Link to article: http://www.telegram.com/article/20141225/NEWS/312259585

Marie Shenette of Worcester watches as her grandson Cole Langevin, 3, of Millbury opens Christmas gifts at the Rose Monahan Hospice Home. At right is Cole's mother, Melissa Langevin. (T&G Staff/PAUL KAPTEYN)

WORCESTER - Surrounded by family on Christmas Day, David F. Shenette Sr. smiled as his wife, Marie, held their grandson on her lap.

The family opened presents, joked, reminisced and did its best to enjoy a merry Christmas together, but an unwelcome truth spent the holiday with them.

About a month ago, Mr. Shenette drove to Rex Monumental Works in Webster Square to pick out his wife's grave marker.

He returned home that day with a picture on his phone of a heart-shaped headstone made of pinkish granite. Mrs. Shenette confirmed that was the one she wanted.

Thursday, at the Rose Monahan Hospice Home on the banks of Coes Reservoir, the family celebrated what likely will be Mrs. Shenette's last Christmas.

The small hospice started the morning with five patients; the staff expected a sixth to arrive in the afternoon.

When it comes to death, Christmas is just another day.

One patient had been at Rose Monahan since October, but most succumb to their illnesses after a few days or weeks, staff said.

"Hospice is unpredictable. I've had patients hang on for months and patients pass after two hours with us," said Candy French, director of hospice houses for VNA Care Network, which operates Rose Monahan and two other hospices in Massachusetts.

Across the country, on every day of the year, hospice nurses and staff help ease the end of life for people like Dave and Marie Shenette.

Mr. Shenette, 58, drives a city trash truck on the downtown route. He's worked for the Department of Public Works for three decades.

Mrs. Shenette, called "Mammy" by her grandson, once worked as a referral analyst at Fallon Clinic. She's 54. Her birthday is in late January.

The couple met online and have been together for 14 years. They were married on May 25, 2013.

Mr. Shenette whipped out his phone to show a picture of them exchanging vows before a justice of the peace at Cana Chapel on the East Side. In the picture, Mrs. Shenette beams happily as she holds her fiance's hands in hers.

"I was very nervous," Mr. Shenette recalled. "We've been together for years, but I was so excited."

Their wedding cake was assembled out of individually wrapped peppermint patty candies. Mr. Shenette, who favors faded jeans and a Harley-Davidson T-shirt, even donned a dark suit and crisp white shirt for the occasion.

In May 2010, Mrs. Shenette had been diagnosed with multiple myeloma, a cancer of the plasma cells in her blood. She was getting sicker.

"We figured it was best for both of us to get married," Mr. Shenette said.

After the wedding, they settled back into their routine. They spent time with family and Toby, their frisky Pomeranian.

Mr. Shenette amused his friends with a beer cooler outfitted with wheels and a small gasoline engine, so you can ride it like a go-kart. Mrs. Shenette took up quilting when she no longer had sufficient dexterity in her hands for knitting.

She was getting weaker.

After roughly four years of fighting cancer, her oncologist recently conceded that the treatments no longer were doing any good. He shifted his focus to making her comfortable.

Last weekend, Mrs. Shenette passed out and fell face first to the floor at home after she got up in the night.

She woke up Sunday in the UMass Memorial Medical Center emergency room feeling woozy and with a deep bruise encircling her mouth and trailing down one side of her chin.

"Little by little, I grasped I wouldn't be home for Christmas," she said. "I thought my time was up in the hospital."

It wasn't, but the emergency room doctors couldn't do much for her there. The cancer was too far advanced.

On Monday, Mr. Shenette moved his wife to Rose Monahan on Judith Street.

"There's death for everyone," Mrs. Shenette said.

She sat in a recliner by the windows, bathed in golden afternoon light reflecting off the reservoir, which remains free of ice after an unseasonably warm stretch. Somebody taped a few holiday cards to the glass to lend the room some festive cheer.

In 1978, Mrs. Shenette spent part of Christmas Day in labor at a hospital. Her daughter, Melissa Langevin of Millbury, was born two days later.

Three-year-old Cole Langevin, Mrs. Shenette's grandson, announced to the family while sitting in her lap Thursday that he wants to be a paleontologist. The remark set off a round of quips among the adults that they would have a hard time even spelling the word.

Mrs. Shenette sometimes loses her train of thought, perhaps as a result of pain medications, but she seemed alert and lucid during the family gathering. At one point, though, she said she hopes to recover from her injuries and walk out of the hospice's front door.

Out in the hallway later, Mr. Shenette said his wife's doctors have told him that won't happen, no matter how fervently he wishes it could.

His wife is dying.

The burly sanitation worker sobbed deeply just saying those words.

Ellen Cellini, a registered nurse and team leader at the hospice, said people she meets often wonder how she can work in the riptide of dying that pulls and tugs at her patients relentlessly until they're swept away.

"I feel privileged being part of the end of somebody's life. It's not that it doesn't bother me. It's my job, and I enjoy working with these patients," Ms. Cellini said. "If I can make their journey a little more comfortable, I'm doing the right job."

Mr. Shenette will be back behind the wheel of his city garbage truck on Monday.

One of the chairs in his wife's room pulls out into a single bed. He plans to spend as much time as he can at the hospice.

"Usually, I'm pretty strong," Mr. Shenette said, his face and forehead flushed scarlet from trying to hold back his tears, "but this here has got the best of me."

Marie Shenette of Worcester, left, talks with her neighbor Kathleen Fitzgerald at the Rose Monahan Hospice Home on Christmas Day. (T&G Staff/PAUL KAPTEYN)

Marie Ann Talbot Shenette - a beloved mother, grandmother and wife - eventually will be buried at North Cemetery in Oxford, next to the graves of her husband's parents.

A pink heart of stone will mark the spot.

She will be missed.

The IV Update 2014 is a MANDATORY In-service for all field nurses who are expected to do IV visits and who have not attended IV classes in the last six months, but did attend classes previously. The presenters are Beth Mena, Elizabeth Dow, Donna Muscente, and Leanne Henderson.

We are learning and reviewing the proposed CMS guidance for 2015...one of the proposals will be tightening up on the Quality Reporting of OASIS assessment data. While this is not new to the home care industry, there is going to be a closer watch from CMS regarding the number and timeliness of the transmissions. The proposal that is being discussed is that there will be a minimum submission level of OASIS assessments set at 70%, less than this level imputes a 2% payment reduction to the provider, and then in subsequent years, move the percentage required for submission up by 10% (e.g., 80% in 2016).

The quality department encourages you to finish your OASIS documentation timely, especially DC OASIS as these are the documents that we sometimes put off doing. We appreciate your assistance in completing these within 48 hours of discharge as this will allow accurate information when completing the OASIS and take it off your to do list!

We will be putting in a process to track DC OASIS more closely, we hope that by being proactive in this request, our tracking will be minimal and the work will be done as timely as possible.

I wish you all the best in 2015 as we continue to work together as a team. Our outcomes are moving in the right direction, we are getting closer to our top 20% benchmark thanks to all of you who take such excellent care of our patients each and every day!

M1041 Influenza Vaccine. The content being collected changed. The item language clarifies the time period for reporting influenza vaccine status.



When completing this item at Transfer or Discharge, only go back to the most recent SOC or ROC to determine if the patient was receiving agency services between the dates October 1 through March 31. 

M1046 Reason Influenza Vaccine Not Received. The item was simplified to report the reason the patient did or did not receive the influenza vaccine from any source. Select only 1 response. Response specific instructions in the OASIS Help Button in Encore explain when to select each response and include age/condition guidelines and medical contraindications.



M1051 Pneumococcal Vaccine. CMS simplified the item intent to report if patient has ever received pneumococcal vaccine and removed all references to the familiar "PPV" from the following items.

M1056 Reason Pneumococcal Vaccine not received. CMS simplified to report the reason patient never received the pneumococcal vaccine. 

CMS removed the CDC recommendations for pneumococcal vaccination from the response specific instructions and placed responsibility with agencies to make the current guidelines available to clinicians. Current contraindications and precautions are listed below.

The VNA Care Network Foundation goal is to be in the top 20% of all publicly reported outcomes and process measures. Both Influenza and Pneumococcal vaccination rates are publicly reported on Home Health Compare.gov. Our current immunization rates are:

*From Fazzi Home Compare Results published July2014

By following Practice Standards developed by the National Vaccine Advisory Committee and promoted by CDC (Centers for Disease Control) for all Healthcare Professionals-whether they provide vaccinations or not-we can help insure that adult patients are fully immunized and improve our scores in 2015:

• Assess immunization status of all patients-adult vaccination rates are extremely low per CDC and opportunities to increase rates are missed if vaccine status is not assessed
• Strongly recommend vaccines that patients need-recommendation by a healthcare professional encourages patients to get the vaccination
• Administer needed vaccines, e.g. Influenza (after obtaining MD order) or refer to a vaccination provider, e.g. PCP for pneumococcal vaccine
• Document vaccines received by your patients-follow up after physician and hospital visits for vaccines administered

THANK YOU for your hard work and your dedication to excellent patient care. Please contact your QI representative with any questions: Maria Dunn ext. 1317 (Southborough), Marilyn Bowden ext. 1271 (Danvers and Gloucester), Maura Vitello ext. 4536 (Needham), Susan McGeary ext. 6824 (Worcester), Terry Dancewicz ext. 1341 (Leominster).

HAPPY NEW YEAR!!! December has ended, and the New Year is here. 2015 brings to us a CMS change, not to fear!

The new OASIS tools are in the McKesson system along with the old tools. When selecting a SOC, ROC, or Recert visit code for Dec. or Jan. the system will automatically pull in the proper OASIS tool.

The challenge is selecting the proper tool for a discharge or transfer.

If you follow these guidelines you will select the proper tool and not be asked to redo any work:

If the MO90 assessment date is in 2014, select the OASIS C 02.00 version from the drop down list.


If the MO90 assessment date is in 2015, select the OASIS C-1/ICD9 version from the drop down list.

If you have any questions please contact Carol Morris 781-535-5380 or cmorris@vnab.org.; Elaine Gardner 617-886-6464 or egardner@vnab.org; Jenn Bilodeau 617-886-6809 or jbilodeau@vnab.org

If a patient has an unstageable pressure ulcer due to black stable eschar at SOC and during the episode it peels off and leaves an area of newly epithelialized tissue, how should this be staged at ROC on M1308?

If unable to obtain any documentation that would support the most advanced stage, an assumption would be allowed that this wound is at least a Stage III, and reported in M1308 as such. Stage I and II ulcers do not form eschar or slough. Due to the presence of this avascular tissue, the assumption is allowed for the less advanced stage of a Stage III. See CMS Q&A Category 4b, Q 89.5 for additional detail.