Its after 8 on a Saturday night and your beeper goes off. Your patient is in the emergency room. Shes been declining rapidly; its probably time for hospice. The family is anxious and scared, but they will just have to wait until tomorrowor maybe Mondaybecause what can you do at this point?
At VITAS Innovative Hospice Care® there is someone waiting for your call. There is an admissions nurse who will meet the family tonight to explain hospice care, talk about the needs of the patient and admit her if thats what they choose to do. There is an admissions coordinator who will follow up with you, the admitting physician, to whatever degree you request. What there are not are more pages, voice mail and messages. Your call puts you in touch with a hospice expert who is on the job, knows how to take your referral call and is skilled at talking to the family at such a difficult and confusing time.
“We need the callers name and number and the patients name and location. Then were in business,” says Don McChesney, director of customer service for VITAS admissions in the Southeast, which covers 14 hospice programs in six states. “We can go to the patient, talk to the case manager, do what is needed. Weve designed the intake process to be painless, quicker and easier than anywhere else. Add to that our extended hours of operation and the professionals we have waiting for your call, and VITAS is the ultimate one-stop shop.”
As stripped down as the referral process can be, those professionals will take all the time necessary to discuss the patients situation if that is the callers need. They explain hospice to those new to the concept, discuss end-of-life care and related issues; explain Medicare, Medicaid and private insurance coverageor just listen if a caller needs to vent. Admissions coordinators are trained to expect the unexpected.
VITAS regionalized its intake process in 1997, enabling professional admissions coordinators to specialize in a specific community and enabling admissions nurses to meet with patients and families until midnight.
“VITAS is 24/7,” says Mary Zalaznik, vice president of hospice program resources. “Since the early 1990s, every time we have increased our hours of operation, our referral sources have responded so well that were encouraged to add even more hours. Our admission coordinators are staffed from 8 a.m. to 11 p.m. six days a week and 8 a.m. to 8 p.m. Sundays and holidays. And were ready to bump that up if its called for! A referral call made after 11 p.m. is managed by our after-hours Telecare staff.”
“We dont believe in nine to five,” McChesney agrees. “Were available when patients and families are available. It turns out, people work for a living; they may not be making hospice calls from work.” It also turns out that the stress and isolation of caring for a seriously ill family member tends to peak during the night, which inevitably generates hospice referrals and inquiries.
“We see every referred patient the same day, unless they request otherwise,” says Zalaznik, adding a firm “
always. Our goal is to see a new referral within the hourcertainly within two to three hours.”
Its no small feat. The Southeast Admissions Center, located in Miramar, received 2,200 referrals last month. Eighty percent of those became VITAS patients, and the other 20 percent were followed up based on the admissions nurses conversation with the patient and family. McChesney figures every referral call generates 25-30 follow-up calls from and to the patient and caregivers; his records show that Miramar handled 65,000 calls last month.
Those calls may be to a case manager or social worker inquiring about the next of kin, to the physician confirming the treatment plan or who will sign the death certificate. It could be to a family member to determine the names of any consulting physicians or the existence of any insurance policies. If a key family member lives out of state, admissions might coordinate a three-way phone call, perhaps at 10 p.m. Eastern time, in order to facilitate family communications. Sometimes the patient and family havent yet heard the word “terminal” from their doctor, and the admissions nurse needs to be forewarned. Some physicians ask to be kept in the loop as the patient transfers to palliative care; others turn care over to the hospice physician. As “stripped down” as the intake process is, ongoing and thoughtful questions during admissions makes for the best hospice experience for the patient and family. And every answer is different.
Except for one:
Q: How soon can you see the family?
A: Today.
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