Nebraska Hospice Veterans Partnership

Nebraska Hospice Veterans Partnership

Sub-Committee Coordination of Care

Annual Report

October 23, 2009

Members:

Cynthia Longstreet - VA, Omaha, Colleen Nielsen - VA, Lincoln; Annette Kasselman, RN - Methodist Hospice Omaha; Brenda Knutson –Eastern Nebraska Veteran's Home; Diane Randolph - Methodist Hospice Omaha; Theresa Wood – St. Francis Hospice Grand Island

Objective: To facilitate a smooth transition for veterans to use hospice care as appropriate.

Goals:

• To review and update the VA 101: What community hospices need to know and distribute to community hospices;
• To educate health care providers in the VA Nebraska Western Iowa Health Care System and Nebraska State Veteran Homes, on the Nebraska Hospice Veteran Partnership goals and information on those participating in the partnership;
• To assess for opportunities that would encourage effective communication between hospice providers and the VA and veterans’ homes.

Accomplishments:

• A new survey was presented at the Annual conference booth in April.
• This survey had a better response than last year (only 11 were returned)

We received 90 this year. We have some positive feedback and some

negative issues that we are trying to resolve.

• The survey alerted us to the fact it was a bit challenging to view the VA-101 on the Nebraska Hospice Partnership website, thanks to Tracy for making the suggestions to the site …now the VA-101 form is more assessable… just 2 clicks away.
• In the process of updating the VA-101, Last revision was 2/08 (Due to retirements and other staff detailed to other area.)
• By participating in this subcommittee, members have been able to keep the lines of communication open with community hospice agencies and community health staff in Lincoln, Grand Island and Omaha.

Our next meeting is pending for December. If you are interested in joining please contact the chair, Cynthia Longstreet@ via email.

NHVP

COORDINATION OF CARE SUB-COMMITTEE

HOSPICE SURVEY UPDATES

APRIL 2009

Number of surveys completed was 90.

1. Have you worked with the VA? 67YES 23 NO

2. If so what site:

Grand Island (GI)29Holdrege 1

Lincoln (LIN) 24Norfolk 3

Omaha(OMA)24North Platt1

Other8

3. Have you worked with any of the Nebraska State Veterans Homes?25 YES65 NO

4. If so what site?

Grand Island (GIVH)20East Nebraska Vet2

Norfolk2Scotts Bluff1

5. If you receive a hospice referral for a veteran, do you know who to call to check VA enrollment and eligibility? *

41 YES49 NO Re-educate on VA -101

6. Do you know who to call for orders?Dr's names are always listed on referral consult

40 YES50 NO

7. Do you know where to mail or fax orders? New process was implemented where to send faxes in Omaha

33 YES44 NO

8. Are you getting your orders and plans of care back in a timely manner? Process refined until recent staff changes

21- 1 Week;7 – 2 Weeks,12 - Longer

9. What challenges or barriers are you facing? These are all the comments made. Some have identified what VA site they work with others did not.

Almost all veterans in nursing facilities have another primary Dr. as VA doesn’t respond to patient needs timely/on patients at HOME still can be very difficult. (GI/LIN/OMA)

I have a good relationship with the GIVH and enjoy all of our hospice patient there. (GIVH)

Response depends on who/which RN/MD are working. Nursing response is very good; physician services, response to veteran patient needs could (should) be improved! To better serve the veteran. (LIN/GI)

I need more knowledge and information. *

There is an excess amount of time to get orders/faxes back sometimes months of requesting. (OMA) New process was implemented where to send faxes in Omaha

Orders is only one day return by fax. ???

The phone system is a bit of a challenge just to try to communicate with them. A positive note is that GIVA is great about sending every supply that we request for our patients. (GI)

Our case manager handles the orders and care plans and I have what I need in a timely manner. (GI/LIN)

Social Worker handles the orders and care plans. (Westpoint)

My challenge is getting a hold of an MD. (OMA) *

Orders and plans of care take too long – no consistent fax number to send to. (GI/LIN) *

Orders and plans of care come back very late and there is no consistency! (LIN)

Returned orders and plans of care take weeks to return! (OMA) New process ongoing

Our community’s VA patients are not identified. The last one was 4 years ago. Typically they are referred to the physician in the community. Then we receive the referral too late and the patient is usually gone in 1-2 days. (OMA) not enrolled?

We find it difficult locating patients. (GI)???

We have to deal with numerous provider changes for our patients with no good follow through. (OMA) Teaching facility

Our challenge is getting the right person on the phone to answer basic questions or even having people answer the phone at all. (OMA)

Good Hospice Benefit and good to work with! (Hot Springs, So. Dakota VA)

No services available for referral/new admission orders on a weekend. Patient needed symptom management. Family upset. Very poor! (Omaha/Des Moines) * /use hospice medical director

Getting orders back within 24 hours is a problem. We had a patient who had to go to the VA in Omaha as he fell and broke his arm. He could not go to a hospital in Lincoln for treatment. Had a patient who had a CT in Omaha and died before he got his results, 3 weeks later.(LIN & OMA) New process ongoing

We want more vets in our hospice program.

We have not utilized hospice benefits through the VA. Utilize local hospice agencies to provide Hospice cares to our veterans. Know contacts – system seems to be working well.

Challenges include nursing home understand of hospice benefit – supplies/equipment included and expecting everything on every member versus individualized care plan and following terminal diagnosis.

Call back time for order request for medication changes phone system awful – antiquated! Pharmacy system difficult to use and staff is rude and unpleasant.

Difficult to get the MD you need to talk to. (LIN) *

Slow response time with requests and orders. Medical director usually ends up following the patient as response times are too slow. Phone system is terrible! (GI, LIN, OMA & GIVH)

Medical director @ Vets Home/GI is biased and forces her preferences on VH staff and outside agencies. She is extremely difficult to work with and has unrealistic expectations. (GIVH)

We continue to work on communication. (GI)

Patients are hesitant to disclose financial information to apply for VA benefits. (LIN)

We know the names to contact in Sioux Falls SD and get prompt response. In Omaha we don’t know who to contact and don’t get prompt response. (OMA) *

Medical director will not refer to certain hospice entity. (GIVH)

Initial VA doc has transferred care to local attending as patient is in local nursing home. (GI)

Timely communication is a barrier. (LIN/OMA) *

Communication is difficult especially on weekends. (LIN/OMA) *

We have been attempting to apply for a VA contract for Nursing Home Care but have met some challenges. We have so many veterans that could use our services and then in turn this could bring in more hospice residents. (McCook, NE)

VA doctor no longer wanted to manage patient and made referral, then when contacted about orders – doctor wanted hospice medical director to manage patient. (GI/HOLDREGE)

Knowing a contact person for hospice/we have a great contact for homehealth! (GI/LIN/OMA) *

*VA -101