MASTERClass AJAS Master Class Innovations in Jewish End-of-Life - - PowerPoint PPT Presentation

2017 AJAS Annual Conference

MASTERClass

AJAS Master Class Innovations in Jewish End-of-Life Care

End-of-Life Care for Jewish Community

Should be informed by and incorporate the following:

• Cultural norms in Jewish community
• Jewish vs. Western medical ethics
• Endorsement by Religious and Lay community
• Jewish providers, liaisons and navigators
• Jewish clinical team members
• Cultural sensitivity training
• Incorporation of Halachic Pathway

Barriers/Challenges to Access

• Hospice ‘philosophy’
• Lack of awareness of Jewish laws and customs
• Exclusion of appropriate stakeholders in decision

making

• Jewish Values and Jewish Medical Ethics
• Cultural norms around seeking aggressive medical care
• Cultural norms around advance care planning
• Loss of hope, hastening death

Recommendations Leading to Best Practice

• Community based model – multi-pronged approach
• Lay, religious, healthcare leadership
• Education/outreach – professional, community
• Synagogue involvement
• Funding support
• Governance/Leadership support
• Infrastructure – human resources
• Value neutral staff
• Marketing
• Communication, communication, communication

AJAS Masterclass

Innovations in Jewish End-of-Life Care

Education

• Professionals
• Community
• Synagogue

7

Center for Jewish End of Life Care History Lessons learned

• Focus Groups
• Snackable
• Changeable

8

To Operate or Not to Operate Hospice?

Sivitz Jewish Hospice

Jewish Association on Aging

Pittsburgh, PA

AJAS MasterClass: Innovations in Jewish Palliative & End of Life Care April 5, 2017 Deborah Winn-Horvitz Mary Anne Foley

Objectives

• 1. Understand how to include Board and Community Leaders in

discussions related to a mission critical program

• 2. Learn how one hospice program redesigned for financial

success

• 3. Understand ways to differentiate your program in a crowded

market

10

Jewish Association on Aging

Home & Community-based Services Residential Services

Meals on Wheels Outpatient Rehab Adult Day Program Home Health Hospice Personal Care Facilities Skilled Nursing & Rehab AgeWell AgeWell at Home Service Coordtrs Private Duty JCC Rehab Satellite Memory Care Asst’d Living Indep. Living

11

History of Sivitz Jewish Hospice

• Developed and opened 20 years ago, by the Sivitz Family
• Historically a financially stable program

– Strong census despite competition – Overall quality excellent

12

Regulatory Changes Impacting Hospice Providers

• January 2011: Face to Face Ruling went into effect
• October 2012: Medicare Hospice Claims with increased scrutiny
• LOS: Routine & GIP
• LTC/SNF: Debility
• LOS: Alzheimer’s, Debility or COPD
• October 2013: Final ruling: Debility and Adult Failure to Thrive
• July 2013: First Mandatory reporting requirements
• March 2014: Hospice and Medication Part D
• July 2014: First penalties imposed on reimbursement

13

Additional Data Requests (ADRs)

Date # ADRs $ At Risk 11/2013 38 $ 175,976 2/2014 40 $ 254,266 9/2014 42 $ 258,975 Total 120 $ 689,217

14

SJH Operating Trends

FY 11 FY 12 FY 13 FY 14 FY 15 # Admissions 128 126 134 107 111 Total Patient Days 14,688 14,056 11,568 6,660 4,062 ADC 40 38 31 19 11 Live Discharges 13 14 29 18 11 Top 3 Diagnoses FY 11 FY 12 FY 13 FY 14 FY 15 Cancer Debility Dementia Dementia Dementia Dementia Cancer Debility Cancer Cancer Debility Dementia Cancer CHF Neurological Disease

15

SJH Financial Performance

Hospice Task Force Implementation

16

JAA Board Of Directors: Call For Action

• Hospice Task Force developed to conduct a deep dive

evaluation of Sivitz Jewish Hospice

– Implemented September 2014 – Members: Board representatives including Board Quality Committee Chair; Community Leaders and JAA Senior Management – SWOT analysis completed – Questioned: What makes us Jewish?

17

SJH SWOT Analysis

Strengths

• Small service lends itself to more

individualized and personal care

• Dedicated and compassionate staff
• “Patient-Centered Care”
• Mission and Values embedded into daily

care

Weaknesses

• Lack of timely referrals to other JAA entities and

neighboring Riverview Towers (HUD Housing)

• Culture
• Both strength and weakness with referral sources

Opportunities

• Highlight staff in different media
• Improve communication
• Leverage community relationships
• Between JAA entities
• Continue outreach to community Rabbis
• JAA Rabbi Seidman follow up
• Consider vignettes highlighting patient and family

experience

Threats

• Competitors
• Providers admitting patients on to

services when not appropriate

• Providers admitting patients to GIP

when not appropriate

18

Maintain Independence or Merge?

• Valuation performed by 3rd party
• Evaluation of Sale/Merger opportunities
• How would Jewish culture be maintained?

19

Task Force Decision – Maintain Independence

Why?

20

21

Staff Education Volunteer Training Bereavement Recognition Community Expectations What makes us Jewish?

How Did We Revitalize SJH?

• Expense reduction
• Increase marketing & exposure

– Closure series

• Improved internal referral processes and relationships
• Enhance volunteer programs

22

SJH Financial Performance Today

23 Hospice Task Force Implementation

SJH Today

• Preferred Provider within JAA continuum
• Staff retention
• No ADRs
• Hospice item set = 100%
• Deficiency free surveys
• Working more closely with Jewish Community Rabbis
• Partnership with Hillman Cancer Center
• 20th anniversary celebration

24

SJH Future Plans

25

• MCCM Recipient

– Phase II

• Staff certification
• AgeWell collaboration bereavement support for caregivers

AJAS Masterclass: Montefiore Inpatient Hospice

Seth Vilensky April 5, 2017

Montefiore Hospice: History

• Founded in 1992 – NCJW
• First Jewish Hospice agency in the state of Ohio
• Endowment through Jules and Ruth Vinney

Philanthropic Fund, 2011

Montefiore Hospice: Today

Full service hospice agency

• Palliative care consult service
• Hospice at home
• Hospice in nursing home/assisted living
• Inpatient hospice unit – 6 beds

45 – 50 patient average daily census

• Medical Director
• Nurses, Aides, Social Workers, Chaplains,

Bereavement

• Music, Art, Massage, Reiki therapists
• Volunteers

Montefiore Hospice: Team

Why build an Inpatient Hospice Unit?

• Market opportunity
• Full-service program
• Milt and Tamar Maltz

Project Timeline

Jan 2012 Fundraising Plan April 2015 Unit Opens Oct 2012 Design begins August 2014 Ground Breaking June 2013 130th Anniversary GALA 2013 - 2014 Continued fundraising Sept 2014 Construction completed March 2015 Regulatory approval

FUNDRAISING OPERATIONS

Project Funding

• Total Project Cost: $3.0m
• Total $ raised: $3.0m
• Maltz Foundation: $1.5m
• Additional fundraising: $1.5m

The Maltz Hospice House

• Virtual Tour

Differentiators

• Design and ‘home-like’ feel
• Location
• Team and staffing ratio
• 1 RN
• 1 STNA
• Medical Director
• Chaplain, social worker, integrative therapies,

volunteers

Volume and Financials

FY 2017: July - February Occupancy (ADC) 4.11 Revenue $493,696 Operating Expense $554,855 Net Operating Surplus ($61,162) Depreciation $114,563 Net Income $(175,725)

Lessons Learned

• 1. Patient mix: residential vs GIP
• 2. Medical supervision
• 3. Staffing a 6-bed unit
• 4. Marketing advantage
• 5. Community benefit