v a h o s p i c e c a r e p r o g r a mv a p a l o a l t o h e a l t h c a r e s y s t e m

Palo Alto, California

C I T A T I O N O F H O N O R

I N N O V A T I O N H I G H L I G H T S

OUTREACH TO NON-VETERAN

POPULATION, FILLING AN UNMET NEED

COLLABORATION WITH COMMUNITY

HOSPICE AGENCIES

CREATIVE APPROACH TO FUNDING

In operation for 21 years, the VAPalo Alto Health Care System’s

(VAPAHCS) Hospice Care Center isone of the oldest in California and inthe Department of Veterans Affairs. For many years, home hospices in thearea have referred veterans to HospiceCare Center when inpatient hospicecare was needed. But often, families ofveterans asked staff, “Where can we goif we need inpatient end-of-life care?We’re not veterans.”

No single hospice has been largeenough to independently support adedicated inpatient ward or facility. Andno local hospital or skilled nursing facilityhas had dedicated palliative care beds.

Taking an outside-the-box approach,Hospice Care Center opened its 25-bedinpatient hospice program to non-veteransin 1999. Non-veterans have access toeleven beds. This is the first hospiceprogram in the Department of VeteransAffairs approved to care for non-veterans.

“Reaching out is part of the VA tradition,” says Dwight Wilson,Associate Chief for Extended Care.“We’ve always been a safety net forveterans. Now, we’re extending ourreach beyond our customary niche.”

For the VA, expanding its servicebase offers a creative way to address the growing issue of excess beds and the accompanying funding squeeze. “By contracting with home hospiceagencies to care for non-veterans, wecan turn earned revenue back into oursystem, enabling expanded hospiceservice for veterans,” says Wilson. Inapproximately two years, the extended

program has served 134 non-veteransfrom five home hospices. In turn, theprogram has been able to increase itsveteran admissions by 50 percent.

Moved in 1999 to the main tertiarycare hospital at the Palo Alto Division,the hospice unit — by virtue of itspresence — is changing the culture ofmedicine throughout the hospital. “Byfollowing patients onto the unit, clinicianscan get a taste of what excellent end-of-life care really is,” says James Hallenbeck,M.D., medical director. “The ICU team,following a patient after withdrawal of life support, can experience howimportant it is to support the family, as well as the patient. They’ve learnedthat a family room is not the same as awaiting room. And they’ve learned thatwhen they talk with families abouttreatment withdrawal in the ICU, theycan now speak of what will be donefollowing withdrawal, not just what will not be done.”

For community hospice organ-izations the program is a welcome,much-needed option, offered in a spiritof collaboration, rather than competition.

It offers a model for other hospiceagencies to work with a local facility tooffer inpatient hospice care. Communityhospices appreciate how the VAPAHCSHospice Care Center creates a seamlessshift between home hospice and institu-tional care, and allows home hospicestaff to continue to provide occasionalcare, consultation and charting.

“Being able to work with VAPAHCSHospice Care Center has been a greatbenefit for our patients,” says Linda Blum,hospice supervisor for Sutter VNA inSan Mateo, California. “For patientswho lack a strong, caregiving supportsystem, the VAPAHCS Hospice CareCenter offers a way of having a home.In addition, for complicated cases, the VA is ideal, because they’re used todealing with people who have dualdiagnoses. There’s no comparable facilityin northern California. It’s a win-winfor everyone.”

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