MAP-IT Project

Joseph Mills

College of Central Florida

Community Nursing

NUR 4636C 

October 23, 2015 

MAP-IT Project 

Mobilize 

My community is the recipients’ of hospice care in Citrus County.  Because of the rural nature of this community, it is quite expansive. The Hospice of Citrus and the Nature Coast encompasses 12 counties. There are competing hospices overlapping on the north and the south of this region, Haven Hospice to the North and HPH Hospice to the South.  The impact to the areas smaller hospitals is significant, as well as, impact to social and support services and facilities. Hospice provides comfort and palliative care to the terminally ill and dying patients.

The population is comprised of the terminally ill with a diagnosis of less than six month to live and the actively dying. These include those with chronic and end stage diseases, injuries and illnesses. Hospice care is paid for through reimbursement from Medicare 74%, Medicaid 19%, employer based insurances and private insurance 4.5%, fund raising (dedicated thrift stores), and donations 2.5%. (Florida’s Certificate of Need Process, 2006, p. 6)  The primary stakeholders are the Patient, their families (through support care), the providers of care and the payer sources. Secondary stake holders are the area hospitals, overlapping hospices, local and state government, the area churches and community leaders, and various others indirectly involved. A coalition of both primary and secondary stakeholders is necessary to represent the interest of all concerned within this community to facilitate the raising and use of funds, logistical problem solving, and community education. (Dreher & Skemp, 2011)  

Assess 

The area demographics show Citrus County encompassing 581 square miles of rural North Central Coastal Florida. For the period of July 2012 to June 2013 (last period available), shows a total of 1,747 patients admitted to Hospice of Citrus County. Projected deaths for Citrus County for 2015 are 2,480 of which 1,723 are projected hospice patients.  (Florida Need Projections for Hospice Programs, 2015, p. 13) The County demographics show 35% of the population is over age 65. The overall population ethnicity is comprised of 88% White, 5.2% Hispanic, 3.1% Black and 0.4% Asian. Females make up 51.6% of the County population. (Citrus County Census, 2015) The characteristics of the Hospice population vary in age, gender, and ethnicity. Approximately 21% of the patients are admitted with some form of cancer; the other causes of terminal illness are heart failure, renal failure, end stage heart and lung disease and end-stage Alzheimer dementia. About 19% are under 65 years of age, with the majority, 72.7% over age 65. (Florida’s Certificate of Need Process, 2006, p. 15)  The percentage of those over 65 in this area now is 35.2%, one of the highest in Florida. The number of residents in Citrus County is projected to be near 55% over the next 8 to 10 years. (Florida Demographics, 2011)  There are currently two licensed programs serving this area with a population of 153, 965. The Comparison of the area demographics are contrasted sharply by some of the more densely populated areas of Florida. Flagler and Volusia counties are serviced by five licensed programs serving a populations four times as large as Citrus County at 646,858. The percentage of those over 65 is 25.8%. The combined area of the five counties, Baker, Clay, Duval, Nassau and St Johns, utilizes four licensed programs to service nearly 1.5 million people, with an even lower percentage of residents over 65 of 14.9%.  (Florida Need Projections for Hospice Programs, 2015, p. 12, 13)  

The hospice team is comprised of physicians, nurses, social workers, home health aides, bereavement counselors, volunteers and various members of the administrative team. There are currently 13 dedicated community leaders serving on the volunteer board. The In-house facility can accommodate 16 resident patients, with an additional 8 beds available in the Hospice Care Unit of Citrus Health and Rehabilitation Center. The remainders of the admissions are provided support and care in their home and places of residence, (nursing homes, veterans’ homes and jails). The education of the public to the services provided would provide for a larger support base as well as utilization for end of life options and palliative comfort care. ("Recognizing the need for hospice and palliative care," 2015)  The care of patients with terminal disease and illness, is best served by those institutions and personnel trained in the delivery of palliative and end of life care. (Hospice Demographic and Outcome Measures, 2014)

There are many National organizations and resources available. Some of these are American Academy of Hospice and Palliative Medicine, National Hospice and Palliative Care Organization, Children’s National Hospice, the International Association for Hospice and Palliative care, Hospice and Palliative Nurse Association, Hospice Foundation of America, and Hospice Net. Hospice of Citrus County is locally supported by Wings Grief Services, Fire and EMS services offering community education, and multiple levels of volunteering. Citrus County is a small rural community and as such the local resources are wide spread and are not very plentiful. Coastal land is very expensive for facilities but, much of the rural area offers mid range availability. The Median annual income is $39,100. (Florida Demographics, 2011)  By overlapping into surrounding rural counties the pool of resources are increased. (Florida’s Certificate of Need Process, 2006)

The top five problem areas for this community are almost entirely related to funding and support. 1. Additional facilities must be built or re-purposed to facilitate the growth of an increasing in-patient population. 2. Funds must be obtained for the addition of staff to provide services to the growing demographic requiring services. 3. Delineation of service boundaries to improve governmental reimbursements and market share, (certificate of need). 4. Availability of physicians trained in end of life and palliative care medicine and funds to attract them to the area. 5. Funds to educate the public and private sectors to promote the benefits, efficiency and cost savings of dedicated end of life services.

The impact of the five problem areas stated above are; first the ability to facilitate growing numbers of hospice patients in the next 5 to 10 years. Secondly, the continued support of the programs in place now and in the future.  Thirdly, there is the availability of trained personnel, physicians, nurses and home care techs, administrators, counselors and funding for the same. The impact of changes in the reimbursement by State and Federal government will create a deficit in funding. With the increase in the over 60 population, there will be an increased need for hospice services. Based on current demographics this will present an overwhelming burden to other healthcare systems not designed for this care. 

Plan 

To facilitate the five named problems of this community any plan must start with securing funding. In order to garner the strongest support, the community must be educated and informed to facilitate a buy-in by the primary and secondary stakeholders. Policymakers are essential to long-term growth and support. This can be achieved by educating them to the efficiency and cost savings of the role hospice plays in the future of health care. Educating the public both locally and at the state level will help in rallying constituent support to help persuade the policymakers to vote in support of policies that promote hospice and public health care. At a local level, education will bring attention and volunteer support as well as participation, which is necessary to build this program. Coalition members must include local officials and community leaders as participants.  This will help to insure the right fit for and participation of the community. With education and dissemination of information, the plan can capture the widest support and capture revenue to facilitate growth. As growth happens the niche is created to attract professionals within the health care fields. The local officials can canvas for state support to extend the reach of the rural communities and join them in a more conducive, cost effective collaboration to facilitate a certificate of need.  This would make available local support that may not be available to many because of such large service area with a low density of population. (Florida Demographics, 2011)   The outcome of the plan is to meet the goals specified with flexibility to accommodate the input of the coalition members to facilitate success and support for future growth.  

Implement 

A timeline must be developed utilizing the coalition members to set forth goals at three months, six months and annually, with specific responsibilities delegated and enumerated, and resources and barriers identified with frequent review. The specific action steps should be specific with individual timelines established. On review barriers can be realigned with specific action plans and adjusted timelines. (Dreher & Skemp, 2011)

The human resources necessary to implement the community plans calls for professional support of physicians, nurses, home health care aides, and social workers. Additionally, clergy, community groups, volunteers, area businesses and community leaders will needed to be involved. (Dreher & Skemp, 2011) 

Track 

In order to track the progress of the planned goals, monitoring must be established and recorded to report progress and findings necessary for the frequent evaluation by the coalition members. Trends in admissions and demographic data over time will need to be collected, to confirm the expected growth and needs. Staffing levels and area compensation must be trended, to remain competitive in hiring paid personnel. Government policy legislation must be monitored for important agendas, and votes pertinent to the goal direction. Education of the public and their understanding of hospice and its acceptance should be surveyed to monitor effectiveness of educational campaigns. Area hospitals should be surveyed for the necessity of staff education about their understanding of hospice and palliative care. Financial and budget data needs to be meticulously collected to show challenges and successes to the plan.

Forms for tracking the areas mentioned should be of simple design to easily capture data on a timeline aimed at specific goal dates. Both short term, 90 days or less and long term tracking at semiannual and annual dates should be established. Funding goals towards established plans can be in actual dollars. Public notice after review can establish trust and support from the community. (Dreher & Skemp, 2011)     

 

 

References

Citrus County Census [Census report]. (2015). Retrieved from http://www.census.gov/en.html

Dreher, M. C., & Skemp, L. E. (2011). Laying the Foundation for a Healthy Community Agenda. In Healthy places healthy people (2 ed., pp. 181-208). Indianapolis, IN: Sigma Theta Tau International.

Florida Demographics [Report]. (2011). Retrieved from http://edr.state.fl.us/Content/presentations/population-demographics/DemographicOverview_4-20-11.pdf

Florida Need Projections for Hospice Programs [Report]. (2015). Tallahassee, Florida: Certificate of Need Office.

Florida’s Certificate of Need Process Ensures Qualified Hospice Programs; Performance Reporting Is Important to Assess Hospice Quality [Report]. (2006). Tallahassee, Florida: OPPAGA Report Production.

Hospice Demographic and Outcome measures [Report]. (2014). Retrieved from http://elderaffairs.state.fl.us/doea/evaluations.php

Hospice Demographics and Outcome Measures [Report]. (2014). Retrieved from http://www.elderaffairs.state.fl.us/doea/evaluations.php

Recognizing the Need for Hospice and Palliative Care. (2015). Retrieved from http://www.valleyofthesunhomecare.com/recognizing-the-need-for-hospice-and-palliative-care/