5 advantages of early election of hospice benefits in assisted living and skilled nursing

Published in McKnight’s Senior Living by Rhea Go-Coloma, LMSW

For many, hospice care is associated with care received in the home. When provided early enough for residents in assisted living facilities and nursing homes, however, hospice care can provide important benefits for the resident and facility operator alike.

Hospice care, which is covered by Medicare and most private health insurance plans, eases pain and alleviates discomfort when a resident’s illness no longer is responding to treatment.

In fact, about one-third of assisted living residents receive end-of-life care at the community they have made their home. When residents become terminally ill, however, operators must provide care that may go beyond their capabilities.

When this happens, residents may be better served in a hospital or nursing home setting, but frequently it’s in the best interests of the resident to remain in the assisted living community. This is largely because residents have grown accustomed to the people and environment and feel the most at home.

When an assisted living community resident opts for hospice care, he or she also may be able to remain in the facility during the last months of life. This is best achieved when the assisted living community operator partners with an outside hospice provider. In this situation, it’s important for both organizations to work closely together to provide the best possible care for the resident.

Whether the hospice care is being provided in an assisted living community or nursing home, good communication between the family, staff, hospice staff and caregivers is important. Equally critical for success is early adoption of hospice care.

Early adoption of hospice makes all the difference

When adopted early, hospice care offers significant benefits for residents and families. Significantly, hospice healthcare specialists help residents and their families prioritize wishes and goals, creating a greater sense of ease and comfort.

Team-oriented hospice healthcare specialists work with the staff members of the assisted living community or nursing home to coordinate and plan care. Here’s a look at the five most important advantages of early election of hospice care for residents, families and facilities striving to meet the needs of these individuals:

Family support. Early involvement of an interdisciplinary team of hospice specialists helps families on many fronts: teaching family members how to care for the person who is ill, providing support and counseling to family and friends, offering education about the care process.

The hospice team also is there to help families clarify patient wishes, establish physician and patient relationships and balance family dynamics during this stressful time. Bottom line: hospice provides a way for residents to have a diverse group of committed professionals advocating for their needs.

Care goals. Hospice gives families the time they need to discuss goals of care, including an advance directive, a legal document that spells out end-of-life care ahead of time. The hospice team — including doctors, nurses, therapists, healthcare aides, clergy and social workers — addresses every aspect of a resident’s illness, with emphasis on controlling and reducing pain and discomfort. Team members provide symptom management and pain relief, increase quality of life and relieve patient suffering.

Family counseling. Guidance and support are a crucial feature of hospice, helping families deal with the range of emotions that surround this difficult time, offering guidance from social workers and chaplains. Hospice also offers bereavement and grief counseling after a loved one has passed, and it helps with some of the after-death tasks that need to be completed. Ultimately, choosing hospice care early makes end-of-life a calming and successful experience during a difficult time.

Dignity for the resident. Hospice offers the resident a chance to die with dignity. Hospice patients are not hooked up to loud machines, their vital signs are not constantly checked by medical personnel and they do not undergo invasive procedures to prolong life. It’s about respecting patient wishes.

By making arrangement to provide hospice care, operators of assisted living communities and nursing homes can make it possible for residents and families to focus on spending time with their loved one and not dealing with the red tape and medical procedures associated with hospital care.

 

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Suggestions for adult children caring for aging parents

Published in OA Online By Raylene Weaver, LPC of Centers for Children and Families

The Beatles will always be one of my favorite groups. One of their songs that has hit home with me while thinking about this particular article is, “When I’m Sixty-four”.

People want to be needed and appreciated especially when approaching a time in life when it’s easy to be disregarded or forgotten. The aging process can be stressful, causing some to suffer anxiousness and sadness. Several of my clients and friends have faced or are facing tough decisions that are affecting their parents and themselves. I would like to pass on a few suggestions regarding the physical, emotional, mental and financial aspects of AGING that might alleviate some of the stress that can definitely arise for all concerned.

A…ASK parents specific questions concerning their health. Do family members know their medical history, names of their doctors, any medications they might be taking or appointments they are scheduled on a regular basis? If on Medicaid or Medicare, do they also carry supplemental insurance? Are all financial papers, investments, bank account information, bill payment procedures, updated will, computer passwords and any other important documents or information easily accessible? Do they have a bereavement plan?

G…GUILTY feelings about wanting to be prepared by creating a plan for a parent’s future? Questions concerning the private aspects of their lives might seem like prying but this can hopefully be of some consolation for parents, knowing that they will be taken care of “when the time comes”. The objective for the children is to be “in the know” not to be “nosey”.

I…INDEPENDENT lifestyle is what one wants for aging parents. Parents hope to be independent for as long as possible. They want to continue to travel, take care of their own bills, shop, visit friends and attend worship services. Children sometimes become too “helpful” when parents are capable of handling chores and projects and making decisions for their future. Parents do need family members visiting and checking in on them, showing care and concern, just not insisting on control.

N…NECESSARY intervention will be inevitable for many parents. Knowing when to step in and offer the appropriate type of care and assistance can be stressful. Emotions will surface that might not have been seen or experienced before. When going thru matters for instance, pertaining to insisting a parent not drive any longer, taking over their physical and financial aspects of daily life or ultimately moving them into a facility for mental or physical issues or children becoming caretakers of parents in their own homes, professional agencies might be considered. Seeking assistance from those in the medical field, state/local agencies and counseling professionals might become necessary. But until this time arises…

G…GIVE the gift of respect, love and kindness to parents. They are experiencing and living life to the best of their abilities like their children. One article I came across by Evan H Farr, “What Aging Parents Really Want from Their Adult Children”, stated that adult children should: 1) make suggestions instead of giving orders, 2) pick your battles about what parents can and cannot do, 3) reframe, don’t blame and 4) stop and think how you would want to be treated.

So I guess that brings me back to the Beatles. A couple of the lines from Paul and John’s song says, “Will you still need me, will you still feed, me when I’m sixty-four?” Can I just ask…when I’m 74, 84, 94?

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How AI can improve end-of-life care

Published in Stanford Medicine’s SCOPE by Amy Jeter Hansen

It’s hard to wrap your brain around. It’s hard to even type these words, but here they are: it’s useful for physicians to be able to predict when a patient will die.

Photo by Edward Caldwell

Don’t misunderstand. It’s not about playing God or acting nefarious. It’s about doctors being able to help patients die on their own terms, as comfortably as possible, having received the best, most appropriate care.

In the new issue of Stanford Medicine magazine, writer Kris Newby describes a Stanford pilot program that marries technology and compassion, artificial intelligence and palliative care, with the aim of helping doctors better understand which patients could benefit from end-of-life conversations while there is still time.

In the article, palliative care physician Stephanie Harman, MD, tells Newby:

Ideally with this AI model, we’re identifying patients who are sicker than we realize… And it gives us an excuse to say, ‘It’d be great if we could talk about advanced care planning.’ Or, ‘Have you had a discussion with your regular doctor about what matters most to you if and when you get sicker?’ I think the twist is that we’re using machine learning to add more to a patient’s care without taking anything away.

Developed by Nigam Shah, MBBS, PhD, the model uses an algorithm to calculate the probability that a patient will die within the next 12 months, based on comparisons of the past year of the patient’s medical history with records of millions of other patients. Many factors are considered, including the number of hospital admissions, disease classification codes and prescription codes.

The tool provides Harman with a daily report of newly-admitted hospital patients who have a 90 percent or higher probability of dying in three to 12 months. Harman reviews the medical records to decide if the patients have palliative care needs. “She’s found the list to be helpful,” the article explains, “and she sees how it can improve hospital care and enable her to spend more time with the most critical patients.”

This is important because, as the article notes, less than half of admitted hospital patients who need palliative care actually receive it. And many more people would want to die at home than actually do.

Hopefully, tools like this will help.

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Advance directives: How to talk with patients about them

Published in AMA Wire

A patient’s comfort in contemplating, completing or even discussing an advance directive can greatly depend on what the physician has to say and offer.

It is often an awkward situation, in large part because many patients only see the advance-directives process in terms of suffering and death. That does not have to be the case.

“When physicians approach advance-care planning from the aspect of living well and quality of life, then patients feel reassured and then they want to engage with you and tell you what matters most,” according to internist VJ Periyakoil, MD, director of palliative care education and training at Stanford University School of Medicine.

Dr. Periyakoil wrote the “Planning for End-of-Life Decisions with Your Patients,” online physician education module.

The module is part of the AMA STEPS Forward™ collection of more than 50 practice-improvement education modules. It is part of the AMA’s strong support of advance directives and the help it provides to physicians on end-of-life matters, including guidance from the AMA Code of Medical Ethics.

Medicare also has helped spur interest in advance directives, with payment starting in 2016 for every patient to have a voluntary consultation on the matter with a physician or qualified health care professional. This benefit has been widely used, with about 14,000 providers billing almost $35 million in the first year.

A recent review of 150 studies of advance directives found more than a third of Americans have them, in some form or another. That leaves a large majority—many with the most immediate need for advance directives—without written instructions that will protect their intentions or provide for trusted family or friends to make care decisions if they are unable.

A focus on what matters most

The CME credit-eligible module from the AMA is based on the Stanford University Department of Medicine’s Letter Project. The module’s central, downloadable element is a three-page letter template that in plain language guides the patient through expressing life values and goals, as well as care instructions such as palliative sedation.

The letter template is available in eight languages and written at a fifth-grade reading level. Patients can complete the letter by themselves or be aided by patient navigators or other clinicians. At Stanford, completed letters are scanned into the patient’s electronic medical record using a barcode.

Though not a formal advance directive or living will—those are governed on a state-by-state basis—the letter can be used as a worksheet to help patients express their wishes in simple language. A physician can include the letter in a patient’s medical record as patient-generated health data.

The module provides detailed advice about how to initiate the conversation. Dr. Periyakoil said her approach is to “normalize” the process by saying, “I ask this of all my patients.”

In that way, “patients don’t feel that they are singled out for this.” Her goal, she assures them, is “to provide you with the best possible care and to do that it really helps me to understand what matters most to you.”

The letter provides check boxes for standard end-of-life care questions and space for naming the individuals who can make medical decisions if the patient is unable, but starts and devotes most of its space for patient to write about what’s most important to in terms of what’s important in life:

“The physician can then move in confidence with clinical care that is in sync at all times with what the patient wants. Physicians often give medical advice or make care plans in a vacuum, “and we know very little about the patient as a person,” said Dr. Periyakoil.

“It is incredibly important to know everything there is to know about the disease,” she added. “It is equally important to know about the patient’s life goals and values,  so that the care we provide is guided by what matters most to the patient. .”

AMA’s STEPS Forward is an open-access platform featuring more than 50 modules that offer actionable, expert-driven strategies and insights supported by practical resources and tools.

Based on best practices from the field, STEPS Forward modules empower practices to identify areas or opportunities for improvement, set meaningful and achievable goals, and implement transformative changes designed to increase operational efficiencies, elevate clinical team engagement, and improve patient care.

Several modules have been developed from the generous grant funding of the federal Transforming Clinical Practices Initiative (TCPI), an effort designed to help clinicians achieve large-scale health transformation through TCPI’s Practice Transformation Networks.

The AMA, in collaboration with TCPI, is providing technical assistance and peer-level support by way of STEPS Forward resources to enrolled practices. The AMA is also engaging the national physician community in health care transformation through network projects, change packages, success stories and training modules.

 

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Mesothelioma Patients to Learn about Hospice

Published in mesothelioma.net

Palliative care experts are using the occasion of Aretha Franklin’s death to urge mesothelioma patients and others diagnosed with terminal illnesses to learn about hospice care and understand that it provides far more than just a “days before” benefit. Franklin’s family announced that she would be entering hospice care just three days before she died, less than the national median length of stay in hospice which is just slightly over three weeks and far less than the amount of time that the service is available. According to palliative care experts, when announcements are made that celebrities are entering hospice just days before their deaths, it confirms the public’s impression that hospice is a place to go before you die, rather than its actual goal of anticipating, preventing and managing patient suffering. The earlier mesothelioma patients enter hospice care, the more benefit they are able to get and the greater the improvement in their quality of life.

People diagnosed with mesothelioma who are considering hospice care would do well to learn about those celebrities who have used it to its fullest: columnist and author Art Buchwald called the five months he was in hospice “the best time of [his] life”, where he was able to continue working, seeing friends and dying with a minimum of discomfort, in a warm and comforting environment. Palliative care professionals are working to spread this news and reframe the narrative about what hospice care from “nothing more we can do” to “living as well as you can for as long as you can” writes Jennifer Moore Ballentine, executive director of the CSU Institute for Palliative Care, based at Cal State San Marcos.

In an article she wrote for the San Diego Union Tribune, Ballentine urges family members and physicians alike to remember that palliative care is available for mesothelioma patients and others with a life expectancy of six months or less who are no longer seeking treatment. Unfortunately, a study in the AMA Journal of Ethics found that specialty physicians are less likely to suggest palliative care than are family and internal medicine clinicians. Much of this is due to the challenge of having difficult conversations.

If you or someone you love has been diagnosed with mesothelioma, you are already aware that the rare form of cancer has no cure. If you would like information on the benefits of palliative care or any other resources to support you as you face this challenging disease, contact the Patient Advocates at Mesothelioma.net today at 1-800-692-8608.

 

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Five Reasons Home Health Care Is on The Rise

Published in Third Age by Tina Marrelli, MSN, MA, RN, FAAN

If you have tried to get care at home for a loved one, it may have been a difficult and time-consuming process. You are not alone. I also had the experience of trying to find care for an older adult family member, and though I have worked in home care for many years, it is not an easy experience. According to the National Association for Home Care and Hospice, around 12 million people in the United States (U.S.) receive home health care from more than 33,000 provider organizations. As the population continues to grow, that number will likely more than double by 2050, increasing to 27 million.

Here are five factors contributing to the complexity.

*Aging of the population. This has been referred to as the graying tsunami, and for good reason. The projection that roughly 10,000 baby boomers will turn 65 each day, and that this trend will continue for the next 19 years, is staggering, no matter how many times it is repeated.  In the U.S., one of the fastest growing segments are those people who are age 85 or older. Called the “oldest old” by the National Institutes on Aging (NIA), they constitute the most quickly growing segment of the U.S. population. And now think about how many people you know who are in their 90s and maybe have passed the 100 mark? My sweet father-in-law moved in to our home when he was 93 and lived with us for three years – until he died at our home with care and hospice support. This scenario is not unusual. And think about the health implications in the oldest old with the frailty and other challenges that come from living to that age.

*Home care means many things. There are home health agencies certified by Medicare and Medicaid. These are agencies that provide what are called “intermittent” visits by nurses, aides, therapists and/or social workers. These services are provided under a physician-directed plan of care. There are specific rules related to coverage and care provided and like any medical insurance program, there are covered and non-covered services. There are also private duty organizations that provide services, such as a “shift” of 4 or 8 hours. In this instance, a family may contact a number of organizations to obtain an aide to be with and care for a family member who might have personal care needs, such as a need for assistance with bathing, dressing and/or meal preparation.  There are also home care services that are provided to very ill or technology-dependent people at home, and they may need specialized nursing care, such as that provided by a registered nurse.

*Lack of enough trained caregivers. According to the Bureau of Labor Statistics, (BLS) home health aides and personal care aides are two of the fastest growing jobs. In fact, according to the BLS, their job outlook, defined as the projected numeric change in employment from 2016-2026, is 41 percent; which is much faster than average. The employment increase is estimated at 1,208,800 more aides!  Varying factors contribute to organizations having trouble finding and then retaining more aides.

*Chronic conditions and the growing complexity of care. According to the Centers for Medicare and Medicaid Services, it is estimated that 117 million adults have one or more chronic health conditions, and one in four adults have two or more chronic health conditions. These conditions can include cardiovascular (heart) conditions, such as heart failure, respiratory (breathing) conditions such as COPD (chronic obstructive pulmonary disease) or asthma, arthritis, cancer, depression, diabetes and more. Such chronic diseases also demand trained caregivers to help people better manage their health conditions.

*People wanting to age in place. This may be their home or may be an assisted living residence. It was not so long ago that people were cared for primarily at home and oftentimes died at home. Many patients receive care in their homes through the Medicare hospice benefit. In fact, most hospice care is provided in the home setting. Wanting to age in place is a great goal, although it may not always be realistic, depending on the person, the care needs and safety concerns.

So all these kinds of care at home are home care and are increasing the need for these specialized services. The term “home” becomes flexible as people seek the “best” situation for themselves and their loved ones to age in place. There is no question that home care is more complicated than people think. When finding care for yourself or a loved one, ask for (and check) references, read reviews and do your homework. Some of the best knowledge is local, so ask your neighbors and friends who they have worked with when care was needed for their family member.

Tina Marrelli, MSN, MA, RN, FAAN is the author of the Handbook of Home Health Standards: Quality, Documentation, and Reimbursement (6th edition, 2018) and A Guide for Caregiving: What’s Next? Planning for Safety, Quality, and Compassionate Care for Your Loved One and Yourself. 

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Veterans Journal: Long-term care benefits for veterans protect your retirement

Published by George W. Reilly in Providence Journal

 

A long-term care event for a veteran or any adult can happen at any age, and the potential financial and emotional strain that comes with it can have an impact on you, your family and your loved ones.

Did you know millions of Americans require long-term care during their lifetime, according to the Centers for Disease Control and Prevention, which includes the need for either cognitive or physical assistance with everyday tasks such as bathing, eating and dressing.

Unfortunately, traditional health insurance, including TRICARE or TRICARE for Life, does not pay for the chronic, ongoing assistance with daily living that is most often associated with long-term care.

As a member of the armed services, you are entitled to apply for benefits provided by the Department of Veterans Affairs, although several factors come into play when determining eligibility. For this reason, and to ensure you are prepared for any situation, it is important to understand how VA benefits work so you can form a clear understanding of your traditional health-care benefits as well as what a long-term care event might mean for retirement planning.

The VA health benefits program provides coverage for long-term care, but you must qualify for the program. The VA determines the number of veterans who can be enrolled in the program based on congressional funding allocated each year. Due to the limited availability of enrollments, the VA has established eight separate priority groups (see VA Health Care Eligibility online at www.military.com/benefits/veterans-health-care/va-health-care-eligibility.html) to categorize enrollees and determine the level of benefits they are entitled to or whether the potential enrollee is eligible at all.

Eligibility to receive long-term care benefits depends on many factors, including service-connected disability status (70 percent or greater — see the VA’s Federal Benefits for Veterans, Dependents, and Survivors online at https://bit.ly/2zcGyLv), current income levels, and even your ability to contribute to the cost of care.

Members of the uniformed services seeking long-term care benefits may find they are unable to meet the VA’s eligibility criteria. Long-term care can be expensive, and service members often rely on the VA to cover the associated costs. Depending on your eligibility status in the VA benefits program, the level of coverage available to you may not be enough. For this reason, you may want to consider applying for standalone long-term care insurance like the plan offered through the Federal Long Term Care Insurance Program at https://bit.ly/2tUYTau.

FLTCIP provides long-term care insurance for enrollees who are federal and U.S. Postal Service employees and annuitants, active and retired members of the uniformed services, and their qualified relatives.

With benefits designed specifically for active and retired members of the uniformed services since 2002, the FLTCIP offers a good way to help protect your savings and assets should you or your loved ones need long-term care. Designed to provide solutions for a range of financial situations, this employer-sponsored program has grown to be the most successful and used program of its kind, providing comprehensive coverage for more than 270,000 people.

Certain family members, or qualified relatives, are also eligible to apply even if the veteran does not. Qualified relatives include spouse, domestic partner, parents, parents-in-law and adult children.

To learn more about the FLTCIP’s benefits and features or to find the average long-term care costs in your geographic area, visit online at LTCFEDS.com. Certain medical conditions or combinations of conditions will prevent some people from being approved for coverage. You need to apply to find out if you qualify for coverage.

The Federal Long-Term Care Insurance Program is sponsored by the U.S. Office of Personnel Management, insured by John Hancock Life & Health Insurance Company and administered by Long Term Care Partners, LLC.

For personalized assistance, call (800) 582-3337 or TTY (800) 843-3557 to speak or interact with a program consultant available to answer any questions and provide step-by-step information on plan design and the application process.

 

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Hospice is here for patients and families

In the health care industry, awareness for hospice care continues to grow as more patients and families turn to hospice and understand the care hospice provides.

Although myths about hospice are that “it is only for cancer patients”, “hospice is giving up” or “too expensive, indeed the opposite is true.

Hospice illustrates that it is a vital part of end-of-life care and plays a significant role in health care in communities.

Here are some facts to know about hospice:

 

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Those in hospice need additional care

Published in Picayune Item by Leah McEwen

Those who are in hospice care often have many needs, but don’t always have access to the assistance required.

One of my grandmothers developed Alzheimer’s about ten years ago and lived with it for several years. She was in her 60s when she received the diagnosis. While the onset of the illness was slow, when it worsened, it became unmanageable.

She forgot who we were, disappeared from her home several times and eventually became a danger to herself. As her condition worsened, she also developed several other illnesses, which made taking care of her impossible for my grandfather. Thankfully, my family was able to pay for outside help to provide the care she needed until she passed away.

Unfortunately, this isn’t the case for everyone. Many elderly adults don’t have family to care for them, and do not have the funds to pay for outside help such as a nursing facility or in-house nurse.

Many hospice services fill this gap by providing care that is paid for through donations, or government programs like Medicare and Medicaid. There are also non-profit organizations that can provide everyday necessities like groceries.

I recently met a man in his early nineties who had saved enough money to pay for his livelihood until he reached 85-years-old. He said he hadn’t expected to live past that point, but when he did, he found himself penniless and with no one to turn to.

With the help of local volunteers and nonprofit organizations who discovered his need, he was relocated to a better home, his utilities were paid and he was provided with groceries and medical coverage.

Organizations that help elderly adults and hospice patients in need improve the quality of life for patients and their families.

 

 

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Coping with bereavement

Don’t bottle things up

Not everyone can express their sadness openly. But intentionally bottling up your feelings won’t help. Don’t try to compare yourself to someone who has gone through something similar. Grief is an individual experience, so don’t put a time limit on it based on how others have coped. Remember that it often takes much longer to get through bereavement than most people think.

Talking goes a long way.

Talk about it

One of the most helpful things to do after a bereavement is to talk about what you’re going through. You may, for instance, find it easy to talk to friends and family members. But if you’re the type of person who prefers to experience grief privately, you may prefer to talk to a counselor. You could also try getting help from a charity that specializes in bereavement counseling. Other support services may exist in your area – ask at your doctor’s surgery for details.

Plant a memorial

Research suggests that maintaining bonds with someone who has died is healthy, as many bereaved people fear their loved ones will be forgotten. Being able to pay your respects at a graveside can help, as it provides a place you can associate with the deceased.
You could also consider planting a tree in your local park, or even a rose bush in your garden as a reminder of the person you’ve just lost? To plant a tree in a favorite spot, contact the parks department of your local municipal council.

Take small steps

When someone close to you dies, don’t rush to make big decisions. Instead, take small steps such as starting a new hobby or taking a short break. Then in time, you’ll find the right time and the courage to make any necessary big changes.

 

 

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