STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED

Transcription

1 STATE AGENCY ACTION REPORT ON APPLICATION FOR CERTIFICATE OF NEED A. PROJECT IDENTIFICATION 1. Applicant/CON Action Number Compassionate Care Hospice of Florida, Inc./CON # Aquamarine Avenue Naples, Florida Authorized Representative: Ms. Judith Grey (201) Odyssey HealthCare of Collier County, Inc. d/b/a Odyssey HealthCare of Central Florida/CON # North Harwood, Suite 1500 Dallas, Texas Authorized Representative: Mr. Jason S. Howard (214) Seasons Palliative Care of Florida, Inc./CON # Shafer Court, Suite 700 Rosemont, Illinois Authorized Representative: Ms. Marcia Norman (847) United Hospice of Florida, Inc./CON # Jeurgens Court Norcross, Georgia Authorized Representative: Mr. Neil L. Pruitt, Jr. (770)

2 CON Action Numbers: VITAS Healthcare Corporation of Florida/CON # East Huntland Drive, Suite 270 Austin, Texas Authorized Representative: Ronald T. Luke, JD, PhD (512) Service Area/Subdistrict Hospice Service Area 4A (Baker, Clay, Duval, Nassau, and St. Johns Counties) B. PUBLIC HEARING A public hearing was not held or requested regarding the proposals to establish a new hospice program in Hospice Service Area 4A. Letters of support are detailed below: Compassionate Care Hospice of Florida, Inc. (CON #10061) included two letters of support in its application and the Agency independently received one letter. All three letters were signed and dated during December Sandra L. Murman, former member of the Florida House of Representatives ( ) stated she served as chair of the Health and Human Services Appropriations Committee and the Health Care Council. Representative Murman stated she has come to know Compassionate Care over the last year and that the organization has her highest respect. She also stated that she believes the applicant would bring a commitment to excellence and professionalism to the people of Duval and surrounding counties. James Wood, President and CEO, Memorial Hospital-Jacksonville and Thomas Pentz, Chief Executive Officer, Orange Park Medical Center (located in Clay County, Florida) submitted letters indicating that they would be willing to enter into appropriate agreements for the applicant to use their facility s hospital beds to provide inpatient level hospice care. Odyssey HealthCare of Collier County, Inc. d/b/a Odyssey HealthCare of Central Florida (CON #10062) submitted 46 unduplicated letters of support. These letters were arranged in the following order: the Dream Foundation (one letter) acute care hospital, skilled nursing facility (SNF), assisted living facility (ALF) and related support (11 letters) and family letters of thanks (34 letters). 2

3 CON Action Number: Thomas Rollerson, Founder/President of the Dream Foundation, stated that his foundation is the first national wish-granting organization for adults 18 years of age or older with life-limiting illnesses, and that it was founded in Santa Barbara, California in According to Mr. Rollerson, the Dream Foundation is made possible in part by a grant from the Odyssey VistaCare Hospice Foundation and has had the pleasure of working with Odyssey s Florida programs by granting wishes to Florida patients. Mr. Rollerson stated that he has been impressed with Odyssey s dedication and that the company is a national provider of quality hospice services. The 11 support letters from a Hospice Service Area 4A acute care hospital, SNFs, ALFs and related facilities/providers were dated during November through December These were from James Wood, President and CEO, Memorial Hospital-Jacksonville; Kevin Harris, MSH, NHS, RHP, Executive Director, Administrator, W. Frank Wells Nursing Home (located in Baker County, Florida); Jacqueline Smith, RN, BSN, Director of Nursing, Jacksonville Nursing and Rehab Center; Neil Ramski, NHA, Administrator, Cedar Hills Healthcare Center; Paul Callis, Director of Social Services, Moultrie Creek Nursing and Rehabilitation Center (St. Johns County, Florida); John Schaum, Executive Director, Sunrise Assisted Living of Jacksonville and Barbara Tidwell, RD, LD, MHA, FACHE, Owner/Administrator, Some Place Like Home, Inc. A recurring theme is that increased competition and choice will enhance existing hospice services. The hospital and SNF support letters make no mention of entering into appropriate agreements for the applicant to use hospital or SNF beds to provide inpatient-level hospice care. Ms. Tidwell of Some Place Like Home, Inc. (an ALF) specifically expresses concern with the existing hospice landscape in Hospice Service Area 4A regarding a need for more communication with family during the dying process. The 34 support letters of thanks from family members served by the applicant were mostly hand written notes and cards of appreciation for the care provided a loved one. Five of these were from Daytona Beach, six had a Miami-Dade County, Florida address but most did not distinguish a location. Seasons Palliative Care of Florida, Inc. (CON #10063) submitted 105 unduplicated letters of support and the Agency received one support letter independently. These were categorized by the applicant as 17 professional and 89 family and friend support letters. The applicant s 17 professional support letters were from Florida and non-florida hospitals, a Florida university professor, a Hospice Service Area 4A local bank, non-florida medical doctors, non-florida nursing 3

4 CON Action Numbers: homes, and Seasons Hospice staff. All of these letters were signed and most were dated December A sampling of these follows: Hoyt Ross, Chief Executive Officer, Kindred Hospital - North Florida (Clay County, Florida); staff from Henry Ford Hospital (located in Detroit, Michigan); Martin Gorbien, MD, Rush University Medical Center (located in Chicago, Illinois); Christopher Holroyde, MD, Phoenixville Hospital (located in Phoenixville, Pennsylvania); Caprice Knapp, PhD, Assistant Professor, University of Florida College of Medicine and Liz Porter, Business Development Specialist, Heritage Bank of North Florida (located in Clay County, Florida). Mr. Ross, of Kindred Hospital - North Florida, stated he would welcome the applicant into his facility and is willing to contract for general inpatient levels of care. Mr. Ross letter is not dated. Caprice Knapp, PhD, of the University of Florida s College of Medicine stated she is impressed by the applicant s devotion to providing pediatric palliative care and the Kangaroo Kids program in Chicago. Dr. Gorbien of Rush University Medical Center commented on the applicant s open access program. Dr. Gorbien stated this program allows individuals in hospice to continue to receive certain treatments or procedures that might be considered too aggressive (i.e., highly costly), by other hospices. Matthew Shuster, MD, Co-Medical Director, Seasons Hospice and Palliative Care of Massachusetts described open access as a policy in which no patient is rejected simply because they choose to continue some element of life-sustaining therapy. The Agency recognizes that as part of Season s admissions policy, the patient/legal representative must make an informed decision to forego curative treatment for the terminal illness in preference for palliative treatment/services. A recurring theme is that increased competition and choice will enhance existing hospice services. The 89 unduplicated support letters of thanks from family members served by the applicant were mostly hand written notes and cards of appreciation for the care provided a loved one. None were from Florida residents, as the applicant does not operate in Florida. Many of the letters were not dated and did not distinguish a location. Most expressed exceptional thanks and gratitude for hospice services provided to family, friends or loved ones. The Agency notes the many comments in these support letters and cards about the applicant providing services beyond those commonly or frequently offered by hospice providers (such as ventilator care). Many of these cited the applicant s promptness, genuine caring and attentiveness to patient and family needs. 4

5 CON Action Number: United Hospice of Florida, Inc. (CON #10064) submitted 63 unduplicated letters of support and the Agency received two support letters for this applicant independently. The applicant categorized these letters as follows: community and United Hospice staff (20 letters); UHS- Pruitt subsidiaries (five letters) and United Hospice patients and families (39 letters). The 21 unduplicated support letters from the community and United Hospice staff were all signed or at least had distinguishing applicable provider letterhead. Most were signed between November 12 and December 14, A sample of these support letters include: James Wood, President and CEO, Memorial Hospital-Jacksonville; Hoyt Ross, CEO and Administrator, Kindred Hospital-North Florida (located in Clay County, Florida); Kevin Harris, MSH, NHA, CASP, Administrator, W. Frank Wells Nursing Home; Tamara Patton, Coordinator, Emergency Services and Homeless Coalition of Jacksonville, Inc.; Brian Snow, Director of Family Services, I.M. Sulzbacher Center for the Homeless; Ju Coby Pittman-Peele, CEO/President, Carla White Mission, Inc.; Mark Landschoot, Executive Director, Family Promise of Jacksonville; Julie Wood, BSRN, Nurse Care Coordinator, The Medical Home for Homeless Children Project; Van Snead, Home Safe Program Manager, Presbyterian Social Ministries, Inc.; Mary Canestorp, Administrator, Buckingham Smith Assisted Living Facility (located in St. Johns County, Florida); Paul Callis, MS, Social Services Director, Moultrie Creek Nursing and Rehabilitation Center and Andrew McCraw, MD, McCraw Family Medicine (located in Simpsonville, South Carolina). Many of these support letters had an emphasis on care for the homeless (both adults and children). Ms. Canestrop stated that she has met with United Hospice representatives and believes they share our quality and compassion to provide our residents with the highest level of care. She also stated that her facility is affiliated with the St. Johns Welfare Federation. Bill Saunders, RN, BSN, MBA, Administrator, Confident Care of Florida Corp (located in Jacksonville, Florida) and Carol Waters, life coach, licensed massage therapist, hypnotist, and Clay County resident, expressed dissatisfaction with the current hospice environment in Hospice Service Area 4A, with Mr. Saunders commenting on decreased care of hospice patients in some instances, particularly with regard to nursing care. Ms. Waters stated that existing hospices in the area are 5

6 CON Action Numbers: less receptive to massage, aroma and music therapy than the applicant. Gayle Eckerd, Chief Executive Officer, River Point Behavioral Health and Wekiva Springs Center for Women (both located in Duval County, Florida); John Griggers, Administrator, Life Care Center of Orange Park, (Clay County, Florida) and Stephen Jordan, Administrator, Quality Health of Fernandina Beach (Nassau County, Florida) indicated their willingness to contract or enter into appropriate arrangements with the applicant for general inpatient levels of care. The five letters from UHS-Pruitt subsidiaries were signed with a December 9, 2009 signature date. All signatories indicate a location of Norcross, Georgia. Richard Gerhardt, Vice President of Health Services issued two of the five letters. Mr. Gerhardt indicated that his company would provide appropriate medical equipment and supplies. Other subsidiary letters indicated interest in providing pharmacy, nutritional, dietary counseling, physical, occupational, speech and respiratory therapy and related services. The 39 unduplicated support letters of thanks from family members served by the applicant were mostly hand written notes and cards of appreciation for the care provided to a loved one/family member. Many of these thank United Hospice and some Peachtree Christian Hospice (a Georgia Hospice managed by UHS). Many of the letters and cards were not dated. Of those dated, the year was 2008 or VITAS Healthcare Corporation of Florida (CON #10065) submitted 53 unduplicated letters of support and the Agency independently received two letters of support. Nearly all were signed and all have applicable affiliate letterhead; most are dated December The letters are described below in the following order: those received by the Agency independently, three found in CON Application #10065, Tab 11- Charitable Contribution Condition Letters and 50 letters in Tab 15-Letter of Support. The applicant s Tab 15 included a list of these noncharitable contribution condition letters. Four support letters lack a signature: John Drew, Tax Collector, Nassau County, Florida; Sharon James, President, Daytona Beach Black Nurses Association; Leonard Love, Archbishop, Truth for Living Ministries (Duval County, Florida) and Nancy Austin, RN, CHPN, Chapter President, Hospice and Palliative Nurses Association (Miami-Dade County, Florida). Thirty-seven of the 55 support letters have a Hospice Service Area 4A address. The support letters are identified by the following groups: charitable contribution 6

7 CON Action Number: letters, elected officials, willingness to contract letters, Hospice Service Area 4A support, and non-hospice Service Area 4A support. A relatively common theme is the applicant s seeking to provide hospice services to the African American population, the HIV/AIDS population and patients with other non-cancer diagnosis that are in need of hospice service. Michele Querry, Director of Major Gifts, Florida State College Foundation provided a $298,690 proposal stated to outline unique partnership opportunities for VITAS to assist in the Foundation s critical funding needs, $285,000 of which will be submitted for State matching funds and $13,690 matched by the Foundation for Florida s Community Colleges for the Blue Cross Blue Shield of Florida Nursing and Allied Health Scholarship. The State matching funds consist of $190,000 for the Northeast Florida Initiative for Nursing Workforce Diversity, $55,000 for a VITAS Innovative Hospice Care Endowed Teaching Chair and $40,000 for a VITAS Innovative Hospice Care Endowed Scholarship. Barbara Drake, Chair, Board of Directors and Connie Hodges, President, United Way of Northeast Florida, stated that the United Way would be willing to steward a VITAS gift of up to $500,000 that would span over a two to three year period beginning in the summer of According to this letter, the funds would be used to expand the Elder Care Advocacy Program provided to Shands Jacksonville Medical Center. Richard Danford, President, Jacksonville Urban League (JUL) indicated that a proposed $50,000 VITAS grant would be used to support anti-obesity programs promoted by the JUL, educational end-of-life JUL quarterly seminars and workshops and expansion of JUL community health and end-of-life care awareness initiatives. Eight elected officials support the applicant s proposal. These officials include: the Honorable Audrey Gibson, District 15, Florida House of Representatives; the Honorable Stacey Johnson, County Commissioner, Nassau County Board of County Commissioners; the Honorable John Drew, Tax Collector, Nassau County; the Honorable Tommy Hazouri, Representative, Duval County School Board and the Honorable Richard Clark (Council President), William Bishop, AIA, Michael Corrigan, Jr. and Warren Jones, Councilmen, Office of the City Council, City of Jacksonville. These letters indicated that VITAS is a leader in end-of-life care and would make an excellent additional choice of hospice providers in the area. Representatives of six Hospice Service Area 4A skilled nursing facilities expressed commitment or interest in entering into appropriate agreements to provide inpatient hospice beds, should this applicant be approved. These providers are: Chris Adams, Executive Director; Harts Harbor Health Care Center; Elizabeth Sholar, NHA, Fleet Landing; 7

8 CON Action Numbers: Raymond Prudencio, NHA, CNA, Administrator and Preceptor, The Terrace at Fleming Island (Clay County, Florida); Glenford Wright, MSHRM, BSBA, Administrator, West Jacksonville Health and Rehabilitation Center; Jerry Tomack, MHSA, NHA, Executive Director, San Jose Health and Rehabilitation Center and Eric Weisz, Executive Director, Governor s Creek Health and Rehabilitation Center (Clay County, Florida). Letters from Hospice Service Area 4A were received from Neal Henning, PhD, Dean of Workforce Development, Florida State College of Jacksonville, Dr. Steven Wallace, President, Dr. Barbara Darby, North Campus/Nassau Center President and Gwendolyn Yates, Vice Chair, Duval County, District Board of Trustees, Florida State College at Jacksonville. Kevin Harris, MSH, Administrator, W. Frank Wells Nursing Home stated confidence that residents of his county will significantly benefit from this project, if approved. Archbishop Leonard Love, Truth for Living Ministries, stated interest in the applicant s cultural sensitivity to the African American community. Deborah Thompson, Owner, Deborah Thompson Consultants identified herself as a Board Member of the Jacksonville Urban League and Agape Community Health Center, a federally qualified health center [FQHC], and stated that VITAS is a proven leader with a record of accomplishments and that she is confident that VITAS will implement out-reach programs for the African-American community. Many of the applicant s letters of support from outside Hospice Service Area 4A attest to VITAS success in other parts of Florida and the nation. These include Jerry Santeiro, Executive Director, Guardian Program of Dade County, Inc., Public Guardian for the 11th Judicial Circuit (Miami- Dade County, Florida), Linda Quick, President, South Florida Hospital & Healthcare Association cited the success VITAS has experienced in the South Florida area particularly with African American and terminally ill non-cancer patients. Max Rothman, JD, LLM, President and CEO, Alliance for Aging, Inc. (Miami-Dade and Monroe Counties, Florida) also cited the applicant s excellent service to the African American terminally ill and indicated that like results might be realized in Hospice Service Area 4A with approval of this applicant. Maria Lazo, Miami-Dade County Hispanic Affairs Advisory Board Director, indicated that VITAS has community outreach programs which recognize that hospice outreach is necessary for persons of Hispanic descent and African American descent, and that those with non terminal illnesses are better served. She stated that she is confident VITAS will address these needs in District 4A. Sharon Jones, President, Daytona Beach Black Nurses Association, stated that VITAS has provided scholarships for student nurses at Daytona State College and at Bethune Cookman University for the past 8

9 CON Action Number: four years, has been especially sensitive to African American end-of-life issues and is uniquely qualified to provide culturally appropriate information, services and care to African Americans and traditionally underserved populations. Maria Pams, MHS, Project Director, Senior Community Services Program, American Association of Retired Persons (Miami-Dade County, Florida) recognized the applicant s success in reaching out to the African American population in her area. Martha Sanchez, Chief Executive Officer, Area Health Education Center (Miami- Dade County) makes similar comments. Nancy Auster, RN, CHPN, Chapter President, Hospice and Palliative Nurses Association (Miami- Dade County, Florida) stated that the applicant will provide a tremendous service to the underserved of the area, particularly the African American community. Deborah Alexander, President, the Amyotrophic Lateral Sclerosis (ALS) Association of Florida Chapter (Hillsborough County, Florida), indicated that VITAS has consistently demonstrated commitment to ALS patients. Marco Carrasco, NHA, MHSA, Administrator, West Gables Health Care Center and Region 1 Vice President, Florida Health Care Association, indicated that VITAS s programs bring value to his community and would bring similar value to the proposed area. Barbara Grasch, LMFT, Director of Program Services, Alzheimer s Association Southeast Florida Chapter (Palm Beach County, Florida), and Patricia Lange, Executive Director, Florida Assisted Living Association (located in Tallahassee, Florida) also submitted letters of support. Support letters from national African American organizations were also included in the application. Iva Carruthers, PhD, General Secretary, Samuel DeWitt Proctor Conference, Inc. (located in Chicago, Illinois), indicated that VITAS has had success with hospice care from an African American faith perspective. Bishop Arthur House, Jr., Full Gospel Baptist Church Fellowship International, Office of Home Missions (located in Hampton, Virginia) also indicated that VITAS has had successful efforts to reach out to the African American community concerning end-of-life concerns. Millicent Gorham, Executive Director, National Black Nurses Association, Inc. stated that for the past five years VITAS has provided continuing education programs at her organization s national conferences including one in Broward County, Florida in Ms. Gorham also indicated that recently, principals from VITAS engaged the Daytona Beach Black Nurses Association to discuss issues around end-of-life care. 9

10 CON Action Numbers: Summary of Contractual Letters of Support CON Application #10061 (Compassionate Care) included two acute care hospital letters of willingness to provide inpatient beds for hospice services one from Memorial Hospital-Jacksonville (Duval County) and one from Orange Park Medical Center (Clay County). CON Application #10062 (Odyssey) does not include an acute care hospital or SNF commitment letter to enter into inpatient bed arrangements. CON Application #10063 (Seasons) included a letter of willingness from Kindred Hospital-North Florida to provide inpatient beds for hospice services. CON Application #10064 (United) included four letters of willingness to provide inpatient beds for hospice services. These were from River Point Behavioral Health which also operates Wekiva Springs Center for Women (Duval County inpatient psychiatric hospitals) and two SNFs Quality Health of Fernandina Beach (Nassau County) and Life Care Center of Orange Park (Clay County). CON Application #10064 (VITAS) included six letters of willingness from SNF providers to provide inpatient beds for hospice services. Two of these are located in Clay County, The Terrace at Fleming Island and Governor s Creek Health and Rehabilitation Center and four are Duval County nursing homes: Fleet Landing, Harts Harbor Health Care Center, San Jose Health and Rehabilitation Center and West Jacksonville Health and Rehabilitation Center. C. PROJECT SUMMARY Compassionate Care Hospice of Florida, Inc. (CON #10061), a forprofit provider, proposes the establishment of a new hospice program in Hospice Service Area 4A, consisting of Baker, Clay, Duval, Nassau and St. Johns Counties. Compassionate Care was founded in 1993 and has developed 23 start-up hospice programs in 15 states: Delaware, Georgia, Illinois, Kansas, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Jersey, New York, Pennsylvania, South Dakota, Texas and Wisconsin. Compassionate Care also has CON approval via CON #10036 to establish a program in Hospice Service Area 6B and states this program is projected to be operational in February According 10

11 CON Action Number: to the applicant, Compassionate Care is an expert in start-up operations, in programs that are opened in markets with existing providers and that none of its programs were purchased from other providers. Compassionate Care states that it will aggressively address the unmet hospice need in Hospice Service Area 4A, and will seek to identify and serve any underserved groups (racial, religious, financial, diagnostic category). Compassionate Care states that it will establish three office locations upon commencement of services including one in Duval County (zip code 32218), one in Clay County in the Orange Park area (zip code 32073) and one in St. Johns County (zip code 32092). The applicant states these three locations, in total, will serve the entirety of the hospice service area. The applicant is proposing total project costs of $227,616 for equipment, project development and start-up costs. In its Schedule C, the applicant includes the following general statement of conditions and proposes eight specific conditions: Compassionate Care Hospice s General Statement on Willingness to Accept Conditions in Service Area 4A It has become a routine practice for many hospice organizations to provide the various required components of hospice services through lengthy listing of numerous specific conditions for award of the CON. As required by law, Compassionate Care Hospice is willing to accept any such conditions on its CON based on any representations made throughout this CON application. Compassionate Care will provide all of the required components of hospice care, and meet all Medicare conditions of participation, and Florida hospice licensure requirements, including the provision of all levels of services (routine home care, continuous care, general inpatient, respite) to all type of patients (cancer, non-cancer, Alzheimer's, COPD, elderly, young adult, pediatric) without regard to race, ethnicity, gender, age, religious affiliation, diagnosis, financial status, insurance status, or any other discriminating factor. Compassionate Care commits to offering excellent quality specialized and individualized programs delivered by highly qualified interdisciplinary teams of professionals, and will implement continuous quality improvement, performance improvement, quality assurance and monitoring programs. Compassionate Care will offer all types of services 11

12 CON Action Numbers: including physical care and pain management, bereavement counseling and support services (for as long as the bereaved needs such services, without limitation on duration), psycho-social services, spiritual care and counseling, memorial programs and services, palliative radiation or chemotherapy, and massage, music, pet, aroma, and other alternative therapy programs. Compassionate Care will implement a volunteer program and offer a wide array of services through its volunteers. Compassionate Care is firmly committed to the continuing and ongoing training, orientation, and education of its staff, and will implement specific programs such as tuition reimbursement, ongoing in-service and training programs, library resources and payment for certification of staff. Compassionate Care will ensure that its staff has the resources, equipment (such as laptop computers, Personal Digital Assistants, or other IT equipment) to perform effectively in the delivery of care to their patients and families. Compassionate Care will conduct extensive community education and outreach programs in all communities, including all racial, ethnic, or religious minority communities, Veterans groups and organizations, and will initiate specialized programs and services to meet the individual needs of such communities in terms of language needs or specialized cultural or religious needs. Examples include such programs as Compassionate Care's Jewish Hospice Certification, use of a culturally diverse staff, use of bilingual staff, and production of education materials and service forms in Spanish, Vietnamese, Russian or other languages as needed in the community; and sensitivity and training for the special needs of veterans. Compassionate Care will contribute to community organizations including universities, community colleges or other organizations involved in the training of health care professionals, or in the delivery of social services to the community. Compassionate Care will provide services beyond those mandated and reimbursed by Medicare and Medicaid, including specific financial assistance to meet the special individualized needs of patients through its charitable foundation, including special "last wishes" of a patient or family, need for specialized equipment not reimbursable, travel for a special family member to visit with a dying patient, or simply need for assistance with mortgage payment, rent, utilities, groceries, or other necessities. 12

13 CON Action Number: Compassionate Care believes that all of the above types of programs, services, policies, and protocols should be provided by any hospice provider, and therefore would accept as a condition to its CON approval any or all of these general conditions. However, in order to assist the Agency in distinguishing Compassionate Care from other applicants, the applicant offers the following specific conditions, that are aimed at specific measurable actions that will increase access and quality of care for hospice patients. Specific Conditions 1. Office Locations: In order to increase awareness and visibility of hospice services in the 3,221 square miles that represent Subdistrict 4A 1 (Baker, Clay, Duval, Nassau, and St. John's Counties) and to provide for accessible meeting places for interdisciplinary care teams, bereavement support groups, family counseling meetings and sessions, community education meetings, and other types of local activities, Compassionate Care commits to opening three office locations upon commencement of services including one in Duval County (zip code 32218), targeted to meeting needs in Duval and Nassau Counties; one in Clay County in the Orange Park area (zip code 32073), targeted to meeting needs of Clay County, Baker County, and southwest Duval County; and one in St. John's County in zip code targeted to meeting the needs of St. Johns County and specifically west St. Johns. Compliance with this condition will be measured by providing to the Agency the location addresses for each office upon commencement of services. 2. Program Accreditation: As a demonstration of commitment to quality, Compassionate Care will become accredited by the Community Health Accreditation Program within 24 months of its initial licensure. Compliance will be demonstrated by forwarding a copy of the accreditation to the Agency. 1 CON Application #10061, page #4. 13

14 CON Action Numbers: Medical Directors: Medical directors will assess every patient upon admission to hospice, and will provide patient visits in the home or place of residence. Medical directors will either be board-certified in hospice and palliative care medicine, or will apply for boardcertification within five years of employment as medical director. Compliance will be demonstrated through an annual report to the Agency. 4. Community/Education Outreach Coordinator: In order to continuously assess the needs of the community, to expand the information base in regard to the benefits of hospice care, and to reach populations in need that may not be easily accessible through the health care referral system, Compassionate Care will provide a full-time dedicated staff member, located in the Jacksonville office and serving all five counties, with the exclusive responsibility of serving as a community outreach coordinator to the non-health care community. This individual will work closely with the community leaders and organizations in the subdistrict focused on seeking to identify unmet hospice need in underserved populations, providing hospice information and educational sessions to inner city and other area churches, civic organizations, employers, and advocacy groups such as AAA, area offices on aging, cancer support groups. Compliance will be demonstrated in an annual report to the Agency which identifies the key activities of this position on no less than a monthly basis. 5. Pain Reduction: Compassionate Care will effectively reduce severe pain in its hospice patients within 48 hours of admission to hospice. Compliance may be demonstrated based upon an annual report of Compassionate Care s initial pain scores for patients, and recorded pain scores after 48 hours. Compassionate Care will achieve a reduction for at least 75 percent of patients with severe pain (score of seven to 10) to a pain score of five or less within 48 hours of admission. This exceeds the requirement in Section , Florida Statutes. 6. Other Staff Qualifications: To ensure high quality, Compassionate Care will adopt the following standards and qualifications for staff: registered nurses will be encouraged to become certified in hospice and palliative care nursing, and by the third year of operation, 50 percent of all supervisory nurses shall attain such certification, with 100 percent of all supervisory nurses attaining such certification by the fifth year of operation; chaplains shall be masters of divinity, with demonstrated completion of an accredited clinical pastoral education program; social workers shall be 14

15 CON Action Number: masters level and licensed clinical social workers. Compliance with these qualifications shall be demonstrated in an annual report to the Agency. 7. Continuous Care: Compassionate Care commits that it will provide at least 1.5 percent of total patient days as continuous care days. They plan to have continuous care staff at the bedside within two hours of receipt of a request for such services and will maintain the service until no longer needed. Compliance will be measured and demonstrated by maintaining records of requests for continuous care and providing an annual report to the Agency on response times and total patient days. See Appendix R for additional information on continuous care at Compassionate Care. 8. Patient Visits: Compassionate Care will commit that every patient shall be contacted on a daily basis to determine their needs for the day, and all patients shall receive in-person visits from Compassionate Care staff at least five times per week for at least two hours per day. Compliance will be monitored by submitting an annual report to the Agency. Odyssey HealthCare of Collier County, Inc. d/b/a Odyssey HealthCare of Central Florida (CON #10062), a for-profit provider, proposes the establishment of a new hospice program in Hospice Service Area 4A, consisting of Baker, Clay, Duval, Nassau and St. Johns Counties. The applicant states its sole shareholder and parent is Odyssey HealthCare Operating B, LP, founded in The parent is stated to have approximately 92 Medicare-certified hospice programs in 29 states. The applicant also indicates that rather than attempting to be all things to all people it chooses to focus solely on hospice care and on its core competencies, particularly clinical competencies and its CareBeyond program, in which disease-specific hospice care is applied to applicable patients. The applicant also states affiliation with two existing Florida hospices owned and operated by the parent Odyssey Healthcare/Daytona (Hospice Service Area 4B) and Odyssey Healthcare/Miami (Hospice Service Area 11) 2. Odyssey HealthCare s two Florida hospices were initially licensed during 2005 and 2006, respectively. The applicant indicates that the parent is finalizing licensure and expects to open its third Florida hospice program, Odyssey HealthCare of Marion County, Inc. (Hospice Service Area 3B) in early The applicant states that special and not normal circumstances exist in Hospice Service Area 4A and that the specific terminally ill 2 Odyssey HealthCare of Marion County, Inc. is licensee for Service Areas 4B & 11 effective Odyssey HealthCare of Marion County, Inc. added Marion County to its license effective

16 CON Action Numbers: population not being adequately served is as follows: cancer patients age 65 years and older; non-cancer patients under the age of 65 years and non-cancer patients age 65 years and older. Odyssey conditions (condition #21 below) CON approval to the immediate development of its main office in Duval County and two satellite offices, one in Clay County by the end of year one of operation and a second satellite office in Nassau County by the end of year two of operation. The applicant is proposing total project costs of $666,972 for equipment, project development and start-up costs. In its Schedule C, the applicant proposes 25 itemized conditions, as follows: 1. The applicant will provide supportive hospice services, such as but not limited to: palliative radiation therapy and palliative chemotherapy related to the patient s terminal diagnosis. This will be measured via a signed declaratory statement by the applicant, which may be supported via a review of patient medical records. 2. The applicant will provide continuous care. This will be measured via a signed declaratory statement by the applicant, which may be supported via a review of patient medical records. 3. The applicant will implement the Care Beyond program. This will be measured via a signed declaratory statement by the applicant. 4. The applicant will provide hospice services 24 hours a day, seven days a week including weekend care as indicated by the patient s medical condition. This will be measured via a signed declaratory statement by the applicant, which may be supported via a review of patient medical records. 5. The applicant will admit all eligible patients without regard to their ability to pay. This will be measured by the applicant s Medicare certification which requires this standard. 16

17 CON Action Number: The applicant commits to having every patient being assessed by a physician upon admission to the hospice. This will be measured via a signed declaratory statement by the applicant, which may be supported via a review of patient medical records. 7. The applicant will immediately implement its performance improvement plan including the following assessments: pain management, family satisfaction, employee satisfaction, and referral source satisfaction. This will be measured via a signed declaratory statement by the applicant, which may be supported via a review of patient medical records. 8. The applicant will make available a range of non-covered supplementary therapies such as but not limited to: pet, music, massage, aroma and other holistic treatments. This will be measured via a signed declaratory statement by the applicant, which may be supported via a review of patient medical records. 9. The applicant will implement Odyssey s triage and on-call programs upon licensure. These programs provide for uninterrupted 24-hour care seven days a week. Further explanation of the program is offered in the application narrative. This will be measured via a signed declaratory statement by the applicant. 10. The applicant will establish a local ethics committee within the first year of operation. This will be measured via submissions of the names and other relevant information of the Ethics Committee members and the related schedule of meetings to the Agency. 11. The applicant will establish a local medical advisory committee within the first year of operation. This will be measured via submissions of the names and other relevant information of the medical advisory committee members and the related schedule of meetings to the Agency. 12. The applicant will provide educational programs, including but not limited to, in-service training (components of Odyssey University) resources to the community, including nursing homes, assisted living facilities, Council on Aging. In-service training would be offered to registered nurses, social workers, administrators and other staff that would benefit from an increased knowledge of hospice care and services. The applicant will host at least one seminar annually during the first two years of operation for clergy 17

18 CON Action Numbers: and community faith leaders (The Clergy End of Life Education Program), to enhance spiritual support for hospice patients in the district. This will be measured via a signed declaratory statement by the applicant. 13. The applicant will provide patients, family members and referral sources with information of services provided by the Dream Foundation. The Dream Foundation is the first national group of its kind that exists for terminally ill applicants over the age of 18. Through its Day Dreams (a program for terminally ill adults over the age of 65), Emergency Dreams and Quality of Life Dreams, the Dream Foundation provides patients and families with a sense of completion and fulfillment. Odyssey has partnered with the Dream Foundation to improve care for our patients and to advance our mutual interests in the field of hospice. This will be measured via a signed declaratory statement by the applicant. 14. The applicant, through Odyssey HealthCare, Inc. or the Odyssey VistaCare Hospice Foundation, will make a $25,000 contribution to an appropriate not-for-profit entity in the community to fund education for end-of-life issues. Upon approval, Odyssey will meet with the Area Council on Aging or similar organization to identify and determine the most appropriate entity within the community related to education for end-of-life issues. This will be measured via a signed declaratory statement by the applicant and evidence of funds provided to the not-for-profit entity. 15. The applicant will commit to 0.5 FTE the first year of operation to evaluate the need, if any, for an expanded children s hospice program in the community including, but not limited to, the need for a children s program that offers an expanded hospice benefit for patients up to age 21. The program would focus on longer term services for patients who may not otherwise qualify for hospice such as those with developmental conditions, cancers, chronic illnesses or brain injury that shorten lives and place special demands on families. If during the first year of operation it is determined that existing children s hospice services in the community are available to meet local needs, the applicant will donate $25,000 to support existing local children s hospice programs. If after the first year there is found to be a need for additional children s hospice services, a child and family support program interdisciplinary team will be established to support the needs of this target population. This will be measured via a signed declaratory statement by the applicant. 18

19 CON Action Number: The applicant will commit to 0.5 FTE the first year of operation regarding community bereavement programs in the community. The bereavement program will be broadly based to extend beyond the families of patients admitted to Odyssey HealthCare. These programs will be an extension of the programs currently offered in the hospice service area. The applicant will provide bilingual staff to provide bereavement services to the Hispanic population, including Hispanic children. At a minimum, one bereavement group consisting of approximately eight sessions will be offered by the end of the first year of operation. As the bereavement client census increases after one year, full-time staff will be employed. This will be measured via a signed declaratory statement by the applicant. 17. The applicant will commit to the provision of programs for the Hispanic and other minority populations which will include support from or involvement of bilingual staff, translated literature, training on cultural differences and competencies and flexible programming to meet their unique needs. Hospice staffing will reflect the racial and ethnic mix of the local community served. This will be measured via a signed declaratory statement by the applicant. 18. The applicant will develop a community resource library during the first year of the proposed hospice s operation. The library will include various lay and professional education pieces related to chronic illness, death, dying and bereavement. This will be measured via a signed declaratory statement by the applicant. 19. The applicant commits that the Odyssey VistaCare Hospice Foundation will facilitate the provision of a children s bereavement camp in Florida by the end of the first year of operation, similar to what Odyssey currently provides via Odyssey s SkyCamp, Camp Healing Tree and Camp Odyssey. This will be measured via a signed declaratory statement by the applicant. 20. The applicant will have a minimum of at least three community education representatives, expanding community awareness of hospice services and educating local medical staff, community leaders and potential hospice patients as to the benefits of and availability of hospice care. Compliance with this condition will be measured via submission of an annual report confirming that at least three CER staff members are employed at the proposed new 19

20 CON Action Numbers: service and active in the local community. Additionally, if approved, Odyssey will provide education, training and assistance in development of respite care policies, procedures and protocols to nursing homes. 21. Satellite offices: Hospice Service Area 4A includes five counties: Baker; Clay; Duval; Nassau and St. Johns. Odyssey commits to the immediate development of its main office in Duval County and two satellite offices; one satellite in Clay County by the end of year one of operation and a second satellite office in Nassau County by the end of year two of the operation. 22. The applicant commits to become accredited by the Joint Commission and the National Institute for Jewish Hospice by the end of its second year of operation. 23. The applicant commits to medical directors assessing every patient on admission and providing visits in home or place of residence. Medical director to be board-certified in hospice and palliative care medicine or will apply for board-certification within five years of employment. 24. The applicant commits that every patient will be contacted on a daily basis. 25. The applicant commits to sponsoring two to four education seminars per year for physicians, long-term care facilities and ALFs. The focus of these seminars is to educate the local health care community on the provision of hospice services within ALFs and other long-term care facilities: a coordinated plan of care for the patient, increased support for patient, family and facility staff, and the provision of equipment, medication and supplies. Seasons Palliative Care of Florida, Inc. (CON #10063), a for-profit provider, proposes the establishment of a new hospice program in Hospice Service Area 4A, consisting of Baker, Clay, Duval, Nassau and St. Johns Counties. The applicant states that it operates hospice programs in 10 states: California, Delaware, Illinois, Indiana, Maryland, Massachusetts, Michigan, Pennsylvania, Texas and Wisconsin. The applicant currently has no CON approved or licensed hospice programs in Florida. According to the applicant, it promotes a patient focused Circle of Care program strategy in which the patient and family form the hub from which needs emanate. In this strategy, the applicant states every patient will have dignity throughout the end-of-life process, pain will be controlled and wishes will be met. In addition, the applicant 20

21 CON Action Number: states commitment to what is stated as the fundamental principal upon which the program was founded - to die at home. The applicant proposes to specifically serve what it finds as the following two underserved groups cancer patients age 65 and older and non-cancer patients age 65 and older. The applicant indicates that it will establish a main office in Clay County, near or in Orange Park. The applicant is proposing total project costs of $658,585 for building, equipment, project development and start-up costs. In its Schedule C, the applicant includes the following 20 itemized conditions: Initiated within the First Two Years 1. Location in Clay County Will locate the main office in Clay County Measurement: Provide a physical location and street address in Clay County 2. $50,000 outreach, promotion and expansion of hospice services in Clay County Within six months of final approval of the CON, Seasons will meet with the Chairman of the Board of County Commissioners (and others as directed) on how best to establish a transparent process to allow for the donation and expenditure of $50,000 to promote outreach and education of hospice services. Measurement: Status report to Agency for Health Care Administration regarding the process and procedures, with final notification of donated funds. 3. $15,000 pilot project on outcome measures for two areas: infections and falls Within six months of licensure, meet with representatives of the Agency and Department of Elder Affairs to review the process and procedures for the pilot program to collect data and development measures within the areas of infections and falls to design best practices. 21

22 CON Action Numbers: Upon approval of the process and procedures by the pilot project committee, Seasons will begin data collection and analysis, submitting the information as scheduled to the Department of Elder Affairs. By end of the second year, Seasons will complete the pilot program designed to report outcome measures to the Agency and to the Department of Elderly fairs relating to the provision of hospice services. Measurement: Periodic status reports as scheduled by the oversight committee, with a final report (in the third year), and recommended best practices for preventing infections and falls among hospice patients. 4. Seek and maintain accreditation by The Joint Commission Within the first two years, conforming to the eligibility criteria for accreditation, begin the preparatory activities for accreditation. Measurement: Once accreditation is achieved, provide a copy of accreditation to the Agency and to the Department of Elder Affairs, and provide copies of renewals thereafter. Broad Community Benefits 5. Seasons Hospice & Palliative Care Newsletter and the monthly news letter PharmSmart. These newsletters are designed to transmit the latest research and information on hospice and palliative care, with a focus on professionals, physicians, physician assistants, nurse practitioners, and nurses (available to patients and families as well). The PharmSmart newsletter is written by a pharmacist and used for education for the community including physicians and pharmacists. By the end of the first year have published at least one edition of each newsletter and made it available within the service area. Measurement: Provide a copy of each issue of the newsletters to the Agency and to the Department of Elder Affairs. 6. CEU provider for nursing and social workers By the end of the second year, have established approval to provide continuing education units for licensed nurses and licensed social workers. 22