Welcome to  Bluegrass Care Navigators - PowerPoint Presentation

Slide1

Welcome to 

Bluegrass Care Navigators

Volunteer Training

2020

Slide2

Overview

The History of Hospice

Understanding Hospice ServicesThe Plan of Care The Interdisciplinary TeamBluegrass Care Navigators: Service LinesThe Hospice Patient

Universal Precautions

Grief & Bereavement

Communication & Boundaries

HIPAA

Advance Planning

Volunteering for Hospice

Slide3

Hospice Means More Moments

If clicking on the above picture does not open video,

click here.

Slide4

What is hospice?

Hospice is for the terminally ill and focuses on quality of life when quantity is limited.

Hospice provides interdisciplinary, evidence-based medical care to control symptoms and pain including emotional and spiritual support to patients and those who love them.

Hospice should be considered when curative therapies are

no

longer

possible or fail to add to the patient’s quality of life.

Slide5

Mission Statement

Our mission is providing patient-centered care to the seriously ill and their families with excellence and compassion; engaging in community partnerships, education and counseling; offering opportunities to staff, volunteers and donors to enrich lives through their gifts.

Slide6

Our Vision and Core Values

OUR VISION

Be the leader in delivering comforting care at the right time to the seriously ill. 

OUR CORE VALUES

Compassion

Excellence

Teamwork

Respect & Dignity

Diversity

Integrity

Innovation

Sustainability

Slide7

Yesterday & Today

Started in 1978 as Community Hospice of Lexington

Today we have six offices serving 32 counties: Barbourville (Bell, Clay, Harlan, Knox, Laurel & Whitley Counties)

Cynthiana

(Bourbon, Grant, Harrison, Nicholas and Scott Counties)

Frankfort

(Anderson, Franklin, Owen & Woodford Counties)

Hazard

(Breathitt, Floyd, Knott, Leslie, Letcher, Magoffin, Morgan, Perry, Pike & Wolfe Counties) Care Center

Lexington

(Fayette & Jessamine Counties)

Care Centers

(Lexington: St. Joe and UK)

Northern

Kentucky

(Boone, Campbell, Carroll, Gallatin, Grant & Kenton Counties)

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Slide9

The History of Hospice

Slide10

Dame Cicely Saunders

Founder of Modern Hospice Movement

Saunders trained as a nurse, a medical social worker and finally as a physician. Involved with the care of patients with terminal illness since1948, she lectured widely on this subject, wrote many articles and contributed to numerous books.

Saunders founded St Christopher's Hospice in 1967 as the first hospice linking expert pain and symptom control, compassionate care, teaching and clinical research. St Christopher's has been a pioneer in the field of palliative medicine, which is now established worldwide.

Dame Cicely Saunders died July 14, 2005.

Slide11

Hospice Philosophy

Death is a normal life process

Hospice neither hastens nor postpones deathEveryone deserves symptom management and supportive careHospice offers a interdisciplinary approach to carePatient should be autonomous in decision making concerning their care

Hospice care is provided under the direction of a physician

Focuses on quality of life (care and comfort, not a cure)

Slide12

Hospice Eligibility

Two physicians certify that patient is terminal with a prognosis of six months or less

Palliative care elected over curative treatmentPatients of any age or illness are eligible as long as the aforementioned criteria is met

Slide13

How is Hospice Care Paid For?

Medicare

MedicaidPrivate InsuranceNo one is ever denied services because of an inability to pay thanks to the support of our generous donors.

Slide14

Top Referral Sources

Hospitals (45%)

Physicians (23%)Family (18%)Nursing Facilities (7%)Home Health (5%)Other (2%)

Slide15

Where is Hospice Care Provided?

Home

Long Term Care FacilitiesAssisted Living CentersInpatient Units

Hospice Care Center (Lexington)

UK

Greg & Noreen Wells Hospice Care Center (Hazard)

Hospital

Veteran Centers

Wherever the patient resides

Slide16

Understanding Hospice Services

Services are available around the clock

People Services: Interdisciplinary Team

Pharmacy Services: Medications related to the primary diagnosis

Durable Medical Equipment (DME): hospital bed, shower bench, etc.

Other Medical Supplies

Slide17

The Hospice Patient’s Bill of Rights

A few of the items covered include:

Right to information on medical conditionRight to be treated with care and competenceRight to be have privacy respectedRight to emotional and pastoral services

Right to die in peace and with dignity

A complete copy of the Hospice Patient’s Bill of Rights is in your handbook.

Slide18

The Hospice Plan of Care

Hospice care is driven by the needs and goals of the patient and family.

Volunteers are a part of the plan of care

Slide19

The Interdisciplinary Team

Slide20

The Role of the Hospice Physician

Experts in pain and symptom management

Participates in interdisciplinary team meetingsCertifies and recertifies terminal illnessWrites prescriptionsVisit patients with pain and symptom management issues

Slide21

The Role of the Hospice Nurse

Ongoing medical/physical assessments

Management of symptomsEducation for patients and caregiversOversight of the CNADocumentationPronouncing death

Slide22

The Role of the Hospice

Certified Nursing Assistant

Provide personal careSimple wound careTransfersRepositioning

Light meal preparation

Education to patients and caregivers

Report changes in condition to team

Slide23

The Role of the Hospice Social Worker

Completes a psychosocial assessment of the patient & family’s:

Knowledge about the disease

Identifies strengths and coping skills

Family dynamics

Literacy and communication barriers

Environmental safety

Assess for complicated grief

Culture and beliefs about death

Provides information on volunteer services for patient and family

Slide24

The Role of the Hospice Chaplain

Provide initial, and ongoing, spiritual assessment of patients and caregivers

Provide spiritual support to patients and caregivers

Connect patients and families with local clergy

Conduct funerals at the request of families

The role of the chaplain is different than ministry in a church:

A chaplain maintains the ability to respect and support the faith stance of the patient and family

A chaplain refrains from imposing own faith stance and belief

Slide25

The Role of the Hospice

Bereavement Counselor

Continues to follow the surviving family members for one year after the patient’s deathProvides free, individual bereavement counseling

Provides support groups to facilitate working through the grief process

These services are open to the community as well, at no cost

Slide26

Bluegrass Care Navigators

Programs & Departments

Slide27

Bluegrass Extra Care

Private pay

Personalized service for clients in their home, nursing or assisted living facility. Services can include homemaker, certified nursing assistants, sitters and skilled nursing.Extra care is provided on a fee for service, hourly basis. Patients assume responsibility for the cost of the care.

Slide28

Bluegrass Transitional Care

Provided by the hospital or insurance company at no charge to the consumer.

Staffed by nurses with special training to assist patients after a hospital stay. Our goal is to help patients understand and improve their health.

Slide29

Bluegrass Palliative Care

Palliative care focuses on providing relief from the symptoms and stress of a serious illness.

The goal is to improve the quality of life for patients and families. Specialized expert medical care Physicians Nurse practitioners Social workers

Counselors

Chaplains

Slide30

Palliative vs. Curative Treatment

Palliative care

is a comprehensive approach to treating serious illness that focuses on the physical, psychological and spiritual needs of the patient. Its goal is quality of life for the patient by pain and symptom management.

Hospice care is a type of palliative care

.

Slide31

Bluegrass Grief Care

Provide grief care to anyone in the community who has experienced the loss of a loved one.

Support groups Short-term individual counseling are available to people of all ages.Counselors can make home and school visits, when appropriate.

Slide32

Philanthropy

Bluegrass Care Navigators is a 501c3 organization

Philanthropy is an important part of non-profit’s financial stability;

provides resources, supplements shortfalls in budget, builds for the future

Donations are given by:

individuals, corporations, organizations, the community, hospice family members, friends, board members, volunteers and staff

Common types of donations:

memorial gifts; special events; direct mail responses; planned gifts

Slide33

Veterans Outreach

1 out of every 4 dying Americans is a Veteran

The vast majority will die outside of the VA systemBluegrass Care Navigators is committed to engaging Veterans about hospice and palliative care servicesWe utilize the military history checklist to better understand the needs of veterans at end of life

Bluegrass Hospice Care is proud to be recognized as a “We Honor Veterans” Level 4 Partner

Slide34

Bluegrass Adult Day Health Care

Adult Day Care Centers are designed to provide care and companionship for older adults who need assistance or supervision during the day. Programs offer respite to family members and caregivers, allowing them to go to work, handle personal business, or just relax while knowing their relative is well cared for and safe.

Medical Model as well as a social Model

Slide35

Adult Day Health Care Program Specifics

Hours are 8 am – 4pm, Monday – Friday

663 Teton Trail, Frankfort KYCost is $69/day with private pay, Medicaid and some long-term insurance policies acceptedStaff includes a Licensed Practical Nurse, Nursing Supervisor and Director

Transportation for participants will be provided through Bluegrass Ultra Transit and other contracted providers.

Slide36

Additional Training

If you are interested in additional training on our service lines please contact your Community Engagement Coordinator 

Trainings our offered throughout the year

In depth information on: Extra Care, Home Primary Care, Adult Day Health Care, Transitional Care, Palliative Care and Grief Care.

Slide37

The Hospice Patient

Slide38

The Most Common Diseases

of Hospice Patients

CancerDementia Heart Disease

Lung Disease

Any disease in its end stage

Slide39

Common Signs and Symptoms

of Hospice Patients

PainFatigueNausea/VomitingConstipationDeliriumShortness of BreathWeight Loss

Slide40

What is the Palliative Performance Scale (PPS)?

The Palliative Performance Scale (PPS)

is a useful tool for measuring the progressive decline of a patient.

It has five functional dimensions:

Ambulation

Activity level and evidence of disease

Self-care

Oral in-take

Level of consciousness

Slide41

Palliative Performance Scale (PPS)

Slide42

A Few Possible Signs and Symptoms

of Impending Death

Decreased need for food and fluids

Swallowing ability decreases

Sleeping More

Semi-responsive to unresponsive

Increased weakness and agitation

Changes in breathing patterns

Incontinence

Diminished desire for communication

Confusion

Slide43

11

th

Volunteer Training If you are interested in becoming an 11th Hour Volunteer please let your Community Engagement Coordinator know.  To be an 11th Hour Volunteer you must attend an extra 2-hour training Training includes in depth discussion with hospice nurse and chaplain about signs and symptoms of impending death

Slide44

Universal Precautions

Slide45

Infection Control Practices

Hand Hygiene:

wet hands and apply soap; rub all surfaces for 40-60 seconds; rinse hands and dry thoroughly. Use an alcohol-based hand sanitizer before entering and after leaving a patient’s home.Do not visit patients if you are feeling ill.Avoid taking any non-essential items into a patient’s residence (e.g. purse or bag) as they can serve as a fomite for infectious organisms.

Slide46

Protect Yourself

Universal Precautions

are methods of preventing infection by treating all human body fluids as if they were contaminated and using proper personal protective equipment whenever you come into contact with these fluids. Personal protective equipment (PPE) includes latex gloves, gowns, mouth pieces, resuscitation bags, face masks and foot protection.

**Universal Precaution education to volunteers is mandated by Medicare and state regulations; However, it is BCN’s goal NOT to put volunteers into any situation that could be potentially harmful to you or the patient.

Slide47

Understanding Abuse and Neglect

Slide48

Types of Abuse

Physical

: hitting or strikingSexual: unwanted sexual advances/contact, touching without permissionMental: taunting, making fun, intentionally trying to confuseVerbal

: yelling, castigation, derision

Slide49

Negligence and Exploitation

Negligence

- when a caregiver fails to supply patient with the necessary food, clothing, shelter, health care or supervision.Exploitation- when an individual uses a patient’s resources for monetary or personal benefit, profit or gain without the informed consent of the patient.If you

suspect

any form of abuse, negligence or exploitation immediately report to the team or the Community Engagement Coordinator.

Slide50

Negligence and Abuse

If you are interested in more training on Negligence and Abuse, please contact your Community Engagement Coordinator.

This training includes an in-depth discussion with Hospice Social Worker about elderly abuse and neglect. 

Slide51

Grief and Bereavement

Slide52

Grief Issues

Patient and family are coping with many losses and anticipated losses.

Possible Losses:Physical capacities

Inability to talk, walk, dress/care for self

Inability to drive

Inability to feed self

Loss of work, hobbies, home

Slide53

Types of Grief

Anticipatory Grief

– As the reality sinks in about the inevitable death of your loved one, you begin to experience an array of emotions, thoughts, doubts, and reactions which can be consuming, intrusive, overwhelming, and unfamiliar. Complicated Grief – poor support system, ineffective coping skills, past/current issues of abuse, alcohol/drug addictions, unemployment, mental and/or physical disabilities, unresolved conflict, fragile caretaker, multiple losses such as deaths of loved ones, divorce, loss of income, loss of home, role changes, needing to move, etc.

Slide54

Communication & Boundaries

Slide55

Communication Techniques

Create a safe, calm environment

Actively listen- you may uncover fears and anxieties as a volunteer that might not be shared with othersLet the patient set the paceBe aware that when the patient and family wants to end the conversation you should do so

Slide56

Active Listening

Observe body language and behavior of person to whom you are listening

Sometimes it is helpful to restate the words of the speaker Don’t argue or interruptAvoid barriers to active listening, distractions (e.g. cell phones)Maintain good eye contactPortray positive body language

Slide57

Boundaries

Due to the nature of the work of hospice, boundaries can sometimes become fuzzy.

Being aware of boundaries will help create a framework for your behavior as a hospice volunteer.If you feel no one can help a patient/family but you, then there are boundary issues.

Slide58

Types of Boundaries

Physical

PersonalSpiritualSexualConfidential

Role of Volunteer

* Volunteers and employees are not to give or receive gifts from patients or patient families.

Slide59

More Information on Boundaries

Physical Boundaries

:Respect a person’s physical space

Be sensitive to cultural differences

Personal Boundaries

:

Meet the patient where they are

Do not try to pry for information

Use good judgment when revealing personal information about yourself

Spiritual Boundaries:

Respect an individual’s spiritual beliefs

Be non-judgmental

Slide60

Understanding HIPAA and Confidentiality

Slide61

Overview

What is HIPAA?

HIPAA’s Privacy RuleHow does HIPAA impact volunteers? Penalties for violating HIPAA

Slide62

What is HIPAA?

HIPAA

is the Health Insurance Portability and Accountability Act, a federal law that protects the privacy of a patients personal and health information and provides guidelines for the electronic and physical security of person and health information.All

healthcare organizations (including all healthcare providers, health plans, public health authorities, healthcare clearinghouses, and self-ensured employers) must comply with HIPAA.

Slide63

HIPAA’s Privacy Rule

Establishes a minimum

Federal standard for safeguarding the privacy of individually identifiable health information. Punishes individuals and organizations who fail to keep patient information private.

Gives patients federal rights to gain access to their medical records and restrict who sees their health information.

Slide64

HIPAA Violation Penalties

HIPAA calls for severe civil and criminal penalties for non-compliance, including:

fines and/or imprisonment for disclosing private health information or obtaining private health information under false pretensesfines up to $250,000 and/or imprisonment up to 10 years for knowingly misusing individually identifiable health information

Slide65

How does HIPAA impact volunteers?

It is important that you always keep the identities of the patients you are working with confidential. Telling others the names, initials or identifying details about a patient is a HIPAA violation. 

You should never send information about a patient, including their name or initials through email, unless BOTH parties have secure email systems. Bluegrass Hospice Care email is secure, however, most personal/commercial emails sources (Gmail, Yahoo, etc.) are not secure. 

Patient information should 

NEVER

be sent via text message including name or initials. 

Slide66

How does HIPAA impact volunteers?

It is important that you properly dispose of all patient information once your assignment is complete.

Shred

Burn

Turn it back into the volunteer coordinator and/or

staff member at BCN

It is important that you keep all patient information out of sight of others.

Never leave patient information laying in the seat of your car.

Never leave patient information laying out around your home.

Slide67

Reporting a Violation

If you believe you have encountered a violation of the HIPAA Privacy Rule please inform the Community Engagement Coordinator

Volunteers are required to follow Bluegrass Hospice Care’s confidentiality procedures. Failure to do so will result in dismissal from the program.

Quality care involves protecting our patients’ privacy.

Slide68

Understanding Advance Care Planning

Slide69

Advance Directives

This is a general term for any document that gives instruction about your health care and/or appoints someone to make medical treatment decisions for you if you cannot make them for yourself (American Bar Association).

Slide70

Why is Planning Important?

Most of us will die with a chronic, life-threatening illness

80% will die with health care provided50% of people are not able to participate in decisions at end of lifeHealth professions will usually make decision to treat when no plan has been madeHow do people know what you want if you do not tell them?

Slide71

Why Should a Person have an Advance Directive?

Creates an environment of shared decision making among individuals, loved ones and health professionals

Allows your loved ones to respect your wishes, values, and right of self-determinationHelps your loved ones make difficult decisions

How will people know if you don’t tell them?

Slide72

Durable Power of Attorney for Health Care

A document in which you appoint someone else to make all medical treatment decisions for you if you cannot make them for yourself. The person you name is called your agent, proxy, representative, or surrogate. You can also include instructions for decision-making.

Slide73

Do Not Resuscitate Order (DNR)

A DNR is a request to not initiative cardiopulmonary resuscitation if your heart stops or you stop breathing

Decisions regarding a DNR can be indicated in a living willA DNR order is added into your medical chart by your doctor

Slide74

Conversation Project

If you are interested in learning more about advanced care planning such as living wills and power of attorney, please contact your Community Engagement Coordinator 

The Conversation Project is a team panel of hospice nurses, Physician, Social Workers and Funeral Home Directors.  The Conversation Project is offered annually. 

Slide75

The Role of the Hospice Volunteer

Slide76

Patient Care Volunteers

Companionship

Respite CareCare CallsBereavement CallsTransportation

11

th

Hour

Care Centers

Cooking

Bereavement Camps

Comfort Care through

Massage, music, & pet

Handyperson/Yardwork

Slide77

What Happens on a Volunteer Visit?

Reading to patients

Playing a game – checkers, cards, crossword puzzle, etc.Writing letters for patientListening to patient/familyPlaying music for patientPet Companionship

Providing simple comfort care:

Lotion on hands, brush hair, provide blanket/pillow,

etc

Slide78

Administrative Volunteers

Used in all departments

Office Support: Data entry, filing, receptionistMailingsWork in our Library

Advocacy

Community Outreach

Fundraising

Special Events

Health Fairs

Assist in Volunteer Trainings

Mentoring new volunteers

Slide79

Bereavement Volunteers

Assist Bereavement Department with services such as:

Bereavement CallsCamps for Grieving Children

Monthly Bereavement Mailings

Bereavement Bears, Scrapbooks, Memory Boxes/Keepsake Items

Slide80

Volunteer Bereavement Training

Extra 2 hour training if you would like to be a bereavement volunteer

In depth discussion with bereavement counselors about grief and loss

Slide81

Professional Volunteers

Massage Therapy*

Pet Therapy*Beauticians*Legal Services** Must provide proof of professional license and Liability Insurance annually

Slide82

Our Volunteer Program

More than 300 active volunteers in 32 counties

Volunteers annually provide almost 30,000 hours of service to our organization – a cost savings of almost $720,000Volunteers work in a variety of roles – patient care, bereavement, office duties, transportation, special events and much more!

Slide83

Volunteer Requirements

Volunteers must complete:

Volunteer Application

2- Step TB test (Provided at no cost to you)

Show proof of Flu Vaccination during flu season

Criminal Background Check Release

Acknowledge Policies: Sign Confidentiality Statement; Sexual Abuse & Sexual Harassment Policy, Code of Conduct

Volunteer Training

One-on-One Interview with Community Engagement Coordinator

Slide84

Volunteer Requirements

Volunteers must have:

Access to transportationSuffered no significant loss within the past 12 months (may be reviewed on a case-by-case basis)

Yearly Recommitment Form, Competency Survey, Satisfaction Survey and Evaluation Requirements, annual one-step TB skin test, and proof of flu vaccination

Slide85

Medicare Conditions of Participation (COPs)

The volunteers must be used in defined roles and under the supervision of a designated employee

Volunteer services provided to the patient/family must be in the hospice plan of care.Hospices are also permitted to use volunteers in administrative and non-direct patient care activities. (Non-Direct care services are not considered when calculating the level of activity. Ex: Fundraising, sewing)

Slide86

Medicare Conditions of Participation (COPs)

The hospice must document and demonstrate viable and ongoing efforts to

recruit and retain volunteersThe hospice must document the cost savings achieved through the use of volunteersVolunteer have same requirements as employees (Medicare views volunteers as “non-paid staff”)

Slide87

More About our Volunteers

Volunteers are a

mandated clinical component of hospice careVolunteers must provide day-to-day administrative and/or direct patient care services in an amount that, at a minimum, equals 5% of the total patient care hours of all paid hospice employees and contract staff

Volunteers are a part of the interdisciplinary team

Volunteers support Bluegrass Hospice Care’s patients, their families and our staff.

Slide88

Volunteer Rights

Right to receive recognition for services

Right to decline any assignmentRight to leave any situation where you may feel uncomfortable (notify the team)Right to submit feedback on the volunteer program

Slide89

Volunteer Responsibilities

Document all volunteer activities

Submit all volunteer hours to the Community Engagement Coordinator by the 7th of the month or soonerhttps://give.bgcarenav.org/volunteer-hours

Ask if you have questions about your assignment

Complete all Annual Volunteer Requirements such as Education Survey, Recommitment Form, TB Screening (for patient care volunteers), Volunteer Satisfaction Survey, etc.

Slide90

Volunteer Code of Conduct

Treat each person with full respect for human life, dignity and worth

Cooperate fully with interdisciplinary teamRespect the privacy of all persons and treat all patient information confidential

No volunteer shall use their service for personal advantage or material gain

Volunteer will seek advice, consultation as needed and keep open lines of communication with the interdisciplinary team

Make every effort to foster self-determination on the part of the patient and family

Slide91

General Guidelines for Volunteering

Be Yourself

Patient’s/Family’s interest/needs most importantBe prepared to listenBe prepared to provide the Gift of PresenceMaintain good boundaries and confidentiality

Reach out to Volunteer Coordinator when you have questions

Recognize your own limitations and times of “burn out”

Slide92

During a patient visit:

Wear your Bluegrass Hospice Care Volunteer nametag

Identify yourself as a Bluegrass Hospice Care VolunteerDress appropriately

Slide93

Limits of Care

Volunteers are prohibited from administering medications to patients

Volunteers will not provide medical advice/suggestions.Volunteers are prohibited from assisting patients with legal or financial paperwork.Volunteers should not engage in any activity that would be considered skilled nursing.See Limits of Care handout in your training manual.

Slide94

Volunteer Self-Care

Take care of your own needs before others

Learn to say no and limit your volunteer assignmentsRecognize your own limitationsAsk for support

Slide95

Reporting Requirements

Pain or any symptom the patient or Patient Caregiver expresses concern/questions (Report to team as soon as a patient says they are in pain)

In case of emergency, call the on-call 24/7 Bluegrass Hospice Care phone number ______________________

Slide96

If You Need to Cancel an Appointment

Volunteers

must speak with the Community Engagement Coordinator when needing to cancel a volunteer visit.

If it is

after regular business hours

(after 5pm, evenings, weekends) volunteers

must call both

the

on-call Nurse and the family/patient.

Slide97

Safety Awareness

We want our volunteers to be safe.

Please be aware of:Weather conditions

Fall Awareness/Prevention

Pets in patient’s homes

Personal Safety

Smoking with Oxygen in home

Slide98

Safety Awareness/Emergency Preparedness Plan

Additional Training on Safety Awareness is mandatory for all volunteers.

Training will be offered  annuallyThe Community Engagement Coordinator will review the Emergency Preparedness Plan Binder with you during your 1:1 interview.

Slide99

The Next Steps

Schedule a time to meet with the Community Engagement Coordinator for interview, and to review paperwork, availability and interests.

Read the Volunteer Training Manual and think through any questions you may have.Complete Self – Competency Complete and submit Volunteer Application and all other required documentation.

Schedule the first of your two- step TB Skin Test.

Slide100

Community Engagement Coordinator

@bgcarenav.org

Office:

Cell:

Follow Bluegrass Care Navigators:

@bgcarenav