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continued from previous pageHospice bereavement programs are expected to providethe program is accountable for implementing andsophisticated grief support and education to their hospicecoordinating the hospice bereavement program, as directedfamilies for a minimum of thirteen months following aby such policies and procedures.patient’s death. This conveys availability of support as thebereaved individual anticipates the one year anniversary ofthe date of death, and recognizes that people are usually inScope of Hospice Bereavement Services: an emotionally different place by the 14th month after theloss. Bereavement support is accomplished through acombination of measures that includes providing supportgroups and memorial services, informational and educationalresources, counseling, and referrals to appropriatetherapeutic and community resources. Hospices should develop personalized plans of care with bereaved clientsthat detail frequency as well as scope of services provided.In addition to addressing the needs of bereaved individuals,hospice bereavement programs should identify and define the responsibilities they assume with respect to theircommunity’s loss and grief needs while never sacrificing theneeds of hospice family members. Services differ markedlyfrom program to program based upon community need andavailable resources. It is imperative, however, that hospicestaff have the requisite knowledge and skills needed toprovide or refer appropriate services to community bereaved.The Medicare Conditions of Participation includebereavement counseling to residents and employees ofSkilled Nursing Facilities/Nursing Facilities, IntermediateCare Facilities for cognitively impaired or developmentallydelayed individuals, or other facilities when appropriate andidentified in the bereavement plan of care. (Department of Health and Human Services, 42 CFR Part 418 Medicare andMedicaid Programs: Hospice Conditions of Participation;Final Rule, 418.112). Visiting a hospice patient’s roommatewho is affected by a death, providing a support session forstaff affected by several deaths in a short period of time, orsimply following up with facility staff after the death of along time resident are examples of ways hospicebereavement professionals should be providingbereavement counseling services to residents andemployees of healthcare facilities.It is important that hospices create bereavement-specificguidelines that detail the availability and scope of servicesand clearly delineate policies and procedures. Thebereavement staff person with responsibility for directing8NHPCO NewsLine Spring 2018 Identify family members in need of bereavementsupport, prior to and following the death of thepatient, including:– children in the home– caregivers– other friends or family membersAssess patient and family strengths, bereavementrisk, concerns and needs related to grief and lossfrom start of hospice care through the end ofbereavement careProvide basic grief information and supportthrough:– written materials (e.g., supportive letters,newsletters, articles)– audiovisual educational resources– individual contacts (e.g., phone calls or visits)– support groups– commemorative activities such as memorialservices– counseling sessions with a bereavement counselor– social events– collaborative work with the bereaved individual’sprimary mental health or healthcare practitionerEmpower families to recognize and develop skills tomanage grief by exploring ways they have effectivelycoped in the past and identifying areas of strengthand resilience, assisting families in identifying currentsocial and spiritual resources for support.Refer family members who need services forcomplicated bereavement, mental health or otherneeds that are outside the scope of the hospicebereavement program to quality resources in thecommunity. These might include the bereaved whorequire intervention for difficulties other than thedeath, such as substance abuse, significant mentalhealth or financial concerns.

Variations in Care: Hospice programs differ in the: Human and administrative resources available to provide bereavementservicesMethods used to track, manage, and report bereavement program activitiesLength of their follow-up care (programs range from 12 to 24 months)Additional services offered beyond those listed above (e.g., grief camps,retreats, lending libraries, special events, grief therapy, educational trainings,and crisis response)Note that the regulatory requirements from the Medicare Conditions of Participationspecify bereavement services must be offered ‘up to one year’ after the death of thepatient and the NHPCO Standards suggest a 13-month time frame.Regulatory Requirements:Medicare COP: §418.64(d)(1): Bereavement counseling. The hospice must:(i.) Have an organized program for the provision of bereavement services furnishedunder the supervision of a qualified professional with experience or education ingrief or loss counseling.(ii.) Make bereavement services available to the family and other individuals in thebereavement plan of care up to 1 year following the death of the patient.Bereavement counseling also extends to residents of a SNF/NF or ICF/MR whenappropriate and identified in the bereavement plan of care.It is important that hospicescreate bereavement-specificguidelines that detail theavailability and scope ofservices and clearly delineatepolicies and procedures.(iii.) Ensure that bereavement services reflect the needs of the bereaved.(iv.) Develop a bereavement plan of care that notes the kind of bereavementservices to be offered and the frequency of service delivery. A special coverageprovision for bereavement counseling is specified in §418.204(c).Spring 2018 NHPCO NewsLine9

continued from previous pageAcknowledgmentsQ & A with the NCHPPSection LeaderGuidelines for Bereavement Care in Hospice was created bythe Bereavement Professionals Section of NHPCO’sNational Council of Hospice and Palliative Professionals.The National Hospice and Palliative Care Organizationgratefully acknowledges the following individuals andorganizations for their contribution to this valuable resource.Diane Snyder Cowan, MA, MT-BC, CHPCANCHPP Bereavement Professional Section Leader, HospiceDiane Snyder Cowan, MA, MT-BC, CHPCA is the NCHPPBereavement Professionals Section Leader and wasinstrumental in the development of the Guidelines.NewsLine had the opportunity to ask Diane a fewquestions for some for additional insight regarding therevised and expanded publication.Q: The new resource Guidelines for Bereavement Care inof the Western Reserve, Inc., Cleveland, OHHospice seems far more comprehensive than theRex Allen, MAon revising this document?Providence Hospice of Seattle, Seattle, WAPatti Anewalt, PhD, LPC, FTPathways Center for Grief & Loss, Hospice & CommunityCare, Mount Joy, PAprevious edition. Was this intentional as you workedYes, we tried to cover all areas related to hospice andbereavement. We utilized a crosswalk that comparedtopics covered in other sections, reviewed what we feltwas missing and included references to the MedicareRobin Fiorelli, MSW, LCSWCOPs and NHCPO standards of care.VITAS Hospice, San Diego, CAQ: How long did the group of professionals who wroteChelsea Johnson, MS, MT-BC, LMTthe new Guidelines work on this project?Trustbridge, Inc., West Palm Beach, FLAlmost two years. We were small but mighty group. WeSarah Layton, MSW, LCSWdivided up areas to work on independently but thenHeartland Home Health Care and Hospice,reviewed each other’s work and edited the projectSt. Louis, MOcollectively. We also had wonderful help from NHPCO staff.Daniel A. Speis, MSW, LICSWQ: Throughout the collaboration process, are thereHospice of the Panhandle, Martinsburg, WVthings that each of you working on the projectWesley Sturgis, LCSWcoming to consensus on a difficult aspect of care?Novant Health Hospice & Palliative Care, Charlotte, NCNHPCO Staff Who ReviewedThese GuidelinesKristi DudashSenior Manager, Research and QualityAndrew Duncan, MAVice President, Membershiplearned or areas that challenged you all in terms ofOne of the challenges was verbiage. Do we use bereaved,grieving, loved one, etc.? One difficult aspect of care wascomplicated grief which is in and of itself a complex issue.It wasn’t so much of a challenge in coming to consensusas to best practice, it was more about finding the rightwords to say what we wanted to say.Q: The Annotated Bibliography and Resources is quitecomprehensive. As a professional in the field, do youJennifer Kennedy, MA, BSN, CLNCthink it’s important to continually read newSenior Director, Regulatory and Qualitypublications and access online resources?Life-long learning is critical in the world of grief andPrinter-Friendly PDF10NHPCO NewsLine Spring 2018bereavement. There have been additions and changes inthoughts about grief work, theories and approaches. While

the “evergreen” books still hold weight today, we need to keep current with importantadvances and innovations to best meet the ever changing communities we serve.Q: We know that many hospice programs are facing tightening budgets and limitedresources, is there advice you might give a program that if facing such constraints?It’s important to know what other resources are available in the community from otherhospices, faith communities, mental health agencies, funeral homes, etc. Avoidduplication of programs and offer services that are not only unique but fulfil a need.Know where to refer folks who fall outside your agency’s scope of services.Q: There seem to be many things happening in the world around us that couldbenefit from the skills of a hospice bereavement professional; are there wayshospices can engage with communities apart from traditional care patients andfamily caregivers? Are there things a hospice should be cautious about in termsof reaching out to the community?Absolutely. Hospices can work with local media reporting on community grief issuessuch as natural disasters, school shootings and the opioid crisis. Hospices can providegrief education seminars, offer hand-outs and other literature on grief topics. Someagencies offer grief counseling to community clients. Others provide death-related crisisresponse. Loss specific grief support groups, school based programs and consultationare also ways to get involved. Bereavement professionals need to know their skill leveland have training in providing any specialized community grief support. Agencies mayhave limited resources.It’s important to knowwhat other resourcesare available in thecommunity fromother hospices, faithcommunities, mentalhealth agencies, funeralQ: Is there additional advice you would like to offer for someone who might be anew bereavement professional working in the field?homes, etc.Become engaged with NCHPP, sign up for My.nhpco.org. Join the chats – especially the“new to bereavement” chat. Post questions on the discussion threads. There is a breadthand depth of wisdom and expertise out there and we can all learn from one another. (Seepage 30 to learn more about NCHPP, My.NHPCO and the many benefits for members.)Q: Any additional thoughts to share?One thing to remember is that the guidelines are suggestions. They are notrequirements by any governing bodies. Sometimes, professionals are looking for cutand dry answers about caseloads, visit frequencies, etc. The guidelines providesuggestions for best practices and what to consider, but ultimately it is an agency’sdecision to determine what their bereavement program can and will look like.Spring 2018 NHPCO NewsLine11

continued from previous pageExamples of Bereavement OfferingsIn response to a request forI am now without the Center forinformation from the BereavementHospice Care’s caring, professional,Professionals group on My.NHPCO,kind influence.”NewsLine shares some examples ofbereavement programs that reflectthe creativity and range of servicesHalcyon Hospice andPalliative Care, Coloradoavailable from hospice programsYoga for Griefacross the country.Yoga is the union of breath withAseraCare Hospice,across the U.S.gradual and intentional movementand teaches us safe and approachableways to connect and listen to ourA Butterfly to Rememberbodies. This yoga therapy group isThese events offer an opportunity formade up of a series of 90-minutefriends, family and communityrestorative classes that incorporatemembers to remember and honor thebreathing exercises with gentle poseslegacy of those who have died withto bring peace and calm to the bodythe release of butterflies, bubbles orand mind.doves. Held at AseraCare Hospiceagencies across the country, eachcelebration is unique to its location.Hospice & Community Care’sPathways Center for Grief &Loss, PennsylvaniaCasa de la Luz Hospice,ArizonaSchool Crisis Response Teams: ThreeMind-Body Skills GroupThis three day series provides theOver the course of eight sessions,basics needed for crisis teamparticipants explore different ways tomembers to feel prepared to respondcope with stress that providesto a wide range of incidents involvingeducational components as well asthe deaths of students or staff.skill building tools such as breathing,Content includes the ‘big picture’ ofmeditation, autogenic training,crisis response, developmentallybiofeedback, drawing, journaling, andspecific information and strategies todancing.address diverse needs of bereavedCenter for Hospice Care – LifeTransition Center, IndianaDay Flight Team Trainingfaculty and students of all ages. Thosetrained become part of the countyCrisis Management Flight Team andLoss After Addiction Groupare deployed to area schools asThe group is a bi-monthly educationalneeded to supplement local schools inand grief support group for adultstimes of tragedies.who have experienced the death of aloved one to drugs or alcohol abuseand/or overdose. One of the originalmembers of the group stated, “Iwould not be living the productive life12NHPCO NewsLine Spring 2018Hospice of Santa Cruz County,CaliforniaWriting through HealingPutting pen to paper is a powerfulway to explore a personal journey in amanner that is both meaningful andrich with complexity — especiallywhen talking about grief does notcome easily for a person. Creativeexercises are designed to helpparticipants grow and heal, in newand gently surprising ways.Hospice of the WesternReserve, OhioRiding through Grief: The HealingPower of HorsesThis day camp is offered incollaboration with Fieldstone FarmTherapeutic Riding Center for childrenages 8-12. Through fun horsebackriding lessons and un-mountedactivities with horses, participantsexplore grief issues. Prompted by thesuccess of the Riding through Griefcamps, this program has beenexpanded to an adult equine retreat.Infinity Hospice Care, NevadaResponse to Las Vegas ShootingFollowing the tragic shooting onOctober 1, Infinity Hospice Careresponded to offer services andsupport to first responders and thecommunity. Ongoing efforts includesupport groups for victims of thetragedy that include 911 operators andnight staff at local funeral homes.Other programs in the area have alsostepped up to help with the myriad ofcommunity needs following thisnational tragedy.

Mary Greeley Hospice, IowaCooking for OneA workshop designed to address issues that accompany a newly bereaved spouse, bothin the practical and psychosocial domains relating to mealtime. Combining the expertiseof a dietitian, executive chef, and bereavement counselor, participants will receiveeducation and support as they adjust to sitting next to an empty chair at the table.Seasons Hospice, Georgia and MichiganI would not be living theThe Widow’s WalkOffered by the Seasons Team in Georgia, bereaved spouses/partners meet at a differenttrailhead once per month on a Saturday and hike together. Along the way, theyreminisce and support one another; while at the same time getting physical exercise,which is known to be a healthy way of dealing with emotional stress.productive life I am nowwithout the Center forHospice Care’s caring,Holiday PartyHosted every December by a Chaplain at the Michigan location, the Holiday Partyconsists of a nice dinner at local event space. It is a time of fellowship, support, andsharing where strong bonds are made among group members.professional, kindinfluence.VITAS Healthcare, CaliforniaDay of the Dead EventIn the Mexican tradition, Día de los Muertos is considered the day that departed soulsreturn to Earth — so it is dedicated to remembering and honoring those that have died.Family members typically gather graveside to mourn their loved ones and to celebratetheir lives. Some of our programs recreate this event that includes building an altar,providing traditional foods and even making sugar skulls.Printer-Friendly PDFGuidelines for BereavementCare in HospiceGUIDELINES FOR BEREAVEMENTCARE IN HOSPICEBrand New! These guidelines serve to promote theprovision of effective bereavement services and advance thepractice of quality hospice and community bereavement care.The guidelines cover essential components of a hospicebereavement program providing information on how foster aprogram that goes beyond the baseline services required bystate and federal regulations.Order online from NHPCO’s Marketplaceor call 1-800-646-6460.PROFESSIONAL DEVELOPMENT AND RESOURCE SERIESSpring 2018 NHPCO NewsLine13

NHF Receives Grantfrom LGA to Create“Find a BereavementProvider” ToolLegal & General America has awardedFrom FEBS to EGSSEvaluating Hospice Bereavement Servicesa 25,000 grant to the NationalHospice Foundation for the creation ofan online resource to help the publicNHPCO is committed to providinga) are intended to match the bereavedhospices with the means to receiveperson’s need for support, whilefind information and communityfeedback and compare theirrecognizing that not all individualssupport services addressing grief andperformance to national data as awill have the same needs; andbereavement.mechanism for ensuring quality ofcare. An important part of that processis the development of performancemeasures that provide useful,meaningful, and actionable data.The Family Evaluation of BereavementServices (FEBS) survey was developedby NHPCO in collaboration with theb) have the goal of assisting theLGA will work with staff at NHPCO tobereaved person to manage thecreate an online searchable databaseimpact of loss.that will offer resources such asThe survey design also takes intoaccount that hospices offer servicesbased on their particular preferencesand resources, and that this, in turn,individual counseling, group supportand workshop activities designed tohelp individuals struggling with griefand loss.creates wide variation in the numberIn addition to the online “find aand nature of bereavement servicesprovider” tool, the grant will support aoffered by hospices. The surveyconsumer outreach and educationincludes questions on a wide range ofinitiative. NHPCO believes thatservices, many of them optional so thateveryone should have access tohospices may tailor the EGSS survey tosupport whenever faced with seriousreflect the specific services they offer.loss, grief and bereavement.of NCHPP bereavement professionals,Because the quality of a bereavementOur online database will allow a personNHPCO revised the survey in 2017 andprogram cannot be evaluated based onto search from any device anywherebegan implementation of the newwhere its clients are in the grievingand locate and contact bereavementsurvey in 2018. That revision wasprocess, the survey does not include anprofessionals offering counselingaccompanied by a change in the nameassessment of respondents’ progress.services, group support, specialof the survey to Evaluation of GriefWhile grief assessment may be usefulservices (activities specific for childrenSupport Services (EGSS).for bereavement staff in screening andand teens or bereaved who have lost aplanning interventions for individualspouse, a child, etc).National Council of Hospice andPalliative Professionals BereavementProfessionals Section as a means forhospices to evaluate and improve thequality of their bereavement services in2007. With feedback from FEBS usersand guidance from an advisory groupNHPCO continues to provide onlinedata submission and comparativereporting of survey results for hospicesto use in their quality assessment andperformance improvement efforts.clients, individual grief assessment haslittle utility in reporting and interpretingcomparative program evaluation dataat the national level. A screeningquestion has been included, however,The EGSS survey is designed toto identify persons who may needevaluate bereavement services from theadditional follow-up and assistance.perspective of the recipients of theservices. The survey is based on theassumptions that bereavement services:NHPCO is eager for member hospiceprograms to implement EGSS duringthe first quarter of 2018. For moreinformation and to access the survey,visit the EGGSS page at nhpco.org/egss.14NHPCO NewsLine Spring 2018In 2017, LGA awarded NHF a grant tocreate an educational videohighlighting the importance of advancecare planning. The video, “AdvanceCare Planning,” was released last year.

NHPCO ResourcesHOSPICE VOLUNTEERNHPCO’S 2016 NATIONALPROGRAM RESOURCESTAR REPORT (PDF ONLY)MANUALThe Surve

must identify complicated grief interventions within their scope of services. The goal is for all clients to learn to recognize their grief as part of a process that includes learning how to integrate the death, understanding the need for additional support if they face complicated grief, an