Fearing death is natural

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Fearing death is natural Facing it alone is
not. Hospice provides comfort, care and hope to
families facing end-of-life issues
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Principles

• Patients first
• Hospice governance administration model
• Partnership evidenced by a contract
• End-of-life care
• Industry best practices evolving
  evidenced-based model
• Quality control
• Stability predictability
• Integrated with volunteer support
• No duplication seamless care
• Full accountability and public reporting

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Hospice Fast Facts

• Independent community healthcare charity
• Governed by 14-member Board of Directors
  healthcare, business and education professionals
• Managed by full-time ED - healthcare and
  non-profit business specialist
• 2.2 program and administration staff
• Over 140 Volunteers
• Annual Budget 900,000
• Serving 500 people per year palliative and
  grief support
• 2004 2005 Canadian Donner Awards for service
  mgt.
• 2008 - Named one of Canadas top palliative
  healthcare charities for impact giving by
  Charities Intelligence Canada
• Own Atlantic Canadas only stand-alone Hospice
  House and establishing the FIRST 10-bed
  Residential Hospice

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Bobbys Hope House

• Purchased from the Sisters of Charity in 2007
• 100 owned by Hospice Greater Saint John

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Residential HospiceA Community Palliative Care
Home

• A home away from home to live and die in peace
  and dignity surrounded by loved ones and cared
  for by a team of qualified professionals and
  volunteers.

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Welcome to Hospice!
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10 Residential Hospice Bedrooms In Development
Compassionate 24-hour palliative care for people
who can no longer be cared for at home, but do
not need to be in hospital.
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4 Family Bedrooms
A home away from home a place for rest, peace
and comfort where you can be near your loved one
as they face their final days
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IWK Foundation NB Childrens Foundation
Play Areas

• Children will have access to a cheerful
  playroom and garden area designed just for them.
  
• Pets will also be
• welcome.

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Saint John Energy Garden of Hope Healing
A peaceful haven of hope and healing where
patients will have quality care and families will
have time to be together and to say goodbye.
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The Business CaseCommunity Needs

• Today, 800 people die annually of a palliative
  illness in the Greater Saint John area.
• Currently, over half of the annual palliative
  deaths take place in one hospital
• - 200 in the Palliative Care Unit
• - Another 200 in other hospital beds at
  theSJRH
• In the last month of life, 50 of palliative
  patients are hospitalized because they need
  24-hour care that families are unable to provide.
  
• Seniors account for 75 of these palliative
  deaths. Experts say that by the year 2025, the
  proportion of seniors in NB is projected to be
  21 higher than the national average. Palliative
  deaths are set to rise significantly,
  particularly in Saint John, which has NBs oldest
  population

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Palliative Patients at the SJRH2008 Snapshot

• 10.4 days is average stay in PCU
• 498 new consults 331 patients transferred to
  PCU
• 260 admissions/transfers to PCU form other parts
  of SJRH
• 71 palliative patients died in other hospital
  beds while waiting for a transfer to PCU
• 151 not appropriate to come to PCU at the time of
  consultation at least 50 of those patients
  died in hospital beds outside of PCU
• A total of 146 patients died in a hospital bed
  outside the PCU

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The Business CasePatient/Family Benefits

• Dying Patients - 130-150 dying patients per year
  who will otherwise face hospitalization in the
  last month of life will receive quality,
  comprehensive care at the Residential Hospice.
• Acute Care Patients - People requiring elective
  surgery who are currently on long wait lists due
  to limited access to acute care hospital beds
  will receive their surgery in a more timely
  fashion
• Families Experts say HPC delivered by a
  qualified team positively influences the quality
  of dying and the recovery of survivors. This has
  a positive impact on health services and
  economies as survivors are less likely to become
  patients themselves and are better able to resume
  work and life responsibilities. With the death of
  one person affecting an average of 5 other
  people, 650 750 families and loved ones will be
  supported by the care offered by this new service

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The Business CaseHealthcare System Benefits

• Hospital Wait Times This new healthcare service
  will move 150 palliative patients per year from
  acute care beds at the Saint John Regional
  Hospital to the Residential Hospice. This will
  increase access to acute care beds for up to 600
  patients on surgical wait lists, etc. and reduce
  wait times.
• Health Human Resources Healthcare systems face
  a growing nursing shortage where in the near
  future, demand for nurses in individual homes
  will outstrip the supply. The residential
  hospice model provides a home-like environment
  and maximizes health human resources by
  concentrating patients in one location where one
  nurse can provide care to many more people than
  if she/he had to travel to individual homes
  throughout the community.
• Tax Dollars - The cost of care in a Residential
  Hospice is 300/day compared to 1,000/day in an
  acute care hospital. The NB Government could
  re-allocate 3.3 million dollars a year currently
  spent on palliative patients in hospital to acute
  care services.

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Fraser Health Performance Targets

• Fraser Health (FH) performance targets included
  decreasing acute cancer deaths in hospital by 3
  in one year.
• In 2005, 56.2 of cancer deaths in FH occurred in
  hospital, compared to 49.3 in 2006 a reduction
  of 6.9
• In 2004, 60.4 of cancer deaths in FH occurred in
  hospital, compared to 49.3 in 2006 a reduction
  of 11.1 over two years.
• Conclusion Residential Hospice is helping
  Fraser Health reduce in hospital palliative
  deaths.  

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The Business CaseBusiness Benefits

• Employers The US Grief Recovery Institute
  estimates 37.5 billion dollars of lost
  productivity - absenteeism, lack of
  concentration, mistakes, workplace injuries,
  problems with customers/co-workers - in 2003 due
  to the death of a loved one. There is evidence
  that families who have the support of Hospice
  Palliative Care Services are better able to cope
  with the multiple losses and changes associated
  with a death, transition through their
  bereavement and better able to rebuild their
  lives and reintegrate into society.
• Economic Growth Saint John is poised to be the
  energy hub of Atlantic Canada. One of the pillars
  needed to attract and retain in-demand workers is
  a quality, accessible health-care system.
  Reducing wait times for acute care hospital beds
  helps government and businesses attract and keep
  workers. This project will also create 60
  temporary jobs during the renovations phase,
  expected to last up to 12 months in total and,
  20 or more permanent jobs.

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Twinning Sharing for Success
Our Residential Hospice model is being guided by
the following experts in the field Carpenter
Place, Burlington, ON www.thecarpenterhospice.co
m Hospice May Court, Ottawa, ON
www.hospicemaycourt.com Vernon District
Hospice, Vernon, BC www.vernonhospice.ca Rosedal
e Hospice, Calgary, AB www.hospice.calgary.com
Red Deer Hospice, Red Deer, AB
www.reddeerhospice.com Hospice Niagara, St.
Catherines, ON www.hospiceniagara.ca Dr. Bob
Kemp Hospice, Hamilton, ON www.kemphospice.org
Sharon Baxter, Executive Director, Canadian
Hospice Palliative Care Association Janet
Dunbrack, Healthcare Consultant and Former
Executive Director, CHPCA Carolyn Tayler, RN, BN,
MSA, Director, Hospice Palliative Care, Fraser
Health, BC Michael Ahearn, Pallium Project,
University of Alberta
Thank You!
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Standards

• A Model to Guide Hospice Palliative Care,
  Canadian Hospice Palliative Care Association,
  2002
• Residential Hospice Standards, Hospice
  Association of Ontario
• Fraser Health Hospice Residences, Creating a
  healing and caring environment at the
  end-of-life, Fraser Health, 2007

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Medical Care

• Patients admitted by Family Physician
• Hospice Medical Director - .2 FTE position
• Dr. Chris OBrien
• Role Oversee Quality of Care
• Medical Support Consultation
• Patient Rounds/Family Consultations
• Nursing Support Team Education
• Primary Physician for palliative patients without
  a family physician

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Nursing Care Personal Support

• Hospice FT Nurse Manager Monday to Friday
• Role Admissions, PT/Family Liaison, Quality of
  Care, Care Team Scheduling/Supervision, Physician
  Liaison, Evaluation, Reporting, etc.
• 24-hour Nursing Personal Care (ON Standards)
• Day Shift 1RN 1LPN 1PSW
• Evening Shift 1 RN 1LPN
• Night Shift 1 RN 1PSW

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Volunteers

• Resident Care Volunteers will work in four hour
  shifts to help the nursing/personal support staff
  care for patients and families. Duties will
  include non-medical practical, social, emotional
  and spiritual support for RH patients/families.
• Reception Volunteers will greet people, answer
  phones, provide administrative support, etc
• House Volunteers will garden, clean, provide
  building and grounds maintenance, etc.

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Admission Guidelines

• 18 years or older
• Valid NB Medicare Card
• Life expectancy of 3 months or less
• Cannot be managed at home and does not require
  acute hospital care
• Qualifies for EMP Services
• Palliative Performance Scale (PPS) 50
• DNR and agrees to no extraordinary life saving
  measures
• Referral from healthcare professional through
  triage team
• Agreeable to services provided by the Medical
  Director or designate
• Sign an admission agreement

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Palliative Performance Scale
Anderson, Fern et al. (1996) Palliative
Performance Scale (PPS) a new tool. Journal of
Palliative Care 12(1), 5-11
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Exclusion Criteria

• PPS greater than 50
• Able to manage well at home
• Wandering and unsafe
• Chronic prognosis
• Ventilator

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Community Team
Patient/Family Home
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Residential Hospice Triage Admissions

• Two Avenues
• Community through EMP, Family Physicians and
  HPC Outreach Clinic
• Hospital through the PCU

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Residential Hospice Program Budget
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Residential Hospice 788,400 ofIn-Kind Program
Support

• Volunteers
• 6 house/admin volunteers X 12 hours/day/365 days_at_
  15/hour cooking, cleaning, reception, gardens,
  lawn, etc.
• 6 patient/family volunteers X 12 hours/day/365
  days_at_ 15/hour support to PSWs, nursing staff
  and PSS support to patients and families

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Residential Hospice Funding

• Hospice will cover the capital costs of the
  facility, renovations to bring it up to building,
  fire and healthcare codes and the annual
  maintenance and upkeep costs.
• Hospice will fully cover the costs of non-medical
  support services (information, education,
  anticipatory grief, bereavement grief support)
  provided in the home and in the community to
  patients and families.
• Hospice will fully cover the costs of volunteer
  support services and provide nearly 800,000 of
  in-kind support through volunteers.

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Supplies, Equipment Medications

• 10 electronic patient beds mattresses
• Patient and family room furniture
• Stretchers, wheelchairs, IV poles,
  Rescu-stretchers, bandages, needles, attends,
  etc.
• Patients will be responsible for their own
  medications through third party insurers and/or
  the provincial drug plan.
• A physician will write the prescription to the
  patient to be filled at a local pharmacy.
  Families or volunteers will pick it up and the
  bills will be dealt with by the patient/family.
  RNs will store and dispense the medications.
  Emergency and other palliative medications will
  be supplied by EMP or purchased by Hospice.

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Residential Hospice Timelines

• April 2009 Secure Remaining Renovation Funds -
  500,000
• Sept. 2009 Complete Renovations
• Sept. 2009 Volunteer Recruitment General
  Training
• Dec. 2009 Secure Furniture, Equipment Funds -
  200,000
• Dec. 2009 Contract with NB Government for 2010/11
  confirmed
• Feb. 2010 Complete Installation of Furniture,
  Equipment Décor and set-up
• Feb. 2010 Contract Medical Director Nurse
  Manager
• Site Visits to Hospice May Court Carpenter
  Hospice in ON
• March 2010 Recruit Hire Nursing and Support
  Staff
• Training and Orientation for all Staff
• Tour and Orientation for Community/Hospital
  Medical Staff
• Public Grand Opening and Tour
• April 2010 Gradual Start-Up and Admission of
  Patients
• May 2010 Full Operations

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Residential HospiceArchitect
Donating 5 of his fees!
Mike RichardRichard Co. Architecture Inc.
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Residential Hospice Renovations November 2008
September 2009

• 1.6M
• Sprinkler System
• Elevator
• Fire System
• New Plumbing System
• Furnace Upgrade
• Window Lighting Upgrades
• Automatic Generator
• Parking Expansion
• New Flooring
• Architectural Design
• Nurse Call System
• Security Upgrade

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1.6M Realize the DreamResidential Hospice
Capital Campaign
1.1M Raised
Honorary Chairperson Capital Campaign Senior
News Editor Anchor CTV News
Capital Campaign Chairperson Hospice
Founder Radiation Oncologist, SJRH
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• At some time, in some way, we
  must
• all face the end of life.
• And most us share a common hopethat when death
  comes to us or to a loved one,
• it will be peaceful and free of pain.
• We hope to face death surrounded by a circle of
  support, feeling safe, comfortable and cared for.
  
• This is the promise of Hospice
• Greater Saint John.