Latino Hospice Program at
VNA Care Network & Hospice
Patient Navigation and Community Education
to Reduce Disparities in End-of-Life Care
VNA Care Network & Hospice
1
Introductions
Jacquelyn Toledo
Latino Client Navigator
VNA Care Network & Hospice
Cathy Romeo, VNA Care Network & Hospice
2
Introductions – the Group
 Name
 Where you work?
 Any CHWs?
 Special population(s) you
work with
 What super power you would choose to have
and why?

derived from OWTI of CMAHEC, Inc.
Cathy Romeo, VNA Care Network & Hospice
3
Ground Rules
 Start on time and end on time
 Time keeper
 Vibes watch keeper
 Silence cell phones
 Only one person speaks at a time
 Step Up, Step Back
 No side conversations
 Respect others’ opinions
 Confidentiality within the group
Cathy Romeo, VNA Care Network & Hospice
4
Break-Out Session
Objectives & Agenda
Objectives
 History of the project and why it
was implemented


General VNACN&H history
& Hospice Knowledge

“Hospicio” – Perceptions,
Experiences, Challenges

Tools & Resources

Next Steps

Q&A, Evaluation
 Case Studies
 Provide education on how
PN/CHWs can impact
inequalities with end-of-life care
& improve better dying
experiences
Agenda
Welcome and Introductions
Cathy Romeo, VNA Care Network & Hospice
5
Pre-Test
Q&A
 What is Hospice?
 What is a Latino?
 How can you qualify for hospice?
 What is Palliative Care?
 What is a CHW?
 Is the VNACN&H private or non-
profit?
 When was the VNACN&H founded
or years in service?
Cathy Romeo, VNA Care Network & Hospice
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VNACN&H
 A Medicare-certified home care agency providing skilled
services, palliative and hospice care, and wellness
services
 Service 200 communities in Eastern & Central
Massachusetts
 Care provided in homes, nursing facilities, and three
hospice residences.
120 Thomas Street
Worcester, MA 01608
(800) 521-5539
Website: www.vnacarenetwork.org
Cathy Romeo, VNA Care Network & Hospice
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Hospice & Palliative Care
 Special concept of care designed to provide comfort
and support to patients and their families when a lifelimiting illness no longer responds to cure-oriented
treatments

Palliative Care – Care Choices© Program





pain & symptom mgmt
t/i disease process
focuses on comfort
still have access to specialized clinicians
Hospice



like Palliative care
deals with the emotional, social and spiritual
impact of the disease on the pt, pt’s family and
friends
Offers variety of bereavement and counseling
services before & after a pt’s death
Cathy Romeo, VNA Care Network & Hospice
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Hospice History
 word “hospice” stems from the Latin word “hospitium”
meaning guesthouse
 used to describe a shelter for weary & sick travelers
returning from religious pilgrimages
 1960’s – Dr. Cicely Saunders began the modern
hospice movement


St. Christopher’s House near London
team-approach developed for professional CG
 1974 – 1st hospice in the U.S. in New Haven, CT
 VNACN&H – 1st hospice agency in MA to be certified
by Medicare
Cathy Romeo, VNA Care Network & Hospice
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Hospice History Continued
 Today – over 4,700 hospice programs in the U.S.
 Hospice programs cared for 965,000 people enrolled
in Medicare in 2006**, and nearly 1.4 million in the
U.S. in 2007*

Most health insurance plans have hospice benefit
 Hospice is not a place but rather a concept of care
 80% provided in pt’s home
 inpatient hospice facilities, hospice residences
*nhpco
**CMS
Cathy Romeo, VNA Care Network & Hospice
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Multicultural Services
Established in 2001 to improve the VNA’s cultural
competency and to increase cultural awareness
and sensitivity.
Cathy Romeo, Manager
Multicultural Services
VNA Care Network & Hospice
175 Highland Avenue
Needham, MA 02494
(888) 663-3688, Ext. 4528
FAX: 781-444-5393
Email: cromeo@vnacarenetwork.org
VNA Care Network & Hospice
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The Face of
Massachusetts
Over 20% of MA
residents speak a
language other than
English at home. One in
seven (14%) Bay State
residents were born in
another country.
2010 Census and Annual Updates,
MDPH Community Reports
12
National Research
 National Hospice & Palliative Care
Organization (NHPCO)

Focus groups conducted in 2006
 Findings: Health disparities in
quality end-of-life care for Latino
population
 Disparities in diverse populations
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Health Disparities
 “…health disparities adversely affect groups of people
who have systematically experienced greater obstacles to
health based on their racial or ethnic group…or other
characteristics historically linked to discrimination or
exclusion”
-- HealthyPeople.gov
 Health disparities are differences in incidence, prevalence,
mortality, and burden of diseases and other adverse health
conditions that exist among specific U.S. population groups.
Latinos, for example, suffer various disparities in cancer, chronic
disease, obesity and other conditions.
--SaludTodayBlog, by UT Health Science Center San Antonio
http://ihpr.uthscsa.edu/disparities.html
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NHPCO’s efforts to reduces disparities
in Latino Population
 # of Latinos in the U.S. continues to
increase

felt strongly to expand outreach and
programmatic efforts to ensure
Latinos receive quality end-of-life care
 NHPCO’s Caring Connection created
a Latino Outreach Guide

key findings from focus groups:



advance care planning
end-of-life caregiving
hospice
15
Why did we focus on end-of-life care for
the Latino community?



Few Latinos utilized our hospice services.
NHPCO effort to decrease disparities in care
for Latino populations.
Senior management asked for a plan.
VNA Care Network & Hospice
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VNACN&H ‘Leading Change’
 Communicate Vision for Change
 Educate & Empower Staff
 Create Short-Term Wins and Long-
Term Goals
 Reinforce Change
 Build Reputation in Community and
Among Referral Sources
John P. Kotter, Harvard Business School, author of
seventeen books on leadership and change
VNA Care Network & Hospice
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Asking the community
 Never plan
for the community -- plan with the community!
 Contracted with Central MA AHEC to conduct focus groups and key
informant interviews within the Latino population
 Sought and received partial funding from BCBS Foundation
 Reports compiled
VNA Care Network & Hospice
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“Hospicio”
Individual & Cultural Perceptions & Challenges
 Negative connotation
 A place of abandonment of person or





child
An asylum
“…the ones that come to the house
to kill the patient”
“…they help you die faster”
A place to go and die
Take place of family’s role
VNA Care Network & Hospice
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First Steps

Latino Hospice Program initiated in 2009

Latino Hospice Advisory Board developed

Culturally-Relevant Bilingual Patient and Community
Educational Materials Created

Patient Navigator/CHW role created
VNA Care Network & Hospice
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PN/CHWs Different from
other Health Professionals





Hired for their understanding of the populations
Conduct outreach
Provide services in community settings
Promote, support, protect the health of individuals, families, communities
Perform four primary functions:
1.
client advocacy
2.
health education
3.
health system navigation
4.
outreach

Have various job titles

Health Educator

Health Advocate

Outreach Worker

Patient Navigator

Promotor(a) de Salud, etc.
MA DPH http://mass.gov/dph/communityhealthworkers
sampled from OWTI of CMAHEC, Inc.
VNA Care Network & Hospice
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CHWs are NOT clinicians!
 “CHWs working side by side with clinicians and registered
nurses, providing adjunct care in chronic conditions”
 the licensed health professionals carry out essential clinical
tasks
 CHWs do not substitute for the clinical role of the licensed
health professionals
 …(CHWs are) assuming responsibilities for the social and
routine aspects of chronic care”
CHWs in Chronic Care Discussion Paper
http://www.communityhealthworks.org/images/CommunityHealthW
orkersandChronicCare.pdf
Sampled from OWTI of CMAHEC, Inc.
VNA Care Network & Hospice
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Latino Client Navigator @VNACN&H
Community Services
 attend health fairs; meet with physician practices; church groups
community education & outreach; informal counseling; social
support; advocacy
 participation in Latino Advisory Board; ongoing support

Internal Services
 staff and patient support (in-services, end-of life cultural views,
Latino hospice)
 identification of diverse patient education materials
 translation projects: patient information documents, brochures,
website pages
VNA Care Network & Hospice
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“Calidad de Vida”
www.nhpco.org
VNA Care Network & Hospice
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General end-of-life care knowledge
 Unclear on where care can be received
Pt’s home, nursing home, ALF, RMHH
Replaces the family
 The nurse helps care for pt/teaches
the family
 Pt/family decide who else from team
allowed in the home
Only for the elderly
 Affects all age groups
Only for people with cancers
 Other debilitating diagnoses
To young to talk about this stuff
Advance Directives – taboo to talk about
death






VNA Care Network & Hospice
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Tools/Conversations Starters

 Share
What are your thoughts about your
mom’s illness?

 Ask


 Make it clear
 Discuss action steps
Explore goals for next few months,
etc.



Have you thought about what you
may need?
Hospice one of best ways to keep pt
home with family


Anything afraid of?
Finding clinical findings accurate?
vs. 1 year ago?
It can be difficult to do it alone


Learned so far?
Worries regarding her prognosis?
Have you heard of it?
Explore readiness & importance

VNA Care Network & Hospice
Meet them where they’re at
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Case Studies
 Case #1: Don Santiago
and Aurelia’s Dilemma
 Case #2: Consuelo &
Maria’s Dilemma
VNA Care Network & Hospice
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Utilization Increases
total #
monthly average
% +/-
 2010
32
2.66
↑
 2011
36
3
↑
 2012
39
3.25
↑ 24%
VNA Care Network & Hospice
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Finalist Innovation Award
 3rd Annual Nonprofit Awareness
Day -- June 2011
VNA Care Network & Hospice
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Continuing Steps to Success
 Continue to educate wider community




about culturally-sensitive end-of-life care
that supports traditional Latino values &
enable families to care for loved ones at
home
Maintain effective staff education
Maintain Latino Advisory Board
Identify translation, resource needs
Offer our expertise to Atrius and others to
enhance community development
partnerships
VNA Care Network & Hospice
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Resources
 National Hospice and Palliative Care Organization

http://www.nhpco.org/
 Central Mass AHEC

http://www.cmahec.org/
 U.S. Department of Health and Human Services

http://www.hhs.gov/
 UT Health Science Center San Antonio

http://ihpr.uthscsa.edu/disparities.html
 Centers for Disease Control and Prevention

http://www.cdc.gov/minorityhealth/CHDIReport.html?s_cid=fb2326

Health Disparities & Inequalities Report -- analyzes recent
trends and ongoing variations in health disparities and
inequalities.
 Hospice Foundation of America

http://www.hospicefoundation.org/
VNA Care Network & Hospice
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Post-Test
Q&A
 What is Hospice?
 What is a Latino?
 How can you qualify for hospice?
 What is Palliative Care?
 What is a CHW?
 Is the VNACN&H private or non-
profit?
 When was the VNACN&H founded
or years in service?
Cathy Romeo, VNA Care Network & Hospice
32
Break-Out Session
Objectives & Agenda
Objectives
 History of the project and why it
was implemented


General VNACN&H history
& Hospice Knowledge

“Hospicio” – Perceptions,
Experiences, Challenges

Tools & Resources

Next Steps

Q&A, Evaluation
 Case Studies
 Provide education on how
PN/CHWs can impact
inequalities with end-of-life care
& improve better dying
experiences
Agenda
Welcome and Introductions
Cathy Romeo, VNA Care Network & Hospice
33
Thank You!
Jacquelyn Toledo, Latino Client Navigator/CHW
VNA Care Network & Hospice
Phone: (508) 361-2699
Email: jtoledo@vnacarenetwork.org
VNA Care Network & Hospice
34