This two-part report presents an organizational change plan for integrating existing nursing staff into an in-house hospice program within a healthcare facility. Part one introduces the proposed change, describes the hospice care landscape in the United States, and outlines how mandatory overtime will be used to train nursing professionals in hospice philosophy and holistic patient-centered care. Part two examines the financial and market rationale for the change, including Medicare and Medicaid reimbursement structures, and details implementation and monitoring strategies. Key metrics such as shift workload, absenteeism, training outcomes, and staff morale are identified as essential indicators for evaluating the program's success.
This two-part report aims to create a plan for an organizational change involving mandatory overtime for nursing professionals in both hospital and long-term care settings. The proposal is to incorporate the nursing staff into an in-house facility hospice program. This combining of responsibilities is an idea that will gain considerable momentum on a national basis in the near future, because the comprehensive project not only helps to improve the final days for fatally ill patients, families, and friends, but also provides a social service to the immediate community. It will raise the level of respect and confidence in the facility, create a new source of revenue, and may even open potential academic and educational offerings for other facilities looking to follow suit. The program will require some mandatory overtime for nursing staff in order to train, provide service, and support patients, family members, and friends.
It is important to note that this change will affect all key stakeholders, including the facility, administration, patients, families and friends, the broader community, and, of course, the nursing team.
The United States healthcare system has been growing rapidly. It encompasses far more than nursing staff — it includes health plans, physicians, hospitals, clinics, consumers, public health programs, and hospice organizations. As one source notes: "Governmental initiatives and not-for-profit foundation funding bolstered the spread of hospices here. In 1978, the National Cancer Institute awarded grants to three hospices as demonstration projects to investigate the costs associated with care and to describe the actual manner in which care was provided to patients. Shortly thereafter, the Health Care Financing Administration (HCFA) was charged by Congress and the Carter Administration to initiate a research and demonstration study to examine the costs, benefits, and feasibility of having Medicare pay for hospice care. Existing hospice programs were invited to apply" (Hospice Benefits and Utilization in the Large Employer Market).
The aging of America's population has been widely documented. The current median age is rising, and more Americans will require hospice services. This facility currently provides these services through external hospice organizations, which are often severely short-staffed. Hospice programs do not aim to cure fatal diseases; rather, their goals center on providing help with the pressures related to caring for terminally ill patients, usually in the final stages of life. Hospice programs also assist patients with confirmed life-threatening illnesses, with the goal of providing an acceptable quality of life — keeping patients as comfortable and pain-free as possible. As Rubenfeld and Scheffer (1995, p. 100) observe, "Nurses need to identify patients' strengths so they can use those strengths to help overcome the problems."
Since the late 1970s, hospice services were traditionally performed in a patient's personal residence. "In 1977, the National Hospice Organization (NHO) was formed in the United States" (Hospice Benefits and Utilization in the Large Employer Market). However, an increasing number of hospice organizations have been called upon to serve healthcare facilities such as free clinics, hospitals, and nursing homes. This trend will only grow as more Americans reach the stage of life where hospice services are required.
Just as there are significant shortages of qualified nursing professionals across all areas of healthcare, hospice programs have had to seek additional assistance from alternative sources. Accordingly, this facility proposes to train existing nursing professionals to administer the nursing care required for both potential and current hospice recipients.
The mission, structure, and community position of this facility will not change significantly with this proposal. The organization will continue to provide excellent patient care. The mandatory overtime required of nurses will be distributed as evenly as possible so as not to place undue strain on any individual member of the existing nursing staff. The objective is to instill the hospice philosophy in the nursing staff through thorough training delivered by experienced hospice nursing trainers. The goal is to explain and teach the holistic, family- and home-centered approach to death and dying.
The primary reason for mandatory overtime is that a hospice approach requires more social and psychological training and theory than hands-on clinical implementation skills. Nurses will be trained to focus on the patient rather than the illness — a principle that has been the foundation of many globally renowned hospice organizations already delivering excellent service in a cost-effective manner.
Mandatory overtime will also be used to help create the individualized care plans that fatally ill patients and their families require. The nursing staff will be prepared to work as part of a multidisciplinary team caring for the terminally ill, collaborating with physicians, homecare aides, social workers, counselors, and volunteers. Nurses will also be taught to coordinate direct nursing care and to provide patients and families with the education and support they need.
"Why hospice services belong in this facility"
The facility aims to assure families that staff are fully prepared and trained to provide the needed rest and relief. The nursing staff is already proficient at administering the medications commonly required for medical and biological patient needs. Nurses, alongside physicians, will also become more skilled at providing bereavement support following a patient's death.
From various marketing perspectives — including market analysis, economic projections, and financial analysis — the facility stands to benefit significantly from establishing an in-house hospice-prepared nursing staff working mandatory overtime shifts. The hospice program provides near-guaranteed patient eligibility. Because of legal and social support structures, hospice is one area of the healthcare system that has not placed heavy emphasis on a patient's financial situation. The facility will offset the cost of overtime through the fact that the single credential for hospice qualification is that the patient is fatally ill.
This means that all terminally ill patients who can be classified as being in a final phase of life become eligible to receive hospice care, and the facility becomes entitled to mandated financial reimbursement. The prospective new market also includes individuals in a progressive stage of any life-threatening illness. Hospice eligibility is not a financially discriminatory process. For the facility, the key point is that patients of all ages — whether insured or uninsured — are covered by a combined system of Medicare, Medicaid, and the majority of private insurers such as Health Management Organizations (HMOs). As a result, the cost of mandatory overtime will be a covered hospice-related expense.
When Congress accepted hospice as a fully Medicare-covered program, it noted that all working individuals generally have a lifetime coverage limit of approximately two hundred days. Utilization trends show that Medicare pays for nearly eighty percent of hospice care in America. As the number of Medicare beneficiaries grows due to the aging of the baby boomer generation, the program may be adjusted. However, current hospice figures indicate that only about twenty percent of all elderly individuals who die are enrolled in hospice programs, suggesting substantial room for growth.
"Training phases, monitoring metrics, and staff roles"
This two-part report aimed to create a plan for an organizational change whereby the internal nursing staff would be required to perform duties during periods of mandatory overtime in order to complete a training process designed to add hospice services to the facility. This combination of responsibilities offers the facility an excellent opportunity to provide a highly sought-after social service to the immediate community, raise the level of respect and confidence in the facility, create a new source of revenue, and potentially offer academic and educational programming for other facilities wishing to follow a similar path.
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