An Extra Olive

The olive is an ancient symbol meaning ‘let us make peace’.  It is also that tasty treat found in your favorite martini.  Relationships can be much like a martini – simple and clean or downright dirty.  But the best martinis come with an extra olive – preferably stuffed with goodness.  The same is true of our relationships with our local hospices.

For some in funeral service, the word hospice invokes negative thoughts fostered by an adversarial role between the two businesses.  Yes, hospice, just like your funeral home, is in business.  Like any business, hospice’s primary role is to promote their business, not yours.  Sometimes, hospice, like many businesses in their quest for growth, overreach into areas that place them either in direct competition or at a minimum in an adversarial position.  Examples may include trying to open a funeral home as was the case in Florida years ago, or simply having volunteers that tell families to choose a simple cremation and have the service at their facility instead of the funeral home.  Hence, the dirty martini.

For others in funeral service, the word hospice invokes positive thoughts based on a supportive role, one based on trust, cooperation, education, and relationship.  In this scenario, hospice, like you, are still in business and their primary role is still to promote their business.  However, their vision is to seek growth through relationships that support one another.  It is a relationship of mutual respect and professionalism, with both organizations achieving more.  Hence, the traditional martini – simple and clean.

Do not get me wrong, relationships are a two-way street.  I have seen just as many relationships sour between funeral homes and hospice due to the funeral director’s behavior toward the “Helping Hannah” hospice worker; but I have also seen the relationships flourish for the same reasons.  That is where the olive comes into play.  Let us look beyond what was, or even what is, and instead focus on some ideas about what could be…let us focus on the olive!

A December 2019 article in the New England Journal of Medicine entitled “Changes in the Place of Death in the United States” revealed that more Americans are dying at home of natural causes as opposed to hospitals or nursing homes.  This trend is the first time this has occurred since the early 20^th Century, making home deaths once again commonplace.  Therefore, if home deaths are becoming the norm yet again, we must find ways to solidify our relationship with the “gatekeepers” of the residence.

This graph illustrates the decline in deaths occurring in hospitals, nursing homes, and other places.  The only two locations that are on the rise are home deaths – the largest category – and hospice facilities.

Figure 1-Source: New England Journal of Medicine 2019; 381:2369-2370

According to the Centers for Disease Control (CDC), there were 2,839,805 deaths in the US in 2018.  Of these deaths nationwide, 54.59% (1,550,000 deaths) were handled by hospice organizations in 2018 per the website Statista.  Lastly, according to the National Hospice and Palliative Care Organization (NHPCO) 2018 Facts and Figures Report, 55.7% of hospice deaths were residential.  This means that 30.4% of all deaths in the US occurred at home under hospice care.  So, if one-third your funeral home’s potential clientele are dying at home under hospice, and more than one-half of your death calls involve hospice, shouldn’t you search for ways to build relationships?

Given this rise in hospice deaths and our need to foster great relationships, I turned to my good friend and industry leader Ernie Heffner, with Heffner Funeral Homes in York, PA, who has created and fostered a strong relationship with the local hospices in his service area for advice.  Ernie’s take on building this relationship is quite insightful and comes from the position of education for the hospice worker, so they feel confident that the funeral home will provide the seamless transition of the patient from hospice care to funeral care.

“It’s not about dropping off donuts or serving on a board of directors whereby none of the actual hands-on care providers ever interact,” said Ernie.  “The key to building a relationship is a sincere commitment to education.”  Education is a consistent theme in the world today; it is certainly applicable in our business, whether we are educating ourselves, the consumers, or the local hospice.  But are we listening, and we do we begin?

If you have not already stopped reading this article, then you are listening, so on to the next step, where do we begin?  We begin by educating ourselves about hospice to understand their business model, statutory requirements, Medicare/Medicaid funding, and more.  Ernie recommends a thorough review of the NHPCO website at https://www.nhpco.org/ to learn the historical facts and current stats.

Once you have educated yourself, Ernie shares that the next step is for funeral directors to foster a mutually respectful relationship that is appreciated by both parties.  “It is a commitment that requires serious time and effort,” states Ernie, but the rewards can be significant.  Here are Ernie’s steps to success:

1. Research RN licensing requirements in your state
2. Develop RN continuing education programs relevant to hospice care providers
3. Recruit a person dedicated to community outreach, preferably a former hospice social worker who is retired but would still like to work 3 days a week part-time. Since the hospice profession is dominated by women, a female representative would be preferred.  This person’s activities will include:
   1. Offer orientation tours to hospice nurses and volunteers
   2. Provide RN CE programs (hospice often is licensed to do the certification for you)
   3. Utilize your facilities for hospice to perform their statutorily required memorial ceremonies
   4. Attend multiple monthly meetings each month networking with groups specific to serving the senior community

On a side note, you are probably questioning how some of this may work given the recent COVID pandemic and the need for masks, social distancing, and isolation from the senior population.  It is true that our current COVID situation has hampered some of these activities for Ernie and his team, but this newsletter helps you plan for tomorrow, not today.  So, this is a great time to prepare yourself to implement this plan post-pandemic.  If you already have a program in place, why not offer Zoom trainings for hospice nurses, or look to other ways to connect with your groups – perhaps a virtual Senior Happy Hour.

Ernie has been successful through his educational offerings for the “hands-on” hospice worker.  He even started his sought-after “Keys to the Future” seminars, which are now in their 15 year and still as popular as ever.  The program is “a comprehensive presentation of American history in end-of-life care and today’s issues concerning personal choice, legal requirements, options to consider in advance planning and time of need arrangements.”  Hospice attendees earn seven hours of RN CE credit covering a host of topics.  They also enjoy the warmth and beauty of the Florida Keys with a day of relaxation to rejuvenate before returning the world of death and dying.  The program attendees are chosen from a list of applicants and allows for ample relationship building time with about 24 hands-on providers each year.

Some industry colleagues have said in the past that Ernie’s program is ethically questionable, but I disagree.  Ernie is very direct, with colleagues and with hospice workers, that this is not a quid-pro quo relationship. “One of the missions for hospice is to provide information to clients and without making recommendations,” Ernie continues, “ultimately, when the question of who would be your provider comes up, they may not recommend a firm but rather only provide a list of firms in the area and any information/knowledge they might have about the firms.”  Ernie unequivocally states, “our mission is that they know more about our firm and what we do than any other firm.” 

So, what about sitting on the board at hospice or making that large charitable donation?  Well, Ernie is not a big believer in either of these options because of the disconnect between serving on the board with the higher ups versus building a relationship with the hands-on givers.

On a personal note, I shared with Ernie the major capital campaign gift our funeral home provided to our local hospice years ago and the outcome that came from it.  Sure, we were invited to every black-tie event the hospice foundation had for the next decade and we had their leadership on speed dial, but it did absolutely nothing to affect what was happening on the ground.  We experienced first-hand situations where our transfer staff would be in route to a hospice facility death for our premier brand only to receive a cancellation call five minutes before arrival.  Then, five minutes later, the same transfer person would be re-engaged on the same call but for our low-cost brand.  It didn’t take long to realize that the leadership might understand the relationship from the six figure donation or the seat on the board, but the ones that were actually on the frontlines serving the grieving families had a different story to tell.  It was definitely an eye-opener for me and for my team, and one that caused a major change in our relationship building strategy.

I will leave you with one final thought from Ernie that he shared in a 2014 ICCFA article.  “Hospice caregivers are passionate about death and dying.  There is no other group in your community that shares your interest in – and is more passionate about – meaningful conversations about death and dying.  Today, hospices, not funeral homes, own that territory.”  Thank you, Ernie, for your honesty and your continued willingness to share with your fellow colleagues in hopes of continuing to elevate our profession.  I am honored to call you a friend.

In closing, most of you know that I am committed to the customer experience, so much so that Nikki and I wrote a book on it.  Well, I would be remiss if my final thought on relationship building, whether with your local hospice or your funeral home clientele, did not include a customer experience reminder.

In the book, The Intuitive Customer, Colin Shaw and Ryan Hamilton share seven imperatives for moving the customer experience to the next level.  One of the important reminders they share is that “memories are everything.”  Positive or negative they form customer loyalty because loyalty is built through creating memories.  As such, it is important to ensure the final memory someone has of you and your company is a positive one.

Tying this concept back to hospice and how to create a loyal fan, Ernie provides each attendee with a memory book filled with pictures from throughout their trip to the Keys to the Future seminar.  This memory books highlights all attendees, includes the itinerary, training highlights, and event narrative, as well as the fun, the relaxation, and the laughter.  It is a reminder of an amazing and educational opportunity and leaves each attendee with a positive image.  Ernie lives the “R” (Remember the WOW!) that Nikki and I share in our book.  Well done!

Now it is your turn, whether you prefer shaken or stirred, just get out there and give them the olive – one that is overstuffed with goodness and sincerity.

I would love to hear your success stories with hospice.  It may spark another article or topic for me to share with our readers.   Or, if you have a subject you would like for us to cover, please let me know at John@TheForesightCompanies.com or call me direct at 727-580-6411.

REFERENCES

Cross, S. and Warraich, H. (2019, Dec).  Changes in the place of death in the United States.  New England Journal of Medicine [Article 381:2369-2370], DOI: 10.1056/NEJMc1911892. Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMc1911892

Elflien, John (2020, Aug 27). Total number of hospice patients served in the United States 2009-2018.  Statista [Health & Pharmaceuticals: Care & Support].  Retrieved from https://www.statista.com/statistics/339851/number-of-hospice-patients-in-the-us-per-year/

Heffner, Ernie (2014).  Survey finds interest in improving hospice relationships.  Memento Mori, an ICCFA Magazine [ICCFA News].  International Cemetery, Cremation, and Funeral Association, Sterling, VA.

NHPCO Fact and Figures (2019). National Hospice and Palliative Care Organization (Revision 7-2-2019). Retrieved from https://39k5cm1a9u1968hg74aj3x51-wpengine.netdna-ssl.com/wp-content/uploads/2019/07/2018_NHPCO_Facts_Figures.pdf

Xu JQ, Murphy SL, Kochanek KD, and Arias E. (2020, Jan). Mortality in the United States, 2018.  NCHS Data Brief, no 355. Hyattsville, MD: National Center for Health Statistics.  Retrieved from https://www.cdc.gov/nchs/products/databriefs/db355.htm#:~:text=In%202018%2C%20a%20total%20of,at%20birth%20increased%200.1%20year.