Heart Failure and Hospice

By: Marisol Ramirez, RN

Now more than ever, it is imperative to manage serious conditions in the comfort of a patient’s home. Physicians, patients, and families can all agree that a caring and competent team is needed for optimal patient care. Under this joint effort, patient outcomes improve and overall healthcare costs lower for patients, specifically those experiencing congestive heart failure (CHF).

Caring for a loved one with heart failure in hospice

Making decisions for a loved one with heart failure can be difficult. You want the best care for your loved one.

  1. But how do you know when hospice care is the best option for your loved one experiencing advanced heart failure?
  2. Does having hospice mean that your loved one will be placed far away in a nursing home type of facility?

If you have some of these questions going through your mind, you are not alone.

The beauty of hospice care is that it does nothing to either hasten or postpone death. Instead, the focus is to provide the patient with the best quality of life, provide comfort measures, and ensure the patient is safe and pain-free. We can provide hospice care in the comfort of the patient’s home or at a compassionate facility, depending on their needs and preferences.

What is congestive heart failure?

Congestive heart failure (CHF), also known as heart failure (HF), happens when the heart is no longer able to pump blood throughout the body adequately. There are several different reasons why the heart’s pumping efficiency becomes impaired:


    • Coronary Artery Disease (CAD)- arteries become blocked or narrowed
    • High Blood Pressure/Hypertension
    • Heart valve disorders
    • Heart rhythm abnormalities
    • Thyroid disorders
    • Viral infections


At first, the heart may try to compensate, so it works harder to continue to meet the body’s demand. Eventually, the heart becomes damaged and overwhelmed due to the excessive demand on it to supply blood, oxygen, and nutrients to all vital organs and tissues. Heart failure soon begins to manifest itself.

Common signs and symptoms of heart failure

    • Shortness of breath
    • Difficulty breathing even while at rest or lying flat
    • Chest pain
    • Fluid retention- often appears as swelling of feet, ankles, abdomen, and fluid build-up in the lungs

What are the different stages of heart failure?

Signs and symptoms that the patient may feel vary depending on how far along the disease has progressed. The New York Heart Association explains heart failure stages.

Class A

Heart failure is in the beginning stage. Patients may not be aware since they can perform physical activity without experiencing fatigue or shortness of breath on exertion.

Class B

Patients begin to notice a decline in their physical activity. This happens as they begin to experience increased:


    • Weakness
    • Fatigue
    • Heart rate
    • Difficulty breathing
    • Chest pain


But when at rest, they may feel no symptoms and feel comfortable.

Class C

Minimal and ordinary activities become more difficult to complete. Their decline in physical activity participation becomes more prominent as they continue to feel increased weakness, fatigue, increased heart rate, difficulty breathing, and chest pain. But again, when at rest, they may feel no symptoms and feel comfortable.

Class D

Patients can no longer complete physical activities and experience the classic signs and symptoms of heart failure (weakness, fatigue, shortness of breath, chest pain) even while at rest.

Tracking symptoms and treatments through the stages of heart failure in hospice

Having peace of mind while living with heart failure is important. Grane Hospice Care strives to ensure that your loved one is competently taken care of through the disease process. Competent and skilled nurses perform routine assessments to accurately track the symptoms and administer treatments prescribed by the medical team.

How to treat heart failure with hospice at home

Treating heart failure at home is definitely a team effort, involving the patient, their family or caregiver, and the medical team. Your healthcare team’s goal is to provide the patient and their families with the tools needed to prevent exacerbation and provide strategies to prevent a CHF crisis. Your loved one will feel more in control by implementing simple ways to track their symptoms.

Monitor blood pressure

Daily blood pressure monitoring is essential. Keeping blood pressure under control and in normal ranges will help the heart from over-exerting itself. Our expert nurses will teach the patient and family the implications of healthy blood pressure. They will also explain the normal parameters as recommended by the team of physicians.

Daily weigh-ins

When cardiac performance is deficient, this causes a decrease in cardiac output. In turn, this causes the kidneys to retain water and salt. This extra fluid can typically accumulate in the legs, ankles, feet, abdomen, and lungs. This increase in water retention causes an apparent weight increase. Thus, it is recommended that daily weights be completed and weight gain be closely monitored. Generally, any weight gain of more than 2-3 lbs a day or 4-5 lbs in five days means you should contact your nurse or physician.


Having a well-balanced diet is important. Incorporating fruits, vegetables, and whole grains is beneficial. However, the most important element to monitor in the diet is sodium (salt) intake. Sodium hides in many foods. Your doctor will tell you exactly how many milligrams to include in your diet. Remember, sodium attracts water. So, you want to avoid water from accumulating to ease the workload on your heart.

Follow medication instructions

Managing your medications used to treat heart failure may cause some fear or anxiety. This may seem like a daunting task for a family caregiver as well. But be at peace knowing your healthcare team will provide expert medication management and education. There are things you should be aware of with medications. For example, diuretics (like Lasix), also known as water pills, help the body eliminate excess water in the tissue. As the diuretics do their job of taking out the unwanted water, it may also cause your body to get rid of essential electrolytes that your body needs for essential functions. Your hospice team will:

    • Help you understand your medications & identify side effects of the medications you take
    • Help you get refills
    • Teach you the importance of staying compliant with your medications
    • Ensure you get regular lab work done to monitor the levels of medications such as Digoxin
    • Ensure you stay hydrated and stay safe while taking your diuretics

Good sleep habits

Research has indicated that good sleep habits affect heart health. Having a good night’s rest, with 7-8 hours of sleep per night, is important in the body receiving sleep benefits. As the body enters into the deep stage of non-rapid eye movement (NREM) stage, the body’s heart rate slows down, blood pressure decreases, and breathing becomes more stable. This becomes important in patients with heart failure because it can help reduce the heart’s workload.

Overall, getting adequate rest allows the body to recuperate. Thus, receiving hospice care at home is essential. This can eliminate frequent night interruptions that are more likely to happen if a patient is in a nursing home facility or a hospital setting.

The role of the caregiver

Taking on the role of caregiver may be challenging, but it doesn’t have to overwhelm you. The caregiver is usually a close relative of the patient, who becomes an advocate for the patient, caretaker, and perhaps the person running the household chores and responsibilities. Having a reliable caregiver available is key. Your Hospice case manager will talk to you to offer support and ensure you have the adequate services available to fill in the gaps for when you need help. Some questions to ask yourself are:


    • Will my emotions of grieving the soon loss of a loved one get in the way of me properly caring for him or her?
    • How will my other responsibilities, if any (ex: jobs, family duties, household chores, etc.), prevent me from performing my caregiver role?
    • Do I have the courage to delegate duties and responsibilities to others when I need help?
    • What services does Medicaid or Medicare offer in providing personal care services to a sick loved one?


We are here to support you every step of the way.

The benefit of in-home hospice services

In-home hospice services bring benefits to the patient in the comfort of their home. Our hospice care team provides the following benefits:


    • Case management and coordination of all services needed by the patient
    • Routine and as-needed skilled nursing care to assess patient status, administer medications or treatments as needed, control pain, and symptoms
    • Continuous care up to 24 hours if a crisis occurs
    • Inpatient care as needed for extra help
    • Respite care up to five days for families who need a little break
    • Bereavement services
    • Medical equipment, supplies, and medications pertaining to the hospice diagnosis
    • Specialty services such as Music Therapy and Pet Therapy

How Grane teams up with physicians to individualize heart failure patient care

Living with heart failure can be very difficult for patients psychologically, physically, and emotionally. These patients and their families have special needs that can only be met by caring clinical professionals and skilled nurses. Some reasons why more physicians are choosing to team up with Grane Hospice:

Keeping you at home

Staying at home with familiar surroundings is beneficial to the patients. Studies and surveys have demonstrated that patients receiving care at home are more at ease psychologically and emotionally.

Individualized care

Every patient is unique and may have different needs depending on their stage of the illness. Our team ensures that individualized care is provided and that personal attention is given to every patient.

Reduce healthcare costs by reducing rehospitalizations

Reducing cost is important. However, it becomes even more important for patients experiencing advanced heart failure to prevent exacerbations, leading to rehospitalization. Rehospitalizations debilitate the patient’s overall health and place them at risk for faster deterioration. Studies have shown that patients receiving healthcare at home have higher chances of avoiding complications.


Ever felt fearful of the unknown? What should you expect with a heart failure diagnosis? Education is key in alleviating fears and gaining clarity in understanding the nature of CHF.

Patients and their families can have peace of mind knowing We will provide them with an easy-to-follow educational program designed specifically for patients experiencing CHF. Key educational teaching points provided by the healthcare team:


    • The nature of CHF
    • Signs and symptoms associated with the disease, ex: fatigue, angina
    • How to manage signs and symptoms
    • How to create an emergency care plan
    • Nutritional education and what foods to avoid
    • Medication management


Remember, you are not alone as you navigate through this process of advanced heart failure. Grane Hospice’s mission, along with our collaborating physicians, ensure that the best possible care is provided. Remember, you are the reason why physicians decide to collaborate with Grane Hospice. Your health and safety at home is a priority.

Hospice for Veterans with PTSD

By: Portia Wofford

After dedicating their lives to our nation, our nation’s veterans often face difficulty as they near the end of their lives. While every veteran has different needs, those with post-traumatic stress disorder (PTSD) face unique challenges. PTSD, sometimes known as combat stress or shell shock, often occurs after a person experiences severe trauma or a life-threatening event.

According to the U.S. Department of Veteran Affairs, the number of Veterans with PTSD, in any given year, varies by service era:

  • Operations Iraqi Freedom and Enduring Freedom. About 11-20%
  • Gulf War (Desert Storm). About 12%
  • Vietnam About 15% were diagnosed at a time of a study in the 1980s. It’s estimated that about 30% have had PTSD in their lifetime

It’s becoming increasingly more evident that veterans have a greater need for quality end-of-life care. Hospice care is a benefit that the VA offers to qualified veterans in the final phase of their lives.

Understanding Symptoms of PTSD in Veterans

Dangerous or life-threatening experiences such as combat can cause veterans to relive frightening events. These experiences cause feelings of uneasiness, anger, irritability, or anxiety. While it’s normal to be alarmed by unsettling memories, veterans with PTSD may experience these symptoms for more than a few months. Additionally, they may have difficulty sleeping, experience nightmares, and feel on edge. The veteran may also lose interest or find it extremely hard to participate in everyday activities. Other symptoms include:

  • Recurrent, intrusive reminders of the traumatic event
  • Extreme avoidance of people or places
  • Negative changes in attitude, mood, and personality
  • Emotionally reactive to people, places, or situations that remind them of the traumatic event

Ways to Alleviate PTSD in Veterans

When providing hospice care for veterans with PTSD, there are several considerations for the hospice team. Some symptoms of terminal illnesses, like severe pain, shortness of breath, and anxiety, may trigger flashbacks or nightmares. Additionally, opioid pain medication can make PTSD symptoms worse. The hospice team will collaborate with the patient’s healthcare team to prescribe the appropriate and most effective medication regimen. The hospice team will work with the veteran’s physician, social worker, and other interdisciplinary team members to create a plan of care. This plan of care may include:

  • Connecting with others
  • Staying social
  • Personalized medication and treatments
  • Personalized and effective non-pharmacological treatments
  • Professional social, emotional, and mental support

How Can Hospice Help Veterans?

Veterans are eligible for hospice care if enrolled in benefits and meet medical needs for hospice (terminal illness with a prognosis of six months or less). As of 2019, because of the VA Mission Act, Veterans now have increased access to more community healthcare options. Those who must drive 30 minutes or more to a VA provider or 60 minutes for specialty care may choose a provider closer to home.

Hospice uses a multi-disciplinary team approach to support and provide Veterans with end-of-life treatment. The team works closely with the VA and can provide support and treatment in the home. Hospice offers the veteran and caregivers:

  • 24/7 on-call care
  • Medical equipment and supplies
  • Pain and symptom management
  • No co-pay for hospice care
  • Collaboration with the entire medical and healthcare team
  • Social workers
  • Spiritual and emotional support
  • Grief counseling
  • Medication management
  • Nurses
  • Hospice aides
  • Case managers

Changes in Communication

As Alzheimer’s and Brain Awareness Month continues, we want to discuss a very important topic- communication and Alzheimer’s. As the disease progresses, a person’s ability to communicate gradually diminishes. Changes in communication vary from person to person, but there are several common issues you can expect to see, including difficulty finding the right words and organizing words logically.

Effective Communication

If someone you love is living with the disease, you know it can be challenging at times to communicate with them. The video above discusses the following ten tips for effectively communicating with your loved one.

  1. Never argue. Instead, listen.
  2. Never reason. Instead, divert.
  3. Never shame. Instead, distract.
  4. Never lecture. Instead, reassure.
  5. Never say ‘remember.’ Instead, reminisce.
  6. Never say ‘you can’t.’ Instead, remind them what they can do.
  7. Never say ‘I told you.’ Instead, just repeat.
  8. Never demand. Instead, just ask.
  9. Never condescend. Instead, encourage.
  10. Never force. Instead, reinforce.

Help Make Communication Easier

In addition to these tips, there are steps you can take to help make communication easier, including:

  • Making eye contact and calling the person by name
  • Being aware of things like your tone, how loud your voice is, how you look at them, and your body language
  • Encouraging two-way conversation for as long as possible
  • Using other methods, such as gently touching
  • Distracting the person if communication creates problems

You also want to encourage the person to communicate with you. You can do this by doing things like holding their hand while you talk and showing a warm, loving manner. It is also important to be patient with angry outbursts and remember that it is just the illness talking.

If The Person is Aware of Memory Loss

Since the disease is being diagnosed at earlier stages, many people are aware of how it is impacting their memory. This can make communication even more sensitive because they may become frustrated when they are aware of the memory loss. Here are some tips for how to help someone who knows they have memory problems.

  • Take time to listen. They may want to talk about the changes they are noticing
  • Be as sensitive as you can and try to understand it is a struggle for them to communicate. Don’t correct them every time they forget something or say something odd
  • Be patient when they have a difficult time finding the right words
  • Find a balance between helping them find the right words and putting words in their mouth
  • Be aware of nonverbal communication. As they lose the ability to speak clearly, they may rely on other ways to communicate their thoughts and feelings

Additional Resources

For more information on Alzheimer’s disease and how it impacts communication, visit the links or reach out to the contacts below:

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