1. Patient Questions and Hospice Myths Presented by: XXX

2. Introductions

3. Local Project Hospice Lead(s) Insert from Speaker Notes

4. Stratis Project Team Stratis Health Staff  Janelle Shearer, RN, MA, CPHQ, Program Manager  Laura Grangaard, MPH, Research Analyst Subject Matter Experts  Barry Baines, MD  Lores Vlaminck, RN, BSN, MA, CHPN

5. Objectives Overview of the TRUE project Explore strategies for discussions with your physician regarding your serious illness Describe the Medicare hospice benefit and services

6. Targeting Resource Use Effectively (TRUE) Goals: –Increase appropriate referrals to hospice –Increase the length of stay of hospice patients (days of care) How:By forming multidisciplinary community based teams to implement strategies to address barriers to optimal hospice use in the XXXXX community

8. THE REALITY, THE PROBLEM, AND THE RESULT

9. Is There an Elephant in the Physician’s Exam Room?

10. The Gap: Having The Talk Patients and their families think that if they have a serious illness, their doctor will start the talk about hopes and goals for care Doctors say that they will have these talks if their patients bring up the topic first Doctors and their patients both think that having these talks are important

11. Reality Persons have a Serious illness Problem Neither the patient nor the physician are talking about it Result Frequently, these talks aren’t taking place or they happen in a crisis situation

12. Opportunities: Having “The Talk” Sooner For Patients: –Encourage patients to ‘ask their doctor’ if they have a serious illness –Provide a list of specific questions to initiate “the talk” (see patient brochure)

15. Patient Questions: Do I have a serious or life-limiting illness? Can my illness be cured? If my illness can’t be cured, are there treatments that can slow down my illness? What kind of care is available to focus on making me comfortable?

16. Patient Questions: If my illness keeps getting worse, when is it a good time to think about getting supportive and comfort focused care? Will you be the one to tell me when to contact hospice? Will you stay involved with my care even when I am no longer looking for treatment for my disease?

17. Shared Decision-Making Between Physician and Patient: Physician’s Responsibility: Inform and recommend best treatment option(s) Patient’s Responsibility: To choose or refuse treatment option(s)

18. A BIT ABOUT HOSPICE

19. MYTHS AND REALITIES ABOUT HOSPICE

20. Myth I have to give up my primary physician upon hospice enrollment Reality Hospice encourages you to keep your primary (usual) physician

21. Myth All my medications and treatments will be discontinued Reality The hospice team, along with your primary physician reviews all medications and treatments to meet your wishes for comfort.

22. Myth I have to pay for hospice Reality For those that meet the hospice eligibility criteria for Medicare, Part “A” covers hospice at 100% without a co- pay or deductible. Most health plans do the same..

23. Myth Hospice is a place I must go to. Reality Hospice is a team of professionals and volunteers that come to the place you call “home.” They bring their expertise, care and supplies to you.

24. Myth If I enroll in hospice, I will die sooner. Reality Actually, research shows people with some diseases live longer if they are enrolled in hospice than if they aren’t.

25. MORE BITS ABOUT HOSPICE

26. Who Qualifies for Hospice Care? Terminally ill persons whose life expectancy is six months or less given the current progression of their disease process (any age-any diagnosis) Patient is seeking palliative care rather than curative treatment

27. Hospice Team Members Core Team Members Medical Director/Attending Physician Nurses (RN on-call 24/7) Social Worker Chaplain/Counselor Volunteers (Active and Bereavement)

28. Hospice Team Members Hospice Aide Therapies (PT/OT/ST) Registered Dietician Pharmacist –Ancillary/Complimentary Therapies

29. Medical Supplies Supplies related to the terminal illness are covered Examples may include: Wheelchair Walker Oxygen Wound care Incontinent products Dressings Ostomy supplies Other

30. Medications and Treatments All medications and treatments related to the terminal and “related” conditions are covered as approved by hospice

31. Who Pays for Hospice Care? Medicare Medical Assistance Most Insurance Plans Private Pay Several Long Term Care Insurances

32. The Reality as Expressed by Many Patients “I wish I had enrolled in hospice sooner” “I didn’t realize all the support hospice offered” “Why didn’t my doctor tell me about hospice?” “Why didn’t I know about hospice?”

33. The Reality as Expressed by Many Families “ I didn’t realize all the support hospice could offer me” “The value of being able to contact a nurse 24/7 was such a comfort” “I had no idea hospice would provide my family with grief support”

34. Questions

35. Contact Information XXXXXXX XXXXXX

36. Stratis Health is a nonprofit organization based in Minnesota that leads collaboration and innovation in health care quality and safety, and serves as a trusted expert in facilitating improvement for people and communities. This template was prepared by Stratis Health, the Quality Improvement Organization for Minnesota, under a contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the US Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 10SOW-MN-SIP TRUE HOSPICE-14-30 031114