Skip to main content

CoPs - obstacle, or inspiration?




by Jerry Soucy, RN, CHPN

The title of Amy Getter’s Geripal piece poses a critical question: As we face forces seemingly beyond our control, how can we stay true to the purpose of hospice, and to our patients and families? 

I share Amy’s concern. This is difficult work under ideal circumstances. We frequently face demands that compete for our time and attention. When the demands are in conflict, sources we expect to support us sometimes don’t seem very supportive.

Amy calls the Medicare Conditions of Participation (CoPs) overwhelming. I’ve worked with colleagues who see them in an even more negative light: as irrelevant, not very helpful, or even an obstacle to effective and compassionate care.

The law can seem byzantine for those of us without legal training, but I think it’s worth the effort to understand, internalize, and act on the values expressed in the CoPs. The logic and structure will become more evident as you read, and every hospice clinician will recognize the language, because it’s the foundation of our practice.

I’ve endured countless mediocre inservice and online programs on the topic. I bet Amy has, too. In my experience, negative comments about CoPs at IDG, in orientation, and elsewhere are frequently accompanied by nonverbal language that screams “Bear with me, even though we’d all rather stick needles in each others’ eyeballs.”

I disagree. I also don’t like needles. We should draw upon the CoPs to inform our actions, and share what they say about the spirit and purpose of hospice with the public.

Instead of fearing or scapegoating CoPs, or shunning them as snooze-inducing, overly-complicated, or of questionable worth in the “real world,” let’s consider them in the same way dedicated baseball fans consider that game’s rules: the final arbiter of the most basic question - “What is this all about?” - and the source of every critical element that makes the game possible.

We practice under authority granted by the CoPs, just as we practice within the scope of our state-issued licenses. They are the law, and a basic fact of our professional lives. They are also a great roadmap, providing both clarity and detail. Entire phrases can be lifted to answer anyone who asks, “You work in hospice - what’s it about?” 

Officially, they’re 42 CFR Part 418 - Hospice Care. Here’s a quick exercise: Grab a copy (pdf), and find § 418.52 Patient’s rights. Start your reading there, or skip ahead to (c) Standard: Rights of the patient. “The patient has a right to the following:  (1) Receive effective pain management and symptom control from the hospice for conditions related to the terminal illness;  (2) Be involved in developing his or her hospice plan of care; (3) Refuse care or treatment; (4) Choose his or her attending physician; 

Rights 5 to 8 address confidentiality, being fully informed about what will and will not be provided under the benefit, and the right to be, “free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of patient property.” 

I don’t think any hospice clinician disagrees. There’s plenty more good stuff where that came from.

Amy's practice is informed by the patients who have shown her, “time and again to STOP, leave my agenda behind, LISTEN to their hopes and desires…” She’s given us a prayer to recite quietly each time we enter a home. 

Her insight joins this reminder: we are engaged in an approach to caring that has been proven to improve the quality of life of patients and their families, allows a patient to remain at home for as long and as comfortably as possible, and with dignity.

I got that from page 32088 of the Federal Register / Vol. 73, No. 109 / Thursday, June 5, 2008 (pdf). I played with the structure of the statement, but didn’t change any words.

You never know where a helpful phrase might pop up.


Photo: image of the Federal Register from the public domain

Comments

Amy Getter, RN, MS said…
Jerry; I still maintain that an entire notebook of regulations is cumbersome, but the CoPs are part of standardizing hospice care which is extremely important considering the vastly increasing numbers of hospices throughout the country. The CoPs are the rule book, indeed the “road map”…and help keep everyone honest. Thanks for clarifying, in case anyone thought we could do away with them! Along with regulatory guidelines, the hospice team must be educated and prepared to meet the needs of a dying patient…but getting “back to basics” and at the heart of hospice is the incredible privilege to be invited in, hear the stories, and walk alongside a family in crisis. Amy
Jerry said…
You're right, Amy - it's all about what happens at the point of care.

Popular posts from this blog

Lost in Translation: Google’s Translation of Palliative Care to ‘Do-Nothing Care’

by: Cynthia X. Pan, MD, FACP, AGSF (@Cxpan5X)

My colleagues often ask me: “Why are Chinese patients so resistant to hospice and palliative care?” “Why are they so unrealistic?” “Don’t they understand that death is part of life?” “Is it true that with Chinese patients you cannot discuss advance directives?”

As a Chinese speaking geriatrician and palliative care physician practicing in Flushing, NY, I have cared for countless Chinese patients with serious illnesses or at end of life.  Invariably, when Chinese patients or families see me, they ask me if I speak Chinese. When I reply “I do” in Mandarin, the relief and instant trust I see on their faces make my day meaningful and worthwhile.

At my hospital, the patient population is about 30% Asian, with the majority of these being Chinese. Most of these patients require language interpretation.  It becomes an interesting challenge and opportunity, as we often need to discuss advance directives, goals of care, and end of life care options…

Elderhood: Podcast with Louise Aronson

In this week's podcast we talk with Louise Aronson MD, MFA, Professor of Geriatrics at UCSF about her new book Elderhood, available for purchase now for delivery on the release date June 11th.

We are one of the first to interview Louise, as she has interviews scheduled with other lesser media outlets to follow (CBS This Morning and Fresh Air with Terry...somebody).

This book is tremendously rich, covering a history of aging/geriatrics, Louise's own journey as a geriatrician facing burnout, aging and death of family of Louise's members, insightful stories of patients, and more.

We focus therefore on the 3 main things we think our listeners and readers will be interested in.

First - why the word "Elder" and "Elderhood" when JAGS/AGS and others recently decided that the preferred terminology was "older adult"?

Second - Robert Butler coined the term ageism in 1969 - where do we see ageism in contemporary writing/thinking?  We focus on Louise's…

Psychedelics: Podcast with Ira Byock

In this week's podcast, we talk with Dr. Ira Byock, a leading palliative care physician, author, and public advocate for improving care through the end of life.

Ira Byock wrote a provocative and compelling paper in the Journal of Pain and Symptom Management titled, "Taking Psychedelics Seriously."

In this podcast we challenge Ira Byock about the use of psychedelics for patients with serious and life-limiting illness.   Guest host Josh Biddle (UCSF Palliative care fellow) asks, "Should clinicians who prescribe psychedelics try them first to understand what their patient's are going through?" The answer is "yes" -- read or listen on for more!

While you're reading, I'll just go over and lick this toad.

-@AlexSmithMD





You can also find us on Youtube!



Listen to GeriPal Podcasts on:
iTunes Google Play MusicSoundcloudStitcher
Transcript
Eric: Welcome to the GeriPal Podcast. This is Eric Widera.

Alex: This is Alex Smith.

Eric: Alex, I spy someone in our …