Lightways Hospice and Serious Illness Care, Joliet, IL

Background

Lightways Hospice and Serious Illness Care is an independent, nonprofit healthcare provider of serious illness care, hospice care, and grief support for adults and children. Founded in 1982 as Joliet Area Community Hospice, the organization recently went through a major rebrand to reflect its increased focus on palliative and serious illness care. In this interview, Sara Dado, LCSW, senior director of clinical programs (pictured), shares insights on the organization’s philosophy of putting patients first and how Lightways has expanded its program to better serve the needs of the community.

Q: How would you describe your staffing model?

A: Our team consists of an M.D. who is our overseeing physician, four advanced practice nurses (APNs), one full-time licensed clinical social worker, a practice manager who oversees day-to-day scheduling and operations, and me. We’re a small practice serving about 250 patients in their homes. These are patients facing serious and/or chronic illnesses, who need ongoing, home-based primary care which is where our serious illness team comes in.

Our serious illness team can also use other staff resources for patients on an “as needed” basis, including music and massage therapy, and chaplaincy services. In addition, if a patient has psychiatric or mental health needs beyond what our APNs or licensed clinical social worker can accommodate, we will make a referral to one of our community partners.

Q: What recent challenges/pain points (COVID-related or other) has your practice faced and how have you overcome them?

A: For a non-COVID related example, when I took the helm of the serious illness program about two years ago, one big challenge was to reframe what serious illness and palliative care is, both within our organization and in the community. Serious illness care is a comprehensive, long-term service for patients facing serious and chronic illness ─ it’s not just for end-stage patients who don’t want hospice.

Palliative care continues to be one of the most misunderstood services in the healthcare field. We’re always faced with the challenge of educating our community, patients, and even our staff, on what palliative care is… and what serious illness care is intended to be. To overcome this, we continue to talk about what we do, and think about the services we provide, in a different way. It’s also about tracking how we are doing with keeping patients out of the hospital, improving their quality of life, and ensuring we’re getting them moved into the right services.

Other non-COVID related challenges are our changing industry, payment model changes, and looking at how we care for patients differently. We’re getting better about tracking outcomes or capturing, in real ways, the value of what we do. We know we take great care of people, but we must quantify that with real outcomes ─ which is something we have worked hard on during the last 18 months. We’ve  also gone into the direct contracting (DC) model and are working on alternative payments, really looking at what measures we need to track, and figuring out how to do that with a small team that doesn’t have all the resources a larger program might have.

In terms of COVID, our main challenge was not being able to see our patients in-person. So, we had to pivot quickly to using telehealth. That, though, is especially challenging when you are caring for elderly people in their homes who don’t always know how to use technology—so we spend a good amount of time teaching patients and caregivers how to log on to their telehealth app. It’s both an operational and financial challenge, but we were able to make it work.

Q: What makes you especially proud of your practice?

A: I don’t think any of us ever imagined what COVID was going to be, particularly for home-based providers going into people’s homes. We’re dealing with things we never thought we would have to deal with, and our hospice and serious illness teams just took it in stride, always with the top priority of making sure our patients’ needs were met. I’m super proud of that and how we came together and continued to operate through what history will probably show has been one of the most challenging times the healthcare industry will ever face. Finally, I’m also proud of our outcomes—we have reduced our hospitalizations by more than 50% in the last 18 months and we’re showing good numbers in how we’re caring for patients in the home.

Q: Can you identify the most important goal your practice is working toward?

A: Our biggest goal is to be ready for year two of the direct contracting entity (DCE) starting in January 2022. We are trying to get our staffing models correct and ensure that we have solid outcomes to report. We are also trying to ensure that our infrastructure is ready for this continued change in payment models.

Q: If you had to name one thing that your practice really does right, what would it be?

A: We really know how to take care of people in their homes, and that is what sets us apart. We’ve been around for a long time and are well-established and respected in the community. Our motto here is, “Say yes.” We start with yes, and we go from there to figure out how to make things work for our patients—and as long as we keep that perspective, we’ll always serve our patients to the highest level.

Q: Why do you love house calls?

A: As a community-based provider, we have a completely different perspective about how to care for people versus a provider seeing patients in an office or clinic or an acute care setting. When you’re sitting at the kitchen table with someone, looking through their 18 pill bottles and talking about what’s in their refrigerator, you get to see the individual and their issues and challenges in a completely different light. That’s what I love about community-based work—that’s where the best work happens, that’s where the real care should be provided, and that’s where people want their care to be provided.

We’ve known for years that when people are asked where they want to die, 80-plus percent say they want to die at home, yet less than 20 percent do. We need to change the conversation about how we’re caring for people and what types of services we can provide to people in their homes because we can do so much. That’s one thing COVID has shown us ─ there’s a lot more that we can do than we ever thought… right in people’s living rooms.

For me, like many others in the field, this type of work is a true calling. It’s hard. It’s not the easiest path. I have so much respect for our nurse practitioners because they could easily go work in a hospital or a clinic where they could do their 12 hours and go home, yet our practitioners are dedicated and devoted to going into what are not always the best neighborhoods or the best homes. They put patient care needs first because they believe in the importance of this work. It’s not just about providing services ─it’s about providing comfort and establishing a different level of trust. People trust someone who comes into their home in a different way than when they’re seeing a provider in a clinic or an office setting.