($ Inpatient Units) Catherine Mitchell VP Finance and CFO Hospice of the East Bay Napa Valley Hospice & Adult Day Services

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1 ($ Inpatient Units) Catherine Mitchell VP Finance and CFO Hospice of the East Bay Napa Valley Hospice & Adult Day Services

2 The Bruns House In 2004, we opened Bruns House, the first freestanding adult hospice facility in the East Bay. The House accommodates six acutely ill patients in comfortable, medically appropriate, private rooms. Patients experience privacy and quiet that cannot be achieved in a hospital, and intensive around-the-clock care that cannot be achieved at home. Visiting family members enjoy unrestricted access and the opportunity to just be family members and not caregivers.

3 Bruns House Value of donations

4 Our Financial Pictures Year over Year Statistics MLOS ADC Respite GIP Routine NI (279,753) (677,846) (647,745) Occupancy Rate 83.33% 75.14% 80.23%

5 PPD 2013 YTD Patient-Related Expenses Actual Budget DME Ambulance Dietary Lab & Imaging Outpatient Medications Medical Supplies Mileage Other Patient Expenses Therapies Payroll-Related 1, ,001.52

6 2013 Initiatives Swing beds MDs, Social Workers, RNs Staggered shifts Visits and On-Call Donated Services Staffing Ratio Worksheets Acuity Admissions, D&D

7 Revenue REVENUE YTD Medicare - GIP 791, % Medicare - Respite 10, % MCR 2% Sequestration (12,192) -1.2% Medicaid 52, % Commercial Ins. 191, % Commercial Ins. - Respite 3, % Self Pay - GIP % Self Pay - Respite / Routine 32, % Contractual Allow/Bad Debt (35,267) -3.4% 1,034, %

8 Our Staffing Budget (3 shifts)

9 Staffing Model: Susan Buscaglia, RN

10 Acuity & Staffing guidelines 10 or greater: Second nurse should remain at the Bruns House. < 9 and NO admissions scheduled, nurse crossed trained: No second nurse, and Notify Team Manager or Triage Nurse Reposition nurse if needed elsewhere. < 9 and NO admissions scheduled, nurse is not crossed trained: No second nurse, call off. < 9 and admissions scheduled: Retain second nurse for admission Follow points above when admission completed. Unexpected events: Call Triage and ask for LVN back up. EACH ADMISSION adds 2 points.

11 Acuity Level I Patient is here for uncomplicated medication adjustment and may require varying levels of assistance with ADLs Respite patient who is on oral medications and requires minimal assistance with ADLs Any patient who does not need direct nursing care/intervention more than every 4 hours

12 Acuity Level 2 Patient requires more frequent intervention (e.g., repositioning, routine procedures, tube feedings, medication administration) Patient has infrequent breakthrough or infrequent symptoms Direct nursing care/intervention is required every 2-4 hours for greater than 8 hours per day

13 Acuity Level 3 Patient needs frequent monitoring for airway management (e.g., suctioning, positioning, oxygen) Patient needs PRN or more frequent breakthrough medications Family requires teaching related to pain and symptom management or frequent support related to patient s declining condition Patient requires direct nursing care/intervention every 30 minutes to 2 hours for greater than 8 hours per day to manage increased symptoms (e.g., pain, dyspnea, seizures)

14 Acuity Level 4 Patient is admitted for acute symptom management and has rapidly changing or severe symptoms (e.g., intractable pain, nausea, dyspnea, agitation, or bleeding) Intense psychosocial support for patient and family related to complex family issues or significant decision making Family requires significant teaching for home management Patient has high potential for crisis and requires direct RN (not LVN) intervention and/or assessment at least every 30 minutes or greater than 8 hours per day Patient is 1:1 nursing care for 2 hours in an 8 hour shift for extended wound care, IV/SQ medications, symptom management or symptoms out of control Death with extended post-mortem care

15 Acuity Level 5 Patient requires an extraordinary level of care including 1:1 RN care and significant use of other care team members to manage significant decision-making and crises Requires nurse to be in the room continuously, e.g., agitated or confused patient

16 What causes variances to our model? Rates, Sequestration Admissions and D&D Maintenance Staff out for extended periods Inexperience with the model Residency program Contracts

17 Considerations & Discussion Reporting that is JIT ( just in time) Collaboration across hospices with inpatient units SB 135 Thank you, Carolyn Peterson & Catherine Mitchell