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Hospice News Nebraska, June 15, 2017
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June 20 (Tues) - Volunteer Coordinators Networking Conference Call.

June 22 (Thurs) - Chaplains Networking Conference Call

Nebraska News


The summer edition of the We Honor Veterans newsletter is available. In this issue:

  • Cornerstone Hospice and Palliative Care Creates First Virtual Flight to Honor; 
  • Veteran-to-Veteran Volunteer Program; and
  • We Honor Veterans Partner Resources.

Contact NHPCA Board Member to Receive Nomination Form

Through in-person and virtual gatherings, book discussions, and connections with state and national leaders, Nebraska Health Care LEAD (Lead, Excel, Advance, Develop) Program equips professionals to positively shape the future of health care in Nebraska; benefit their local communities; benefit employers through succession planning, operations improvement, and public relations; and work toward personal growth.

Through a nomination process, the Nebraska Hospice and Palliative Care Association will have one member participate in the 2017-2018 Nebraska Health Care LEAD Program. The nominee can be employed in any position by any NHPCA provider member organization. Nominees must have all applicable licenses in good standing and pledge to attend NHPCA’s 2018 Convention in Lincoln.

Class II Connections

  • Sept. 20, 2017 – Orientation lunch, Pinnacle Bank Arena, Lincoln (in conjunction with Sept. 18-21 Nebraska Nursing Facility Association/Nebraska Assisted Living Association Fall Convention)
  • Oct. 26-27, 2017 – Kickoff Retreat, Lincoln
  • Jan. 9, 2018 – Video conference
  • Date TBD, 2018 – Legislative Day, Lincoln
  • April 23-26, 2018 (exact date TBD) – Lunch at Nebraska Nursing Facility Association/Nebraska Assisted Living Association Spring Convention, Younes Conference Center, Kearney
  • May 31, 2018 – Summer Retreat, Lincoln
  • Sept. 17-20, 2018 (exact date TBD) – Special recognition, Pinnacle Bank Arena, Lincoln (as part of Nebraska Nursing Facility Association/Nebraska Assisted Living Association Fall Convention)

Thanks to generous sponsors, the participant will only pay for his or her mileage. All other expenses are covered.

If you would like to be considered for participation, contact a NHPCA Board Member to obtain a nomination form which, along with all required supporting items, must be submitted to Nebraska Health Care Association by June 23, 2017.

NHPCA Board of Directors
Gary George
Beth Nelsen
Marcia Cederdahl
Mandy Miller
Joanie Kush
Paul Jensen
Diane Randolph
Tim Snyder
Lisa Weber


ASPR TRACIE is a Centers for Medicare and Medicaid Services resource for Emergency Preparedness. It provides timely and useful resources, from exercise templates and tips on how to retain and care for staff after a disaster, to understanding the new CMS Emergency Preparedness (EP) Rule. ASPR TRACIE also provides a monthly newsletter, The Express. The June 2017 issue of The Express includes information on upcoming webinars, and updates and information on the CMS EP Rule and ASPR TRACIE domains.


NHPCA 2017-7 - Hospice Provider Preview Reports Now Available
The Centers for Medicare and Medicaid Services released the Hospice Provider Preview Reports on June 1, 2017. NHPCA encourages you to download and review the reports as this information will be used when the Hospice Compare website is publicly released later this summer. This special bulletin also includes an email CMS sent in regard to the Hospice Provider Preview Reports.

NHPCA 2017-8 - CMS Releases Workaround for Hospices Submitting Routine Home Care and Service Intensity Add-On Payments
The Centers for Medicare and Medicaid Services released Special Edition article 17014 to correct two Medicare hospice payment errors that could result in overpayments. It also provides hospices with a workaround to deploy when submitting certain claims to ensure proper payment.

Hospice and End-of-Life Notes

* The Centers for Medicare and Medicaid Services has issued a “Hospice Quality Public Reporting” statement alerting providers that Hospice Compare is coming soon. Hospices are encouraged to review their reports. Hospice Compare will be available to hospices 30 days before going public. A full review and suggestions for action are online. (CMS)

* The Centers for Medicare and Medicaid Services has issued “Required Workaround for Hospices Submitting Routine Home Care (RHC) and Service Intensity Add-On (SIA) Payments at the End of Life.” The document is “intended for hospices that submit claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.” The document calls for hospice providers to “submit adjustments to claims with outstanding SIA and RHC payment errors, except for those where the prior benefit days are greater than 99.” (CMS)

* Advance care planning is key to patient-centered outcomes at the end-of-life. So how do we keep the planning progress from getting bogged down in legalese? “Legal formalities impose barriers to creating advance directives. Eliminating legal requirements would allow such documents to be more easily integrated into health care systems and would increase the likelihood of their being used to achieve their intended goals.” (NEJM)

* Many physicians are not trained to notify family members of the death of a loved one, and there is no standardized process for informing others about a death. Research published in the Journal of Palliative Medicine finds “poor communication skills during death notification may contribute to complicated grief for surviving relatives and stress among physicians.” (JPM)

* Many clergy members may be making the end of life more difficult for those they serve. “Two new studies find that many clergy are both ill-prepared and reluctant to fully engage in end-of-life conversations with terminally ill congregation members and their families. The result, both studies suggest, is that more believers may be spending their final days enduring painful treatments with little chance of success in intensive care units rather than receiving comfort care at home.” (Huffington Post)

* Do you have an “A-Team” of end-of-life allies? An article from Kaiser Health News explains how seniors are gathering supporters to serve as encouragers and health care proxies at the end of life. (KHN)

* A Jewish rabbi in New York State is taking the initiative in talking about the end of life. Rabbi, Julie Danan, of Pleasantville Community Synagogue introduced the three-part “Death and Dessert: A Community Conversation on End-of-Life Issues” to her congregation and the wider community. Topics covered included an exploration of end-of-life choices, concepts of the soul’s afterlife in Jewish thought, and Jewish funerals. (New York Jewish Week)

* Intensive care physician Jessica Zitter gives advice on how to “soothe the senses” of a dying loved one. “What might your loved one want to see? Perhaps a fresh vase of flowers, or photos of loved ones. Maybe a piece of art from home. The aroma of a baking banana bread. Would her glasses be helpful, and do they need polishing? Would she like the window shades open or closed?” (Washington Post)

* The quality of end-of-life care people receive after a stroke varies widely, according to new research published in Neurology: Clinical Practice. “Early use of a palliative approach by individual hospitals ranged widely, from less than one percent of people with stroke to 38 percent, and rates among those with intracerebral hemorrhage reached 76 percent at some hospitals. Early palliative care was more likely to be initiated in rural than in urban hospitals, in hospitals in the Midwest, South, and West regions versus those in the Northeast, and in smaller hospitals.” (Medpage Today)

* Dying at home is what many Americans would prefer. But is it really the best for everyone? Ann Brenoff of the Huffington Post argues that home-based end-of-life care is primarily focused on saving money, even at the expense of caregivers and family members, who she says bear the brunt of this style of care. (Huffington Post)

* Are you caring for a loved one? Make sure that you take care of yourself, too. An article from Kaiser Health News provides suggestions and resources for caregivers who need support. “Caregiving is hard, it may get harder, and it often leads to emotional, physical, and financial hardship.” (KHN)

* Death is often imagined to be a miserable experience, but findings published in Psychological Science suggest the dying express largely positive emotions. “In our imagination, dying is lonely and meaningless, but the final blog posts of terminally ill patients and the last words of death row inmates are filled with love, social connection, and meaning.” (MedicalXpress)

* Choosing a health care proxy is important. An article from Next Avenue urges readers to choose a proxy, and gives some tips on how to choose one. “It’s best for patients and their physicians to understand under what conditions a person wants to be resuscitated, be intubated, or receive comfort care only.” (Next Avenue)

* Legacy therapists are helping dying patients share their stories with their families. Therapists listen to patients, ask questions, and draw out the parts of their story that have to do with meaning and purpose and relationships so they can leave the legacy they want.” (Sacramento Bee)

* A photojournalist, and daughter of two dying parents, captures beautifully the last days of her parents, as they battled cancer side-by-side. “By confronting what I feared most, using my camera as my shield,” says Nancy Borowick, “I was able to move past the trauma that I anticipated and truly enjoy the time we had left together.” (NPR)

* How does hospice really work? Alia Hoyt offers some helpful information about what hospice care is – and isn’t. She clarifies common misconceptions about hospice, such as the idea that hospice is primarily for cancer patients. (How Stuff Works)

* When a family member dies at home, caregivers end up as the walking wounded. “While they’re paying their loved ones’ extraneous expenses—and often essential ones as well—they’re depleting their own savings. ... And during this time, even for a relative on hospice care, they seldom receive enough support from an outside source to relieve the burdens they carry. And while some hospice organizations may do an excellent job of supporting the family, others do not. The relative is left to carry the burden alone, sometimes at a terrible emotional cost.” (Benefits Pro)

* Alzheimer’s cases in the U.S. are predicted to triple by 2050. There’s never been a greater need for providing support to caregivers. “ ... While eight in 10 caregivers agreed that it ideally ‘takes a village’ to care for someone with Alzheimer's or dementia, more than 80 percent said they had insufficient help from other family members. Almost two-thirds of caregivers said they felt isolated or alone, and roughly half said they had no one with whom to discuss their hardships.” (HealthDay, Home Health Care News)

* “Death doulas” are helping spread conversations about end-of-life wishes. “Around 200 to 300 people apply every year to join the Doula Program as volunteers,” says Amy Levine, executive director of the Doula Program to Accompany and Comfort. “Only about a dozen are admitted every application cycle.” Janie Rakow, president of the nonprofit International End of Life Doula Association, says being a doula is “profound work.” (Huffington Post)

Palliative Care Notes

* As the U.S. population ages, some doctors see a role for palliative care in the ER. This influx of elderly patients “is prompting more clinicians to rethink what happens in the fast-paced emergency room, where the default is to do everything possible to extend life. Hospitals across the country, including in Ohio, Texas, Virginia, and New Jersey, are bringing palliative care, which focuses on improving quality of life for patients with advanced illness, into the emergency department.” Still, there is little hard evidence that palliative care improves health outcomes. (PBS NewsHour)

* The National Hospice and Palliative Care Organization released a new installment in its Palliative Care Resource Series. “Sibling Grief” explores the particular experience of losing a sibling. “Sibling relationships are like no other. There is a commonality that does not often exist in other relationships. When a sibling dies, the loss can be overpowering.” (NHPCO)

* The number of palliative care apps targeting physicians has grown dramatically in the last five years. In 2012, there were only six such apps. Today, there are at least 46. However, many of these apps do not report enough information for clinicians to judge the evidence upon which the apps are based. (JPM)

* Palliative care treatment helps patients with incurable cancer to cope. “Early integrated palliative care for patients with newly diagnosed incurable cancer increase their use of active coping strategies that lead to improvements in quality of life and depression, investigators from Harvard Medical School and Massachusetts General Hospital in Boston reported at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting.” (Oncology Nurse Advisor)

* Palliative care is “a pathway to value-based care for nursing homes,” says Diane E. Meier, MD. “Nursing homes that integrate palliative care can build a track record of high-quality care and low rates of readmission and emergency department use that will position them for success as reliable partners to the clinicians and the hospitals in the community.” (McKnight’s)

* A documentary on pain and the role of opioids has aired on many public television stations. But the doctor behind it has “significant financial ties to the manufacturers of opioid medications—a fact not disclosed in the program.” The documentary, “The Painful Truth,” “chronicles the plight of several patients struggling to find effective treatment for chronic pain. Throughout the 57-minute-long program, politicians, federal agencies, and others are depicted as having overreacted to the epidemic of opioid-related overdoses; the documentary suggests pain specialists have been discouraged from prescribing opioids to patients who genuinely need them.” (STAT)

Other Notes


As the U.S. population ages in coming decades, cancer is projected to become the most frequent cause of death. Yet many cancer patients are not currently being educated about their end-of-life options. Research published in the Journal of Palliative Medicine reveals this lack of hospice coverage for these patients with advanced cancer might stem in some degree to a lack of awareness and education around hospice and end-of-life care issues among these who need it most. Read More


Dr. Jason Chertoff responds to an article on POLST in Oregon, referring to the white population of Oregon (87.6 percent) and Washington (80.3 percent). In the rest of the nation, he says the white population is 77.1 percent. Whites generally accept end-of-life care more than non-whites, says Chertoff. Blacks and other minority groups, he argues, are more likely at the end of their lives to use intensive care and life-sustaining treatment and to die in the hospital, and are less likely to receive comfort-directed care. Because of this, Chertoff questions if the Oregon experience “can be extrapolated to the rest of the United States.” Read More


The U.S. health care system is not providing the care seriously ill patients need and want, say authors of an article in Healthcare Affairs. While most Americans say they would prefer to die at home, more than two-thirds die in institutionalized medical settings. Because the medical experience of the vast majority of seriously ill patients is overseen by Medicare, authors Janet Corrigan, Josh Rising, and Tom Valuck argue the new federal administration has a unique opportunity to shape care and end-of-life experience for millions of Americans. Read More


Expensive cancer treatments are growing by leaps and bounds. Some individuals have more options for treatment than ever before. Yet many patients “are largely kept in the dark because their doctors either can’t or won’t communicate clearly.” At the same time, many patients join the conspiracy to keep themselves in the dark by avoiding what they don’t want to hear. Read More

Thanks to Barb Hansen, Brenda Clarkson, and Katherine Lally for contributions.

Hospice Analytics is the national sponsor of Hospice News Network for 2017. Hospice Analytics is an information-sharing research organization whose mission is to improve hospice utilization and access to quality end-of- life care. For additional information, please call Dr. Cordt Kassner, CEO, at 719-209- 1237 or see

Hospice News Network is published 45-47 times a year.  Copyright, 2017.  All rights reserved to HNN subscribers, who may distribute HNN, in whole or part, to provider members of the subscribers’ state organizations.  If readers need further information, they should consult the original source or call their state association office.  HNN exists to provide summaries of local, state and national news coverage of issues that are of interest to hospice leaders.  HNN disclaims all liability for validity of the information.  The information in HNN is compiled from numerous sources and people who access information from HNN should also research original sources.  The information in HNN is not exhaustive and HNN makes no warranty as to the reliability, accuracy, timeliness, usefulness or completeness of the information.  HNN does not and cannot research the communications and materials shared and is not responsible for the content.  If any reader feels that the original source is not accurate, HNN welcomes letters to the editor that may be shared with HNN readers. The views and opinions expressed by HNN articles and notes are not intended to and do not necessarily reflect views and opinions of HNN, the editor, or contributors.  Only subscribing state hospice organizations have rights to distribute HNN and all subscribers understand and agree to the terms stated here.