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Hospice is a special type of care for those living with a terminal illness and a life expectancy of six months or less, should the disease run its natural course. It uses a team approach in which the care team focuses on the patient’s physical, emotional, and spiritual needs.
Although over 1 million patients and families experienced the value of hospice firsthand in 2018 alone*, there are still a lot of misconceptions about hospice care.
* https://www.nhpco.org/hospice-facts-figures/
A big part of hospice is education. We want to do all we can to educate our communities about the services hospice offers and how they can benefit you and your loved ones, starting with some common misconceptions.
Many people think that when they choose hospice, it means they are giving up hope. We have this instinct to fight and fight until the very end, and to stop fighting means to give up. However, hospice isn’t giving up. It is giving yourself and your loved ones permission to stop running back and forth to the hospital and stop the exhausting curative treatments. Hospice allows patients to be comfortable and at peace and to have the best quality of life possible.
Many people believe hospice is a place you must move to when you elect services. This is not the case. Hospice services can be provided wherever you call home – including your residence or a skilled nursing facility. The majority of patients on hospice services live at their home and continue to live at their home throughout their time on hospice.
Another common misconception about hospice is that it will cost you and your family a lot of money. The truth is actually quite the opposite. Hospice does not cost you anything out of pocket. It is covered by Medicare, Medicaid, Veterans’ benefits, and most private insurances.
This includes not only the cost of nursing visits, but also the cost of medications and medical supplies.
Learn more about how hospice is paid for.
The goal of hospice is to keep the patient’s pain under control and to keep them as comfortable as possible. While pain and symptom management can include giving the patient morphine and other comfort medications, not all patients will need it.
Hospice does not expedite death and does not help patients die. In fact, we sometimes find that patients live longer than expected when they choose to receive the support of hospice services. Hospice is about ensuring the patient is no longer suffering from the symptoms of their terminal illness. It keeps them comfortable by managing pain and symptoms, such as shortness of breath or restlessness.
This could not be further from the truth. When you elect hospice, you (or your power of attorney) are always in control. You are in the driver’s seat, and hospice is here to support you. If you decide you no longer want the support of hospice, you can make that decision. And if you are ready for hospice again at a later time, you decide that, too.
Hospice will not tell you what to do. You tell hospice what your care goals are and what you want. If you do not want certain medications, they will not be forced on you. The hospice care team will work with you to honor your wishes in every aspect of your care.
Many people think hospice is only for the very end of a patient’s life, but that’s not the case. Although hospice is for patients who have a life expectancy of six months or less (should the disease run its natural course), you can be on hospice for much longer than that – and many patients are.
Hospice patients are assessed regularly during each benefit period. As long as they continue to meet Medicare criteria, patients can continue to receive hospice support, indefinitely.
You do not have to give up your primary care physician (PCP) when you are admitted to hospice. In fact, your PCP is a very important part of the hospice care team. The hospice team will work with your physician to be sure they are updated on your condition and any changes in your care plan.
It is commonly thought that only cancer patients can receive hospice support. However, hospice is for any patient with any terminal diagnosis. Other common diagnoses of hospice patients are end-stage lung diseases (such as COPD or emphysema), heart disease, kidney disease, Parkinson’s, ALS, Alzheimer’s and other Dementias. Patients who have multiple chronic illnesses, that together result in their health being more fragile, also qualify for hospice services.
These are only some of the most common misconceptions about hospice care. If you are still feeling unsure of whether you or your loved one qualify for hospice or if it’s the right choice for you, please feel free to give us a call. We are happy to answer any questions you may have about the services we provide.
Just because you call, doesn’t mean you have to elect hospice. It never hurts to ask questions and learn more. If it’s not the right time now, maybe it will be later. And by calling now, you’ll have all the information you need to make an informed decision when the time is right.
By: Dr. Laura Mantine
Love is all around this month, especially on Valentine’s Day, when we take time to turn to those closest to us and say those three magical words. However, if you have a loved one who suffers from advanced cardiac disease, one of the best ways to show how much you care may not come in a sentimental card or a box filled with chocolates. Instead, it may come from calling hospice. Oftentimes, people don’t realize that hospice care is an option for people who suffer from advanced cardiac disease. Instead, these patients often spend their final days and months in and out of the hospital, receiving treatments that do little to improve the course of the disease. Hospice offers a supportive program of holistic care designed to help patients manage symptoms, forego emergency room visits and receive convenient, compassionate care right in their places of residence.
The estimated annual cost of heart disease is about $200 billion each year. Heart disease is the leading cause of death in the United States across all demographics. Heart disease accounts for 17.8% of hospice deaths, second only to cancer (30.1%). During hospice care, cardiac patients are monitored by a team of physicians and nurses, who administer medications and treatments to keep them as comfortable as possible. Social workers can access valuable community resources. Chaplains and counselors provide emotional and spiritual care for the patient and family. Volunteers can sit with patients, read to them or help them with light household chores, and allow caregivers to get some much-needed respite.
End-stage heart failure is often marked by an abrupt, dramatic decline, followed by recurring recovery and stability until sudden death. Patients are ideal candidates for goals-of-care conversations when they have severe refractory heart failure or extensive symptoms of cardiac insufficiency, have tried or cannot tolerate maximum medical management and are not candidates for curative therapies or surgical interventions. Hospice care addresses a wide range of symptoms, including shortness of breath, chest pain, weakness and functional decline. Eligibility for hospice may require documentation of progressive loss of functional capacity over years, progressive failure to respond to therapies and a desire to discontinue curative treatment. Patients should check with their physician to see whether they are eligible for hospice based on their history of congestive heart failure, arrhythmias or heart attacks. The physician may also consider any coexisting diseases like HIV, diabetes, respiratory illness or kidney disease when transitioning a patient to hospice care.
In addition to increasing a cardiac patient’s quality of life, hospice often increases the cardiac patient’s quantity of life as well. In a study reported in the March 2007 Journal of Pain and Symptom Management, congestive heart failure patients who chose hospice survived 81 days longer than those who did not. Even when modern-day technology or surgery can no longer offer hope, patients with late-stage cardiac disease need to know that help is always available. Hospice allows these patients to experience as much joy as possible in their remaining days while minimizing their discomfort and pain.
References:
Centers for Disease Control and Prevention, National Center for Health Statistics. (2016). Multiple Cause of Death 1999-2015 on CDC WONDER Online Database. Data are from the Multiple Cause of Death Files, 1999-2015, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program.
Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association. Circulation. 2017;135:e1–e458. DOI: 10.1161/CIR.0000000000000485.
National Hospice and Palliative Care Organization. (2018). NHPCO Facts and Figures 2018 edition.
Ziaeian, B., & Fonarow, G. C. (2016). The Prevention of Hospital Readmissions in Heart Failure. Progress in cardiovascular diseases, 58(4), 379–385. doi:10.1016/j.pcad.2015.09.004
As the end of National Hispanic Heritage Month grows near, we are shining a spotlight on Director of Business Development, Nereida. We asked her what Hispanic heritage means to her. Thank you, Nereida, for sharing your story with us!
Hispanic/Latin/LatinX heritage and culture, to me, means family.
I was raised with a large, loving family. Food, music, and family created a sense of warmth, love, and good times. At the center of it all, our matriarch, my Abuela Juana. She moved to the United States from Puerto Rico in the 60’s. She was always in the service of others. From being a social worker to a home health aide, she was love, selflessness, and caregiving exemplified.
I became a nurse because of her. After her stroke, I experienced first-hand the weight of not having advance care planning in place. 9 children, 46 grandchildren and 40 great-grandchildren had to come together to make decisions on her behalf.
After a long illness, she needed hospice. Seeing how hospice allowed us to be family and experiencing that gift, I was drawn to hospice after 19 years of nursing.
My passion, drive, advocacy, and love for hospice is fueled by the love for and from my Abuela. I am honored to carry on her legacy in the service of others while assisting people and families at a pivotal moment in their lives.
Breast cancer is one of the most common cancers among women in the United States, second only to skin cancer. It’s a disease in which the cells in the breast grow out of control. There are several types of breast cancer, but there are two that are most common. Invasive ductal carcinoma is when the cancer cells begin in the ducts and then grow outside them into other parts of the breast tissue. Invasive lobular carcinoma is when the cancer cells begin in the lobules and then spread from there to the breast tissues that are close by. It is possible for both of these invasive cancer cells to spread to other parts of the body.
Symptoms of breast cancer can vary from patient to patient, and some may not experience any at all. However, some common symptoms one may experience are:
If you have concerns about any symptoms you are experiencing, see your doctor right away.
There are several factors that can put a person at higher risk for developing breast cancer. Some are beyond our control, while others we can change. One of the main factors that puts a person at risk for breast cancer is being a woman. Although men can get breast cancer, women are at higher risk.
If you or someone you love has been diagnosed with breast cancer, and curative treatment is no longer an option, hospice may be right for you.
We do our best to stay healthy by making nutritious food choices and exercising regularly but getting a little help from the experts is another important step to take. It goes beyond just going to the doctor when you are sick. It’s important to have a healthcare team that also takes a proactive approach to help keep you healthy. This is where a primary care physician comes in.
A primary care physician (PCP) is a general practitioner who provides their patients with continuous medical care. They are trained to treat a wide variety of health-related problems, and they often serve as your first contact in the health system when you have a question or concern. You may contact your PCP for:
Aside from the points mentioned above, there are additional benefits to having regularly scheduled visits with your PCP. One example would be that you have a healthcare professional who knows the ins and outs of your overall health. This can be beneficial if you need to go to a specialist. They can not only refer you to one, but they can help you to communicate important information to the specialist to ensure you receive the best care possible.
When you see your PCP regularly, you develop a level of comfort with them. This can help you feel at ease when discussing difficult topics related to your health. You also come to trust their opinion, so it makes you feel more confident when making health decisions.
It’s a common misconception that a primary care physician is no longer involved once a patient elects hospice care. However, this is not true. Most hospice organizations encourage the PCP to remain involved in the patient’s care.
PCPs are typically the ones who have the best knowledge of the patient’s overall health. Oftentimes, they have been caring for the patient for an extended period, so they understand the patient’s health history and what may have led them to their current state.
When a PCP remains involved during hospice care, they can offer reassurance and support to the patient and their family during a difficult time. When a patient has been with a physician for a long time, they develop a level of comfort with them. Sometimes they just need a familiar face to explain things to them to make them feel at ease. This also works the other way. The PCP can offer clear communication to the hospice provider when a patient may not be able to.
You’ve decided to schedule regular visits with a PCP, but how do you choose the right one for you? For some people, it’s as simple as finding a doctor whose office is close to home. However, for some, there’s a lot more to consider. You want someone who you “mesh” with – someone you feel comfortable with. It’s also important to find someone who communicates clearly and effectively. When it comes to your health, there’s no room for miscommunication.
Many hospital systems have online ‘find a doctor’ tools where you can search for a specialty and location. Some allow you to filter based on various criteria such as if they are accepting new patients or if they have extended hours. This will allow you to narrow down your search based on what is important to you.
Reading reviews is also a great way to help you choose. They give you an opportunity to learn more about the physician directly from other patients.
Once you’ve made your selection, make an appointment. Just because you see them once, doesn’t mean you can’t explore other options. Maybe you liked the front office staff and nurses, but just didn’t jive with the doctor. Next time, try a different doctor in that practice. Find the doctor who is the best fit for you. It will make it that much easier to stick to scheduling to regular appointments.
By: Marisol Ramirez, RN
Every stage of life is important. Clinicians understand how to care for late-stage heart failure patients. Every minute of life is valued and deeply treasured, emphasizing our utmost commitment to providing the best expert care in the last moments of life that matter most. It is a great honor to be a part of vulnerable moments, provide expert care, and provide emotional support and guidance when deciding the best options for your loved one. Have you or someone you love been diagnosed with advanced heart disease? Has a physician suggested hospice care, but you are just not sure where to even begin searching for answers? In honor of World Heart Day, we’ve put together this guide to bring you clear answers that will allow you to make the best-informed decisions for you or your loved one.
Hospice care is specifically designed with the patient and family in mind. Ensuring patients are safe in their homes, comfortable, and pain-free is essential. Comprehensive hospice services are essential to satisfy the patients’ and their families’ most pressing needs.
You may find yourself in need of expert clinicians and skilled nurses to help you manage your heart failure, help with pain control, and preserve a sense of normalcy during the last months of life. Know that your hospice team is here for you and your loved ones.
Patients on hospice services have less than six months of life remaining. This may be the most difficult decision you will ever need to make, but you do not have to go through the process alone. Invite your family and special people in your life to provide support and be present when discussing options with your physician.
Your hospice team can support you in educating your loved ones on the disease process and can provide support during this time.
Recognizing the signs and symptoms of end-stage heart failure is critical. According to the American Heart Association, end-stage heart failure is when most treatments may no longer work and when the patient experiences more frequent symptoms.
Frequent and recurring angina, or chest pain, is common at end-stage heart failure. It may become more difficult to breathe, in addition to feeling short of breath with minimal exertion or at rest. Your doctor may recommend supplemental oxygen to alleviate the strain, or medications to relieve chest pains or heart palpitations.
According to a Heart.org study, medical records of patients with end-stage heart failure tend to have symptoms very similar to patients with cancer:
Other common symptoms to note that may affect daily functions:
In addition to the cardiac insufficiency, these symptoms may cause patients to feel overly fatigued and with less energy to complete their normal functions of daily living. Patients may require more hands-on care from their caregivers or family at this time. This may include performing tasks such as bathing, dressing, and grooming care.
There may come a point – even before the last six months of life prognosis – in which patients may come to terms with their end-stage heart failure diagnosis. They may have already decided that they will not consent to further medical interventions if it causes more pain or a poor quality of life. The patient’s loved ones must be present with kindness, support, and respect for the patient’s decisions. The patient’s decision to refuse further medical treatment can often bring discord from family members.
The nature of end-stage heart failure is complex. It involves providing support both for the patient and their families during their most vulnerable moments.
Hospice services provide an array of benefits for patients with advanced heart disease:
If you think you may benefit from the following services below, then hospice care may be for you.
Every patient is unique and will present different needs towards their end-of-life care. Your case manager will create your hospice plan of care to suit your needs, preferences, and health goals.
Competent healthcare professionals and physicians are on staff to specifically address your concerns, signs and symptoms, physical discomforts, and other medical questions you may have. On-call staff are available around the clock to support you to ensure you receive the best possible medical care in the comfort of your home.
Our hospice care team is committed to providing patients and families with the emotional and spiritual support they need.
Our hospice team’s goal is to relieve the patient’s pain and suffering, prevent complications, ensure safety in the patient’s surroundings, and provide education regarding end-of-life best practices. Our hospice services ensure that you or your loved one will receive the following:
Your care team may offer continuous care for up to 24 hours if the patient requires close monitoring or interventions due to a severe problem or health crisis.
A team of expert and compassionate professionals conduct regular home care visits. The goal is to help in alleviating symptoms, pain control, and educating patients and their families.
Providing the best possible experience at this stage of life is important. Our team understands that patients need to obtain the proper medical equipment and medical supplies, as related to the primary diagnosis.
Inpatient care is critical during those moments when extra help is needed to control pain or other symptoms. A short-term inpatient stay will be available in such cases.
The absence of proper end-of-life planning for families can be even more difficult when losing a loved one. Ultimately, hospice means:
Care at home requires a team effort and collaboration from the various parties involved. However, everyone knows that the patient’s family at the bedside is generally the one most involved physically and emotionally in the care of their ill loved one. Hospice provides families up to five days of inpatient respite services. This gives caregivers and family a much-needed break during this time.
Hospice providers understands that death is a life-changing moment for the survivors. Hospice provides bereavement services for the family to provide care and support after a loved one’s death.
Often, hospice accepts Medicare, Medicaid, private insurance, and other forms of payment. You may contact your local hospice branch to find out more about hospice services and insurance questions.
According to the National Institute on Aging, 61% of Americans aged 65 or older have multiple chronic conditions. Aging is an inevitable part of life. There’s no avoiding it, but there are things we can do to age in a healthy manner. In honor of Healthy Aging Month, we are sharing some tips for focusing on healthy aging.
There are several components to consider when thinking about healthy aging. There is the obvious one: physical health. But it is also important to focus on others like mental health, social health, and even financial health.
Exercise is one of the most important ways to care for your physical health. Scientific evidence suggests that people who exercise regularly not only live longer, but they also live better. Keeping your body moving by doing things like walking the dog or gardening can help you stay independent as you age. Practicing exercises that focus on your balance can help you to avoid falls, while stretching can improve flexibility which can help your body maintain the freedom to do everyday activities.
Making smart nutrition choices is also important in helping maintain physical health. As we age, our bodies change, and thus so do our nutritional needs. AARP’s MyPlate for Older Adults breaks down exactly what a balanced nutrition plan looks like for older adults. It includes fruits and vegetables, healthy oils, herbs and spices, fluids, grains, dairy, and protein.
Regular health screenings are also important for maintaining physical health. There are many debates about how often an older adult should see their doctor, but it’s common to hear a recommendation of at least once per year.
Another incredibly important part of our overall wellbeing – at any age – is mental health. When your mental health suffers, it can have a negative impact on your physical health, as well. Clinical psychologist Carla Manley, PhD says people with mental illnesses can experience a variety of physical symptoms, including muscle tension, headaches, insomnia, and feelings of restlessness.
So how can we take care of our mental health as we age? One way would be to participate in activities that bring you joy. Research shows that having a hobby is linked to lower levels of depression and may even prevent depression. Some examples of hobbies that are good for our mental health are playing music, gardening, fishing, yoga, and writing. Puzzles like word searches, crossword puzzles, or sudoku are great hobbies that help to keep our mind sharp.
Research has linked social isolation and loneliness to a higher risk of physical and mental conditions such as high blood pressure, heart disease, a weakened immune system, depression, and Alzheimer’s disease. Engaging in meaningful activity with others gives us a sense of purpose which ultimately leads to a boosted mood and longer life. We can focus on several aspects of our health at once by taking our hobbies and making them a group activity. This could be in the form of a gardening or book club or simply taking a walk with a friend.
With most of the focus being on our physical health as we age, we can’t forget the importance of our financial health. This can be a little trickier to manage, and with all the information that is available online, it is tough to determine what is reliable. Senior Finance Advisor put together a list of reliable resources that help with investment advice and financial protection resources.
They also recommend finding a trusted fiduciary planner who can help you manage your money. The law requires them to always act in your best interest, and they tend to be more transparent in discussions of financial opportunities.
Remember, what we do today impacts tomorrow. It may feel overwhelming to think about changing bad habits or creating new healthy ones, but it’s the key to living a longer, healthier, happier life. Start small and remain consistent and dedicated to your goals. It will pay off!
By: Laura Mantine, MD
Ovarian cancer is cancer that grows in a woman’s ovaries. Damaged or deformed cells start to grow out of control. Although treatment has a high rate of success if the cancer is found at an early stage, in many cases it isn’t discovered until advanced stages when the cancer is harder to treat. A biopsy, or small surgery, is often performed when ovarian cancer is suspected. This is done to confirm the disease by taking tissue and fluid samples for analysis. Some ovarian tumors are benign, which means they don’t grow into cancer. Treatments for ovarian cancer vary based on the stage of the disease, but often include surgery and aggressive chemotherapy. These treatments may come with distressing side effects like pain, sleep problems, nausea, fatigue, loss of appetite, anxiety, or depression.
Facing ovarian cancer is difficult. It can have a big impact on your physical and emotional health, all of which may cause enormous stress for both you and your family. But you don’t have to face this alone. Treating the pain, symptoms, and stress of cancer is just as important as treating the cancer itself. Palliative care and hospice care are forms of supportive services available to people with cancer. Supportive care focuses on providing comfort, relieving pain or other symptoms, and improving quality of life. Supportive care doesn’t cure disease. The main difference between these two types of care is that you can receive palliative care at the same time you are receiving treatment, whereas hospice care begins after stopping standard cancer treatments for end-of-life management.
Once you decide to no longer receive chemotherapy or other standard cancer treatments, transitioning to hospice may be beneficial for both you and your family. When you choose hospice care, it means that the goals of treatment have changed with a shift from curative to comfort-based care. Hospice care is usually offered at the end of life, when you’re expected to live less than six months. The aim of hospice is to care for you rather than attempt to cure the disease.
Hospice care is very personalized. Your hospice care team will focus on making you as comfortable as possible. They will work with you and your family to create a care plan that best suits your goals and needs for end-of-life care. A hospice team member is generally on call 24 hours a day to provide support. You may receive hospice care in your home, a special hospice facility, a nursing home, or a hospital. A hospice team usually includes doctors, nurses, home health aides, social workers, clergy members or counselors, and trained volunteers. Services may include medical services, supplies and equipment, medications to manage pain and other cancer-related symptoms, spiritual support and counseling, and short-term relief for caregivers.
Medicare, Medicaid, and most private insurance plans will cover hospice care. Most U.S. insurance plans require a statement from your doctor that you have a life expectancy of six months or less. You may also be asked to sign a statement that you accept hospice care. Hospice care can continue for longer than six months, but your doctor may be asked to give an update on your condition.
Getting supportive care, whether palliative care or hospice care, can be beneficial to your mental and physical well-being. Talk to your doctor, family, and friends about your supportive care options.
According to the CDC, in a typical year, at least 1.7 million adults in America develop sepsis and nearly 270,000 Americans die as a result of it. So, what exactly is sepsis and who is at risk? In honor of Sepsis Awareness Month, we want to answer these important questions.
Sepsis is the body’s extreme response to an infection and can be life-threatening. Your immune system works to protect you from infections and fight off any that occur, but it’s possible for it to have an overreactive response to infection.
Although a medical assessment by a healthcare professional is needed for a diagnosis, a patient who has sepsis may have one or more of the following symptoms:
There are three different stages of sepsis. Each has its own variation of symptoms a patient may experience. A patient can develop sepsis while they are still in the hospital recovering from a procedure, but that is not the only time/place it can develop. If you are experiencing any of the symptoms below, it is important to seek immediate medical attention. Seeking treatment early on can be lifesaving.
The first stage is simply called sepsis. Symptoms a patient may experience in this stage are:
The second stage is severe sepsis which occurs when there is organ failure. The following are common symptoms of this stage:
The third and final stage is septic shock. In this stage, a patient will experience the symptoms of severe sepsis plus a very low blood pressure.
Anyone can get sepsis, but some people have a higher risk of infection. Those at higher risk include:
Adults who are aged 65 or older are reportedly 13 times more likely to be hospitalized with sepsis than those who are younger. Researchers believe our immune system becomes less effective at fighting off infection as we age, which means older people tend to contract more infections that become more severe. Since each infection we get presents a risk of getting sepsis, this puts older adults at a higher risk of developing sepsis.
Any type of infection can cause sepsis but the most common among older people are respiratory such as pneumonia. COVID-19 has also become a strong risk factor for sepsis among older adults. Sometimes it is difficult to spot an infection right away in people who are aging. If an older person becomes confused or starts to behave in an unusual manner, it could be a sign of infection.
Sepsis can quickly progress through the three stages and result in death if left untreated. Treatment includes:
The best way to prevent sepsis is to prevent an infection. You can do this by:
Sepsis is a medical emergency. If you or someone you love has an infection that is not getting better (or is getting worse), it is important to act fast. Get medical care immediately and ask your healthcare professional if the infection could lead to sepsis.
Recovery typically starts with rehabilitation in the hospital. This includes building your strength back up and receiving help with things like bathing, sitting up, standing, and walking. Upon returning home, it is normal to feel weak and fatigued and have difficulty sleeping. Some people also experience a loss of appetite which results in weight loss. To help keep the recovery process moving, you can rest and rebuild your strength, eat a balanced diet, and exercise if you are feeling up to it.
Some patients experience long-term effects of sepsis. These can include: