Arizona-based Stoneridge Hospice launched services in 2020 with an aim to address a swelling aging population’s growing need for end-of-life care.
Building the foundation for quality hospice care delivery during a global pandemic came with hurdles that were difficult, but not impossible, to overcome, according to Rollie Seebert, owner and executive manager of Stoneridge Hospice.
Seebert is a retired sheriff of Maricopa County, Arizona. The company was established in concert with his wife, Janet Seebert, director of nursing at Stoneridge Hospice, and his niece, Patti Bratzel, a registered nurse who became co-owner, and executive director.
The idea to open a new hospice in Arizona came from the personal experience of losing a close loved one alongside the professional backgrounds of witnessing the challenges in end-of-life care delivery, Seebert told Hospice News in a recent interview.
Stoneridge Hospice provides home-based hospice and also contracts with other providers to offer facility-based services. The hospice provider also offers palliative care, veteran and bereavement services, and durable medical equipment (DME) and supplies.
Stoneridge Hospice launched in 2020. Can you share what led to the start of your services?
Our management team consists of myself, my wife and my niece. My wife was a nurse in emergency medicine for several years, and my niece was a long-time hospice nurse. We set out to provide patients in the greater Phoenix area with the best possible hospice care that they can get.
We recognized that this demographic tsunami was coming that would need this continuum of care with palliative, hospice and home health. We all had some kind of experience with hospice and seeing the difference it can make for patients and families, and we knew that was going to be our next chapter and calling.
We started initially as a home health agency [Southland Home Care], then sold it in 2020 and began talking about opening a hospice. We now have a service-mile radius of 60 miles in Maricopa County, Arizona. We saw that there’s a great need for these services there. In February that year we got our corporation licenses for a business and in November we became Medicare-certified.
What were some of the challenges that came with launching services during the COVID pandemic, and how were those addressed? What were some of the key strategies that you’ll carry forward into the future?
COVID was in full swing by early 2020, and our number one priority to even give patients this service was having an emphasis on personal protection equipment (PPE). We also couldn’t go into the facilities. So that distance was our biggest issue, that we couldn’t have a direct, more personal touch with patients.
It was challenging, but not insurmountable. We had several things offered virtually, some of our chaplain services, patient visits and volunteer care. The pandemic really slowed down how many patients were being referred to us for hospice.
One of our strengths is that we have a good quality assurance and performance improvement (QAPI) program that was really honed during the pandemic. One of the things we do is have our quality program team review charts and monitor tuck-in calls contacts with patients in between services to address specific needs. The biggest takeaway was having that constant contact with our patients at a time when we were restricted with access. We really tried to establish all these other avenues to increase contact and communication.
We have really carried that spirit forward with us. It’s how we strive to provide five-star service.
You took the helm at Stoneridge Hospice after retiring from local law enforcement. What led you to hospice, and how has your law enforcement background informed your leadership approach?
I worked in Phoenix at the sheriff’s office from 1976 to 2012. I was a deputy chief and went all the way up in the ranks. I was in charge of the jail system, which had about 10,000 inmates at that time, and we contracted out for medical care across five clinics and had a small inpatient unit. After I retired, I really leaned into home health and hospice.
Having a law enforcement background helps specifically with quality improvement and oversight. Planning, patrolling and supervising are in my nature, and I think what I bring to the table is the ability to problem solve in a very systematic way. It’s making decisions and maintaining a high level of review to execute a plan and make sure the results are heading in the direction you want to go. My strengths lie in that quality assurance area and running the business part.
Can you share details about some of your strategic plans, and whether you intend to expand your service region in your state (or others)?
Our business plans call for potentially franchising, and that’s easy to say but difficult to accomplish.
We are probably at least looking at starting another hospice. I would love to go to Florida and open another hospice, or even to Tucson, Arizona. It’s not in our plans, but in the future that’s kind of the direction we’re headed. It’s about determining demand both in states with and without certificate of need laws. Access, quality of care, responsiveness, all of those things could be impacted.
Arizona is a state without hospice certificate of need laws in place. What was your experience in determining a need for a new hospice provider in your service region? What were some key considerations, and how did you navigate them?
It’s about meeting the Medicare standards and accreditation requirements, whether it’s home health or hospice. You have to make sure that you have all the requisite criteria to meet those basic needs. The questions become, ‘Where are the patients? What are their general needs?’
We’re in a giant metropolis area here, with almost twice as many people living here in Maricopa County as they do in the city of Phoenix alone. The patients are here, but it becomes an issue of marketing to other [referral] resources, not necessarily the individual patients. You have to build yourself a group of resources and build a reputation. That involves hiring the right people, having the right clinicians to go out and do a good job.
Part of that is taking on problematic patients at times. You get a reputation in hospice that you can make yourself available for wound care and dementia patients, or veteran patients. It’s an important piece of the puzzle not to limit yourself. You have to be broad enough while still maintaining quality to take care of and find patients. You have to find ways to best present yourself and your services appropriately, then provide services at a high quality level.
Program integrity concerns have heated up in states such as Arizona, California and Nevada, among others. What are some of the challenges of operating in Arizona amid increasing program integrity concerns and ways to address these?
We have more than a hundred hospices servicing patients, some with only 20 patients on their daily census. You have to make sure not only that you are providing all of your quality measures, but also that you are looking at specific areas and reviewing to see whether you’re meeting the mark.
It’s sort of reverse engineering [by] looking at good eligibility criteria at the very beginning to avoid huge red flags like live discharges. The patients may need help, but if they don’t qualify with a life-limiting condition that will run a normal course of life within six months, then they don’t qualify.
You have to watch for the reg flags and pay attention to them [to] identify the potential areas of fraudulent use and make sure you’re clearing those red lines. It comes with hiring the right medical directors and clinicians to make sure patients are eligible. It really and truly is monitoring your organization and making sure you are complying with the regulatory criteria that’s already in place, because that’s set up to work. Just follow the rules.
Walk me through some of the services that you offer, aside from hospice. Why are these important to include in your service offerings?
We offer durable medical equipment at no cost to our patients, and that includes everything you could possibly think of.
We also began a texting communications program, which will enhance our bereavement program.
We are starting a palliative care program in the state of Arizona. Palliative is important, because it’s between home health and hospice. They don’t need to be homebound, and the patient doesn’t have to have a terminal diagnosis yet. During that time, many patients are lost. What a palliative care program does is it gives you the opportunity to help them navigate the health care system.
It gives you a chance to touch those patients and be a resource for them to call. It’s so they don’t run to the emergency room all the time, and so they don’t do things that will not be beneficial to them and be costly to the overall health care community. The costs of health care goes up and up as you age, and a lot of that is because people are unsure of what services they need and so they go to the ER. Our goal in palliative care is to help stop the recurring emergency room visits. It’s good for the patient; it’s good for the system.
We also have our Hispanic outreach program. We have a gigantic Hispanic community with people that have been here for a while. There’s a big underserved group and a large percentage of our caregivers are Hispanic. That gave us an opportunity to communicate with people who might otherwise not get the service due to a social barrier. They have that bridge between various communities.
Our number one goal is to introduce in underserved communities a benefit that they have a right to, that they just don’t know is out there. They don’t understand the benefits of hospice, the social benefits we can help with like finding housing for the underprivileged. We want to get these people the services that they need, and if we can’t provide that then maybe it’ll help some other relatives of theirs. The goal is just to get the services out there.
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