physician of the Year!

Dr Charles Mills Elliot Hospital    The award recognises the physician who, through their current efforts, exhibits leadership in their area of expertise and who has practiced in their chosen area of medicine with exceptional skill and dedication.

NH participates in national observance to make advance health care decisions

A new study released by the Foundation for Healthy Communities found that only 37 percent (506) of 1,363 patients’ medical records reviewed in 25 acute care hospitals had documentation identifying who they would want to make decisions for them if they lacked the capacity to do so.

The Foundation for Healthy Communities and many other organizations in New Hampshire will observe “National Healthcare Decisions Day” on April 16th in an effort to highlight the importance of advance healthcare directives.

Governor Maggie Hassen issued a proclamation recognizing April 16, 2015, as HEALTHCARE DECISIONS DAY in New Hampshire. “National Healthcare Decisions Day is a reminder to talk with family or friends about your wishes in the event of a medical crisis,” said Shawn LaFrance, executive director of the Foundation for Healthy Communities. “Conversations and completion of an advance directive allows you to decide who will make your health care decisions if you lack the capacity to do so.”

In a related study involving 319 patients from nine hospice programs in in the state, the NH Hospice and Palliative Care Organization found that 84 percent of the patients surveyed had an advance directive when admitted into hospice.

“The focus of National Healthcare Decisions Day is on education,” LaFrance added. “Its aim is to increase the number of people who understand the importance of advance care directives and planning for serious illness or end-of-life care. The Foundation for Healthy Communities provides information to help people address the topic with family, friends and healthcare providers and complete a written advance directive, such as healthcare power of attorney and a living will, in accordance with New Hampshire law.” The Foundation’s advance care planning guide and a brief education video are available free of charge online at www.healthynh.com.

The Foundation for Healthy Communities is a nonprofit corporation that exists to improve health and health care in NH communities through partnerships that engage individuals and organizations.


LaFrance Appointed ACHE Fellow

NHHPCO Board Member and past president, Barbara LaFrance, recently became a fellow of the American College of Healthcare Executives (ACHE).

The ACHE is an international professional society of more than 40,000 healthcare executives who lead hospitals, healthcare systems and other healthcare organizations. The established 80 chapters provide access to networking, education and career development for its members, working towards its goal of becoming the premier professional society for healthcare executives dedicated to improving healthcare delivery.
 
Barbara is Director of Hospice and Palliative Care at Home Health & Hospice Care in southern NH. Being a board certified member of ACHE allows her to share her knowledge and experience in hospice and palliative care with other leaders dedicated to improving healthcare systems. NHHPCO Congratulates Barbara on this distinguished achievement.


For additional updates please send news to jmcdermott@nhhpco.org using the subject line "Membership News".

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