The Flutter - Hospice Househospicehouse.us/Vol4No2.pdfin this issue cover story, pg 1 letter from...

IN THIS ISSUE

COVER STORY, PG 1

LETTER FROM EDITOR, PG 1

CUSHMAN’S CORNER, PG 6

HOSPICE OF THE PANHANDLE,JOYS AND WOES, PG 7

HOSPICE NEWS & NOTES, PG 9

QUESTION OF THE HOUR, PG 10

CALL TO THE FIELD, PG 10

The FlutterBRINGING HOSPICE HOUSE PROFESSIONALS TOGETHER

Various Models ofFood Service Delivery

in Hospice Houses

One of the primary responsibilities of operating a facility for ter-minally ill patients is food service. We all have to eat—even if hos-pice-appropriate patients likely are eating less—and local licensing requirements in this area can be quite specific. Even when the pa-tient eats next to nothing, the ritual of serving food is important in creating a homelike setting for care. But if you are feeding your

A LETTER FROM THE EDITOR,LARRY BERESFORD The definition of a Hospice House remains fluid, both within the hospice community and for a larger health care system in flux. Distinc-tions between residential and general inpatient (GIP)-level care, size, length of stay, who will pay for the stay, how it is documented and billed—these are some of the issues that highlight the diversity of models even within our small community, the Hospice House Network. And heightened reg-ulatory scrutiny only adds urgency to these questions. A large hospice in Florida re-cently agreed to a $10.1 million pay-back to the government for inpatient

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The FlutterAugust 2015

Volume 4, Number 2

HopeWest’s Spoons Bistro and Bakery in Grand Junction, Colo., serves meals to the public from 7 am to 9 pm as a natural extension of the hospice’s need to provide warm and healthy meals to the patients in the 13-bed Hospice House Care Center upstairs.(See page 5.) Photo courtesy of HopeWest.

residents, it may not be a great additional stretch to also provide meals to their families, other visitors, staff and even, in the case of an affiliated café, the larger community. Experienced hospice architect and HHN member Tom Mullinax, founder and president of Hospice Design Resource in Hilton Head, S.C., identifies four basic models of food service in Hos-pice Houses. The first is a kitchen in a small fa-cility of fewer than 16 beds, which doesn’t need to be commercial in size or quality of equipment. “The only health department standards typically enforced are for an ansul fire suppression system over the stove and a dishwasher that can achieve 160 degrees.” This model works well for preparing breakfast, which is often the main meal of the day for Hospice House residents, Mullinax says. “Eggs, oatmeal, toast, or pancakes, are quick and easy to prepare. Even bacon can be provided, although for liability reasons, I would recommend using the mi-crowave approach, rather than frying it.”

“Once the leap to a commercial kitchen is made, it typically means the addition of a cook and leads to offering meals to families and some visitors. Menus are typically larger.” -- Tom Mullinax

Spoons Bistro and Bakery, a café located in the same building as the Care Center of HopeWest, a hospice in Grand Junction, Colo., is open to the public as well as supplying hot meals to hospice patients. It earned a Certificate of Excellence for its hospitality from TripAdvisor. Photo courtesy of HopeWest.

A second approach is food catered in from vendors, with a warming kitchen to heat before distribution. “This is typically limited to patients and, sometimes, families who order ahead of time so you know the quantity of food to bring in, typi-cally with a very limited menu.” Even if the facility is more than 16 beds, this form of delivery needs very limited rewarming, plating and cleaning capa-bilities—although it typically requires a triple bowl sink and a separate handwashing sink, Mullinax says. In some locales the health department also requires the use of a grease trap, regardless of the kitchen’s size. “Facilities over 16 beds that do not utilize catered food from outside are required to provide a full commercial kitchen. Once that leap is made, it typically means the addition of a cook and leads to offering meals to families and some visitors. Menus are typically larger and the food is typically better.” The fourth category includes a variety of other approaches. Mullinax says he recently learned about a hospital that has a cart that goes from room to room so that small, limited meals can be prepared to order at each patient’s bedside. This is very popular with patients, he says, but would require consideration of fallback position for the commercial kitchen design should the cart approach prove to be infeasible. “A hybrid that we used in a facility in Bloomington, Ind., was pre-packaged, frozen meals prepared, sealed, frozen and stored in a hospital kitchen, transported to the hospice and held in freezers until they are ready to be reheated and served,” he says. Patients could select from a menu and the meals would be pulled, heated and served. Families also bring food from home or take-out restaurants, and family rooms or kitchens may

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COVER STORY, CONT. FROM PAGE 1

The Flutter a publication of the Hospice House Network | www.hospicehouse.us August, 2015 2

https://www.ansul.com

have a variety of resources for self-service meal preparation. Hospice of the Western Reserve in Cleve-land, Ohio, operates two Hospice Houses of 40 and 32 beds, each with its own self-operated dietary services and personnel. “The two sites use the same food services vendor and all menus, recipes, prac-tices and procedures are the same, with an occa-sional slight variation specific to the location,” says dietary services team leader Leslie Griffith, RD, LD. A clinical dietitian completes a nutritional assess-ment for all residents of the two facilities. All food is prepared onsite, with food preferences, intoler-ances and allergies noted. “Hospice of the Western Reserve uses a formal three-week cycle menu, which offers a va-riety of selections for each meal.” Three meals are served daily at set times, Griffith says. “For lunch and dinner, there are al-ways two entrée choic-es. We focus on comfort foods, but also include choices with an ethnic ap-peal. Our staff can always prepare a grilled cheese sandwich, scrambled egg, fruit plate or select soups not featured on the menu that day if there is a special need.” In hospice care, therapeutic dietary restric-tions are liberalized. Patients may be given half or quarter servings or pureed consistencies, Griffith adds. “Our relationship with food is a powerful thing, and we are cognizant of the emotional issues for families attached to their loved one’s ability to eat. Sometimes hospice’s challenge is to try to be sensitive to this transition in dietary ability and to gently guide patients and families through that transition.”

Family visitors also have multiple options, including cafes at both facilities open daily for lunch with soup, salad bar, prepared sandwich-es and snacks and vending options available af-ter-hours. Both facilities also have family kitchens available for visitors to use. “Hospice of the Western Reserve is partic-ularly proud of one of our signature programs—Meal to Remember—available for patients and their guests. Each month at each IPU, a different local independent restaurant and its chef prepare and donate an entire meal serving 80 to 90 peo-ple so that patients and their loved ones can come

together around a table covered in fine linens and decorated with flow-er arrangements created by our volunteers. The simple comforting ritual of enjoying a family din-ner together or going to a restaurant is an experi-ence that frequently gets lost when coping with a serious illness,” Grif-fith says. (See photos on page 5.)“This program works with generous chefs in our local culinary com-munity to bring back that meaningful quality

time,” she adds. “The meals are served on fine china. Donated wine from a local wine merchant is poured. Volunteer pianists from the community provide background music. Photos are taken and given to patients and families as mementos of this special evening.” HHN-member Hospice of the North Coast in Carlsbad, Calif., used to contract for food ser-vice with a skilled nursing facility located across the freeway from its six-bedroom inpatient home, Pacifica House, but found after a year that most of the meals were getting thrown away, reports Ex-

This Hospice House kitchen built for JourneyCare Hospice, Barrington, Ill., was planned adjacent to “soft space” that could be easily relocated to permit eventual expansion of kitchen facilities. Photo by Tom Mullinax, courtesy ofHospice Design Resource.

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http://www.hospicewr.org/news-events/events/remember

days that were improperly billed to Medicare, although the hospice points out that it uncovered the problem on its own of insufficient documentation to support the GIP rate and voluntarily self-disclosed to the govern-ment. And hospice compliance consultant Mary Nester of Amboy, Wash., notes that some Medicare-certified hospices can’t get access to GIP care because the hospitals in their communities are unwilling to give them a bed contract—a conclusion supported by the Office of Inspector General’s discovery that 953 hos-pices provided no GIP care whatsoever during calen-dar year 2011. “There are situations where the most natural place to provide hospice GIP care is in the hospital setting,” Nestor says, but hospitals have no legal ob-ligation to contract with a hospice. The challenge is to educate hospital administrators to consider it part of their service to their community, she says. “Often the hospice hasn’t explained it very well.” Better inpatient hospice options can contribute to the hospital’s patient satisfaction scores and to the continuum of services that will be required for participation in health care re-form. Nester also encourages hospices to document their conversations with the hospital to show the efforts they have made to obtain inpatient contracts, and to consider the role of collective advocacy to demand easier access to inpatient care for all hospices. But if a hospital setting is unavailable and in-vesting in a freestanding hospice facility or unit is not feasible, then hospices are pretty much obliged to turn to skilled nursing facilities. They are urged, however, to be selective about the SNFs they choose to contract with for GIP—and to make sure that a registered nurse is onsite to provide the care 24/7, says Meg Pekarske, an attorney with the Wisconsin firm Reinhart Boerner Van Deuren. “Given recent scrutiny of the medical ne-cessity for GIP, the quality of the facility’s documenta-tion is a key consideration. Likewise, it should be clear to the SNF that it is expected to do something different while providing GIP than when the facility simply pro-vides room and board,” she says. It has been conventional wisdom for many hos-pice facility planners that Hospice Houses are finan-cially viable only if they stick to GIP-level care and bill-ing, eschewing residential care. Yet Margaret Cogswell of Hospice of the Panhandle in Kearneysville, W.Va., says on page 7 of this newsletter that the government’s

expectations for GIP level-of-care determinations have become much stricter since she started planning her agency’s Hospice House. She fully expected to fill the beds of her new facility with GIP patients, but quickly found that if the hospice didn’t take residential cases, the beds would go empty. Meanwhile, the social model or “hospice home” has gotten national attention recently (see page 9). Some HHN members provide this kind of care—often in collaboration with Medicare-certified hospice clini-cal teams responsible for the patient’s hospice care. This model requires large portions of both community support and volunteer staffing. But a facility designed around what the community and patients need—rather than what is covered by Medicare—can sometimes in-spire such support. A noteworthy example is a Hospice House for terminally ill, homeless people in Salt Lake City, which had 300 volunteers before it even opened its doors. We’d like to hear what you think about these variations on the definition of Hospice House and whether residential and GIP care can comfortably co-exist under one roof. Thanks for listening.

LETTER FROM THE EDITOR, CONT. FROM PAGE 1


A family kitchen at Merrimack Valley Hospice House, Haverhill, Mass., is designed for family members to prepare special meals for their loved ones, with a commercial kitchen in the background (above). The small kitchen (below) in the Hospice House of Hospice of Southern Maine, Scarsborough, and its cook are in full view from the dining room. Photos by Tom Mullinax, courtesy of Hospice Design Resource.

https://oig.hhs.gov/oei/reports/oei-02-10-00490.pdfhttps://oig.hhs.gov/oei/reports/oei-02-10-00490.pdf


ecutive Director Sharon Lutz. “Even if the patients ordered the meal, even if they were on respite in-stead of GIP and had a heartier appetite, they’d end up saying, ‘I don’t want to eat,’” she relates. “What we ended up doing was to work with our registered dietitian, who made us a week’s menu, including ready-to-eat entrees of various fla-vors, grilled cheese sandwiches, soups, green sal-ads—all based on high oral gratification and easy to prepare. We also have jello, apple sauce and fresh fruit. There is a substitute menu if a patient does not have the appetite for what is planned. We also try to bake something every day to enhance our warm, homelike atmosphere. We have a patient kitchen where all of these items are prepared for the highest food quality and safety.” The dietitian comes weekly, and as new patients arrive, to work with them on nutritional issues, diet modifications and special needs. On the other side of the facility is the Great Room with a family kitchen offering coffee, tea, milk, morning pastries and fresh fruit, with a fridge full of drinks. “We don’t provide or charge for for-mal meals to families. But they can bring in any-

thing from outside,” Lutz says. Stocking these food items costs about $100 a month, and the facility’s clinical manager goes shopping for them every Monday. “Staff in the facility will cook something up as needed—depending on how busy they are,” she explains. “My advice for other Hospice Hous-es: Keep it at a minimum to start and develop your food service based on your specific focus and needs. People have very different ideas about what they want to eat.”

A Hospice Café Out West

HHN-member HopeWest in Grand Junc-tion, Colo., has taken the food service function a step further with Spoons Bistro & Bakery, a cafe open to the public from 7 am to 9 pm except Sun-days, when it just serves brunch to the public, and offers discounts for hospice families and staff. “There is a synergy involved; it’s in the same build-ing as the Hospice House,” says HopeWest senior vice president and chief administrative officer Terri Walter. “We have an extensive menu inside the

Hospice of the Western Reserve’s Meal to Remember program (see page 3) brings celebrated local chefs into its two Hospice House facilities in Cleveland, Ohio, every month to prepare gourmet meals served on linen tablecloths to the residents and their family visitors (left). Below from left, a staff member from Crop Bar and Bistro applies finishing touches to a dessert to remember at David Simpson House. A menu from Paladar Latin Kitchen describes the Latin American specialties served to hospice patients and families. And a holiday meal prepared by Chef Rocco Whalen and staff of Cleveland’s popular Fahrenheit restaurant is accompanied by dinner music from a hospice volunteer. Photos courtesy of Hospice of the Western Reserve.


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Cushman’s Corner

What is the proper utilization of hospice inpa-tient care for patients discharged from the hospi-tal? Many people with advanced illness could really benefit from hospice inpatient care and inpatient facilities following their hospital stay—but how many have access to this special kind of care? Con-sultant Jay Cushman, President of Portland, Ore.-based Health Planning & Development, LLC, has dipped into the Medicare database to try to get a clearer perspective on these issues. “One of the benchmarks I have employed when judging the accessibility of hospice care for hospitalized patients is the balance between patients who are referred to hospice from a hospital and pa-tients who die as hospital patients,” he says. “These statistics can be read directly from a hospital’s dis-charge abstracts that give the counts of patients by discharge status. The discharge status code for a patient who dies in the hospital is 20, while the dis-charge status code for a patient referred to hospice is either 50 or 51, depending on whether the patient went home for hospice care or to a facility.” Cushman defines the end-of-life (EOL) pa-tient rate as the relative proportion of those dis-charged from the hospital directly to hospice care


Benchmarking the Utilization of Hospice Care Following a Hospitalization

versus those who die in the hospital. “I find that when there is excellent access to hospice care the balance of these counts is around 70 to 30. That is, for every 70 patients who are discharged (still alive) to hospice care, about 30 patients die in the hospital. So I measure a ‘target hospice percentage’ as 70 percent for EOL patients.” Overall, the average rate for EOL patients in U.S. hospitals in 2013 was close to 50 percent (see the chart at left). About 17 percent of the nation’s hospitals had hospice percentages of 70 percent or greater, but 25 percent had hospice percentages be-low 40 percent. “Conceptually, we want the EOL rate of referral to hospice to be as high as reason-ably possible,” he says. “Similarly, we want the per-centage of patients who die without hospice care within six months of hospitalization to be as low as reasonably possible. It is also possible to measure the ‘percentage of deaths without hospice’ using Medicare claims data,” he says. “Where there is excellent access to hospice care, I have found that the percentage of patients who die without hospice care within six months after a hospitalization to be 40 percent or lower. However, the average statistic for ‘deaths without hospice’ following a hospitalization in 2012-2013 was close to 50 percent.” (See the chart below). For more information about these data, contact Cush-man at: 503/636-3920 [email protected].


Hospice of the Panhandle...A Year Filled With Joys and Woes

For Margaret Cogswell, CEO of HHN-member Hospice of the Panhandle in Kearneysville, W.Va., the first year of running a Hospice House facility that opened in March of 2014 has been a heady mixture of joy and woe. “We’ve been in lockdown. We had a gas leak. But we raised $4 million, which was the biggest private funding campaign ever in our community,” she says. “I’m glad we did it. We’re providing a quality of care and of environ-ment that is far superior to anything else in our area. I wouldn’t go back and change things, but I’m glad we have that first year behind us,” says Cog-swell, whose agency recently celebrated its 35th an-niversary. “When we started doing our initial facility projections in 2006, it was a very different regu-latory environment than today. GIP level-of-care monitoring was not on anyone’s radar screen. The projections we did then are now useless, and from the conversations I’ve had with other hospices, those operating in the black at the time no longer are,” she says. The plan was to build 14 inpatient beds for a patient census of 180, which has since shrunk to 150 with a drop in average length of stay, but not provide residential-level care. “A lot of days of care that used to be billed at the GIP level couldn’t be justified today,” Cog-swell says. “Before you put a patient on GIP, you’d better be able to prove what you have done to try to manage them at home. That has not been the hospice community’s interpretation in the past. But that’s definitely our interpretation today, based on what we hear from around the country.” Cogswell says her hospice has not experi-enced large-scale GIP level-of-care denials, but she has tried to revise agency practice based on indus-try norms and to tighten up admissions processes. “We now have a full-time medical director and we try to put all of our eligibility and level-of-care de-terminations in one place (within the agency). We

also instituted a couple of quality reviews, one for patients referred but not admitted, and the other looking at all patient discharges and revocations,” she explains. “I spent a five-year capital campaign telling people in the community that we’d only do GIP and respite care. Now I have more beds filled with res-idential-level patients. Within our first six months we realized that if we didn’t put residential patients in those beds, they would be empty.” The hospice charges a room-and-board rate of $225 for patients on residential care, paid in advance for two-week periods and refunded if not utilized. “We’ve tried it a bunch of different ways. We tried to work flexibly with families, and I drove our staff nuts by trying to be as accommodating as possible. We finally said that’s enough. If you are at the poverty level, we’ll help you find a facility in the community. I’d love to be able to offer this service to everybody, but I can’t,” she says. “I had a hospice

colleague coach me early on by saying: If you base it on ‘ability to pay,’ nobody has the ability to pay for residential hospice care. But if you charge them up front, it’s just not an issue for many families.” One exception is for patients who are brought in on

This patient room shows the homelike atmosphere at the 14-bed Hospice House opened by Hospice of the Panhandle, Kearneysville, W.Va., a little more than a year ago.Photo courtesy of Hospice of the Panhandle.

CONTINUED ON PAGE 8

restaurant, and a more abbreviated menu for pa-tients, with soups, milkshakes, mac and cheese, comfort food, although they can order anything off the full menu. Dinner at Spoons is a little more formal, with table cloths, wait staff and dishes like Filet Mignon, halibut and salmon,” she explains. Spoons Bistro was recently awarded a TripAdvisor Certificate of Excellence award for its hospitality excellence, as voted by customers. “When family members are visiting, they of-ten come down and eat in the café. We also have a room called the family kitchen in the Hospice House, which is stocked with fruit, pastries, soup and frozen meals, stocked by our food service staff. Our café has a commercial kitchen and we serve everything from there. We contract with a food ser-vice management company to staff and manage our restaurant, and we pay them a management fee,” Walter says. “We probably could have figured it out on our own, but it’s been nice to have someone who really knows that business. We hit our stride recently with our great executive chef and wonder-ful general manager, who are included in our ad-ministrative team meetings.” Commercial-grade kitchens cost more, she adds. “Construction is more expensive, and state code requirements, such as a hood over the stove, add to the costs. But we want to be accessible to our community. We want family members to feel part of our community and come back to visit us. We have a great patio and local musicians perform there. We don’t have a liquor license but we have an agreement with a local winery to be a ‘remote tasting room’ for them. Patients can also order a glass of wine with their meals.” For more information, contact Tom Mullinax at: [email protected]; Leslie Griffith at: [email protected]; Sharon Lutz at: [email protected]; and Terri Walter at: [email protected].



GIP-level care while actively dying, and then their condition stabilizes such that they’re no longer eli-gible for GIP but are still actively dying. “Then the patient can stay and we’ll send the family a bill.” Two other challenges Cogswell faced in the first year of operation are the facility manager’s role and staff scheduling. “I’m on my third inpatient di-rector. We never did this before and we all had a lot to learn. The issues were more administrative than clinical, although the inpatient director also has to be available as emergency nurse to provide back-up on the floor. Initially I had the inpatient director reporting to me; now they report to our agency’s clinical director. This job is so much about patient care and the things that happen to patients, wheth-er at home or at the IPU. I am a nurse, but I’ve been in my administrative job for 28 years. My clinical skill set just isn’t there anymore,” Cogswell says. “We also made a decision to schedule 12-hour shifts for our Hospice House nurses and aides. There’s good and bad to that approach. Staff like the three-day weeks, and you end up with lower FTEs. But because we’re new and growing, we often rely on home care staff to help fill holes in sched-uling the unit, and they are on eight-hour days—so the schedules don’t match. We’ve had many con-versations about this,” Cogswell says. “Call-offs when census goes down can be nightmares. I’d love to have part-time pool staff who could come in at short notice, but the reality is, in this area, I can’t recruit for that.” The 14 beds are rarely all filled, Cogswell says. More often the facility is staffed for seven, and the agency brings in additional staff when cen-sus goes above seven. “I think we need to do a bet-ter job of outreach to referral sources—and to our own staff. Nobody in this community has much ex-perience yet with hospice GIP-level care or how to use it.” For more information, contact Cogswell at: [email protected].

HOSPICE OF THE PANHANDLE,CONT. FROM PAGE 7

mailto:tommullinax%40hospicedesign.org?subject=

Social Model Hospices: The “social hospice” model has been highlighted recently with a Huffington Post blog posting by author and hospice physi-cian Karen Wyatt, MD, and an article in the Tulsa World about Clarehouse, dubbed the “moth-ership” of social hospice homes. Dr. Wyatt said the social hos-pice, which is staffed and oper-ated largely by volunteers, grew out of the AIDS hospice resi-dences of the 1980s and now is needed again to “revolutionize end-of-life care” in order to ad-dress looming national shortag-es of family or paid caregivers for patients at the end of life. In Tulsa, Clarehouse, founded in 2003 by Kelley Scott in a rented three-bedroom apartment, has become a model for social hospices nationwide. In 2009, a new 10-bedroom fa-cility was built debt-free, with an outdoor chapel, offices, kitchen and den. Its annual bud-get of $1.1 million covers staff and other expenses, but guests are not charged to stay there. Another social hospice is now being built in Tulsa by Cath-olic Charities, and 75 people gathered in Tulsa in July for the third annual conference of the national Social Hospice Net-work. The Inn Between is a project designed to offer a Hos-pice House setting for terminal-ly ill, homeless residents of Salt

Lake City, Utah. Organizers held an emotional ribbon-cut-ting ceremony in May, then ran into the barrier of an emergen-cy temporary ordinance passed by the City Council to block its opening. It now appears to be moving forward as an unli-censed congregate living facility of up to 16 beds for residents who can exit the facility unas-sisted in case of a fire. The first volunteer Hospice House of its kind in Utah, it will be housed in a former convent and will also offer classes to clients and the public. Admission criteria include a terminal diagnosis or serious injury or illness that would qualify for home health care, and a referral by a health professional. According to its website, about 50 homeless res-idents of Salt Lake City die on the street every year.

Seven Cornell University stu-dents of various fields of-fered advice in April to Dale Johnson, Executive Director of HHN-member Hospicare & Palliative Care Services of Tompkins County, Ithaca, N.Y., and HOLT Architects, who are planning a new wing for the agency’s Nina K. Miller Hos-picare Center. In a seminar led by Paul Eschelman, professor of design and environmental health analysis at Cornell, stu-

Hospice House News & Notes From All Overdents presented their ideas for how to maximize the comfort and psychosocial support of hospice patients, with a focus on the patient’s experience. Examples include using re-motes for adjusting the cur-tains without having to get out of bed, offering bath towels in the patient’s favorite color, and adding light and views of na-ture to the patient rooms. “Our recommendations are concrete, with special configurations to show how rooms can be shaped to support the notion of con-tinuous change throughout the process of dying,” noted human biology student Michelle Cor-rea.


Evenings at Spoons Bistro and Bakery (see page 5), the café that serves patients of HopeWest’s Care Center as well as the public, wine is poured and the food gets a little fancier. Photo courtesy of HopeWest.

http://www.huffingtonpost.com/karen-m-wyatt-md/social-model-hospice_b_7641916.htmlhttp://www.tulsaworld.com/communities/bartlesville/clarehouse-in-tulsa-pioneers-social-hospice-care/article_1dd3f684-fdf9-5107-bee1-44601bfaabac.htmlhttp://www.theinnbetweenslc.orghttp://www.theinnbetweenslc.org

Our aim for the Hospice House Network and for this publication is that they will become indispensable resources for all hospices that have, are considering, or dream of building a Hospice House, as well as a forum for the exchange of information, tips and lessons learned. Tell us what you are planning and visit our website at http://hospicehouse.us for more information, additional photographs and links to other Hospice House resources. And if you have a new Hospice House, please send us a picture.

Call To The Field

Flutter is published by the Hospice House Network, founded by Jay Mahoney of the Summit Business Group, LLC, of Rochester, N.Y., in 2012 and currently under the management of Editor and Publisher Larry Beresford. For information about membership or content in the newsletter, contact him at 510/263-9446 or [email protected], or write to HHN at P.O. Box 2224, Alameda, CA 94105.

© 2015 by Hospice House Network. All rights reserved. Members are permitted to reproduce this newsletter for their internal use only. Other than that encouraged exception, no part of this publication may be reproduced, in any form or by any means, without prior written consent from the publisher.

This newsletter strives to provide timely and accurate information related to hospice care generally and to “Hospice House” matters specifically. Items in the newsletter are brought to our readers from a variety of sources, all of which are thought to be accurate and reliable. Nevertheless, it is specifically understood that the publication is not intended to provide legal or other professional services, counsel or advice. Readers requiring such services are encouraged to contact appropriate professionals.

We are moving and expanding our photo department to a publicly accessible page at www.hospicehouse.us, and any HHN members that want their own page with up to six photographs, captions and a brief description of the facility and its features are welcome to participate. Members may begin by downloading this form and following the instructions on the form. Contact publisherLarry Beresford at 510/263-9201 with any questions.

Would you like to feature your Hospice Housein the HHN Photo Gallery?


Question of the Hour:

What do you feel you have truly mastered from among all of the tasks involved in operating a Hospice House facility?

If you will share your answer with your peers, along with a sentence or two elab-orating on how you do it or what you have learned, we will share the answers in an upcoming issue of this newsletter.

The 14-bed Hospice House at Hospice of the Panhandle, Kearneysville, W.Va., (see page 7) was planned to provide mostly inpatient care, but in practice has also admitted residential patients.Photo courtesy of Hospice of the Panhandle.
http://hospicehouse.ushttp://hospicehouse.us/about/photogallery.htmhttp://hospicehouse.us/about/photogallery.htmhttps://drive.google.com/file/d/0B60HzOxhUzSaZUZ3LXhkd1huN3c/view?usp=sharing

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