VNA Care Network & Hospice1 Latino Hospice Program at VNA Care Network & Hospice Patient Navigation...

VNA Care Network & Hospice 1

Latino Hospice Program at

VNA Care Network & Hospice

Patient Navigation and Community Education to Reduce Disparities in End-of-Life Care

Cathy Romeo, VNA Care Network & Hospice 2

Jacquelyn ToledoLatino Client Navigator

VNA Care Network & Hospice

Introductions


Introductions – the Group

Name Where you work? Any CHWs? Special population(s) you

work with

What super power you would choose to have and why?

derived from OWTI of CMAHEC, Inc.


Ground Rules

Start on time and end on time Time keeper Vibes watch keeper

Silence cell phones Only one person speaks at a time

Step Up, Step Back No side conversations Respect others’ opinions Confidentiality within the group


Break-Out SessionObjectives & Agenda

Objectives History of the project and why it

was implemented

Case Studies

Provide education on how PN/CHWs can impact inequalities with end-of-life care & improve better dying experiences

Agenda Welcome and Introductions

General VNACN&H history & Hospice Knowledge

“Hospicio” – Perceptions, Experiences, Challenges

Tools & Resources

Next Steps

Q&A, Evaluation


Pre-TestQ&A

What is Hospice? What is a Latino? How can you qualify for hospice? What is Palliative Care? What is a CHW? Is the VNACN&H private or non-

profit? When was the VNACN&H founded

or years in service?


VNACN&H

A Medicare-certified home care agency providing skilled services, palliative and hospice care, and wellness services

Service 200 communities in Eastern & Central Massachusetts

Care provided in homes, nursing facilities, and three hospice residences.

120 Thomas Street

Worcester, MA 01608

(800) 521-5539

Website: www.vnacarenetwork.org


Hospice & Palliative Care Special concept of care designed to provide comfort

and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments

Palliative Care – Care Choices© Program pain & symptom mgmt t/i disease process focuses on comfort still have access to specialized clinicians

Hospice like Palliative care deals with the emotional, social and spiritual

impact of the disease on the pt, pt’s family and friends

Offers variety of bereavement and counseling services before & after a pt’s death


Hospice History

word “hospice” stems from the Latin word “hospitium” meaning guesthouse

used to describe a shelter for weary & sick travelers returning from religious pilgrimages

1960’s – Dr. Cicely Saunders began the modern hospice movement St. Christopher’s House near London team-approach developed for professional CG

1974 – 1st hospice in the U.S. in New Haven, CT VNACN&H – 1st hospice agency in MA to be certified

by Medicare


Hospice History Continued

Today – over 4,700 hospice programs in the U.S. Hospice programs cared for 965,000 people enrolled

in Medicare in 2006**, and nearly 1.4 million in the U.S. in 2007* Most health insurance plans have hospice benefit

Hospice is not a place but rather a concept of care 80% provided in pt’s home inpatient hospice facilities, hospice residences

*nhpco

**CMS


Multicultural Services

Established in 2001 to improve the VNA’s cultural competency and to increase cultural awareness and sensitivity.

Cathy Romeo, Manager

Multicultural ServicesVNA Care Network & Hospice175 Highland AvenueNeedham, MA 02494(888) 663-3688, Ext. 4528FAX: 781-444-5393

Email: [email protected]

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The Face of Massachusetts

Over 20% of MA residents speak a language other than English at home. One in seven (14%) Bay State residents were born in another country.

2010 Census and Annual Updates, MDPH Community Reports

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National Research

National Hospice & Palliative Care Organization (NHPCO) Focus groups conducted in 2006

Findings: Health disparities in quality end-of-life care for Latino population

Disparities in diverse populations

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Health Disparities

“…health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group…or other characteristics historically linked to discrimination or exclusion”

-- HealthyPeople.gov

Health disparities are differences in incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific U.S. population groups. Latinos, for example, suffer various disparities in cancer, chronic disease, obesity and other conditions.--SaludTodayBlog, by UT Health Science Center San

Antoniohttp://ihpr.uthscsa.edu/disparities.html

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NHPCO’s efforts to reduces disparities in Latino Population # of Latinos in the U.S. continues to

increase felt strongly to expand outreach and

programmatic efforts to ensure Latinos receive quality end-of-life care

NHPCO’s Caring Connection created a Latino Outreach Guide key findings from focus groups:

advance care planning end-of-life caregiving hospice


Why did we focus on end-of-life care for the Latino community?

Few Latinos utilized our hospice services.

NHPCO effort to decrease disparities in care for Latino populations.

Senior management asked for a plan.


VNACN&H ‘Leading Change’

Communicate Vision for Change Educate & Empower Staff Create Short-Term Wins and Long-

Term Goals Reinforce Change Build Reputation in Community and Among Referral Sources

John P. Kotter, Harvard Business School, author of seventeen books on leadership and change


Asking the community

Never plan for the community -- plan with the community!

Contracted with Central MA AHEC to conduct focus groups and key informant interviews within the Latino population

Sought and received partial funding from BCBS Foundation

Reports compiled


“Hospicio” Individual & Cultural Perceptions & Challenges

Negative connotation A place of abandonment of person or

child An asylum “…the ones that come to the house

to kill the patient” “…they help you die faster” A place to go and die Take place of family’s role


Latino Hospice Program initiated in 2009

Latino Hospice Advisory Board developed

Culturally-Relevant Bilingual Patient and Community Educational Materials Created

Patient Navigator/CHW role created

First Steps


PN/CHWs Different fromother Health Professionals

Hired for their understanding of the populations Conduct outreach Provide services in community settings Promote, support, protect the health of individuals, families, communities Perform four primary functions:

1. client advocacy2. health education3. health system navigation4. outreach

Have various job titles Health Educator Health Advocate Outreach Worker Patient Navigator Promotor(a) de Salud, etc.

MA DPH http://mass.gov/dph/communityhealthworkerssampled from OWTI of CMAHEC, Inc.


CHWs are NOT clinicians! “CHWs working side by side with clinicians and registered

nurses, providing adjunct care in chronic conditions”

the licensed health professionals carry out essential clinical tasks

CHWs do not substitute for the clinical role of the licensed health professionals

…(CHWs are) assuming responsibilities for the social and routine aspects of chronic care”

CHWs in Chronic Care Discussion Paperhttp://www.communityhealthworks.org/images/CommunityHealthWorkersandChronicCare.pdf

Sampled from OWTI of CMAHEC, Inc.


Community Services attend health fairs; meet with physician practices; church

groups community education & outreach; informal counseling;

social support; advocacy participation in Latino Advisory Board; ongoing support

Internal Services staff and patient support (in-services, end-of life cultural

views, Latino hospice) identification of diverse patient education materials translation projects: patient information documents,

brochures, website pages

Latino Client Navigator @VNACN&H


“Calidad de Vida”

www.nhpco.org


General end-of-life care knowledge

Unclear on where care can be received Pt’s home, nursing home, ALF, RMHH

Replaces the family The nurse helps care for pt/teaches

the family Pt/family decide who else from team

allowed in the home Only for the elderly

Affects all age groups Only for people with cancers

Other debilitating diagnoses To young to talk about this stuff Advance Directives – taboo to talk about

death


Tools/Conversations Starters

Share Ask Make it clear Discuss action steps

What are your thoughts about your mom’s illness?

Learned so far? Worries regarding her prognosis?

Explore goals for next few months, etc.

Anything afraid of? Finding clinical findings accurate?

vs. 1 year ago? It can be difficult to do it alone

Have you thought about what you may need?

Hospice one of best ways to keep pt home with family

Have you heard of it? Explore readiness & importance

Meet them where they’re at


Case Studies

Case #1: Don Santiago and Aurelia’s Dilemma

Case #2: Consuelo & Maria’s Dilemma


Utilization Increases

total # monthly average% +/-

2010 32 2.66 ↑

2011 36 3 ↑

2012 39 3.25 ↑ 24%


3rd Annual Nonprofit AwarenessDay -- June 2011

Finalist Innovation Award


Continuing Steps to Success

Continue to educate wider community about culturally-sensitive end-of-life care that supports traditional Latino values & enable families to care for loved ones at home

Maintain effective staff education Maintain Latino Advisory Board Identify translation, resource needs Offer our expertise to Atrius and

others to enhance community development partnerships


Resources National Hospice and Palliative Care Organization

http://www.nhpco.org/ Central Mass AHEC

http://www.cmahec.org/ U.S. Department of Health and Human Services

http://www.hhs.gov/ UT Health Science Center San Antonio

http://ihpr.uthscsa.edu/disparities.html Centers for Disease Control and Prevention

http://www.cdc.gov/minorityhealth/CHDIReport.html?s_cid=fb2326 Health Disparities & Inequalities Report -- analyzes recent

trends and ongoing variations in health disparities and inequalities.

Hospice Foundation of America http://www.hospicefoundation.org/


Post-TestQ&A

What is Hospice? What is a Latino? How can you qualify for hospice? What is Palliative Care? What is a CHW? Is the VNACN&H private or non-

profit? When was the VNACN&H founded

or years in service?


Break-Out SessionObjectives & Agenda

Objectives History of the project and why it

was implemented

Case Studies

Provide education on how PN/CHWs can impact inequalities with end-of-life care & improve better dying experiences

Agenda Welcome and Introductions

General VNACN&H history & Hospice Knowledge

“Hospicio” – Perceptions, Experiences, Challenges

Tools & Resources

Next Steps

Q&A, Evaluation


Jacquelyn Toledo, Latino Client Navigator/CHWVNA Care Network & HospicePhone: (508) 361-2699Email: [email protected]

Thank You!

VNA Care Network & Hospice1 Latino Hospice Program at VNA Care Network & Hospice Patient Navigation...

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