Home Care and Hospice

• Patient Care Manager: Liz Leighton
• Medical Director: John McNamara, MD
• Pediatric Division Patient Care Director: Becky Bedore
• Pediatric Division Chief: Clark Smith, MD
• Pediatric Division Operations Strategist: Jonathan Sackett

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Types and ages of patients served

Home Care and Hospice provides service to newborns, infants, toddlers, preschoolers, school-aged children and adolescents. Twenty-one years of age is the usual age limit, but it may go beyond 21 if exceptional client conditions exist.

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Scope and complexity of patient care needs

Settings and sites where care is provided:

• Home and community-based services are provided to pediatric and young adult clients throughout the seven-county metropolitan area (Hennepin, Ramsey, Dakota, Anoka, Scott, Washington, and Carver) within a 30-mile radius from Children’s St. Paul and Children’s Minneapolis.
• The Home Care office is located at the 910 Medical Office Building, Minneapolis, MN 55404, Suite 300.
• Children’s Home Care and Hospice program is a system-wide program of Children's Hospitals and Clinics of Minnesota.

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The top five procedures/diagnoses encountered:

• Diagnoses:
  -- Prematurity/Newborn – Conditions originating in the Perinatal period
  -- Congenital Anomalies
  -- Neoplasms
  -- Respiratory
  -- Gastrointestinal
  -- Neurologic
• Procedures:
  -- Skilled nursing assessments
  -- Direct skilled nursing care
  -- Infusion therapy, including IV antibiotics, TPN, IVIG
  -- RSV prophylaxis (Synagis)
  -- Patient-family teaching

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Methods used to assess and meet patients’ care needs

Services (skilled nursing, social work, chaplain, child life, volunteer services and pharmacy) are provided to children and their families in the home and community setting.

Services provided include:

• Care coordination
• Intermittent home nursing visits
• Hospice care with multidisciplinary team members including MD, RN, SW, Chaplain, Child Life, Pharmacist and Volunteer – under the umbrella of Pain and Palliative Care services
• Medical social services/psychosocial intervention
• Home pharmacy services for infusion and enteral needs

Patient review includes home care and hospice multidisciplinary treatment teams conducting patient care planning as a part of regularly scheduled meetings. The planning meetings include:

• Hospice rounds.
• Home care and hospice advisory council.
• Patient review on the inpatient units.

The disciplines available to meet patient needs include:

• RNs.
• LPNs.
• Pharmacists.
• Social workers.
• Chaplain.
• Child Life.
• Volunteers.
• Physicians.
• Medical Directors.
• Psychologists
• Clerical.
• Administrative.

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How appropriateness, clinical necessity, and timeliness of support services are provided directly by the organization or through referral contracts

Care is provided according to the needs of the child and as ordered by the physician. Registered nurse care coordinators communicate with the physician and discharging institution, and the home care pharmacists, as appropriate, to set up the home care plan. Community health nurses provide care on an intermittent basis (e.g. one visit/day or one visit/week) as determined by the medical needs of the child and the learning needs of the family. When Home Care pharmacy is involved, pharmacists work closely with the family and nurses to assure safe and effective medication delivery.

Admission process:

• Within 24 hours of receiving referrals, an initial assessment of eligibility is made, and that initial decision regarding acceptance is communicated to the referral source.
• The final decision to admit a patient is made by the community health nurse following the first home visit.
• Home Care admits patients for service if:
  -- The patient’s medical, nursing, social, and/or pharmacy needs can be adequately met in the home environment.
  -- Competent staff is available to provide services at the required level of intensity.
  -- A licensed physician directs treatment and prescribes the plan of care.
  -- The patient’s home is within the identified geographic area

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Home Care and Hospice has no referral contracts

Availability of necessary staff

Hours of operation:

• Regular office hours for home care nursing and pharmacy 0800-1630 Monday-Friday. Scheduled home visits are made until 9:00 p.m. Weekend Hours – 8 :00 AM to 9:00 PM Community health nurse coverage for acute visits and newly referred discharges.
• RN on-call coverage for emergent home visits 24 hours/day, seven days/week. Pharmacy on-call coverage for infusion needs 24 hours/day, seven days/ week.
• Pager: On-call RN and on-call pharmacist carry pagers and are contacted by the answering service.
• Answering service (provided through Children’s Physician Network answering service).
• A service agreement is developed with each client that meets Minnesota licensure regulations and states a contingency plan for the delivery of essential and nonessential home care services.
• The client’s individualized service agreement and the program business cards show how they are to secure service after regular business hours. Clients are to call the regular home care and hospice office number (612-813-6246) 24 hours/day and 7 days/week. After regular office hours, their call will be automatically routed to the answering service.

Availability of home care staff members:

• Master staffing plan:
  Monday-Friday:
  -- RN care coordinators – five.
  -- Community Health RNs.
  -- Five-six CHNs on days and three-four CHNs on evenings.
  -- Social work – two on days.
  -- Chaplain – six days per pay period and as needed.
  -- Child Life – five days per pay period and as needed.
  -- Pharmacists – two on days
  -- Pharmacy techs – two on days
  Saturday and Sunday:
  -- Triage nurse– one on days.
  -- CHNs one-two days and one-two evenings.
  -- On-call social worker available.
• On-call community health nurse is available after hours and weekends.
• On-call pharmacist is available after hours and weekends.

Staffing level is determined by:

• Volume and intensity of services.
• Productivity levels.
• Projecting staff needs based on historical needs and modifying as necessary.
• Acuity of patients.
• Technology in use.

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Extent to which the level of care or service provided meets patients’ needs

Patients are only accepted for admission if Home Care and Hospice is able to provide the resources necessary to provide safe and appropriate care. If a patient has a change in status that requires a greater level of support than available through Home Care and Hospice, the patient would need to be transferred to the inpatient setting for care.

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Recognized standards or guidelines for practice used

• American Nurses Association.
• Association of Pediatric Oncology Nurses.
• Infusion Nursing Society.
• National Hospice and Palliative Care Organization.
• National Association of Home Care.
• NACHRI – National Association of Childrens Hospitals and Related Institutions.
• Children’s Hospitals and Clinics organization procedures.
• Children’s Hospitals and Clinics nursing clinical standards.
• Minnesota Board of Pharmacy
• American Society of Health System Pharmacists