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 & Residential Community-based Services Services Personal Skilled AgeWell Meals on Outpatient Adult Day Home Hospice Care Nursing Wheels Rehab Program Health Facilities & AgeWell Rehab Service at Home Memory Coordtrs JCC Care Rehab Indep. Asst’d Private Satellite Living Living Duty 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 Weaknesses • Small service lends itself to more • Lack of timely referrals to other JAA entities and neighboring Riverview Towers (HUD Housing) individualized and personal care • Culture • Dedicated and compassionate staff • Both strength and weakness with referral sources •“Patient - Centered Care” • Mission and Values embedded into daily care Opportunities Threats • Highlight staff in different media • Competitors • Improve communication • Providers admitting patients on to • Leverage community relationships services when not appropriate • Between JAA entities • Providers admitting patients to GIP • Continue outreach to community Rabbis • JAA Rabbi Seidman follow up when not appropriate • Consider vignettes highlighting patient and family experience 18
Maintain Independence or Merge? • Valuation performed by 3 rd party • Evaluation of Sale/Merger opportunities • How would Jewish culture be maintained? 19
Task Force Decision – Maintain Independence Why? 20
Staff Education Volunteer Training What makes us Jewish? Bereavement Community Recognition Expectations 21
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 Hospice Task Force Implementation 23
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 • 20 th anniversary celebration 24
SJH Future Plans • MCCM Recipient – Phase II • Staff certification • AgeWell collaboration bereavement support for caregivers 25
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
Montefiore Hospice: Team • Medical Director • Nurses, Aides, Social Workers, Chaplains, Bereavement • Music, Art, Massage, Reiki therapists • Volunteers
Why build an Inpatient Hospice Unit? • Market opportunity • Full-service program • Milt and Tamar Maltz
Project Timeline FUNDRAISING 2013 - 2014 Continued June 2013 fundraising 130 th Jan 2012 Anniversary Fundraising GALA Plan April 2015 Unit Opens Oct 2012 Design begins August 2014 Ground Sept 2014 Breaking Construction March 2015 completed Regulatory approval 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
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