Date: 09/01/2009
Final
Discussion regarding Long Term Care
HOSPICE AND PALLIATIVE CARE
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01:43 PM -- Long Term Care
Jayne Keller from the Heritage Club of Greenwood Village and Arlene Miles from the Colorado Health Care Association introduced themselves and began their presentation. Ms. Keller discussed challenges and barriers to hospice care in her facility. She said that the regulatory environment is an obstacle. She said that many regulators do not understand the role of hospice. She stated that nursing homes are required to provide the highest level of care and treatment, whereas hospice care focuses on comfort and dignity. As an example of this conflict, she described what how each facility would approach maintaining the weight of a patient. She also discussed the financial barriers to providing hospice care. For example, once a Medicare patient who was previously in a long-term care facility, and enters hospice, the patient may be required to pay for their room and board. She describe the benefits of partnerships between long-term care facilities and hospice communities. She described how hospice staff can supplement assisted living and nursing home staff to provide care. Ms. Keller also highlighted the benefit of hospice in helping families deal with the dying process and grief.
01:51 PM
Ms. Miles further discussed the regulatory environment and the annual reviews by the department for long-term care facilities. She spoke to family issues that complicate end of life issues. She gave the example of a 90-year old woman who wanted her daughter to keep getting care even though she was terminally ill and said that the nursing facility was cited for a serious violation for not maintaining adequate care for the daughter. Ms. Miles described the financial penalties and the dispute resolution process. Representative Roberts asked about the portability of the MOST form and if the witnesses were supportive of this. Ms. Miles said they are in favor of portability since it provides clarity when a patient goes between a nursing home and a hospital. Senator Newell asked about the ombudsman program. Ms. Miles stated it was an effective program and that it is not an adversarial process like in other states. Ms. Miles described the importance of education and said that there is not a continuing education requirement for medical professionals regarding end of life directives. She stated that this lack of continuing education hinders knowledge of hospice care and long term care issues.
02:03 PM
Representative Roberts asked if there was a level of staff that did not need to be educated on advance directive issues. Ms. Miles stated that hospice organizations play a critical role in educating nursing care staff and families members of individuals in hospice. Ms. Keller said she could not think of any staff in a nursing care facility that should not be educated on advance directive and hospice care issues. Senator Williams asked about education by each nursing facility and if it was mandated. Ms. Miles said that it is not mandatory, but that if harm resulted from staff not providing the required training that the facility would be responsible for the deficiency. Senator Newell asked if nursing homes have a standard practice of where they keep DNRs (Do Not Resuscitate orders). Ms. Keller said that they are kept in the records office, not in the resident's home. Ms. Keller described their procedures in the event of an emergency, and Ms. Miles described the care plans that are developed for each client in nursing care / hospice.