Welcome to Bluegrass Care Navigators Volunteer Training 2020

Welcome to Bluegrass Care Navigators Volunteer Training 2020

Overview • The History of Hospice • Understanding Hospice Services • The Plan of Care • The Interdisciplinary Team • Bluegrass Care Navigators: Service Lines • The Hospice Patient • • • Universal Precautions Grief & Bereavement Communication & Boundaries HIPAA Advance Planning Volunteering for Hospice

Hospice Means More Moments • If clicking on the above picture does not open video, click here.

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.

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.

Our Vision and Core Values OUR CORE VALUES § Compassion § Excellence OUR VISION § Teamwork Be the leader in delivering comforting care at the right time § Respect & Dignity to the seriously ill. § Diversity § Integrity § Innovation § Sustainability

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)

The History of Hospice 1967 1974 1978 1982 1986 • Dame Cicely Saunders founds St. Christopher’s Hospice • First Hospice in US founded in New Haven, Connecticut • Hospice of the Bluegrass founded in Lexington, Ky. • Congress creates a provision for the Medicare Hospice Benefit • Medicare Hospice Benefit is made permanent by Congress and hospices are given a 10% increase in reimbursement rates. States are given the option of including hospice in their Medicaid programs. Hospice care is now available to terminally ill nursing home residents.

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 since 1948, 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.

Hospice Philosophy • • Death is a normal life process Hospice neither hastens nor postpones death Everyone deserves symptom management and supportive care Hospice offers a interdisciplinary approach to care Patient 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)

Hospice Eligibility • Two physicians certify that patient is terminal with a prognosis of six months or less • Palliative care elected over curative treatment • Patients of any age or illness are eligible as long as the aforementioned criteria is met

How is Hospice Care Paid For? • • Medicare Medicaid Private Insurance No one is ever denied services because of an inability to pay thanks to the support of our generous donors.

Top Referral Sources • • • Hospitals (45%) Physicians (23%) Family (18%) Nursing Facilities (7%) Home Health (5%) Other (2%)

Where is Hospice Care Provided? • • • Hospital Home • Veteran Centers Long Term Care Facilities • Wherever the patient resides Assisted Living Centers Inpatient Units o. Hospice Care Center (Lexington) o. UK o. Greg & Noreen Wells Hospice Care Center (Hazard)

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

The Hospice Patient’s Bill of Rights A few of the items covered include: • Right to information on medical condition • Right to be treated with care and competence • Right to be have privacy respected • Right 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.

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

The Interdisciplinary Team Pharmacist Bereavement Counselor Certified Nursing Assistant Volunteer Goals of Care Chaplain Physician Nurse Social Worker

The Role of the Hospice Physician • • • Experts in pain and symptom management Participates in interdisciplinary team meetings Certifies and recertifies terminal illness Writes prescriptions Visit patients with pain and symptom management issues

The Role of the Hospice Nurse • • • Ongoing medical/physical assessments Management of symptoms Education for patients and caregivers Oversight of the CNA Documentation Pronouncing death

The Role of the Hospice Certified Nursing Assistant • • Provide personal care Simple wound care Transfers Repositioning Light meal preparation Education to patients and caregivers Report changes in condition to team

The Role of the Hospice Social Worker Completes a psychosocial assessment of the patient & family’s: o o o o 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

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

The Role of the Hospice Bereavement Counselor • Continues to follow the surviving family members for one year after the patient’s death • Provides 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

Bluegrass Care Navigators Programs & Departments

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.

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 improve their health.

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

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.

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.

Philanthropy • Bluegrass Care Navigators is a 501 c 3 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

Veterans Outreach • 1 out of every 4 dying Americans is a Veteran • The vast majority will die outside of the VA system • Bluegrass Care Navigators is committed to engaging Veterans about hospice and palliative care services • We 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

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

Adult Day Health Care Program Specifics • Hours are 8 am – 4 pm, Monday – Friday • 663 Teton Trail, Frankfort KY • Cost is $69/day with private pay, Medicaid and some long-term insurance policies accepted • Staff includes a Licensed Practical Nurse, Nursing Supervisor and Director • Transportation for participants will be provided through Bluegrass Ultra Transit and other contracted providers.

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.

The Hospice Patient

The Most Common Diseases of Hospice Patients • • • Cancer Dementia Heart Disease Lung Disease Any disease in its end stage

Common Signs and Symptoms of Hospice Patients • • • Pain Fatigue Nausea/Vomiting Constipation Delirium Shortness of Breath • Weight Loss

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: 1. 2. 3. 4. 5. Ambulation Activity level and evidence of disease Self-care Oral in-take Level of consciousness

Palliative Performance Scale (PPS)

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

11 th Volunteer Training • If you are interested in becoming an 11 th Hour Volunteer please let your Community Engagement Coordinator know. • To be an 11 th 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

Universal Precautions

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.

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.

Understanding Abuse and Neglect

Types of Abuse • Physical: hitting or striking • Sexual: unwanted sexual advances/contact, touching without permission • Mental: taunting, making fun, intentionally trying to confuse • Verbal: yelling, castigation, derision

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.

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.

Grief and Bereavement

Grief Issues • Inability to feed self • Patient and family are coping with many losses and anticipated • Loss of work, hobbies, home losses. Possible Losses: • Physical capacities • Inability to talk, walk, dress/care for self • Inability to drive

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.

Communication & Boundaries

Communication Techniques • Create a safe, calm environment • Actively listen- you may uncover fears and anxieties as a volunteer that might not be shared with others • Let the patient set the pace • Be aware that when the patient and family wants to end the conversation you should do so

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 interrupt • Avoid barriers to active listening, distractions (e. g. cell phones) • Maintain good eye contact • Portray positive body language

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.

Types of Boundaries • • • Physical Personal Spiritual Sexual Confidential Role of Volunteer * Volunteers and employees are not to give or receive gifts from patients or patient families.

More Information on Boundaries • Physical Boundaries: • Spiritual 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 • Respect an individual’s spiritual beliefs • Be non-judgmental

Understanding HIPAA and Confidentiality

Overview • • What is HIPAA? HIPAA’s Privacy Rule How does HIPAA impact volunteers? Penalties for violating HIPAA

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.

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.

HIPAA Violation Penalties • HIPAA calls for severe civil and criminal penalties for noncompliance, including: • fines and/or imprisonment for disclosing private health information or obtaining private health information under false pretenses • fines up to $250, 000 and/or imprisonment up to 10 years for knowingly misusing individually identifiable health information

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.

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.

Understanding Advance Care Planning

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).

Why is Planning Important? Most of us will die with a chronic, life-threatening illness 80% will die with health care provided 50% of people are not able to participate in decisions at end of life Health professions will usually make decision to treat when no plan has been made • How do people know what you want if you do not tell them? • •

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-determination • Helps your loved ones make difficult decisions • How will people know if you don’t tell them?

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.

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 will • A DNR order is added into your medical chart by your doctor

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.

The Role of the Hospice Volunteer

Patient Care Volunteers • • Companionship Respite Care Calls Bereavement Calls Transportation 11 th Hour Care Centers • Cooking • Bereavement Camps • Comfort Care through Massage, music, & pet • Handyperson/Yardwork

What Happens on a Volunteer Visit? • Reading to patients • Playing a game – checkers, cards, crossword puzzle, etc. • Writing letters for patient • Listening to patient/family • Playing music for patient • Pet Companionship • Providing simple comfort care: • Lotion on hands, brush hair, provide blanket/pillow, etc

Administrative Volunteers • Used in all departments • Office Support: Data entry, filing, receptionist • Mailings • Work in our Library • Advocacy • Community Outreach • • • Fundraising Special Events Health Fairs Assist in Volunteer Trainings Mentoring new volunteers

Bereavement Volunteers • Assist Bereavement Department with services such as: • • Bereavement Calls Camps for Grieving Children Monthly Bereavement Mailings Bereavement Bears, Scrapbooks, Memory Boxes/Keepsake Items

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

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

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, 000 • Volunteers work in a variety of roles – patient care, bereavement, office duties, transportation, special events and much more!

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

Volunteer Requirements Volunteers must have: • Access to transportation • Suffered 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

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)

Medicare Conditions of Participation (COPs) • The hospice must document and demonstrate viable and ongoing efforts to recruit and retain volunteers • The hospice must document the cost savings achieved through the use of volunteers • Volunteer have same requirements as employees (Medicare views volunteers as “non-paid staff”)

More About our Volunteers • Volunteers are a mandated clinical component of hospice care • Volunteers 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.

Volunteer Rights • Right to receive recognition for services • Right to decline any assignment • Right to leave any situation where you may feel uncomfortable (notify the team) • Right to submit feedback on the volunteer program

Volunteer Responsibilities • Document all volunteer activities • Submit all volunteer hours to the Community Engagement Coordinator by the 7 th of the month or sooner • https: //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.

Volunteer Code of Conduct • Treat each person with full respect for human life, dignity and worth • Cooperate fully with interdisciplinary team • Respect 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

General Guidelines for Volunteering • • Be Yourself Patient’s/Family’s interest/needs most important Be prepared to listen Be prepared to provide the Gift of Presence Maintain good boundaries and confidentiality Reach out to Volunteer Coordinator when you have questions Recognize your own limitations and times of “burn out”

During a patient visit: • Wear your Bluegrass Hospice Care Volunteer nametag • Identify yourself as a Bluegrass Hospice Care Volunteer • Dress appropriately

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.

Volunteer Self-Care • • Take care of your own needs before others Learn to say no and limit your volunteer assignments Recognize your own limitations Ask for support

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 ___________

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 5 pm, evenings, weekends) volunteers must call both the on-call Nurse and the family/patient.

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

Safety Awareness/Emergency Preparedness Plan • Additional Training on Safety Awareness is mandatory for all volunteers. • Training will be offered annually • The Community Engagement Coordinator will review the Emergency Preparedness Plan Binder with you during your 1: 1 interview.

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.

Community Engagement Coordinator @bgcarenav. org Office: Cell: Follow Bluegrass Care Navigators: @bgcarenav