Hospice and Palliative Care Association of New York State - Annual Interdisciplinary Seminar and Meeting

* Previous year's agenda for reference only. Agenda for 2010 will be posted later *

"The material presented in the educational sessions represents the opinions of the speakers and not necessarily the views of the Hospice and Palliative Care association of New York State. All faculty are required to disclose to program participants any relationship, including financial interest or affiliations with a commercial company, as well as discussion of unlabeled uses. A copy of the disclosure information will be made available to attendees at the meeting."

CONCURRENT #A

Session A: Thursday, May 28, 10:15 - 11:45 am

Reinventing Access Bill Finn, Nancy Pelham, Center for Hospice & Palliative Care, Buffalo, New York Access has become a catch phrase in hospice to describe a plethora of different approaches and hospice experiences. This workshop describes a world-class new service model for access and admissions, creating real commitment to service excellence.
Purpose: At the close of the session learners will be able to:
- Define the current state of "Open Access" in NYS and state the rationale for change
- Detail the process to gain commitment throughout the organization for change leadership
- Discuss mission alignment and the service mindset
- Discuss process improvement and making real change
Managing Conflict in the Workplace Judith Skretny, Center for Hospice and Palliative Care, Buffalo, NY Studies estimate that managers spend at least 25% of their time managing conflict. Furthermore, many relatively successful supervisors and managers have a fear of conflict. Unfortunately, eliminating conflict from the workplace is impossible. The most successful managers learn how to manage conflict effectively so that it does not interfere with productivity and the provision of excellent patient care.
Purpose: At the close of the session learners will be able to:
- Define conflict in the workplace
- Describe misconceptions about conflict
- List consequences of unresolved conflict
- Discuss different approaches to conflict resolution
Vietnam Vets at End of Life Dr. Jennifer Egert and Dr. Carol Luhrs, VA Harbor Healthcare System In six years, 60% of veterans over the age of 65 will be veterans of the Vietnam War and they present unique challenges for care of their physical and psychological needs at the end of life. As a group, they have elevated death rates, often due to biological risks (eg. Hepatitis C and Agent Orange related diseases) and psychosocial factors (social isolation, lack of support, substance abuse). Post Traumatic Stress Disorder and a number of psychiatric conditions are common among Vietnam Veterans and may impact on end of life care, including forming relationships with healthcare providers. In this presentation, we will explore the unique medical and psychosocial experience of Vietnam veterans, with a focus on current health issues and strategies to improve their care at end of life.
Purpose: At the close of the session learners will be able to:
- Describe how the Vietnam War impacted the lives of some veterans
- Discuss the unique medical challenges faced by many Vietnam Veterans
- Discuss the unique psychological challenges faced by many Vietnam Veterans
- Suggest approaches to medical and psychological care to facilitate the dying experience for Vietnam Veterans and their families
Changing Role of Social Worker Flexibility and adaptability do not happen just by reacting fast to new information. They arise from mental and emotional balance, the lack of attachment to specific outcomes, and putting care for self and others as a prime operating principle. Flexible attitudes build flexible physiology. Flexible physiology means more resilience in times of challenge or strain. Staying open-emotionally-insures internal flexibility.
Purpose: At the close of the session learners will be able to:
- Describe how to be flexible and adaptable to change
- Describe Healthy Functioning
- Describe how one can move towards resilience
Palliative Care: Transition from Hospital to Home Dr. Beth Popp, Maimonides Medical Center, Enrique Aguilar, Metropolitan Jewish Hospice, Nella Khenkin, Maimonides Medical Center, Brian Mandel, Metropolitan Jewish Hospice Hospital based palliative care programs strive to help hospitalized patients and families navigate the health care system and facilitate discharges to other care settings in accordance with their expressed goals of care. However, even the best interdisciplinary planning for the patient's transition out of the hospital can be undone overnight if there is a lack of collaboration between the hospital based palliative care team and a community hospice and palliative care program.
Purpose: At the close of the session learners will be able to:
- List the partners and the benefits of a successful collaboration between a hospital based and palliative care team and a community hospice and palliative care program
- Describe the physicians role in a successful collaboration between a hospital based palliative care team and a community hospice and palliative care program
- Describe the physicians role in a successful collaboration between a hospital based palliative care team and a community hospice and palliative care program
- Describe the Oncology Social Worker's role in a successful collaboration between a hospital based palliative care team and a community hospice and palliative care program
- Describe the Hospice and Palliative Care Social Worker's role in a successful collaboration between a hospital based palliative care team and a community hospice and palliative care program
Avoiding Medicaid Audits Jay Spears, NYS Attorney General's Office, Richard Harrow, NYS Attorney General's Office, Rachel Hold-Weiss, Arent Fox, New York, NY Health care attorneys predict that preparing for heightened Medicaid compliance required by the Deficit Reduction Act of 2005 will be one of the top challenges for health care providers. Learn what's new and how to protect yourself.
Purpose: At the close of the session learners will be able to:
- Describe Medicaid fraud
- Describe what is new in Medicaid audits and investigations and how to protect your program

CONCURRENT #B

Thursday, May 28, 2:15 - 3:45 pm

Be Bold- Create a Roadmap for Engaging Your Hospice Talent Jeanne Dennis and Cindy Morgan VNSNY Hospice, New York, NY More and more hospice and palliative care organizations are taking steps to create high engagement cultures, enabling employees to remain flexible and adaptable to changing patient and marketplace demands. Learn about the roadmap taken by Visiting Nurse service of new York to engage, develop and retain their hospice and palliative care talent at all levels.
Purpose: At the close of the session learners will be able to:
- Provide an overview of the processes and tools to assist participants in engaging and retaining Hospice talent
- Discuss practical ideas for transitioning new people into participants' organizations and/or into new roles
- Describe new ideas that can manage talent
Transforming Grief Through Art Rebekah Lancto, Friends of Karen, Purdys', NY and Dayna Wood, VNSNY Hospice, New York, NY Participants will learn how to creatively interact with children, adolescents and their families who are dealing with a terminal illness by using expressive arts. In the expressive arts, all artistic disciplines work together to bring patients/families to a deeper wisdom and transformation of their personal grief.
Purpose: At the close of the session learners will be able to:
- Demonstrate art-making
- Identify the basic principles of expressive arts therapy that can be helpful in working with children and adolescents
- Describe ways that expressive arts therapy is beneficial in working with dying and grieving children and adolescents
Transitioning the Complicated Pediatric Palliative Care Patient from Inpatient to Outpatient Care Scott Klein, MD, Hospice Care Network, Woodbury, NY and John Saroyan, MD, Morgan Stanley Childrens' Hospital at New York Presbyterian Children with life-limiting illnesses spend much of their lives within a hospital. Reasons for this include parental wishes, physician reluctance to discharge, lack of community resources or the care of the child is perceived to be too complicated to manage at home. Medication management can be a special challenge for the pediatric patient in a home environment.
Purpose: At the close of the session learners will be able to:
- List the challenges of transitioning children from inpatient to outpatient palliative care
- Describe the options for transitioning IV to Oral therapy for children
- Name non-traditional pain and symptom management therapies
Improving Communication Using SBAR Daniel Cogan, VNSNY, Hospice, New York, NY Hospice and Palliative Care clinicians need strong communication skills in order to collaborate effectively with care providers and achieve good outcomes for our clients. Communication failures are implicated in 65% of sentinel events described by JCAHO and 90% when root cause analysis is performed. SBR is currently regarded as the gold standard in interdisciplinary communication.
Purpose: At the close of the session learners will be able to:
- Discuss the need for a structured communication process
- Define SBAR
- Describe how improving communication will support achieving hospice and palliative care outcomes
- Describe ways in which SBAR technique may be used in daily practice
Medicaid Audits, Part II Scott Peeler, Arent Fox, James Sheehan, Office of the Medicaid Inspector General Heath care attorneys predict that preparing for heightened Medicaid compliance required by the Deficit Reduction Act of 2005 will be one of the top challenges for health care providers.
Purpose: At the close of the session learners will be able to:
- Describe steps to take if your program is investigated
- Describe 2 key parts of the Medicaid Work Plan
Death and Dying Among Patients with Serious Mental Illness Andrew Coats, MD, Lisa Norelli.ana Tanavde, MD, Capital District Psychiatric Center, Albany, NY Death and dying among patients with serious mental illness raises special challenges, including questions of patient rights, patient autonomy, decision-making capacity, medical paternalism and disparities o care.
Purpose: At the close of the session learners will be able to:
- Describe how serious mental illness can impact a patient's view of end of life issues
- Describe the special challenges of a palliative care team and what the team can offer the family of the dying patient with serious mental illness
- Describe the general issues dealing with capacity and the dying patient with serious mental illness

CONCURRENT #C

Thursday, May 28, 4:00 - 5:00 pm

Regional Collaboration: Meeting the QAPI Challenge Jan Miller, Melissa Radovanovic, Catskill Area Hospice and Palliative Care, Oneonta, NY In 1996, the Institute for Healthcare Improvement (IHI) recognized that the end of life field might be ripe for substantial quality improvement using a collaborative approach. This statement caries even more weight today as hospices implement the new Medicare Quality Assessment and Performance Improvement QAPI) standard. Not all hospices are alike and will have varying degrees of experience with QAPI. The creation of regional collaborations will help all hospices achieve improved quality of care and services.
Purpose: At the close of the session learners will be able to:
- Design a framework for a collaborative partnership
- Identify two data collections tools for collaboration
- Describe three benefits from collaboration
Pain Management in the Cancer Patient with a History of Substance Abuse Robbie Altman, Alice Beal, MD, VA NY Harbor Healthcare System, Brooklyn, NY The patient with pain and a history of substance abuse presents a unique problem for hospice and palliative care practitioners. The pain is often much more complicated than usual physical cancer pain and requires a coordinated approach. The patients are often skilled at manipulating the treatment team
Purpose: At the close of the session learners will be able to:
- Describe the growing need of providing pain management to patients who have a history of substance abuse
- Describe barriers to good pain management in those patients with a history of substance abuse
- Describe treatment recommendations for those patients with a history of substance abuse and cancer pain
Understanding the Patient Centered Medical Home (PCMH) in Relationship to Hospice John Gillespie, MD, Independent health, Buffalo, NY The crisis in primary care includes a decreasing number of primary care physicians and an increasing dissatisfaction with the primary care being received by patients. People, payers and physicians are looking for ways to improve care, improve vale and transform performance. The Patient Centered Medical Home offers a model to all three audiences that can actively be tested and refined.
Purpose: At the close of the session learners will be able to:
- Describe a Patient Centered Medical Home
- Describe how a Patient Centered Medical Home can offer hospice care
- Describe the effect of PCMH on Hospice /Palliative Care
Building a Hospital-Based Palliative Care Program and Hospice Partnership Eileen Roberto, Michol Negron and Mary O'Halloran Feeley, Good Samaritan Hospital Medical Center The growth of hospital based palliative care programs brings with it the need for collaboration with hospice to plan for a continuum of care for patients at the end of life. This workshop will provide participants information and skills to overcome barriers, identify unique cultural differences and successfully partner with hospitals to provide a discharge plan that is consistent with the patient and family's goals of care.
Purpose: At the close of the session learners will be able to:
- Identify best practices used to establish and or implement collaboration with hospice when developing a community- hospital based palliative care program
- Identify best practices used to establish and or implement collaboration with hospice when developing a community- hospital based palliative care program
- Assess the impact of increased palliative care/ hospice collaboration
Sound Strategies for Providing Quality Hospice Volunteer Services to Contracted Nursing Homes Taryn Stery, Janeen Thompson, VNSNY Hospice Care, New York, NY The key to providing quality hospice volunteer services to patients in contracted long term care facilities is volunteer retention. Since 2006, volunteers at Visiting Nurse Service of New York Hospice Care have increased their total hours to long term care facilities by 205%. This session will provide you with sound strategies for training, retaining and supporting those special volunteers.
Purpose: At the close of the session learners will be able to:
- State strategies for recruiting a volunteer corps for longterm care
- Develop an on-site training for volunteers working with low-functioning patients
- Define ongoing strategies for retention and support of volunteers working in long-term facilities
Regulatory Update Judi Lund Person, NHPCO, Alexandria Virginia In December of 2008, the Centers for Medicaid and Medicare implemented new Medicare Conditions of Participation for Hospices. As of March 2009, CMS has issued on a draft version of interpretive guidelines for hospice surveyors.
Purpose: At the close of the session learners will be able to:
- Describe examples of data elements that must be included in the patient outcome measures
- Describe the standards of coordination of services and care planning
- Describe the standards for clinical records
- Describe the standards for drugs and biologicals
- Describe the standards for DME accreditation
- Describe the standards for contracts

CONCURRENT #D

Friday, May 29, 10:30 - 11:30 am

The Impact of the "Generation Mix" in Hospice and Palliative Care Carol Shenise, The Community Hospice, Albany, NY For the first time in history, four different generations are in the workforce at the same time. What does this men to you as an interdisciplinary team member or as a supervisor? Attend this session and delve into the styles of four different generations along with pointers for working with each style. Explore the impact this has on interdisciplinary group and patient/family interactions
Purpose: At the close of the session learners will be able to:
- Describe working styles of the "generation mix. Identify the "generation mix" of your team members and supervisors
- Outline strategies for successful collaborations with each generation member and supervisor to obtain the best patient/family care outcomes
Compassion Fatigue- Who is at Risk? Robbie Altman, VA Harbor Health Care System, New York, NY Are you at risk for compassion fatigue? Find out what it is and how to prevent and combat it before it leads to burn out. Due to the high demands of caring for the dying patients and their families and frequent exposure to death, hospice care workers ate at increased risk of compassion fatigue. We must learn healthy ways of coping to maintain healthy lives.
Purpose: At the close of the session learners will be able to:
- Describe what compassion fatigue is and how it differs from burnout
- Describe symptoms of compassion fatigue and symptoms of burnout
- Describe strategies to avoid compassion fatigue
- Set 3 personal goals to improve or avoid compassion fatigue
Concrete Operational Performance Strategies Los Rudolph, Deborah Childs and Mary Keeney, The Center for Hospice and Palliative Care, Buffalo, NY Surveyors have documented the areas for the Top 10 deficiencies on survey and certification based on the original hospice regulations issued in 1998. The new Conditions of Participation have demonstrated a focus on four Conditions and corresponding Standards. Implementation of new processes is critical to demonstrate adherence to these new regulations. Quality of patient care with demonstration of improved outcomes of care is a critical component that will be evaluated during the survey process. Learning how to implement new processes as well as monitoring for compliance will be addressed to provide a framework for improved survey outcomes related to the new Conditions of Participation.
Purpose: At the close of the session learners will be able to:
- Describe 2 different processes for implementation of COP Standards
- Describe 2 quality monitors to assure compliance of standards
Managing Anxiety, Agitation and Delirium in Hospice Care Jill Astolfi, Hospice Pharmacia, Philadelphia, PA Anxiety Agitation and Delirium, while quite common symptom in patients at end of life are extremely distressing to both patient and family. The intent of this program is to provide the target audience with an overview of the typical clinical presentation of anxiety, agitation and delirium in the hospice setting and to discuss the various treatment options that are currently available to effectively treat and appropriately manage symptoms.
Purpose: At the close of the session learners will be able to:
- Describe the clinical presentation and symptomatology of anxiety, agitation and delirium
- Differentiate between the experiences of agitation, anxiety and delirium
- Discuss current pharmacotherapeutic treatment options for the management of anxiety, agitation and delirium
How to Approach VTE (venous thombo embolism) in Hospice Patients Pamela Horst, Hospice of Central New York, Syracuse, NY Patients with cancer have an increased risk of venous thromboelbolism (VTE). The risk increases as the cancer progresses. Additionally, we do not know precisely the incidence of VTE in chronically bedridden patients, but studies show a somewhat elevated risk.
Purpose: At the close of the session learners will be able to:
- Describe the benefits and burdens of treatment for VTE in cancer patients in hospice
- Select an appropriate anticoagulant
- Review use of anticoagulant in non- cancer patients in hospice
The Family "Care Bundle": A Structure for Interdisciplinary Team Communication with Families about Goals of Care Daniel Coletti and Danielle Rieber, St. Maty's Hospital for Children, New York, NY The process of formulating and communicating goals of care in a long-term pediatric inpatient setting is dynamic and requires ongoing negotiation between providers, families and children. Communication is the foundation for therapeutic relationship. Effective health care communication is an essential tool for improved outcomes. The "Care Bundle" concept- combining necessary elements in sequence to improve and promote patient safety- was adapted to disseminate best practices for communication between the family and the interdisciplinary team.
Purpose: At the close of the session learners will be able to:
- Describe the challenges of interdisciplinary communication with families about goals of care
- Describe the components of the Family Care Bundle
- State results from using the Family Care Bundle and how it has improved program initiatives

CONCURRENT #E

Friday, May 29, 1:30 - 3:00 pm