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REACHING UNDERSERVED

COMMUNITIES IN END OF LIFE

CARE

Shannon Pointer MSN, RN

Community Educator

Hospice & Palliative Care Center of Alamance-Caswell

LifePath Home Health

KidsPath

914 Chapel Hill Road Burlington, NC 27215

336-532-0100 1-800-588-5879

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Introduction

Hospice Helps Everyone

2015 NHPCO theme for National Hospice and Palliative Care Month.

Equal Access:

Do we help everyone? What are the barriers?

Are we leaving “No Stone Unturned” to ensure no one in our community ever has to say:

“I wish I would have known sooner?”

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Definition3

What Are Some Examples of Underserved Communities?

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NHPCO National Statistics

According to NHPCO Facts and Figures

(2015), In 2014,

7.1% of hospice patients were identified as being of

Hispanic or Latino origin compared to 92.9% that

identified as Non-Hispanic or Latino origin.

76% of all hospice patients were White/Caucasian.

Reference: National Hospice & Palliative Care Organization. (2015). NHPCO’s facts and figures: Hospice Care in America 2015 Edition. Retrieved from

http://www.nhpco.org/sites/default/files/public/Statistics_Research/2015_Facts_Figures.pdf

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US Census Data5

Population Quick Facts

http://quickfacts.census.gov

Alamance County, NC Statistics

People QuickFacts Alamance County North Carolina

Population, July 1, 2015

estimate (V2015) 158,276 10,042,802

Population estimates

base, April 1, 2010 151,241 9,535,692

Persons 65 years and

over, percent, July 1,

2015, (V2015) 16.4% 15.1%

Persons 65 years and

over, percent,

April 1, 2010 14.6% 12.9%

Reference: United States Census Bureau. (2016). State and county quickfacts. Retrieved from

http://quickfacts.census.gov/qfd/states/37/37001.html

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Alamance County, NC Statistics

People QuickFacts Alamance County North Carolina

Hispanic or Latino,

percent, July 1, 2015,

(V2015) 12.4% 9.1%

Hispanic or Latino,

percent, April 1, 2010 11% 8.4%

Asian alone, percent,

July 1, 2015, (V2015) 1.7% 2.8%

Veterans, 2010-2014 9,972 709, 471

Reference: United States Census Bureau. (2016). State and county quickfacts. Retrieved from

http://quickfacts.census.gov/qfd/states/37/37001.html

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Orange County, NC Statistics

People QuickFacts Orange County North Carolina

Population, July 1, 2015

estimate (V2015) 141,354 10,042,802

Population estimates

base, April 1, 2010

(V2015) 133,702 9,535,692

Persons 65 years and

over, percent, July 1,

2015, (V2015) 11.5% 15.1%

Persons 65 years and

over, percent,

April 1, 2010 9.6% 12.9%

Reference: United States Census Bureau. (2016). State and county quickfacts. Retrieved from

http://quickfacts.census.gov/qfd/states/37/37001.html

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Orange County, NC Statistics

People QuickFacts Orange County North Carolina

Hispanic or Latino,

percent, July 1, 2015,

(V2015) 8.5% 9.1%

Hispanic or Latino,

percent, April 1, 2010 8.2% 8.4%

Asian alone, percent,

July 1, 2015, (V2015) 7.9% 2.8%

Veterans, 2010-2014 5,886 709, 471

Reference: United States Census Bureau. (2016). State and county quickfacts. Retrieved from

http://quickfacts.census.gov/qfd/states/37/37001.html

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Additional Statistics

People

QuickFacts

Caswell

County

Alamance

County

Orange

County

North

Carolina

United

States

Black or African

American alone,

percent, July 1,

2015, (V2015) 33.1% 19.7% 12.3% 22.1%

Population,

percent change -

April 1, 2010

(estimates base)

to July 1, 2015,

(V2015) -3.3% 4.7% 5.7% 5.3% 4.1%

Reference: United States Census Bureau. (2016). State and county quickfacts. Retrieved from

http://quickfacts.census.gov/qfd/states/37/37001.html

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Community Health Assessment11

What is it?

How can it help with equal access and

reaching underserved communities?

Community Health Assessment: County

Assessments

http://publichealth.nc.gov/lhd/cha/

Alamance County, NC Community

Health Assessment 2015

Top Three Priority Areas:

1. Education

2. Economy

3. Access to Care

Alamance County has had an “influx of Hispanic residents over the

past decade, which nearly doubled” (Community Assessment 2015,

page 9).

“According to US Census Bureau 2010 data, the growth of the

Hispanic population from 2000 to 2010 is 53 percent” (Community

Assessment 2015, page 9).

“Alamance County is experiencing similar national trends with an

increase in the average age of population being 65 years and older”

(Community Assessment 2015, page 9).

Reference: Alamance County. (2015).Community Assessment 2015. Retrieved from

http://www.alamancecommunityassessment.com/2015CommunityAssessment.pdf

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Orange County, NC Community Health

Assessment 201113

“While Orange County’s Latino population mirrored the percentage of Latinos across the

state, the county’s Asian population was considerably higher, 6.7% compared with

2.2% in the state. The highest concentration of Asians was in Chapel Hill, where in 2010 they comprised 11.9% of the population, up

from only 4.1% in 2000.”(page 31).

Reference: Orange County. (2011).Community Assessment 2011. Retrieved from

http://www.orangecountync.gov/final_2011_orange_county_cha_full_report2.pdf

Orange County, NC CHA 201514

“The largest minorities differ in the three main municipalities. Black residents are the largest group of minorities in Hillsborough

making up 30%; in Carrboro the largest group is Hispanic or Latino residents making

up 14%; and in Chapel Hill the largest minority group is Asian making up 12%.”

Reference: Orange County. (2015). Community Assessment 2015. Retrieved from

http://www.orangecountync.gov/FINAL%20Orange%20County%202015%20Community%20Health%20Assess

ment.pdf

Cultural Competence15

What is it?

Individual

Agency

Reference: American Speech-Language-Hearing Association (2016). Cultural Competence. Retrieved from http://www.asha.org/Practice-Portal/Professional-Issues/Cultural-Competence/

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Individual Cultural Competence

Find online resources, take online continuing

education courses, attend workshops, etc.

With outreach plans, consider the following:

What are resources in your area that underserved

communities trust?

Resource Centers, Hospitals, Doctors, Businesses,

Faith Based Communities, etc.

Set up a time to learn more about their agency.

Find out what you can do to help.

Keep communication and collaboration ongoing.

Look for opportunities to connect to not only your

resources, but other community resources.

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Agency Cultural Competence

What is different when a Non-English

speaking person calls your agency for

information or resources?

How does your agency capture race/ethnicity

upon admission?

Do you ask or do you assume?

How can you determine if your agency is

culturally competent?

Cultural Competence Assessment

http://www.asha.org/practice/multicultural/self/

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Agency Cultural Competence

How can your agency improve? Establish a committed team

Make a long range plan and set reasonable goals, but remember it all goes back to RELATIONSHIPS!

Educate within (individual/staff) so that you can educate others effectively

Develop a Plan of Action

Implement Plan

Participate in Ongoing Evaluation of Plan for Effectiveness

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It’s All About Relationships19

Let’s discuss some tools and strategies

that I used to increase our agency’s

access to underserved communities.

The goal was to strengthen relationships

with all in my community.

NHPCO Latino Outreach Guide

Advance Care Planning – More Likely to Plan by another name, not ACP

“Caregiver” – Family vs. Agency

*IMPORTANCE OF FAMILY

*HOSPICE IS NOT A NURSING HOME

“Compassionate Care”

Latino Board Members

Cultural Competence Training

Fotonovella (Photonovela) – photos to convey messages

Reference: National Hospice & Palliative Care Organization. Latino outreach guide. Retrieved from: http://www.nhpco.org/sites/default/files/public/Access/Latino_OutreachGuide_Abbreviated.pdf

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Quiz – Define These Terms

CURANDERISMO

DíA DE LOS MUERTOS

El NOVENARIO/LA NOVENA

EL VELORIO

FAMILISMO

FATALISMO

HISPANIC

HOSPICIO

LATINO

TRANSCREATE

TRANSLATE http://www.nhpco.org/sites/default/files

/public/Access/Latino_OutreachGuide_

Abbreviated.pdf

Find the answers at:

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End of Life Care: Latino Culture

El Velorio

El Novenario - Body held in home for a minimum of 24 hours after death.

Candles – possibly 24 hours a day

Catholic – Last Rites very important so HAVE A PLAN!

Pictures of Saints

How do you refer to your patient ?– RESPECT! ASK, DON’T ASSUME!

Clear Language - No Jargon!

Typically Non-Aggressive in Communication Style

Be sensitive with discussions on organ donation or autopsy

Reference: Culture Clues. (2007). Patient and family education services end-of-life care: The latino culture. Retrieved from: https://depts.washington.edu/pfes/PDFs/End%20of%20Life%20Care-Latino.pdf

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Plan: National Hospice Month

(Timeline 2-5-15 to11-22-15)

RELATIONSHIP AND TRUST - Meeting

with Centro La Communidad –

instrumental to build trust and strengthen

relationship.

RELATIONSHIP -Emails and Phone

Calls to get approval to reach out to

Blessed Sacrament Catholic Church.

RELATIONSHIP - Met Father Paul at a

community event, obtained business

card and followed up via email to discuss

idea.

TRUST - Father Paul instrumental in

helping to organize a meeting at Blessed Sacrament Church

with team that creates bulletins.

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Plan: National Hospice Month

(Timeline 2-5-15 to11-22-15)

900 English and 900 Spanish agency

programs services flyers in each bulletin were distributed a week

before the offering, plus a special bilingual

statement about our plans to attend and offer

hospice education.

Continued to reach out and thank Centro for

their support.

Coordinated with agency document interpreter,

agency bilingual bereavement counselor

and nursing assistant for assistance, support and

feedback.

Multiple emails and phone contacts in

preparation for the actual event. Event

scheduled 11-22-15.

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Implementation and Evaluation

Blessed Sacrament

11-22-15 – estimated that 1000 people attended

Sunday Mass

Hospice Basics presented in Spanish after Mass.

Meet and Greet after event with hospice staff:

Bereavement, Volunteer questions answered

“We did not know”

Improved relationships with clergy and with

members. Both English and Non-English speaking

Continue to look for ways to strengthen our

relationship.

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The following

three slides are

from the 11-22-

15 presentation.

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Hospice & Palliative Care Center of Alamance Caswell

LifePath Home Health

KidsPath

914 Chapel Hill Road Burlington, NC 27215

336-532-0100 or 1-800-588-5879

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Introductions Introducciones Harald Petrini, Hospice

Bereavement Counselor and Chaplain

Shannon Pointer, Community Educator

Rosa Morales, CNA

Harald Petrini, Consejero de Duelo y Capellán del Hospicio

Shannon Pointer, Educadora Comunitaria

Rosa Morales, Ayudante de Enfermeria Certificada

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What is Hospice? Qué es el Hospicio? Support throughout the

journey. Providing comfort and

relieving pain and symptoms. Person and family driven

plan of care to ensure the best quality of life possible.

Team approach, using the skills of many trained professionals and volunteers.

Care provided wherever a person calls home.

Apoyo durante toda la experiencia.

Proveer comodidad y alivio del dolor y de los síntomas.

Planes de cuidado orientado hacia el paciente y la familiapara asegurar la mejor calidad de vida posible.

Enfoque de equipo, usando las habilidades de muchos profesionales y voluntarios entrenados.

El cuidado se provee donde esté el hogar de la persona.

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NHPCO Chinese Outreach

Guide

Talk about it, It will Happen

Family Duty

Respect for Physician Authority

Remain in Their Own Home

Reference: National Hospice & Palliative Care Organization. Chinese outreach guide. Retrieved

from:

http://www.nhpco.org/sites/default/files/public/Access/Chinese_American_Outreach_Guide.pdf

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End of Life Care: Chinese

Culture

Balance and Harmony

Importance

Herbs, Aromatherapy, Chinese Medicine

Reference: Culture Clues. (2007). Patient and family education services: Communicating with your chinese patient. Retrieved from: https://depts.washington.edu/pfes/PDFs/ChineseCultureClue.pdf

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Plan: Chinese Outreach

(Timeline 12-2015 to 3-2016)

RELATIONSHIP AND TRUST - Meeting with

Senior Center Mandarin Chinese

Liaison - instrumental to build trust and

strengthen relationship.

RELATIONSHIP -Emails and Phone

Calls to get approval to reach out to Mandarin Chinese Population.

RELATIONSHIP –Offered to develop

education materials that could easily be

translated into Mandarin. Mandarin

liaison agreed to translate slides.

TRUST – Liaison trusts my relationship and understands that I

want to help everyone. Liaison sees the lack of knowledge on end of life care and wants to improve awareness.

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Plan: Chinese Outreach

(Timeline 12-2015 to 3-2016)

40 am and 10 pm session attendees learned about

hospice care.

-Only a few attended subsequent volunteer interest meeting but of those few, they were

very interested in volunteering with our

agency.

Continued to reach out and thank them for their

support. Follow up session on volunteering with hospice was held at

the center.

Coordinated with agency team to let them know I am working diligently to increase the diversity of

our volunteer population.

Ongoing communication and follow up phone calls on community

members interested in learning more after the

presentations.

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The following

three slides are

from the 3-9-16

presentation.

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Shannon Pointer, MSN, RN Community Educator

Hospice & Palliative Care Center of Alamance-CaswellZhenzhen Yu, MSW

Project Coordinator/Bilingual Social WorkerOrange County Department on Aging

Hospice & Palliative Care Center of Alamance-CaswellKidsPath

914 Chapel Hill Road Burlington, NC 27215336-532-0100 or 1-800-588-5879

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What is Hospice?什么是安宁疗护

NHPCO Hospice Movement toward care and not

cure Providing comfort and relieving

pain and symptoms Patient and family driven plan

of care to ensure the best quality of life possible

Interdisciplinary approach, using the expertise of many trained professionals and volunteers

Support throughout the journey until the end of life

Bereavement support Hospice is about Living!

美国安宁疗护护理组织

是照护，不是治疗

带来舒适，缓解疼痛

病人，家属，医生，护士等其他护理人员合作照护

获得极大的支持

丧亲心理咨询

注重的是生活质量

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Hospice Care LocationsHospice is NOT A PLACE

Hospice is provided: In your own home or

apartment

In your Independent Living Facility

In your Assisted Living Facility

In your Nursing Home Facility

At an inpatient facility or at a Hospice Home

安宁疗护不是指的一个机构

在不同的地点提供安宁疗护 家/公寓

独立住房社区

辅助性养老院

护理性养老院

住院部或安宁疗护机构

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Interdisciplinary Team 跨行业团队

Help and Support for the Patient and Family

Makes hospice care unique Case coordinator must be

an RN Core Team = MD/DO, RN,

SW, Pastoral or other counselor

Patient can decline services of core team member, but service must be offered and needs monitored

唯一性 注册护士为团队协调人 中间力量

安宁疗护机构必须向病人提供有关这些服务的信息，病人有最终决定权，接受还是拒绝

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From Their Perspective

Video Link

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Next Steps

Within Your Agency

Assess your agencies cultural competence

Implement strategies to improve communication

Language Line

Bilingual Staff – improve comfort

Increase communication and collaboration with

community partners

Increase volunteer diversity

Increase employee diversity

Increase staff education on cultural competence

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Next Steps

In Your Community

Strengthening relationships!

Provide Education – Individuals, Businesses, etc. (Staff Turnover)

Search for events to attend in your community that may reach underserved communities

Work to increase trust and improve access to care, hospice or other care needs (It’s not All About YOU!)

Use bilingual materials when possible to connect (print and social media).

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Learning From Others42

“No one knows it all”!

We are in the business of interdisciplinary teams or groups - We can all learn from each other.

Learning from each other’s perspective will allow us to implement the best plan!

Would anyone like to share a successful outreach effort to underserved

communities in your area?

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How Will You Increase Access?43

Do All “Know Their Options?”

NHPCO Theme for 2016 National Hospice

and Palliative Care Month

Conclusion44

What Are Some Steps You Will Take To Reach Underserved Communities?

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References45

Alamance County. (2015).Community assessment 2015. Retrieved from

http://www.alamancecommunityassessment.com/2015CommunityAssessment.pdf

American Speech-Language-Hearing Association (2016). Cultural competence.

Retrieved from http://www.asha.org/Practice-Portal/Professional-Issues/Cultural-

Competence/

American Speech-Language-Hearing Association (2016). Self assessment for cultural competence. Retrieved from:

http://www.asha.org/practice/multicultural/self/

Bersin, J. (2015, December). Why diversity and inclusion will be a top priority for 2016. Forbes. Retrieved from

http://www.forbes.com/sites/joshbersin/2015/12/06/why-diversity-and-inclusion-

will-be-a-top-priority-for-2016/#4e0b5e6c4bd4

Culture Clues. (2007). Patient and family education services: Communicating with your chinese patient. Retrieved from:

https://depts.washington.edu/pfes/PDFs/ChineseCultureClue.pdf

Culture Clues. (2007). Patient and family education services end-of-life care: The latino culture. Retrieved from:

https://depts.washington.edu/pfes/PDFs/End%20of%20Life%20Care-Latino.pdf

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References46

National Hospice & Palliative Care Organization. (2009). Chinese outreach guide.

Retrieved from

http://www.nhpco.org/sites/default/files/public/Access/Chinese_American_Outreac

h_Guide.pdf

National Hospice & Palliative Care Organization. (2007). Inclusion and access toolbox. Retrieved from http://www.nhpco.org/access-outreach/inclusion-and-

access-toolbox

National Hospice & Palliative Care Organization. (2009). Latino guide. Retrieved

from:

http://www.nhpco.org/sites/default/files/public/Access/Latino_OutreachGuide_Abbr

eviated.pdf

National Hospice & Palliative Care Organization. (2015). NHPCO’s facts and figures: Hospice Care in America 2015 Edition. Retrieved from

http://www.nhpco.org/sites/default/files/public/Statistics_Research/2015_Facts_Fig

ures.pdf

National Hospice and Palliative Care Organization. (2015). What is hospice?Retrieved from http://www.nhpco.org/about/hospice-care

References47

North Carolina Division of Public Health. (2015). Community health assessment. Retrieved from http://publichealth.nc.gov/lhd/cha/

Orange County. (2011). Community assessment 2011. Retrieved from

http://www.orangecountync.gov/final_2011_orange_county_cha_full_

report2.pdf

Orange County. (2015).Community Assessment 2015. Retrieved from

http://www.orangecountync.gov/FINAL%20Orange%20County%2020

15%20Community%20Health%20Assessment.pdf

United States Census Bureau. (2015). State and county quickfacts.

Retrieved from http://quickfacts.census.gov

Website Resources48

http://www.nhpco.org/diversity

http://www.nhpco.org/access

http://www.un.org/en/events/culturaldiversityday/

http://www.un.org/en/events/culturaldiversityday/tenthings.shtml

http://www.nhpco.org/underserved-communities

http://www.va.gov/vetdata/

www.wehonorveterans.org

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THANK YOU FOR ATTENDING

THIS SESSION!

Shannon Pointer MSN, RN

Community Educator

Hospice & Palliative Care Center of Alamance-Caswell

shannon@hospiceac.org

336-532-0100 1-800-588-5879

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