Hospice of New York has reinvigorated its inpatient unit at Wyckoff Heights Medical Center, as well as developed an inpatient palliative care program.
The program begins with one nurse practitioner and one social worker. Today it not only includes those disciplines, but also an attending physician and two nurses, according to founding nurse practitioner Simon Ulubabov of Hospice of New York.
Ulubabovmanages the palliative care service while the attending physician Dr. Ruby Kesar oversees the hospice inpatient unit.
“Palliative care, hospice IPUs increase not just objectively the patient’s experience, not just the monetary remuneration that the facility gets, but more importantly the overall care that these patients get at the end of life,” Ulubabov told Hospice News. “I do believe that there is a way following this model that we’ve created of redeveloping hospice inpatient units in every facility.”
Hospice of New York has had a longstanding relationship with Wyckoff and has operated an inpatient unit there for several years.
The current unit includes six beds and is “particularly busy,” Ulubabovsaid. After admission to the hospital, the palliative care service visits the patient within 24 hours. If appropriate, the patient moves to the hospice inpatient unit.
Effective goals-of-care conversations are an integral part of this process, Ulubabovindicated. Depending on the medical complexity of the patient, either Ulubabov the attending physician or a nurse will conduct these discussions.
If the patient survives the hospital stay, Wyckoff discharges them to home or to a skilled nursing facility depending on the patient’s needs.
Hospice of New York’s presence in the hospital takes a degree of pressure off Wyckoff staff, some of whom may not be trained or experienced in having end-of-life conversations or symptom management, according to Ulubabov.
“The primary teams simply were not comfortable having these difficult conversations about topics of medical futility and symptom management and simply telling patients and their families that certain medications, certain treatments, certain surgeries are not a good idea prognostically,” Ulubabov said. “When it comes to quality of life, these healthcare professionals were not comfortable discussing it.”
The palliative care and inpatient programs have their roots in previous work that Ulubabov did at Nassau University Medical Center (NUMC), which is also a partner to Hospice of New York. The Wyckoff programs replicate the model implemented at NUMC.
Ulubabovpresented the model to Wyckoff leadership, including the CEO Rob Osgood and the company’s chief medical officer, which involved an assessment of the existing unit, an estimate of necessary full-time employees and workflows. After those meetings, Wyckoff approved the programs for implementation.
Looking ahead, Hospice of New York is considering establishing a physician fellowship program in collaboration with the hospital. Also possibly on the horizon is a community-based palliative care program within the next few years.
“These hospice units, as we are seeing here, are functional, comfort-measured units where families come in and spend their last days with their loved ones,” Ulubabov said. “These patients are getting full comfort measures without the fear that very often is expressed by these providers, where doses of opioids can’t go above a certain amount because they’re worried what’s going to happen with the patient. We’re going to keep them comfortable, and nature will take its course.”
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