The North Dakota Nurse - July 2022

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Page 4 The North Dakota Nurse July, August, September 2022 Palliative Care Awareness and Education in North Dakota Nancy E. Joyner, MS, CNS-BC, APRN, ACHPN® National Palliative Care Definition A definition of palliative case was identified by the Center to Advance Palliative Care (n.d.) as follows: Palliative care is specialized medical care for people living with a serious illness. This type of care is focused on providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a specially trained team of doctors, nurses and other specialists who work together with a patient’s other doctors to provide an extra layer of support. Palliative care is based on the needs of the patient, not on the patient’s prognosis. It is appropriate at any age and at any stage in a serious illness, and it can be provided along with curative treatment. (para. 2) Background of Palliative Care Awareness in North Dakota On May 19, 2015, “Quality Care with Palliative Care in Cancer” was presented at the North Dakota Cancer Coalition annual meeting in Bismarck. There was discussion on how palliative care could be added to the qualityof-life aspect of the ND Cancer Control Plan. In October 2015, American Cancer Society/ Cancer Action Network’s (ACS/CAN) North Dakota Cancer Summit focused on palliative care. During the 2016 ND Cancer Coalition annual meeting, a dedicated breakout time was palliative care. Most attendees did not know exactly what palliative care is, where palliative care services were being provided across the state, and what services were provided. To understand the status of palliative care in North Dakota, it was decided by those attending the breakout session to conduct a statewide survey of health care facilities and programs to include any diseases that could benefit from palliative care. To begin the process, a small group of individuals convened to develop and deploy this survey. Members of this survey workgroup, representing state programs, included: • Lynette Dickson (ND Center for Rural Health) • Sally May (Quality Health Associates & Honoring Choices® North Dakota) • Nancy Joyner (Nancy Joyner Consulting) • Sara McGaurvran and Deb Knuth (ACS/ CAN) • Joyce Sayler (ND Dept. of Health) Goals of the survey were to: • increase awareness of and access to palliative care in North Dakota where current gaps exist and • develop a baseline for ND palliative care services. The survey demonstrated more awareness and education was needed throughout North Dakota. ACS Cancer Action Network sought support from the legislature to assemble an advisory committee, focused on palliative care needs in the state. In 2017, Senator Judy Lee reached out to Tracee Capron (Hospice of the Red River Valley) and Patricia Moulton (ND Center for Nursing) to assist with the 2017 Resolution 4010. The formation of state palliative care legislation would maximize the effectiveness of palliative care initiatives in the state by: • providing substantial cost reduction and • improving awareness, education, and workforce about palliative care The goal of this work was to adapt the taskforce into action-oriented workgroups of statewide partners, addressing the palliative care needs in ND. On June 27, 2017, a face-to-face meeting was held in Fargo at Hospice of the Red River Valley. Presenters were: • Nancy Joyner – Palliative Care Survey results and finds • Donelle Richmond – ANA palliative Care paper • Deb Knuth – SCR 4010 • Lynette Dickson – Community needs assessment • Judy Beck – ND statistics North Dakota Palliative Care Taskforce The North Dakota Palliative Care Taskforce (NDPCTF) (2022) assembled workgroups, focused on palliative care access, awareness, and needs in the state: • Provider Education • Access and Reimbursement • Definition and Community Awareness Provider Education Workgroup Members Name Donelle Richmond Doris Vigen Discipline, Representing/ Organization APRN, Fargo, Sanford RN, Mayville, ND Center for Nursing/Sanford Mayville Judy Beck Karen Semmens Kris Hendrickx Nancy Joyner Tracee Capron Liz Sterling- chair Phyllis Heyne- Lindholm Jesse Tran Sara Anderson Minot, Quality Improvement Program Manager APRN, Grand Forks, UND APRN, Grand Forks, UND APRN, Grand Forks, Nancy Joyner Consulting RN, MAOL, Fargo, Hospice of the Red River Valley RN, Fargo, Hospice of the Red River Valley PT, DPT, Bismarck, St. Alexius PhD, Bismarck, NDDOH Comprehensive Cancer Control Program Director ASC Cancer Action Network ND The Provider Education Work Group’s task was to make recommendations to improve access to information that will enhance the understanding of palliative care by providers in all areas of North Dakota. The group also hoped to increase opportunities for members of academia to disseminate information to professionals in the state. The work group members met over the past year and would like to make the following recommendations to the task force. Key Topics: • Access to educational information: RHIHub, Center for Rural Health, was deemed necessary. • The platform will provide information that is current by designating a plan or organization to check the site at least annually. • There is a responsible group to update the information–consider the North Dakota Hospice Association. • The platform has flexibility to house relevant education and training opportunities • Interface with academia needed to be considered. • UND College of Nursing in this workgroup will consider: • Develop programming for students • Program information in the form of posters or other presentations, and • Shared at state conferences or professional meetings.
July, August, September 2022 The North Dakota Nurse Page 5 The following items also need to be considered: • Professional training opportunities for healthcare • End of Life Nursing Education Consortium training modules • Clinical specialties–individual training requirements • Directed by national professional organizations • Center for Rural Health Project ECHO • Implement standard education for providers Access and Reimbursement Workgroup Members Name Tracy Freidt Deb Knuth Shannon Bacon Nick Hillman Nancy Joyner Tim Blasl Jean Roland Courtney Vroman Tracee Capron Sue Heitkampchair Lynette Dickson Courtney Koebele Discipline, Representing/ Organization RN, Bismarck, Sanford ACS Cancer Action Network ND ACS Cancer Action Network ND RN, Bismarck, Sanford APRN, Grand Forks, Nancy Joyner Consulting President, Bismarck, NDHA Minot, Quality Improvement Program Manager Fargo, Hospice of the Red River Valley RN, MAOL, Fargo, Hospice of the Red River Valley RN, CHI, Fargo MS, RD, LRD, Associate Director, State Office of Rural Health, CRH, GF JD, ND Medical Association- Bismarck Types of Palliative Care to Access • Community-based care includes a variety of models of care designed to meet the needs of seriously ill individuals and their families, outside of the hospital setting: • Independent entity • Affiliated with health system or hospital • Separate Business Line of Hospice or Home Health agency • Affiliated with physician practice. • Hospital-based: • Consult services • In-patient Increase Access (community/providers), using GetPalliativeCare.org provider directory tool. • The Community HealthCare Association of the Dakotas (CHAD) will share where current palliative care is offered. Reimbursement • Many private insurance companies and health maintenance organizations (HMOs) have some benefit, mostly fee for service for providers. • In 2017, extra Medicare plan (Part B) offered some palliative care benefits. • Medicaid coverage of hospice and palliative care for people of limited incomes varies by state • Fee for service, shared savings, or capitated payment model • Endowments, grants, or fundraising • Financial contributions • Risk Sharing arrangements • Single-Payer • Accountable Care Organizations (ACO) Definition and Community Awareness Workgroup Members Name Caleb Christiansen Trina Kaiser Discipline, Representing/ Organization Hospice of the Red River Valley, Fargo MD, Bismarck, Primecare Rochelle Schaffer Shannon Feistchair Katie Ambuehl Kristi McCarty Mary Sahl Nancy Joyner Tammy Theurer Theresa Behrens Joyce Sayler Tracee Capron RN, Bismarck, Hospice Sanford APRN, Bismarck, Sanford LSW, Fargo, Essentia -Memory Care of the RR Valley DON, Jamestown, Sisters of Mary of the Presentation Health System Nurse Educator, Harwood, Sanford APRN, Grand Forks, Nancy Joyner Consulting Director, Bismarck, CHI RN, Fargo, Sanford Hospice ND DOH, Bismarck RN, MAOL, Fargo, Hospice of the Red River Valley • Standard definitions to define palliative care and hospice (Created by the NDPCTF Definition Workgroup, posted on the Center for Rural Health website, 2020) • Comparison table to show the similarities/ distinctions • Diagram to show the progression of care over time • A wider range of learning styles • Some type of logo for the NDPCTF Palliative Care Education in North Dakota In 2017, Stratis Health Project (2017-2020), originally the North Dakota Rural Community- Based Palliative Care project, was chosen by Stratis Health for a multi-state effort to increase access to palliative care services in rural communities. North Dakota, Wisconsin, Minnesota, and Washington collaborated in this multi-faceted project to increase access to palliative care services in rural communities and improve quality of life and quality of care for those with advanced illness and complex care needs. • North Dakota Rural Community-Based Palliative Care project was chosen by Stratis Health (2022) for a multi-state effort • Tiered approach: Washington, North Dakota and Wisconsin • Based on Rural Community-based Palliative Care Toolkit being developed The following goals were developed: • Increase access to palliative care services in rural communities • Improve quality of life and quality of care for those with advanced illness and complex care needs. In 2018, a new serious illness definition emerged with new messaging, which reads, “A health condition that carries a high risk of mortality and either negatively impacts a person’s daily function or quality of life or excessively strains their caregiver” (Kelley & Bollens-Lund, 2018, para. 7). This is the definition of ‘Serious Illness’ that is used in the 4th edition of the National Consensus Project Guidelines for Quality Palliative Care (NCP) was critical in removing prognosis and lessening end-of-life/ hospice mindset to defining palliative care. During this time, the Center for Rural Health’s Flex Program appropriated grant funds through August 2022 to promote statewide palliative care by: Full or Part Time RN or LPN Wages depend on experience Starting LPN $24.85/hr • RN $31.81/hr For More Information Contact Kasey Brandenburger, RN DON kasey.brandenburger@stgerards.org 701-242-7891 St. Gerard’s Community of Care • Hankinson, ND Stgerards.org • Offering ND POLST CME on demand online, • Offering monthly ND POLST CE live virtually, • Providing ongoing Project ECHO sessions: Organizing Palliative Care for Rural Populations TeleECHO, and • Expanding rural community-based palliative care throughout ND. When the COVID pandemic emerged in 2020, the NDPCTF efforts were paused. However, in November 2021, a renewed interest in ND’s Palliative care awareness and education emerged. North Dakota’s state senator Judy Lee and State Health Officer Dr. Nizar Wehbi have joined forces to assist in the National Academy for State Health Policy’s efforts to build and support Palliative Care. Call to Action Your help is needed. Please unite the efforts in advancing palliative care awareness, education, and implementation by joining the ND Palliative Care Taskforce and share with others. Reference Kelley, A. S., & Bollens-Lund, E. (2018). Identifying the population with serious illness: The "denominator" challenge. Journal of Palliative Medicine, 21(S2), S7–S16. https://doi.org/10.1089/jpm.2017.0548 Resource Links Center to Advance Palliative Care (CAPC): https://www.capc.org/ Center for Rural Health: https://ruralhealth. und.edu/assets/746-17373/palliative-hospicecare-flyer.pdf Get Palliative Care.org: https:// getpalliativecare.org/ National Academy for State Health Policy/ Palliative Care: https://www.nashp.org/ palliative-care/ North Dakota Palliative Care Taskforce: https://www.qualityhealthnd.org/contracts/ palliative-care-task-force/ Palliative Care or Hospice Care Flyer (Created by the NDPCTF): https://ruralhealth. und.edu/assets/746-17373/palliative-hospicecare-flyer.pdf North Dakota POLST Awareness, Education, and Implementation CE: https://www. honoringchoicesnd.org/event/polst-awarenesseducation-and-implementation-10/ Rural Health Information Hub (RHIHub)/ palliative care: https://www.ruralhealthinfo.org/ search?q=palliative+care UND’s Project ECHO/ Palliative Care: https:// ruralhealtAwh.und.edu/projects/project-echo/ topics/palliative-care
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