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CAPC Palliative Care Discussion Forum
Palliative Care in Long Term Care Settings

Next Reply: Re:Chaplain and Social Services
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Post Chaplain and Social Services
Author: jdescher
Date: Jan 22, 2010 10:39 am
I am in need of Chaplain and Social Services for some of my nursing home patients currently recieving palliative care. I am a one man gang (NP)and adding these services is not in the budget at this time. Our hospice Chaplains and MSWs have interest in providing care to my patients. Is this not a good idea? I offer my patients and their families the choice of any hospice they choose when this decision is made, not just our hospice, but I don't want Medicare thinking I am incentivizing for our hospice. Does anyone in a nursing home based palliative care program use hospice staff for their program? Thanks!
Replies: order by [Date] [Author] [Subject]
Re:Chaplain and Social Services (by SharolHerr on 02/04/2010)
I would review the Conditions of participation guidelines for hospice before trying to use the hospice staff to provide services in the nursing home. You would not be able to bill for either the chaplain or MSW services and this would be taking them away from their primary hospice responsibilities. They would need to be paid out of two distinct cost centers so that there would not be a conflict of interest or violation of Stark and other laws. You could consider developing a collaborative relationship with the chaplain and the MSW in the facility and see about getting a commitment from the facility to have those staff develop skill and expertise in providing palliative care services. You could then regularly interact with them, establish the plan of care with them and nursing. In that scenario, they would remain on the facility's budget. Sharol Herr, RN, MSEd; Nurse Clinician/Education Coordinator; Mount Carmel Health Palliative Care Leadership Center; Columbus, Ohio.
Re:Chaplain and Social Services (by Tim_Ford on 02/05/2010)
Though the odds of a professionally-trained MSW or chaplain providing biased counsel to a resident are slim to none, nevertheless the vulnerability of this population (doubly so among palliative patients) is such that the mere appearance of a conflict of interest is enough to warrant extreme caution. In principle, if the LTC cannot justify what, in my opinion is a base service to the residents, then farming it out to a community partner with a financial bias is unwise. Would they allow your hospice to provide 'pro bono' nursing services or physicians for patients not under your care? Sadly, it is precisely these 'rock-and-a-hard-place' conundrums that sometimes catalyze the FTE's. In the end, it is the LTC's reputation and responsibility that is at stake.

Tim Ford
Palliative Care Chaplain
VCU Massey Cancer Center
Richmond, VA

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