Presentation Outline: The Missouri Department of Health and Senior Services Bureau of Home Care and Rehabilitative Standards will provide a very informative session regarding the hospice regulation and survey process in Missouri. The session will include statistics, most frequently cited deficiencies, bereavement program requirements, and plan of care development. The Bureau staff will provide attendees with survey forms and tools, give real life examples of deficiencies, ideas for an individualized plan of care, and tips to ensure success with your next survey. You can anticipate and be excited to play hospice regulation Family Feud with the presenters! Objectives: Provide hospice providers with Missouri hospice statistics Explain actual immediate jeopardy scenarios and contributing factors Increase attendee knowledge on the recertification survey process Gather detailed information on a successful hospice plan of care

LEADING A FAMILY GOAL SETTING CONFERENCE FOR SERIOUSLY ILL AND DYING PATIENTS AND THEIR FAMILIES 1. What is the need for this type of training? Clinicians who care for seriously ill and dying patients need to meet with patients and families to discuss prognosis and make recommendations to continue, withhold or withdraw life sustaining treatments. Clinicians often struggle with these conversations and the medical-legal, emotional and conflictual issues that arise. Failure to successfully lead these conversations leads to: • Uncertainty, anxiety and unnecessary suffering by patients and family • Avoidable Emergency Department and ICU admissions • Prolonged hospital and ICU length of stay • Excessive use of non-beneficial medical interventions • Excessive non-reimbursable costs to hospitals (care exceeds DRG payments) • Moral distress among hospital staff / staff turnover Timothy Jessick, DO – Dr. Jessick has been a Palliative Medicine Physician for over 10 years. He is board certified in Palliative Care and Family Medicine. He is the co-founder and Past President of the Palliative Care Network of Wisconsin and a member of the American Academy of Hospice and Palliative Medicine and the American Academy of Family Physicians. Dr Jessick received his Doctor of Osteopathy from Kirksville College of Osteopathic Medicine in 1994 and his Bachelor of Science in Exercise Physiology from the University of Wisconsin –Madison in 1990. He is a Clinical Adjunct Assistant Professor at the University of Wisconsin School of Medicine and Public Health. He has presented both locally and nationally on the topics of palliative care, pain management, advance directives, mortality and end of life care and participated in numerous initiatives related to these topics. He has also trained over 700 physicians and providers in goals of care conversations. Dr. Jessick is currently a consultant for Primary Palliative Care Education LLC..

LEARNING OBJECTIVES/OUTCOMES: Describe the potential benefits of hospice for the terminally ill prisoner, the prisoner hospice volunteer, and the family of the terminally ill prisoner. Review the technical, logistical, and sociopolitical difficulties in setting up a prison-based, prisoner-run hospice program in a maximum-security prison. Differentiate between the care provided by trained prisoner hospice volunteers and the non-hospice, non-correctional alternative. FILM SYNOPSIS: Prison Terminal: The Last Days of Private Jack Hall: is a moving cinéma vérité documentary that breaks through the walls of one of America’s oldest maximum security prisons to tell the story of the final months in the life of Jack Hall, a terminally ill person who has been incarcerated for 20+ years and the hospice volunteers, they themselves incarcerated men, who care for him. The film draws from footage shot over a six-month period behind the walls of the Iowa State Penitentiary and provides a fascinating and often poignant account of how the hospice experience can profoundly touch even the forsaken lives of the incarcerated.

LEARNING OBJECTIVES/OUTCOMES: Describe the potential benefits of hospice for the terminally ill prisoner, the prisoner hospice volunteer, and the family of the terminally ill prisoner. Review the technical, logistical, and sociopolitical difficulties in setting up a prison-based, prisoner-run hospice program in a maximum-security prison. Differentiate between the care provided by trained prisoner hospice volunteers and the non-hospice, non-correctional alternative.

Can eligibility support education be fun? Sure! Come find out what NOT to write with a new “look” at a better way to document. Learning Objectives: At the conclusion of this session, you will be able to 1. Define comparative and descriptive documentation 2. Identify cliché phrases to avoid in clinical documentation 3. Gather new techniques for “painting the picture” 4. Demonstrate increased confidence in documenting to support payment for hospice services.

This session will explore how palliative care collaboration can contribute to improve quality of care for patients with traumatic injuries. Learning Objectives: At the conclusion of this session, you will be able to: 1. Discuss how palliative care techniques can enhance the care provided to patients with traumatic injuries 2. List specific actions aimed to improve quality of care for traumatic injury patients.

Quality is imperative in ensuring that your patients receive the very best care and earns you the trust of your community. Join this session to understand how to utilize your QAPI program as a critical tool to drive both clinical and financial success of your agency. Learning Objectives: At the conclusion of this session, you will be able to: 1. Discuss the COP (conditions of participation) requirements for QAPI programs 2. List strategies including HOPE (H – sources of hope, O – organized religion, P – personal spirituality, E – effects on medical care and end-of-life decisions) to make your QAPI program a valuable tool in achieving agency clinical and financial goals. 3. Identify processes to utilize during interdisciplinary group meetings and agency processes to inform and implement successful QAPI projects.

The 3 Wishes Project brings a set of wishes to fulfillment in the final hours to days of a patient’s life, humanizing the dying experience in the ICU and the hope of bringing peace to patients and their families. Learning Objectives: At the conclusion of this session, you will be able to: 1. Apply steps to improve the end-of-life experience for patients and their families in the ICU and to ease the grieving process 2. Support foster patient and family centered care.

This session focuses on twelve concepts of pain management that are essential for optimal medication use, yet often are incompletely recognized by hospice and palliative care teams. Metabolic considerations, dosing parameters, and toxicity profiles are reviewed. This session will ensure that both seasoned clinicians and those newer to hospice and palliative care feel confident in their ability to safely and effectively manage their patients’ pain.

Moral injury refers to the psychological and spiritual distress that occurs when a person engages in, witnesses, or is unable to prevent actions that violate their deeply held moral beliefs and values. Though not formally recognized as a psychological disorder, it has long been indicated in the research as a significant contributor to negative mental health outcomes, especially in professional caregivers. In this presentation, we will learn what the research says about the sources of moral injury for healthcare personnel along with its impact on their physical and mental health. We will then discuss steps that professional caregivers can take to mitigate the negative impact of moral injury in order to help them care more effectively for their patients—and for themselves.

Emergencies happen and often with little or no advance warning. Emergency Preparedness Planning is imperative and will greatly impact how successfully your agency will respond if/when they happen. Join this session to learn how to effectively develop your plan and hear real life stories of emergency response. Learning Objectives: At the conclusion of this session, you will be able to: 1. Discuss the requirements for Emergency Preparedness and Planning for hospice providers 2. Identify types of emergencies to prepare for along with strategies to ensure plan is effective for the emergencies you may face as a provide 3. Discuss lessons learned during a real-life Missouri disaster including what worked and what didn’t.

The use of antithrombotic medications is common in hospice and palliative care. With the anticipated rise in the prevalence of patients with atrial fibrillation, and the use of these medications for numerous other conditions related to stroke and cancer, it is imperative that hospice and palliative care clinicians understand both the benefits and risks of these medications. This session reviews the current research and validated assessment tools that can be utilized for date-driven clinical decision making and discusses the value of informed deprescribing conversations as part of shared decision making with patients and caregivers. Learning Objectives: At the conclusion of this session, you will be able to: 1. Discuss current research regarding risks and benefits of antithrombotic medications in hospice/palliative care 2. Review validated tools for estimating risk/benefit of antithrombotic medications at end of life

Explore the ways that engaging military veterans as volunteers can benefit your hospice program and your veteran hospice patients. Learn best practices for recruiting, retaining, utilizing and managing veteran volunteers. Learning Objectives: At the conclusion of this session, you will be able to: 1. List the benefits of engaging veterans as hospice volunteers, particularly as Veteran-to-Veteran Comradery companions for veteran hospice patients 2. Discuss 15 Things Veterans Want You to Know, to better understand military culture and engage more effectively with veteran volunteers 3. Define best practices for recruiting, retaining, utilizing and managing veterans as hospice volunteers.

Transitioning from a field position to leadership comes with unique challenges and dynamics. Join this session to learn skills and strategies to assist training and avoid pitfalls complete with tools to provide feedback and key performance indicators (KIPs) to evaluate success. Learning Objectives: At the conclusion of this session, you will be able to: 1. Identify key challenges and unique dynamics of transitioning from field clinician to leader 2. Discuss leadership skills and strategies to positively influence teams and improve team outcomes 3. Utilize accountability and expectation management tools.

The session will discuss the role of palliative care and common treatments for patients with dementia. Learning Objectives: At the conclusion of this session, you will be able to: 1. Explain advanced care planning and community DNR in relation to dementia patients 2. Identify behaviors associated with dementia and who should be referred for palliative care.

This session examines Voluntarily Stopping Eating and Drinking (VSED) in hospice care, highlighting its definition, ethical and legal considerations, inter-disciplinary group support, symptom management, policy development, and promoting respectful, compassionate care for patients choosing this option. Learning Objectives: At the conclusion of this session, you will be able to: 1. Define Voluntarily Stopping Eating and Drinking (VSED) and its relevance in end-of-life care 2. Discuss the legal and ethical frameworks surrounding VSED, emphasizing patient autonomy and the role of care teams 3. List the phases of VSED and effectively anticipate and manage associated symptoms 4. Design policies for hospice agencies to provide structured guidance while accommodating.

The goal of this presentation is to review the most impactful research studies over the past 12 months that are clinically relevant to the field of hospice and palliative medicine and can enhance your clinical practice. We will focus on examining studies that can change the way you support your patients and families and emphasize the most prominent studies from our region. Topics presented this year include studies looking at innovative treatments or identifying new evidence to support patients with cancer cachexia, insomnia, treatment resistant depression, and nausea among others. We will also have an interactive small group review of two interesting clinical cases with ethical components addressing medical aid in dying and collectively identify ways we could have optimally handled the situation. LEARNING OBJECTIVES:  Identify three new studies that have the potential to enhance symptom management in the hospice and palliative care setting.  Determine the benefits and burden of each pathway described in the latest research on telehealth vs in-person palliative care visits for the management of patients with advanced cancer.  Describe at least 2 core ethical principles regarding medical aid in dying.

Inpatient Palliative Care (PC) is a critical and challenging component of best care for patients with serious illness. One pivotal aspect of effective PC is building rapport and trust quickly. The concept of emergency intimacy (EI) identifies and formalizes this relational aspect as a concrete and teachable PC intervention. This conceptual presentation will highlight the rationale for, definition of, and examples of EI in the inpatient setting. Learning Objectives: At the conclusion of this session, you will be able to: 1. Discuss emergency intimacy in Palliative Care practice 2. Identify the psycho-social underpinnings of emergency intimacy 3. Respond to cues, clues and stories to accomplish emergency intimacy.

Management by coaching can move an organization from surviving to thriving. Especially in service-based industries like healthcare. Management by coaching outperforms management by pedagogy (i.e., teaching). Advances in technology and medicine have introduced many complex, detailed solutions to many complicated problems in healthcare. The challenge for leaders has become the consistent application of detailed processes due to the sheer number of potential points of failure and a distracted workforce. Ironically, a pre-modern approach of apprenticeship and coaching can led healthcare organizations toward a culture of consistent outcomes. Organizations that consistently coach deliver results consistently. Learning Objectives: At the conclusion of this session, you will be able to: 1. Distinguish the complexity of interdisciplinary versus multidisciplinary teams 2. Describe the need for organizations to embrace a culture of coaching 3. List attitudes necessary to develop an organization driven by coaching 4. Explain a team conflict resolution model & The five Dysfunctions of a Team 5. Discuss the barriers to embracing a culture of “management by coaching”.