Hospice Training for SNF and ICF/MRS to Meet CMS Requirements

1. Hospice Training for SNF and ICF/MRS to Meet CMS Requirements

2. Objectives: • Articulate the regulatory significance requiring the training of staff who give care to hospice patients in Skilled Nursing Facilities or Intermediate Care Facilities with Mental Retardation • Identity and describe the specific components of the training materials. • List implementation strategies • Describe regulatory responsibilities in maintaining records for survey verification

3. Center for Medicare/Medicaid Services Hospice Requirement • Standard 418.112 (f) Hospice staff must assure orientation of SNF/NF or ICF/MR staffing furnishing care to hospice patients in the hospice philosophy, including hospice polices and procedures regarding methods of comfort, pain control, symptom management, as well as principles about death and dying, individual responses to death patient rights, appropriate forms and record keeping.

4. Other Requirements not addressed in this training • Standard 418.112 (d) A written hospice plan of care must be established and maintained in consultation with SNF and ICF/MR representatives. All hospice care provided must be in accordance with this hospice plan of care. • The hospice plan of care must identify the care and services that are needed and specifically identify which provider is responsible for performing the respective functions that have been agreed upon and include in the plan of care. • The hospice plan of care reflects the participation of the hospice, the SNF or ICF/MR, and the patient and family to extent possible.

5. Coordination of Services • Standard 418.112(e) The hospice must designate a member of each interdisciplinary group that is responsible for a patient who is a resident of a SNF/MR or ICF/MR. The designated interdisciplinary group member is responsible for: • Providing overall coordination of the hospice care of the SNF/MR resident with SNF or ICF/MR representatives and… • Communicating with SNF or ICE/MR representatives and other health care related providers participating in the provision of care for the terminal illness and related conditions and other conditions to ensure quality of care for the patient and family.

6. Barriers to meeting this requirement • Orientation had not been created • Time for facility staff • Inadequate tracking mechanisms of training

7. Approach to meeting this requirement • Minnesota Network of Hospice and Palliative Care Standards Committee, Metro Area Managers and Supervisors work group • Developed a standardized paper orientation tool • Reviewed the orientation tool, revised the tool and obtained approval from the Minnesota Department of Health Survey Section • Dissemination of this tool to all facilities and hospice providers in the state of Minnesota • Implementation of the orientation tool within all facilities

8. Structure & Components of the Training Packet • Designed to be a comprehensive tool • Quick and easy to read • 6 components and a post test • Not designed for CEUs

9. Learning Components • Hospice Philosophy • Comfort, Pain and Symptom Control in Hospice • Patient Rights • Communication & Documentation • Death & Dying • What is Grief? • Post Test

10. Hospice Philosophy • Comfort focus • Limited life expectancy • Coverage for Hospice services • Care Team involvement • 24 hour nursing available • Collaborative care

11. Comfort, Pain & Symptom Control in Hospice • Promoting comfort and symptom control through medications • Non-pharmacological comfort and interdisciplinary approach • Comfort maintained in their current setting • Facility staff as family

12. Patient Rights • Respecting the rights of every individual receiving Hospice care • Required under Standard 418.52 of the Center for Medicare/Medicaid Services Hospice Conditions of Participation

13. Communication & Documentation • Promotes quality resident and family care • Continues throughout the resident’s care • Information provided by Hospice • Hospice involvement in the facility survey process

14. Death & Dying • Understanding what is normal and expected • Dying process • No two people die the same however patterns emerge • Hospice is there for you

15. What is Grief? • Normal reaction to loss • Physical and psychosocial responses to loss • Helping yourself and others through the process • Seeking professional help if necessary

16. Post Test • Acknowledges a basic understanding of Hospice services and care • Required as part of the training packet • Emphasis on training staff who care for Hospice residents

17. Implementation Strategies New Staff  • Include hospice training as part of new hire orientation • List hospice orientation as one of the orientation components • Retain hospice orientation test in employee personnel file

18. Implementation Strategies Existing Staff  • Include hospice training as part of facility staff mandatory training, education • Retain hospice orientation test in employee personnel file

19. Regulatory Responsibilities • During surveys hospice programs will be required to provide proof of facility staff orientation • Facility staff orientation will be retained at the facility • Hospice providers will be responsible to audit documentation of hospice training

20. Resources Minnesota Network of Hospice &Palliative Care www.mnhpc.org Hospice Bill of Rights www.health.state.mn.us/divs/fpc/profinfo/ib05_04.html

21. Resources Aging Services of Minnesota www.agingservicesmn.org Care Providers of Minnesota www.careproviders.org Hospice and Palliative Nurses Association www.hpna.org National Hospice and Palliative Care Organization www.nhpco.org