2017 AJAS Annual Conference

MASTERClass

AJAS Master Class

Innovations in Jewish End-of-Life Care

End-of-Life Care for Jewish Community

Should be informed by and incorporate the following:

• Cultural norms in Jewish community

• Jewish vs. Western medical ethics

• Endorsement by Religious and Lay community

• Jewish providers, liaisons and navigators

• Jewish clinical team members

• Cultural sensitivity training

• Incorporation of Halachic Pathway

Barriers/Challenges to Access

• Hospice ‘philosophy’

• Lack of awareness of Jewish laws and customs

• Exclusion of appropriate stakeholders in decision

making

• Jewish Values and Jewish Medical Ethics

• Cultural norms around seeking aggressive medical care

• Cultural norms around advance care planning

• Loss of hope, hastening death

Recommendations Leading to Best Practice

• Community based model – multi-pronged approach

• Lay, religious, healthcare leadership

• Education/outreach – professional, community

• Synagogue involvement

• Funding support

• Governance/Leadership support

• Infrastructure – human resources

• Value neutral staff

• Marketing

• Communication, communication, communication

AJAS MasterclassInnovations in Jewish End-of-Life Care

Education

•Professionals

•Community

•Synagogue

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Center for Jewish End of Life Care

History

Lessons learned

•Focus Groups

•Snackable

•Changeable

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To Operate or Not to Operate Hospice?Sivitz Jewish Hospice

Jewish Association on AgingPittsburgh, PA

AJAS MasterClass: Innovations in Jewish Palliative & End of Life Care

April 5, 2017Deborah Winn-Horvitz

Mary Anne Foley

Objectives

1. Understand how to include Board and Community Leaders in discussions related to a mission critical program

2. Learn how one hospice program redesigned for financial success

3. Understand ways to differentiate your program in a crowded market

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Jewish Association on Aging

Home & Community-based Services

Residential Services

Meals onWheels

Outpatient Rehab

Adult DayProgram

Home Health

Hospice Personal Care Facilities

Skilled Nursing & Rehab

AgeWell

AgeWellat Home

Service Coordtrs

Private Duty

JCC Rehab Satellite

Memory Care Asst’dLiving

Indep. Living

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History of Sivitz Jewish Hospice

• Developed and opened 20 years ago, by the Sivitz Family

• Historically a financially stable program

– Strong census despite competition

– Overall quality excellent

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Regulatory Changes Impacting Hospice Providers

• January 2011: Face to Face Ruling went into effect

• October 2012: Medicare Hospice Claims with increased scrutiny• LOS: Routine & GIP• LTC/SNF: Debility• LOS: Alzheimer’s, Debility or COPD

• October 2013: Final ruling: Debility and Adult Failure to Thrive

• July 2013: First Mandatory reporting requirements

• March 2014: Hospice and Medication Part D

• July 2014: First penalties imposed on reimbursement

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Additional Data Requests (ADRs)

Date # ADRs $ At Risk

11/2013 38 $ 175,976

2/2014 40 $ 254,266

9/2014 42 $ 258,975

Total 120 $ 689,217

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SJH Operating TrendsFY 11 FY 12 FY 13 FY 14 FY 15

# Admissions 128 126 134 107 111

Total Patient Days 14,688 14,056 11,568 6,660 4,062

ADC 40 38 31 19 11

Live Discharges 13 14 29 18 11

Top 3 Diagnoses FY 11 FY 12 FY 13 FY 14 FY 15

Cancer Debility Dementia Dementia Dementia

Dementia Cancer Debility Cancer Cancer

Debility Dementia Cancer CHF Neurological Disease

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SJH Financial Performance

Hospice Task Force Implementation

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JAA Board Of Directors: Call For Action

• Hospice Task Force developed to conduct a deep dive evaluation of Sivitz Jewish Hospice

– Implemented September 2014

– Members: Board representatives including Board Quality Committee Chair; Community Leaders and JAA Senior Management

– SWOT analysis completed

– Questioned: What makes us Jewish?

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SJH SWOT Analysis

Strengths

• Small service lends itself to more individualized and personal care

• Dedicated and compassionate staff

• “Patient-Centered Care”

• Mission and Values embedded into daily care

Weaknesses

• Lack of timely referrals to other JAA entities and neighboring Riverview Towers (HUD Housing)

• Culture

• Both strength and weakness with referral sources

Opportunities

• Highlight staff in different media

• Improve communication

• Leverage community relationships

• Between JAA entities

• Continue outreach to community Rabbis

• JAA Rabbi Seidman follow up

• Consider vignettes highlighting patient and family experience

Threats

• Competitors

• Providers admitting patients on to services when not appropriate

• Providers admitting patients to GIP when not appropriate

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Maintain Independence or Merge?

• Valuation performed by 3rd party

• Evaluation of Sale/Merger opportunities

• How would Jewish culture be maintained?

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Task Force Decision – Maintain Independence

Why?

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Staff Education Volunteer Training

Bereavement Recognition

Community Expectations

What makes us Jewish?

How Did We Revitalize SJH?

• Expense reduction

• Increase marketing & exposure

– Closure series

• Improved internal referral processes and relationships

• Enhance volunteer programs

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SJH Financial Performance Today

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Hospice Task Force Implementation

SJH Today

• Preferred Provider within JAA continuum

• Staff retention

• No ADRs

• Hospice item set = 100%

• Deficiency free surveys

• Working more closely with Jewish Community Rabbis

• Partnership with Hillman Cancer Center

• 20th anniversary celebration

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SJH Future Plans

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• MCCM Recipient

– Phase II

• Staff certification

• AgeWell collaboration bereavement support for caregivers

AJAS Masterclass:

Montefiore Inpatient Hospice

Seth Vilensky

April 5, 2017

Montefiore Hospice: History

• Founded in 1992 – NCJW

• First Jewish Hospice agency in the state of Ohio

• Endowment through Jules and Ruth Vinney Philanthropic Fund, 2011

Montefiore Hospice: Today

Full service hospice agency

• Palliative care consult service

• Hospice at home

• Hospice in nursing home/assisted living

• Inpatient hospice unit – 6 beds

45 – 50 patient average daily census

• Medical Director

• Nurses, Aides, Social Workers, Chaplains, Bereavement

• Music, Art, Massage, Reiki therapists

• Volunteers

Montefiore Hospice: Team

Why build an Inpatient Hospice Unit?

• Market opportunity

• Full-service program

• Milt and Tamar Maltz

Project Timeline

Jan 2012FundraisingPlan

April 2015Unit Opens

Oct 2012Design begins

August 2014 Ground Breaking

June 2013130th

Anniversary GALA

2013 - 2014Continued fundraising

Sept 2014 Constructioncompleted

March 2015 Regulatory approval

FUNDRAISING

OPERATIONS

Project Funding

• Total Project Cost: $3.0m

• Total $ raised: $3.0m• Maltz Foundation: $1.5m• Additional fundraising: $1.5m

The Maltz Hospice House

• Virtual Tour

Differentiators

• Design and ‘home-like’ feel

• Location

• Team and staffing ratio• 1 RN• 1 STNA• Medical Director• Chaplain, social worker, integrative therapies,

volunteers

Volume and Financials

FY 2017:July - February

Occupancy (ADC) 4.11

Revenue $493,696

Operating Expense $554,855

Net Operating Surplus ($61,162)

Depreciation $114,563

Net Income $(175,725)

Lessons Learned

1. Patient mix: residential vs GIP

2. Medical supervision

3. Staffing a 6-bed unit

4. Marketing advantage

5. Community benefit