By maintaining its focus on providing the highest quality care for patients and families, VITAS continues to lead the hospice industry with a senior management team comprised of industry leaders and individuals with extensive management and field experience in medical, healthcare, nursing, hospice and palliative care.

 

Directing its nationwide operations from its Miami headquarters, VITAS has grown to employ 11,868 professionals, operate 44 programs in 15 states and the District of Columbia, and care for an average of more than 16,000 patients per day throughout its 32 inpatient hospice units as well as in hospitals, nursing homes and assisted communities/residential care facilities. Its employees are as diverse and unique as the patient populations it serves, with almost 60 percent of its current workforce comprised of minorities.

 

We recently chatted with these VITAS General Managers from South Florida:

• Miami-Dade County Senior General Manager: Betty Bel, RN, BHS, MHS

• Miami-Dade County General Manager: Laurie Fitz, RN, BSN, MPA

• Broward County General Manager: Donna Borland, RN, BSN

• Broward County General Manager: Susan Acocella, RN, BSN

• Palm Beach County General Manager: Diana Smith, RN, BSN

 

They talked about their work with VITAS, some of their upcoming programs and services, as well as the challenges and opportunities with hospice care.

 

Betty Bel: The reason I continue to be excited after 13 years at VITAS is because of the nature of work we do in taking care of patients and families at the end of life. I feel I’m doing something that I love; I get to help people at a critical time in their lives, and work with people who inspire me every day.

 

Laurie Fitz: This work is meaningful to me because, given the services we provide, we can truly make a difference in people’s lives at a most difficult time. I keep doing it because of my conviction that VITAS, as a company, is truly invested in providing the best possible care to our patients and families, and I’m proud to be a part of that mission.

 

Susan Acocella: Experience and knowledge go a long way in driving the passion I feel about caring for our patients and families, and to put it simply, I love what I do. The most meaningful aspect of my work is the appreciation we receive from the families we care for, and the recognition they give to the employees who care for them. At VITAS, we’re always on the cutting-edge of innovation and deliver the best care to our patients, along with unwavering support for the communities we serve.

 

Donna Borland: As a Registered Nurse, I’m committed to deliver excellent quality care to patients every day and to ensure their needs are met. Hospice has given me the opportunity to take my passion for caring to a higher level, to provide compassionate care at a critical time in the lives of patients and families, at the end of life. It is fulfilling and rewarding. Daily, I’m reminded how important it is for us to live life to the fullest as we are faced with our own mortality and that of our families and friends. At VITAS, I’m also motivated by the outstanding care given by our staff and the difference they make in the communities we serve.

Diana Smith: This work is meaningful to me because I began my career as a nurse providing care to patients at their bedside. What keeps me going is the attention and compassionate care our teams deliver to patients and families, which only keeps getting better.

 

Nationwide, VITAS is achieving its mission to bring access to quality hospice and palliative care to diverse, underserved communities. In fact, VITAS has served as a leading pioneer in the U.S. hospice movement, helping to define the standards of care for hospice and developing its innovative “Access Initiatives” program to elevate awareness and ensure that terminally ill patients and their families in traditionally underserved communities can access quality, compassionate and effective end-of-life care. Moreover, VITAS admits and provides all levels of hospice care to any and all hospice appropriate patients in any location, if they so choose, regardless of their ability to pay.

 

Bel: One of the most unique aspects of the VITAS of Miami-Dade program is that we were the very first VITAS program, established in 1980. And for that reason, we have an enormous amount of expertise in hospice and palliative care. Today, we provide care for more than 1,800 patients in Miami-Dade each day, and we never lose sight of the privilege of caring for those who choose us at the end of life.

 

Fitz: Another unique program we’re proud of in Miami-Dade is our community outreach efforts. We know many people still don’t know a lot about hospice. For instance, many people are unaware hospice is a Medicare benefit accessible to those who are eligible. As part of our outreach efforts, we’re focused on educating the community about how this important benefit works, so they know their options at the end of life. For that reason, we partner with dozens of community organizations representing the various diverse communities, including Hispanic, African American, Jewish, Haitian, and Asian, throughout Dade County.

 

Bel: Another program we’re very proud of in Dade is the work we do with our veteran patients, and veteran community as a whole. VITAS has a dedicated veterans initiative for all of our veteran patients, that ensures their unique end-of-life needs are met while paying them the respect they are due. Our team coordinates recognition and celebration of important events, including holidays such as Veteran’s Day and military anniversaries. Last year, we had the honor of paying tribute to our patient, Tuskegee Airman Lt. Col. Eldridge F. Williams, 97. We presented him with a military bedside salute at the VITAS hospice inpatient unit at University of Miami Hospital. The salute was well-received by all, including Williams, whose appreciation was evident as he mustered the energy to say: “Thank you so much. It’s a grand way to go out.” We were thankful to be a part of his life during his last moments.

Acocella: In Broward, our uniqueness derives from our strong community focus. For example, we employ community liaisons whose focus is tailored to Broward County’s diverse population that is made up of Hispanic, Caribbean and Jewish cultures, as well as Veterans and Public Safety professionals. At VITAS, we know that culture plays a very important part in the decision-making process, especially when dealing with families and their views on death and dying. The clinical care that the VITAS Broward team provides is also unique because of the strength of our committed partnerships within these communities. The ability to care for patients in their homes, in our five hospice inpatient units, in the nursing homes and ALFs, all strengthen our ability to care for the community. When families choose a hospice provider, they want a provider that is able to deliver care with urgent response, 24-hour access to that care, services that meet their end-of-life care needs in a timely manner, and support for their bereavement needs. The VITAS Broward team excels in that commitment.

 

Smith: In Palm Beach County, 78 percent of those 65 and over are of Jewish faith and make up the largest concentration of Holocaust survivors outside of New York City. At VITAS, we’re sensitive to the Jewish culture and their traditions at the end of life, which is why our Jewish Community Liaison, Tali Kentof, goes out into the community to address the benefits hospice care has to offer people of Jewish faith.

 

 

Looking toward the future, VITAS maintains a strong focus on growth and expansion by continuing to invest in infrastructure initiatives that support its hospice programs. The company is focused on building stronger relationships with healthcare providers and to continue educating its communities about their right to access high-quality hospice care.

Acocella: In Broward County, we are focused onforming strong partnerships with our local community and the Broward County Public Safety departments.

Borland: As the percentage of cancer patients that are admitted in our ICU during the last month of life increases in Broward, we are strengthening our relationships with oncologists and the cancer support services in our community to improve the timeliness of accessing hospice care and avoid ineffective treatments. It is important that the oncology community and cancer patients at the end of life be educated about the benefits of receiving the right care at the right time, instead of continued suffering and futile aggressive care.

 

Smith: In Palm Beach, we will be strengthening our outreach to the Spanish-speaking community and address the barriers that create disparities for them to access hospice care. We are also focused on working with managed care companies to demonstrate how appropriate referrals to VITAS can positively affect the quality of life of their members (based on statistical evidence), and also reduce unnecessary healthcare spending, such as avoidable readmissions.

 

 

Dying can be a hard concept to grasp for many people. A patient and/or their family may be faced with certain decisions that they have not explored or discussed before. For instance, they will need to answer questions such as: Where do they want to die? What treatment do they want or don’t want? Do they have a will, advanced directive or healthcare power of attorney? Who do they want involved to make decisions on their behalf if they are unable to do so?

 

Bel: People with different cultural beliefs and values see death and dying differently. As we know, South Florida is a melting pot of various cultures and religions. Understanding cultural differences and people’s views on death and dying is paramount as the hospice team forms their plan of care. One of the areas where we see much apprehension from patients/families is with the issue of pain and suffering and the use of narcotics to treat pain. This is a major area where education and understanding of cultures is extremely necessary. For this reason, we have developed our own training materials geared at explaining the different cultural views about death and dying, and we educate our staff about how to approach certain topics based on cultural preferences.

 

Acocella: The challenge of providing hospice care is that there are many misconceptions about what hospice really is. Some physicians are not as comfortable discussing end-of-life issues, or communicating when the risks of treatment outweigh comfort and having a good quality of life. So our challenges arise from a lack of education within the medical community regarding when it is appropriate for a hospice referral and how hospice can help the family as they struggle with decision-making. It is an industry challenge, as hospices across the country struggle to meet the demands of a changing medical environment and continue to educate the community about the benefits of hospice.

 

Borland: Faith and spirituality plays a significant role in death and dying. Our communities include many faith-based churches and congregations with firm beliefs in their faith. Often, there are misconceptions with faith-based communities about what hospice care really is. They think that hospice means ‘giving up.’ This makes it challenging to recommend hospice or palliative care services or to discuss advanced directives with this community. Therefore, it is important to strengthen our relationships with faith-based communities and provide ongoing education to help them understand that there comes a time when certain medical treatments only prolong suffering.

 

Smith: Hospice is a difficult word for many patients and families, especially when they hear it for the first time. Late referrals continue to persist, resulting in patients passing shortly after admission, and patients and families missing out on the supportive services they can receive which are covered by Medicare. People continue to think hospice care is for the imminently dying, rather than viewing it as a full set of services that address the physical, spiritual, and emotional needs of patients and families during the last six months of life.

 

Fitz: The more knowledge the staff of a facility, hospital, health system, managed care, ACO, etc. have regarding hospice and palliative care, the better equipped they are to educate patients and their families about end-of-life care choices.

 

Bel: We believe it is the responsibility of every hospice and palliative care organization to provide and impart knowledge on end-of-life care. We suggest that healthcare providers be open to offering end-of-life education to all their staff. In fact, VITAS provides tailored presentations about end-of-life care to assist hospital staff members to gain more information about hospice and palliative care.

 

Acocella: Hospice care does not mean that all hope is taken away, in fact, hospice is about giving hope. Healthcare systems can be more diligent and clarify the misconceptions people have about hospice care. Providers can help educate families about the end-of-life care options available to them and restore hope to terminally ill people by letting caregivers know that hospice is about being comfortable at the end of life, while being surrounded by the people they love and care about.

 

Borland: It is very encouraging to see that more people are accessing hospice care in our communities. However, there is still a great need for more education in the community. VITAS Healthcare has partnered with many healthcare systems including hospitals, managed care systems, nursing homes, assisted living facilities and home health companies to dispel the myths and provide end-of-life care education to patients, families and healthcare staff about the benefits of hospice.

Smith: Healthcare systems should make education on hospice care and hospice appropriateness a part of their orientation training. They should be focused on equipping their staff with the tools they require to be confident to have end-of-life conversations at the first diagnosis of a life limiting disease. They should be familiar with advance directives and encourage their patients to complete them and appoint a legally authorized health care surrogate.

 

Bel: According to Medicare.gov, hospice is a program of care and support for people who are terminally ill. If you have Medicare Part A and meet these conditions, you can get hospice care when, 1) Your regular doctor and the hospice medical director certify that you’re terminally ill (with a life expectancy of 6 months or less); 2) You accept palliative care (for comfort) instead of care to cure your illness; 3) You sign a statement choosing hospice care instead of other Medicare-covered benefits to treat your terminal illness and related conditions. Once the patient has been deemed hospice appropriate and admitted onto care, a team of healthcare professionals formulate a plan of care that includes the wishes of the patient and family, which is meant to maximize comfort, while minimizing pain and other symptoms. Hospice also addresses the psychological, social and spiritual needs of the patient and the family, and provides counseling, respite care and support. Unlike traditional medical care, the focus of hospice care is not to cure the terminal illness but rather to support and help provide the highest quality of life possible during the patients’ last days of life.

 

Acocella: I’d like people to better understand that hospice is an end-of-life care option. It is a way to take care of patients during a time when cure is no longer the goal. It is important that people are aware that hospice encompasses many areas of self-determination, decision making and how to implement those decisions based on the needs of the patients. When families understand the range of services that hospice provides—from medical to psychosocial—including the support they will receive from the interdisciplinary team, only then will they be able to take full advantage of the benefits hospice has to offer. Unfortunately, families struggle so much as it’s very difficult to experience a loved one declining, however, hospice helps the family to understand what those changes are and offers guidance to families so they can make informed decisions about their loved ones care.

 

Borland: It is important that people know that hospice is a benefit available for anyone who is appropriate, regardless of their diagnosis, gender, age, ability to pay, race, creed, sexual orientation or disability. With the help of hospice, the caregiver and the family can get support that will help to care for their loved ones and provide them with support also. The care is personalized, and dignified for all patients and their loved ones while surrounded by the people dearest to them in a familiar and comfortable environment. After the loss of a loved one, hospice ensures support is available for the grieving family after their loss.

 

Smith: Hospice is a philosophy of care, and not a place. It is not something to be scared of; it’s a positive benefit to utilize when a loved one is experiencing their end of life journey. Conventional medicine is designed to cure, but it takes wisdom and strength to understand when a cure is not possible, when medicine cannot fix a patient, or reverse the course of a disease. That is when hospice and palliative medicine becomes important and shines the light on a different plan of care that focuses on quality of life, pain and symptom management, and emotional and spiritual support for not only the patient, but also for their loved ones.

 

Bel: The most important thing we would recommend to a family dealing with a loved one who’s been diagnosed with a terminal illness is to review a document called “Five Wishes.” This document, which we are glad to provide, serves as a living will that is used throughout the United States, and has been translated into many different languages. In South Florida, we have it in English, Spanish and Creole. This document is important because it allows an individual to communicate their end-of-life care wishes to their loved ones and their healthcare providers about what they want, who they want to make healthcare decisions, the medical treatments they want or don’t want, and what they want their loved ones to know.

 

Fitz: The second most important thing we advise is to enroll in hospice earlier than later. Many times, I hear families say they wished they had started hospice earlier. Patients value not only the physical care they receive, but also, the support the patient and their family receive. I would recommend talking about hospice care with your family as early as possible, so the whole family can benefit from the care hospice provides. Most families don’t know that hospice is a benefit that is covered by Medicare. Medicaid and most private health insurance plans also pay for it.

 

Acocella: My best advice is to actively listen to patients and families, validate their concerns, and provide solutions to concerns as they arise. Families want to be heard and know that their concerns are being addressed. Open communication is the basis for dealing with both our families and our staff.

 

Borland: Watching a loved one die is difficult for family members or caregivers to witness. During this time, their minds are in turmoil and their world is turned upside down. They are taught to fix the disease, therefore they feel helpless. Hospice can help during this time by providing presence, support, guidance and information about the signs of approaching death. Knowledge is very important to counteract fear and one can better deal with the process if they know what to expect. Therefore we share with family members the signs of approaching death from months to days to hours to minutes before the patient passes away.

 

Smith: Be a good listener. This is a crucial time of your loved one’s life. You want to listen and hear everything that the experts tell you during this important time to help you provide your loved one with the support they will need.

 

Bel: Speak to your family now, when you’re healthy, about your end-of-life wishes. Do not make it a taboo subject in your family. Be open about what you would like at the end of your life, where you would like to die, who you want to be surrounded by and what is most important to you.

 

Acocella: Hospice and palliative care are meant to provide comfort, meet the needs of the patients and families where they are, meet the psycho-social needs of our communities as they struggle with the end of life. Naturally, for many of us who dedicate our lives to providing compassionate care to terminally-ill patients, the work we do becomes our passion. The medical world is changing but hospice will always be about helping not only the patients but their families as all involved cope and struggle with death.

 

Borland: Hospice gives patients the opportunity to die pain free and with dignity, and enables families to have the necessary support to allow us to do so. Choosing hospice does not mean treatment or care stops. Hospice treatments are intended to provide comfort to a patient at the end of life and is not intended to cure their disease, however, at times hospice care can prolong a person’s life. The earlier a patient is admitted into the hospice program it gives more time for the hospice care team to develop a suitable plan to address the patient’s and family’s needs. This fosters a trusting relationship which is vital to develop in order to facilitate a working-relationship between patient/family and the hospice care team, thereby enabling the patient and their family to fully enjoy the benefits hospice has to offer.

Smith: As hospice professionals, our goal is to provide genuine love and care to our patients and lend a helping hand to their families.

 

Acocella: There isn’t anything more rewarding than receiving appreciation and gratitude from a family after the death of a loved one, when they can say that the care that VITAS gave them was priceless. In the changing world of healthcare, filled with audits, ACOs, and regulatory mandates, it’s our patients and families and the care we deliver at the bedside that matters most.