Providing Hospice Care in Rural America: A View from Wyoming

In Honor of National Rural Health Day, I am happy to present some thoughts from Marilyn Connor, Executive Director of Central Wyoming Hospice and Transitions Program, and one of our Hospice Advocates, about the challenges they face in providing quality hospice care in rural America:

Growing up in urban Chicago, I was raised with the misconception that rural healthcare was substandard. In my mind, rural healthcare lacked the sophistication and quality us “urbanites” were privy to.

Having spent the past 13 years as a hospice administrator in Wyoming, I am now a very vocal advocate for the quality of rural healthcare. As a rural hospice provider, we do have unique challenges; but most of those challenges make our program stronger.

Our state can boast we have more cattle than people. This means it may take us a year to find a qualified certified social worker. It also means we are very self-reliant and can work autonomously. It makes us work harder to ensure we are educated and up to date on all issues impacting hospice and palliative care. Our staff is strongly encouraged to spend time on the NHPCO website and become a part of My NHPCO so that we can stay abreast of changes.

We have a serious physician shortage, which, coupled with a limited census, prevents us from having a captured Medical Director. On the flip side, we know every doctor in our service area on a first name basis and they know and trust our staff. We are considered a major player in the community’s continuum of care.

We have a limited pool of nurses to choose from.  As a result of the limited number of nurses, it is no secret as to who Is a choice employer. And it is no secret that while we have very high expectations of our staff, we get so much in return from our patients.

Distance is an enormous challenge, especially in the midst of a typical winter snow. We often times spend more windshield time for a patient than we do bedside time. We are trying to narrow this gap with the use of technology.

We have limited staffing and medical resources but we have an abundance of community support, web and phone based support and an incredibly strong team.  Our QAPI program will demonstrate our care is second to none and our compassion is impressive. We have all of the quality our urban colleagues have, wrapped in a hug from our rural community.  

A small herd of deer that frequent the side door of our building. Living in rural areas means you get up close and personal with wildlife.
A small herd of deer that frequent the side door of our building. Living in rural areas means you get up close and personal with wildlife

Please ask Congress to support the Rural Access to Hospice Act to help ensure quality end-of-life care is available to all Americans! Click Here to Take Action!
















Your Latest Hospice News Update is Ready!


Happy National Hospice and Palliative Care Month! We are happy to kick off a month-long awareness campaign about hospice and palliative care with our monthly news update!

For additional resources, shareable content, and more, check out NHPCO’s National Hospice and Palliative Care Month page! Don’t forget to share the link to the Know Your Options Tool and share the newest Moments of Life Video, Lyle’s Hawaiian Dream. 

News from the Hill:

Hospice Advocates Stave Off MA Carve-In, For Now

Regulatory Update:

  1. 1. NHPCO Meets with CMS to talk NOE/NOTR
  2. NHPCO Podcast: OIG Report on Election Statements and Certification
  3. NHPCO Podcast: The Non-Discrimmination in Health Programs Final Rule
  4. 4. New CMS Data Visualization Tool Available

Advocacy Shout-Out:

Samaritan Healthcare and Hospice hosts Congressman Donald Norcross for a sneak peak of their new Samaritan Center at Voorhees

Good Reads:

  1. French Hospital Adds Wine Bar for Terminally Ill Patients
  2. A Dance for Gloria
  3. The Role of Nurse Practitioners in POLST Form Completion
  4. Facts About Hospice Care (A great article to share for #HospiceMonth!)
  5. Home Based Palliative Care Better, Less Costly than Hospitalization (Another good share for #HospiceMonth!)

A Look Ahead:

  1. Join us Friday, November 4 for Social Media Day! 
  2. Election Day is Tuesday, November 8
  3. Veterans Day is November 11. Make sure you invite your Members of Congress to any Veterans Day or National Hospice and Palliative Care Month Activities!
  4. National Rural Health Day is Novemeber 17. This is a great day to share stories about providing care in rural areas!

We Honor Veterans is now on Twitter @WeHonorVeterans. Follow them to learn more about the great work their partners do for our Veterans!

Shout out to everyone attending the NHPCO Intensives down in Florida! Thank you to Ron Culberson and BJ Miller for providing our keynote addresses. You can follow along on social media using #Intensives16.

Don’t forget to join the #hpm community each Wednesday night at 9pm ET/6pm PT to chat about all things hospice, palliative, end-of-life, etc! Patients, families, clinical staff, friends, supporters, curious onlookers all welcome! Just use #hpm on Twitter to join the conversation!

We hope you have a lovely National Hospice and Palliative Care Month, and please let us know about any events or initiatives you have going on this month! Make sure to use #HospiceMonth, #HospiceAwareness and #hpm on your Facebook and Twitter posts! And as always, you can follow us on Facebook, Twitter, and on our blog!

Fall into the latest Hospice and Palliative Care News Update!


Fall is well underway here in DC, so that means it is time for your monthly Hospice Action Network hospice and palliative care news update!


News from Congress:

House Ways and Means Subcommittee on Oversight Holds Hearing on Health Care Fraud Investigations

PCHETA gets a hearing in Congress

National Voter Registration Day was September 27. Learn more about registering to vote here!

The HAN Advocacy Toolkit has everything you need to connect with your Memeber of Congress


OIG Report on Election Statements and Certifications of Terminal Illness


CMS Update:

NHPCO Staff Meet with CMS to discuss NOE/NOTR

CMS Releases FY 2017 Medicaid Rates

CMS Issues Final Rule on Emergency Preparedness


Coming Down the Pike:

World Hospice and Palliative Care Day is Saturday, October 8

November is National Hospice and Palliative Care Month

Veterans Day is November 11. Learn how to involve a Member of Congress in your We Honor Veterans Ceremony

TO JOEY, WITH LOVE has an additional showing, October 6

The deadline to complete administration of STAR is December 15

Pastoral Care Week is Oct. 16-22. Take a moment to thank the spiritual caregivers in your life!


REMINDER: NHPCO Intensives Conference is October 31- November 2. Learn more and register today! The deadline for online registration is Friday, October 7.


Good Reads:

Gone Fishin’: Hospice Staff Help Veteran Catch Last Fish

Preparing for Death Can Change Your Life: The Friends and Family Letter Project

Hospice Deaths are Increasing, and That’s a Good Thing

Getting to Yes: Overcoming Barriers to Hospice

When Families Don’t Bury the Hatchet: Mediation in Hospice

Most Hospital Palliative Care Prorgams are Understaffed


Advocacy Shoutout:

Hospice Advocacy is alive and well in the Garden State


Also, a big THANK YOU to all our advocates who took the time to personally email their Members of Congress and ask for their support of our legislative priorities. While the House is currently out of session, the Senate is still in session this week if you would like to email your Senators! Learn more here.


Congress will be hanging out in their home districts for the rest of October, so make sure you get out and see your Members of Congress while they are local! Check their websites for information on town halls, visiting hours, and more!


Thanks again for all you do, and as always, keep in touch via email, Facebook, and Twitter!

Adding that “Personal Touch”

Daiva Braunfelds , Vice President pf Advanced Illness Management, Hospice and Palliative Care and Dr. James Baker, Medical Directorfrom VNA Care Massachusetts got the "personal touch" from Elvis at this year's Advocacy Intensive.
Daiva Braunfelds , Vice President pf Advanced Illness Management, Hospice and Palliative Care and Dr. James Baker, Medical Directorfrom VNA Care Massachusetts got the “personal touch” from Elvis at this year’s Advocacy Intensive.

I know we ask you all to contact your Members of Congress through our Action Alerts, and we love how many of you do!

But have you ever wanted to take it one step further? For those of you who want to earn extra “Advocacy Bonus Points”, take a page from Advocate Tracy Grafton’s book.

Tracy is a Counselor at JFK Haven Hospice & Palliative Care in Edison, NJ. She, along with other Advocacy Intensive Attendees, were recently asked to reach out personally to their Members of Congress and request their support for our hospice and palliative care legislation. They were given some suggested language, but Tracy took it one step further and added the personal invitation to visit their program:

Dear Katie:  

Thank you for meeting with me on July 19th to discuss the importance of hospice care in our district. I wanted to reiterate my request for the Representative’s co-sponsorship of HR. 5555, the Personalize Your Care Act, and HR. 5799, the Rural Access to Hospice Act. I am happy to provide additional materials on these bills if necessary. Please let me know if you have any questions and I thank you in advance for your support.

Additionally, I would like to invite you or Congressman Garrett to visit us in person and tour our program at JFK Haven Hospice & Palliative Care in Edison, New Jersey.  During your visit, we hope to share with you information about how our hospice provides high-quality end of life care to our community.  This might include your attending one of our Interdisciplinary Team meetings, meeting a patient, or greeting our volunteers. We can amend this itinerary to accommodate your schedule and are happy to work with your scheduler to find a date that works well for you. 

We would be honored if you could visit and give us a chance to offer a more personal look at end-of-life care in our community.   


Tracy O. Grafton, MSW, LCSW

Haven Hospice Counselor

Key elements of a successful personal letter to a Member of Congress include:

  1. Contact the correct staffer who works on Healthcare Issues. Tracy had previously met with Katie, so she used her first name and her individual email address. HAN can provide this information if you need it.
  2. Remind the staffer of when you last met. Tracy met Katie at the Advocacy Intensive on July 19, and she reminds her of that meeting early in the email. If you have never met, just introduce yourself as a constituent.
  3. Reiterate the requests you made in your meeting. Or initiate new ones if you didn’t make any requests the first time. Here, Tracy reiterates her request, and uses the correct bill name and bill numbers.
  4. Offer to provide additional materials or answer any questions. If they ask for something you don’t have or don’t know, send it to HAN and we can help!
  5. BONUS POINTS: Invite the Member of Congress to visit your program!  You may want to clear this with your Executive Office first, but HAN is here to help you plan any kind of Congressional Visit!
  6. Keep it short. Staffers are busy, and won’t take the time to read long paragraphs, even if they’re great. So keep it short, and feel free to add information once they respond to your first inquiry.

We’d love to see more people sending these personalized emails! Please email us at to be matched with your correct Legislators and their Healthcare Staff. We can even provide you with suggested wording! So go on, add that “personal touch” to your advocacy!


Does your Congressman Support Hospice? Find out here!

Congress has come back to DC for several weeks of legislating before again recessing for the remainder of the campaign season. In the short amount of time they have left, we want to make sure that they are hearing from hospice and palliative care advocates like you!

Below are the lists of which Members of Congress have signed on to our bills. If your Members ARE NOT on this list, please call or email their office and ask for their support of these important bills! Not sure who your Members of Congress are? Check it here!

  1. House of Representatives:
    1. The Personalize Your Care Act ( HR 5555)
      1. Original Co-sponsor: Dr. Phil Roe, TN-01
      2. Original Co-sponsor: Earl Blumenauer, OR-03
      3. Ron Kind, WI, 03
      4. Sander Levin, MI-09
      5. Jim McDermott, WA-07
      6. Ami Bera, CA-07
      7. Mark Takai, HI -01
      8. Jared Huffman, CA-02
      9. Richard Nugent, FL-11
      10. Peter DeFazio, OR-04
      11. Gregg Harper, MS-03
      12. Betty McCollum, MN-04
      13. Bill Pascrell, NJ-09
      14. Scott Peters, CA-52
      15. Jan Schakowsky, IL-09
      16. Charlie Rangel, NY-13
      17. Don’t see your Member of Congress here? Please call or email them and ask for their support of the Personalize Your Care Act!  Even if you have emailed them before, please do it again!
    2. The Rural Access to Hospice Act (HR 5799)
      1. Original Co-sponsor: Lynn Jenkins, KS- 02
      2. Original Co-sponsor: Ron Kind, WI-03
      3. Suzan DelBene, WA-01
      4. Adrian Smith, NE-03
      5. Scott Tipton, CO-03
      6. Peter Welch, VT
      7. Brad Ashford, NE-02
      8. Gregg Harper, MS-03
      9. Jeff Fortenberry,  NE-01
      10. Derek Klimer, WA-06
      11. Steven Palazzo, MS-04
  2. Senate
    1. The Care Planning Act (S. 1548)
      1. Original Co-Sponsor: Mark Warner, VA
      2. Original Co-Sponsor: Johnny Isakson, GA
      3. Tammy Baldwin, WI
      4. Shelley Moore Capito, WV
      5. Susan Collins, ME
      6. Amy Klobuchar, MN
      7. Don’t see one or more of your Senators? Ask them to support the Care Planning Act here! Even if you have already done this before, please contact them again!
    2. The Rural Access to Hospice Act (S. 2786)
      1. Original Co-Sponsor: Shelley Moore Capito, WV
      2. Original Co-Sponsor: Jeanne Shaheen, NH
      3. Kelly Ayotte, NH
      4. Patrick Leahy, VT
      5. Don’t see one or more of your Senators or Congressmen? Ask them to support the Rural Access to Hospice Act here! Even if you have already done this before, please email them again!


Additionally, National Hospice and Palliative Care Month is coming up in November, and that coincides with when most of your Members of Congress will be back in their districts! Now is the time to request a meeting, invite them to visit your program, or plan a We Honor Veterans pinning ceremony for Veterans Day (Nov. 11).

Remember, if you want your Member of Congress to support hospice and palliative care, you have to ask them!

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