Linda Todd

Hospice of Siouxland

1.  What prompted your interest in serving on the NHPCO Board of Directors

My interest in serving on the NHPCO Board of Directors comes from my commitment and passion for advancing quality end of life care. Ever since my previous tenure on the NHPCO Board of Directors (1999 – 2004), I have great admiration and appreciation for NHPCO Board Members and Staff for their vision, advocacy and leadership in advancing hospice and palliative care.  As a provider member, I value the work of NHPCO and would welcome the opportunity to serve as Central Plains Geographic Area Director if so elected by hospice and palliative care providers.

2.  What special expertise would you bring to the board?  See the statement of characteristics to be evaluated for guidance on this question.

The expertise that I would bring to this role includes (27) years of hospice experience and leadership in a Midwest urban/rural hospice program.  Hospice of Siouxland is a community-based program, which has equity ownership by the two highly competitive hospitals each aligned with competing health systems.  In the Midwest, many Hospice programs are affiliated with health systems and unfortunately at times, neither the health system nor the hospice provider maximizes their opportunities for hospice utilization. I believe I would bring health system experience to the NHPCO Board.

My experience also includes operation of a community-based Palliative Care program since 2001 and being able to sustain this program throughout the years.  Community-based palliative care is now positioned to pilot activities to assist the health systems reduce ER visits and recurring hospitalizations.  The Palliative Care goals have led to PACE development in the Siouxland area—though I don’t lead the PACE program at present—the program remains active and has become a service line for one of the health system’s ACO strategy.

I also bring expertise in Hospice care in the rural areas.  Though my program is a mid-size program, there are multiple rural providers surrounding our service area.  I have positioned our program to be an advocate and a friend to rural programs—assisting with consultations to aid in program development; education and training; a trusted friend when the rural Director has questions.  In the highly competitive environment in the hospice world, there is little trust between providers.  I believe I have the trust and respect of many rural providers.

Iowa legislators have been in key leadership roles in Congress, which has led to advocacy efforts on the local and national level.  This has created opportunities in testifying at the Senate hearing on end of life care; participating in the MEDPAC Palliative Care Expert Panel to research palliative care; and numerous letters and visits on varied hospice and palliative care advocacy efforts including rate reductions, palliative care, quality end of life and other issues that face our industry.  On an advocacy level, I believe I have good relationships with Iowa legislators and offer this experience.

3.  How can NHPCO meet the needs of a diverse group of hospice and palliative care providers? (i.e. rural vs. urban, community based vs. corporate, small vs. large)

Diversity is present in hospice and palliative care providers, which is an organizational strength.   It is of utmost importance to understand and respect the diversity of the various programs.  It is my belief that inside diversity, there are committed individuals striving to serve hospice and palliative care patients and families. The majority of providers want to do a good job.  Diversity should be celebrated and opportunities seized that arise from the diversity.

NHPCO’s role is to listen, hear and focus on the common purpose of high quality, value-based service for patients and families facing advanced illness and end of life.  NHPCO has been very diligent in being a tremendous resource to promote, advocate, educate and lead hospice and palliative care providers regardless of program type, size or tax status.  Building and maintaining strong relationships between NHPCO and state associations is critical, especially for rural programs. In the times of heightened scrutiny and numerous challenges for hospice providers, there is need for the leadership, vision, advocacy, education and a voice—NHPCO offers that role for providers. It is critical that NHPCO be the voice to constantly remind and center our focus on mission, vision, and values of patient /family centered care, quality, and integrity.  A Geographic Area Director is a key factor in bridging the local, state and national communication.

4.  What leadership positions, beyond hospice and palliative care, have you held?

Currently I have leadership roles in the following organizations: Board member Holy Spirit Retirement Home; Member of Mercy Medical Center Ethics Committee; Member of the Mercy Medical Center Cancer Care Committee; Member of St. Luke’s Home Care Advisory Committee; Member of Floyd Valley Ethics Committee; Advisory Board member for Briar Cliff University and University of South Dakota Health Advisory Committee; Co-chairperson of Pastor-Parish Committee of personal church.

5.  What roles do you think hospice and palliative care should play in the health care continuum that it currently does not?

Hospice care is at a time of greatest challenge, but a time of our greatest opportunity.  Challenged with cuts in reimbursement, health systems are seeking solutions for recurring ER visits and hospitalizations.  Hospice and palliative care programs are positioned to be the solution to problems facing hospitals, but also unmet needs of individuals and families trying to navigate a fragmented health system.    Hospice and Palliative Care staff have great expertise in interdisciplinary team services, coordination of care, pain and symptom management, grief and bereavement that effectively care for individuals and families. The Medicare Hospice Benefit is a great benefit and has served so many so well, but there are too many people suffering from advanced chronic illness that are lost in the current fragmented healthcare system.  Too many times, health systems focus on huge initiatives such as heart centers, emergency and trauma centers, cancer centers, and hospice and palliative care is lost in the shuffle.  As providers we need to be at the table offering solutions and positioning our programs as a community-based provider in the continuum of care whether that be a community-based palliative care, nursing facility palliative care consultation services, or coordination of care for adult children caring for their elderly parents.

6.  What do you think are the most important issues/challenges facing hospice and palliative care in the next five years?  What do you see as NHPCO’s role with regard to those issues?  How would you, as a board member, help NHPCO fill that role?

Issues and challenges that face hospice and palliative care are heightened scrutiny; rate reductions; changing leadership; positioning hospice and palliative care in the continuum of care; continuing the social change for end of life care; public reporting of quality measures; promoting a positive attitude and opportunity seeking approach within the industry versus a negative attitude --depressed and immobilized in lieu of the challenges.  NHPCO role is to continue with their strong advocacy efforts, which is critical to all programs; creative education with webinars and electronic media; rural task force initiatives that provide a voice and support for rural providers; bridging NHPCO with State Associations; education and support for quality reporting. NHPCO staff attendance at State Association meetings is very important.   Geographic Area Directors must play a key role in listening to needs of providers in the geographic area and bringing their ideas and concerns forward to NHPCO.

7.  Describe an innovative or visionary achievement you led that had a broad effect in your community or state.

In 2001, Hospice of the Siouxland launched a community-based palliative care program which was developed based on unmet needs we saw for individuals and families in our community.  The program was designed utilizing an interdisciplinary team and served individuals and families with advanced illness.   The Hospice Medical Director and I led a major donor campaign and raised a million dollars to launch the program in a community that could barely say the word “palliative,” let alone understand the meaning of palliative care – but based on their own personal experiences – they could identify with the need.

The community-based palliative care program has had great outcomes of relief of suffering and improved quality of life; reduced ER visits and recurring hospitalizations; and has been sustained financially.  The program led to PACE development, which is not under my leadership but has been incorporated into one of the health system’s service lines.  The palliative care program is now in partnership with the health system in a pilot for reducing ER visits and hospitalizations.  Community-based palliative care has been shared locally, within the state, within the region, and nationally.