Hospice & SNF Admins: Pain, Perspectives, & Referrals

It’s very clear that at the end of the day, it’s not the nurses, social workers, event coordinators  or office managers in the facilities who make the decision if that facility is hospice minded or even which agency to choose to have a relationship with. They have input and influence, to a lesser or greater degree, but without overcoming the objections of the people at the top who set the tone and direction, you will not develop a consistent referral source. This tends to hold true across the board, for example, an oncologist group clinic where the nurse manager, nurses, and office staff take their direction from the doctors.

The Journal of Palliative Medicine published a study examining nursing home hospice and the perspective of nursing home admins.

Their conclusion was, “Nursing home administrators’ attitudes toward hospice may influence its availability for nursing home residents.” Source

While facility staff might have heavy case loads and turnover, the admins, aside from setting the direction for a facility given their position, are typically longer term, more stable fixtures within a facility. To build a facility into a stable and long-term recurring source of referrals you must resolve the admin’s issues and adjust their perspective to be hospice-minded and for it to be your hospice.

All The Puzzle Pieces

In our previous article we discussed the value hospices deliver to SNF’s in terms of financial benefits, such as bed hold rates & hospitalizations. Click here to check out the article:  https://www.hospicetools.com/get-hospice-referrals-how-hospice-helps-snf-admins/

But those financial benefits are just one piece of the puzzle and need to be viewed in context.

1st, the SNF isn’t making money off hospice, the value hospices bring financially is that it pretty much just offsets a good chunk what they would have made had the patient stayed under their auspices.

2nd, in many facilities, even those who are pretty good at utilizing hospice, the amount of patients on hospice at any given time are an extremely small percent of revenue.

3rd, even if the value of  hospice offsets the full amount of what they otherwise would have made, is it worth the extra hassle to them to trade dollars?

Talking about finances is super-important, it’s a pain point but it isn’t enough. To build a referral source we need to understand the real pain and adjust the admin’s perspective.

Admin Pains & Perspective

According to the Journal of Palliative Medicine, only approximately 10% of patients dying in a SNF are receiving Hospice care. The key factor in hospice referrals from a SNF is whether the SNF administrators believes their is real value being delivered above and beyond the 24/7 care they are providing.

“Nursing home administrators were less likely than hospice administrators to believe that hospice improves quality of care for pain, emotional and spiritual needs, and bereavement support. Nursing home administrators were more likely to agree that, “Nursing homes provide good care without using hospice for dying residents and their families.” Source

It’s not that SNF administrators aren’t ‘hospice-minded’, it’s that they don’t believe your hospice will bring their patients any more benefit than what their own staff can provide. 

Furthermore, a recent study from the Journal of Palliative Medicine shows that the communication between hospice clinicians and nursing home clinicians decreases referrals to hospice.

“Better communication with residents/family members was statistically significantly (p = 0.015) associated with fewer in-hospital deaths. However, better communication among providers was significantly (p = 0.006) associated with lower use of hospice… Improved communication between providers appears to reduce, rather than increase, NH-to-hospice referrals.” Source

A Guest In Their Home

One of the most powerful lines we’ve heard when doing consents with families at home was, ‘we are guests in your home.’

When describing to a family what it means to have a care team coming in and out of their home, we are guests in your home tells them that our team will be respectful, thoughtful, mindful, and will take direction from them. Not only is the care team a group of strangers coming in to provide a service, it is a particularly delicate and important service. Acknowledging that up front, and having your care team acting accordingly, is a powerful statement.

Hospice delivering standard care a patient in a facility (not continuous care or respite) is also considered treating a patient at home. A 97 yr old dementia patient in a facility and a 30 yr old cancer patient being treated in their home and both in the same benefit period and county (wage index) will bill at the same rate.

Side note: While your hospice may bill the same amount, depending on Room & Board, your agency will make less, and worse, it can be a huge hassle to track and require additional expensive software – unless you’re using Hospice Tools. Check out our built-in Room & Board solution article here: https://www.hospicetools.com/the-hospice-room-board-solution/

Your hospice agency bills at the same rate whether the patient is in a facility or in their own home because wherever they are living is their ‘home.’

But it’s also the admin’s home.

Your care team is entering into the admin’s home. Do they treat the facility and staff the way they do a private home and family? Are they respectful, mindful, and thoughtful? Or, do they treat it as their own home and that the staff should take note of their needs?

While the average hospice nurse has a caseload between 12-16, a SNF provider may have 100+ and changing constantly.  They don’t have time to talk with your clinicians and frankly, don’t really want to; they’re health care providers, they don’t want to be told what to do or guided or instructed by people who come in once in a while to handle a few patients.

Communication between hospice clinicians and SNF staff should be kept to the minimum and when absolutely required, should be communicated with the same respect they would show the family of a patient in their home.

5 Tips to Address SNF Admin Pain Points

To build a relationship with a SNF admin, you need to:

A. Assure them that your team will be respectful of the facility and will be respectful of the staff – especially as it relates to their staff’s time and expertise.

B. Respect. Your team is there to help, not replace or teach or educate other clinicians.

C. Manage the communication. The more communication that can be run through the marketer and through the hospice office staff by fax/email, the better.

D. Make life easy. From referral to after a passing, you’re there to help and need to work in their system, not educate them to work in yours.

E. Communicate the right message: Telling a SNF admin that your team delivers awesome care is like bringing a dish over for dinner to the home of a chef – and even worse, you prepared a dish that they’re well-known for! They have round the clock care. When it comes to care, studies show “They [SNF admins] indicate positive attitudes toward Hospice care coordination, and that Hospice should supplement, as opposed to replace, the care provided by facilities.” Source

Talking about great care won’t get you in the door but delivering great care will help keep you there. Understanding and addressing their pain points is what allows your team the opportunity to showcase their care.

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