Hospice Care | Distance Learning Systems (DLSI)

Hospice Care Experience

The stained-glass wall in the church of the Community Hospice House represents a menagerie of animals quietly experiencing the woodlands, water and air. It’s a field full of life. And life is the focus in this place where individuals come to die. Dee Pringle’s spouse, Gene, spent his last two weeks of life here four years ago. Her spouse had ALS (Lou Gehrig’s Disease) and was getting treatment at Dartmouth-Hitchcock Medical Center. Dee, a retired instructor who lives in Amherst, was looking after him in their house. “And I was excellent,” she said. “I was really excellent.”

But as Gene’s illness developed, his physicians suggested hospice care. For three months, hospice nursing staff offered support and proper care to Gene at home. Then they suggested a move to the 10-bed hospice house run by Home Health & Hospice Care, a charitable organization in Merrimack. And just like that, the pressure of medical care moved to the professionals, Pringle said. “My part was just to be with him.” She calls it “magical.””Those last few days that are valuable, the medical parts are being taken care of and you don’t even have to think about that because the qualified individuals have taken over.” It was also a great comfort to her spouse, she said. “He could rest. “Pringle can’t say enough about the services offered at the property, from food supervisors who serve residents’ wants and needs, to visits from musicians, therapy dogs and Reiki massage treatment practitioners.

She still gets together with members of a bereavement support team she met after her spouse’s death and visits some of the per month academic programs the organization offers. Her son, Frank, said having the professional employees at the hospice house take over the medical care of his dad in his last days was a convenience to the entire family. Home Health & Hospice Care has its origins in a women’s organization that took care of sick employees and their children in Nashua in the late Nineteenth century. The Good Cheer Society became one of the first viewing health professional organizations in the country.

Comfort and Support in Hospice Care

While most hospice services are designed to care for sufferers in their own homes, associates may provide care in assisted living or skilled nursing features if appropriate. Some hospice solutions also have their own features or are associated with hospice programs, such as Scripps. Scripps’ hospice care ensures that Scripps patients have continuity of care. The hospice group continues to help coordinate proper care with primary physicians as well as specialists as may be required.

Hospice benefits not only sufferers, but their close relatives and friends as well. Team members provide support for those facing the loss of a loved one. In addition to offering bereavement services after a patient passes, hospice can be there to help loved ones with the grieving process.

Most insurance companies, such as Medicare, will cover hospice for qualified sufferers. Although many sufferers are older, hospice care is available to sufferers of any age, including children who have a terminal diagnosis with limited life span. Generally, a physician must agree that a patient’s life span is less than six months in order for hospice care to be covered; however, because it is nearly impossible to predict exactly how long a patient will live, some sufferers may receive hospice services beyond six months.

Like hospice care, modern care also concentrates on offering support and comfort to very ill sufferers, concentrates on the whole person and evaluates the physical, mental, emotional, and spiritual needs. Unlike hospice services, however, modern care is offered to sufferers who are still being treated for their illnesses and are not necessarily near the end of life; in fact, many make a full recovery. Palliative care is provided in parallel with curative treatments and can be a tremendous resource. A patent with cancer, for example, may receive modern care to help with the side effects of chemotherapy treatment or can evaluate and treat pain.

Hospice Care Evolution

November is National Hospice and Palliative Care Month, a time to draw and raise attention of this special kind of care. Hospice care is a viewpoint of end-of-life care that concentrates on the comforting and care of a critically ill patient’s symptoms. These symptoms can be actual, psychological, spiritual or social in nature. The idea of hospice as a place to cure the incurably ill has been changing since the 1200’s and first came into the United States in the nineteen seventies in reaction to the work of Cicely Saunders in the United Kingdom. Since its appearance, hospice care has evolved rapidly.

Hospice care is available to sufferers of any age with any terminal diagnosis. Although most hospice sufferers are in treatment for less than 30 days, care may increase beyond six months if an individual’s condition is constantly on the merit for such healthcare. Medical and social services are provided to sufferers and their loved ones by an interdisciplinary group of professional suppliers and volunteers who take a patient-directed strategy to handling sickness. Generally, therapy is not analytic or healing, but is based on what the individual and family members’ goals are. In many situations, hospice services are covered by medical health insurance and other suppliers.

Care may be provided in an individual’s home, experienced nursing service, or assisted living service. The objective of hospice care is to offer comfort to the individual and family members. This can mean independence from actual, psychological, spiritual and/or social pain. Hospices do not seek to speed up loss of life, or extend life. Hospices offer care with an interdisciplinary group. This interdisciplinary group strategy includes all members of the medical care group working together towards the same objective, which in this case is identified by discussions with the individual and family members. Members include the hospice medical director, doctors, pharmacy technician, RNs, certified nurse’s aide, social workers, spiritual consultants and volunteers. The hospice health director is a physician who provides support and guidance to the clinical staff providing care to the patient and family.

Hospice Care and Oncology Patients

Why do doctors have such difficulties adopting hospice care and using it to benefit sufferers, particularly oncology patients? The Dartmouth Atlas Project recently revealed that the amount of melanoma sufferers who are passed on to a hospice program in the last 3 days of life increased by 31% from 2003 to 2007. The total share of melanoma sufferers even getting hospice care was only about 61%. David Goodman, co-principal investigator for Dartmouth Atlas said more sufferers are being admitted to hospice care in the last 3 days of life “when it’s too late to offer much comfort” and that “many sufferers are getting more competitive in-patient care and less effective hospice care.”

There are many wonderful oncologists who take pleasure in looking after for their sufferers until the very end. But there are growing concerns with the doctors who do not utilize hospice care properly and once they do refer the individual, they don’t want to be involved with the care anymore. For example, the Dartmouth Atlas study mentioned the unsuitable use of feeding pipes in dying sufferers. We are all aware, or should be, that feeding pipes do not make dying melanoma sufferers live a longer time, cure injuries, put on weight, or reduce aspiration. They more likely cause aspiration, diarrhea and feeling sick. But family members and doctors continue to force PEG pipes on sufferers without asking them their desires and without full disclosure of the threats and lack of advantages.

It is a natural procedure to quit taking in nutritional value that can no more offer the advantages they did in a recuperative state. Offer food without pressure and never make the individual feel accountable for not eating. It can be challenging for family members to watch as a loved one stops eating and in our community, they often expect the individual to pass away very quickly when they don’t eat or drink. Patients can be kept completely comfortable, but for families, it is a difficult vigil.

New Hospice Care

Two of the most terrifying words one wishes never to listen to are “terminal illness”, especially in regards to yourself or a family member. This is usually followed by a variety of confusing choices that need to be taken like the right doctor, hospice care, insurance issues and confounding medical terms, none of them easy or simple. Pearland-based Altus Healthcare Management Services is stepping in to complete the needs of the critically ill in Sugar Land by starting a new medical center with an in-patient unit in roughly 8 months. The term “hospice” represents a support that provides medicines, equipment, medical center services and additional help, either in the comfort of your home or at an inpatient unit, when life span is about 6 months or less. Sufferers are referred by their doctors to a medical center and the support is usually covered by Medical health insurance.

Altus Health was established in 2004 with a novel idea of “empowering physicians”. In short, it allows doctors to get and become associates at their facilities and once functional, doctors focus on practicing medication and looking after patients while ZT Wealth, manage the day to day management, promotion and cash management. Altus has had a good run starting several hospice care services, imaging, surgery and sleep facilities in Texas, utilizing over 800 individuals and producing $150 million of earnings. Altus’ strength can be found in being patient focused and making a plan of care that is designed to the unique needs of the patient and their family. This is supervised by a care group of experienced doctors who work in combination with the individual’s primary doctor to ensure that the patient gets the best possible care.

Former Mayor Dave Wallace, now a Board Member of Altus Healthcare, described by Gaj as “one of the best individuals to have in your corner”, said he was grateful of the tasks the service would make and the healthcare it would offer for the citizens of Sugar Land. “Detractors may grumble that the wheels of the Government are not turning quick enough,” Wallace said, yet I believe that the “City of Sugar Land is the best oiled machine there is.”

Hospice Care and the Medical Marijuana Bill

Though medicinal marijuana will soon be lawful in certain states, physicians say it will have little to no effect on their day-to-day functions. Whether dealing with sufferers in hospice care or those with HIV or AIDS, hospice care providers do not see marijuana becoming one of their go-to medication. Barbara Lafrante, a health professional and director of hospice and palliative care with Home Health & Hospice in Merrimack, said there are already drugs on the market that provide the same advantages that marijuana is said to have. Lafrante, who rests on the New Hampshire Hospice and Palliative Care Association, recommended “Marinol,” an artificial cannibanoid, which provides identical outcomes. She said most physicians will convert to that medication because it has been approved by the U.S. Food and Drug Administration.

“We have a lot of drugs currently, you know, that we use to provide control for our sufferers,” Lafrante said. “Our sufferers are well-palliated when we use Marinol, an FDA-approved type. And we hardly ever need that.” In an organization where Lafrante said she recognizes about 80 to 100 sufferers weekly with six months or less to live, Home Health & Hospice’s guarantee is to remove the discomfort within 48 hours. “Comfort is the concern,” she said. Wendy LeBlanc, vice chairman of the Southern New Hampshire HIV/AIDS Task Force based in Nashua, said this bill will have little effect on individuals she works with, as well. Using marijuana to fight the devastating outcomes of AIDS is less common than it once was, LeBlanc said. And thanks to new medication and therapies, many HIV and AIDS sufferers do not get as fed up as they once did and some of the drugs used to cure the illness do not come with the same side-effects, like nausea and fatigue, she included.

“It was much more commonly known and approved because individuals did not have a hunger and it certainly assisted,” she said. “Traditional drugs have enhanced for individuals living with HIV, especially for individuals clinically diagnosed more recently.” Dr. Karen Baranowski, president and CEO of Home Health & Hospice said for her, the choice to recommend sufferers marijuana is up to their physicians, but she did not see that becoming a large source for them in the long run. “If it’s appropriate for the individual, they will use the FDA Marinol more regularly, I would think about,” she said. People who do depend on the drug often hesitate to discuss it, LeBlanc outlined. The discussion is even restricted among physicians and medical employees. LeBlanc said she knows of just two individuals who recognize using marijuana to help fight their signs.

Common Questions About Hospice Care

Where can hospice care be provided?

Hospice can be offered wherever your family member or loved one resides, including:

In your loved one’s personal home – Hospices will bring all aspects of the hospital to your loved one’s private home, including equipment, medication and of course, the employees.
Assisted living and personal proper care homes – Hospice care can be offered in an assisted living facility or a private care home. The hospice team works directly with the employees at the facility to coordinate proper care to your beloved relative or parents.
Nursing homes, long-term care (LTC) establishments and skilled nursing facilities (SNFs) – Some patients reside in settings that provide higher levels of proper care (than private care houses or assisted living facilities), such as helped living facilities, long term care facilities and skilled nursing units. The agency works directly with the employees of these facilities to make sure that your elderly loved ones receives proper care.
Brick and mortar hospice – Hospice is also offered in buildings specially dedicated to providing hospital care.

Can you change hospice care providers?

When family members find themselves in a situation where they decide that their current hospital provider is not looking after a family member properly, family members are within their rights to change hospice providers.

How do you pay for hospice care?

Most hospice care facilities currently accept Medicare, there are several other ways that family members typically pay for hospice:

Private Insurance – Your elderly loved one may have a private insurance coverage that may cover all or part of the cost of hospice services.
Insurance from the Veterans Administration (VA) and other government insurance
Personal Payment – For those who do not have insurance coverage or are not eligible for Medicare, some prospective hospice patients may be in a financial position to pay for hospice services out of pocket.

The Move to Hospice Care

Although most individuals would want to die quietly in a relaxed establishment, a new research reveals that almost one in three spend some time in the intensive-care unit of a hospital in their last month of life, while a similar number only get hospice care a few days before passing away. And 40 percent of those late hospice care recommendations come right after an ICU stay, the researchers mentioned. “People end up with these very brief stays in hospice care,” said research writer Dr. Joan Teno, a lecturer of health services, plan and practice at Brown University’s Warren Alpert Medical School, in Providence, R.I. “Those brief stays are difficult on the sufferers and the family members. They don’t benefit from hospice’s psychosocial assistance for sufferers and their loved ones.”

Another professional put it this way: “I think what has occurred is that we’re using hospice care as a last resort. It’s something we do when individuals have gotten so bad that they can’t reply to any possible involvement,” said Dr. Mary Tinetti, chief of geriatrics and lecturer of internal medicine and public health at the Yale University School of Medicine and Yale New Haven Hospital. “Hospice care should be used as a treatment for those who are targeted on total well being,” said Tinetti, who is also the co-author of an article associated with the research. “Some individuals are going to want to have access to modern care prior to the process.”

The research analyzed a unique sample of 20 % of fee-for-service Medicare recipients who passed away in 2000, 2005 and 2009. Each year, fewer individuals passed away in the medical center, according to the research. In 2000, 32.6 % passed away in the medical center. In 2005, 26.9 % passed away under hospice care and 24.6 % did so during 2009. At one time, however, the use of the intensive-care unit in the last 30 days of life increased for every time frame. In 2000, 24.3 % of individuals were in the ICU in their last month. By 2005, that number was 26.3 %, and during 2009, it had increased to 29.2 %.

Hospice Care Costs on Dementia

The RAND Corporation conducted a new study that set off a few red flames about the increasing cost of dementia within the U.S. healthcare system. According to RAND, dementia is one of the nation’s most expensive health conditions, charging the U.S. between $157 billion dollars and $215 billion dollars a year in health care and other expenses.

Compared to other common costly illnesses, the immediate healthcare expenses of treating dementia, approximated at $109 billion dollars in 2010, are in line with cardiovascular disease ($102 billion) and considerably greater than cancer ($72 billion). Beyond immediate healthcare expenses, it is approximated that an additional $48 to $106 billion dollars is spent on the unofficial care for dementia, which primarily includes lost wages and care provided by close relatives at home. The estimated growth is also eye opening, both the expenses and the number of individuals with dementia will more than double within 30 years, a rate that overrules many other serious illnesses. These incredible researches clearly strengthen the need for the U.S. to find better solutions for those suffering from dementia.

Medical health insurance rules require a doctor to approve that an individual coming into a hospital is likely to die within six months or less. Physicians are much more likely to do so when the disease is cancer or heart failure. As a result, too many sufferers are declined access to hospice care, which provides modern care (i.e. comfort care) for the dying and support for their family members. Without hospice care, those being affected by dementia may be exposed to several hospitalizations, obtrusive treatments and poor pain /symptom management.

Today, dementia sufferers are blatantly under served as less than 10% of people dying of dementia receive hospice care and often times are registered too late, within a few weeks of death. Relatively, more than 40% of People in America who die each year are in hospice care. The decision to put a loved one into hospice is without doubt one of life’s most difficult choices. But, better prognoses and education about the benefits of hospice may reduce struggling and needless medical costs.

Population Increase in Hospice Care

Many individuals are still passing away in hospitals, despite the fact that there has been a loss of the variety of sufferers who spend their final days in a setting that most would rather avoid, a new government review reveals. While the variety of individuals admitted to U.S. medical facilities improved 11 % between 2000 and 2010, going from 31.7 million to 35.1 million, the variety of individuals who passed away in medical facilities decreased 8 %, from 776,000 to 715,000, according to the U.S. Centers for Disease Control and Prevention. The fall in medical center fatalities happened mostly among females, the researchers found.

“That could just be that there were older women who were able to be placed in alternative configurations, because women live longer. That is just a speculation,” said review writer Margaret Jean Hall, from the CDC’s National Center for Health Statistics (NCHS). Overall, the in-hospital loss of life amount is 20 % lower for individuals who die from their clinically diagnosed disease, Hall said. For some circumstances, however, the decline is even greater. For example, the in-hospital loss of life amount is down 65 % for kidney disease, 46 % for cancer and 27 % for stroke, Hall mentioned.

Many sufferers could be going to hospice care or to long-term care features, Hall recommended. “But these solutions are less extreme and maybe nearer to a setting that would be much better than the high-tech medical center,” she described. The one area where the in-hospital loss of life rate has improved engaged cases of life-threatening blood infections, moving 17 percent from 2000 to 2010. Whether these infections developed in the medical center is not known because the review only offers with the circumstances sufferers were clinically identified as having when they were admitted to the medical center, Hall said.