“Let me know if there is anything I can do”

Published by unknown hospice physician

“Let me know if I can do anything.” How many times have we uttered that sentence when a friend, distant relative or a colleague has informed us they have suffered a loss of a loved one? Don’t get me wrong, I’m sure most of us mean it and it seems like the right thing to say along with “I’m so sorry.” When I look back through my life, I can easily count how many times people have taken me up on my offer. As you’ve guessed, and I’m sure you can relate, it’s 0 number of times. In a time of loss and pain, people don’t want to ask others to go out of their way to help. They aren’t going to tell you they have no energy to cook, need help watching children, money to pay the bills or buy groceries. They won’t tell you they just need a hug and your gentle presence. We are afraid of impinging on people’s privacy and space. We don’t know what words to share or how to behave and in that uncertainty of what to do or say is where the subsequent isolation occurs for the one grieving. The isolation then leads to a sense of loneliness despite the rich number of friends and family willing to help but not knowing how.

Now that I’ve been through losing a close family member to cancer and experiencing the pain of grief, our family was grateful for people’s thoughts and prayers, however, we very much appreciated those friends who did simple things such as bring us a meal, watch our children (so we could have some quiet time) and checked in on us to see how we were doing. It was those who walked in our shoes through their own similar experiences who didn’t shy away, knew the right words to say and were insistent on being there for us in a tangible way. So what can you do if you haven’t walked in our shoes but want to be there for your friend, colleague or relative who’s lost a loved one?

Here are few suggestions which really helped our family.
1. Ask “How are you doing?” The question is open-ended enough that it allowed me to elaborate on the days I felt like talking or cut the conversation short on the days I didn’t. There were days I didn’t want to talk about my feelings, however, I felt more alienated by those who never asked. The common mistake most people make is to assume they will make the person more depressed by asking, hence, reminding them of their pain.
2. Bring a meal. Sounds simple enough, however, this was much appreciated on several occasions when there was no time or energy to feed my family. Close friends didn’t ask if they could bring us a meal, they just asked what time they should drop it off.
3. If there are small children in the family offer to watch them or pick them up from school. We were so grateful for those families who took our children for play dates or out to meals with their children. It gave us some down time to let us be present with each other and our feelings.
4. Consider gift cards. This is helpful whether there are financial constraints or not. If there are financial constraints, I think it’s harder for people to accept cash, therefore, a gift card to a local grocery store or department store will be appreciated. On the other hand, we were given gift cards to local restaurants, which as stated above, allowed us to spend more time with family than worrying about cooking and cleaning.
5. As a follow-up to #1. We noticed immense support initially, however, it began to dwindle as the months went on which is understandable, however, those that have walked in the same shoes have continued to check in with us and see how we are doing. Nothing too intrusive but that great open ended question of “How are you doing?”

This is a short list but nevertheless a few suggestions that pulled me through some of the darkest times during the grieving process. For those that have gone through losing a loved one, what to do for a friend feels more natural, however, I hope this blog post will help others who genuinely want to help but don’t know how. It would be great to hear more suggestions from those who have experienced support from others so that I can expand this list.

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Financial Assistance for Assisted Living in Texas

The following post contains helpful resource information from assistedliving.org/Texas

 

STAR+PLUS
STAR+PLUS is a multifaceted program which provides reimbursement for people seeking assisted living. The STAR+PLUS Home- and Community-Based Waiver is a part of the program that helps seniors who are assessed as nursing home-eligible continue receiving their Medicaid benefits without being institutionalized. Eligible applicants are reimbursed for services that promote independence, such as assistance with personal grooming tasks, basic mobility, and caregiver respite. Services may be provided by direct care aides at an assisted living facility or by home health contractors.

Who is Eligible?
The STAR+PLUS program has absorbed many Texas Medicaid plans and services, so understanding whether you qualify can be difficult. This is due to the many caveats that may apply if you are eligible for multiple state programs under the STAR+PLUS umbrella, or for other programs like Supplemental Security Income. Eligibility requirements are listed on the Texas Health and Human Serviceswebsite, though understanding what you may qualify for is likely to require the assistance of a dedicated case worker.

Eligible applicants are people who need an institutional level of care and qualify for Medicaid. Medicaid applicants over 65 should have a maximum income of $2,250 and countable assets of no more than $2,000, though eligibility criteria varies with marital status, level of assistance needed, and other factors.

How to Apply
This waiver is a non-entitlement program, which means that it can only support a limited number of active participants. Applying for the waiver is likely to result in one’s name being added to a waiting list for enrollment, so it is advised that interested parties sign up as far in advance as possible. Applicants are encouraged to seek qualified counseling to help them navigate the enrollment process and eligibility requirements of STAR+PLUS. To begin the application process, contact The Office of the Ombudsman at (866) 566-8989, or consult the Texas Area Agencies on Aging by calling (800) 252-9240. Find your local Area Agency on Aging by consulting the directory in this guide.

The Community First Choice (CFC) Program
The Community First Choice program is a lot like the STAR+PLUS HCBS waiver in what it offers, except that CFC is a Medicaid entitlement program, meaning there are no maximum recipient caps and no waiting lists for enrollment. Community First Choice offers Medicaid reimbursement to low-income assisted living residents for the provision of assistance with activities of daily living, such as personal grooming tasks, mobility, and basic house chores. People already enrolled to receive other Medicaid waiver services may elect to switch to the Community First Choice Program.
Services provided under the CFC Program may include:
• Personal assistance with activities of daily living
• Skills education for self-care and independent living
• Emergency response services
• Training for support staff management
• Consumer-directed service options

Who is Eligible?
Applicants for the Community First Choice program must qualify for Medicaid and must be assessed by a physician as nursing home-eligible. Coverage of personal care services through this program is provided based on an assessment of which services an individual requires.

How to Apply
Interested parties can apply online at YourTexasBenefits.com, or call 2-1-1 for guidance and consultation. Your local Area Agency on Aging can also help with Medicaid and non-Medicaid applications. To initiate an assessment and determine your eligibility, consult the directory in this guide to find a nearby Area Agency on Aging.

PACE
Serving the cities of El Paso, Amarillo, and Lubbock, PACE is the Texas branch of the national Program for All-Inclusive Care for the Elderly. It is a Medicaid-administered program intended to provide total coverage of all medical and personal care needs for especially frail seniors, helping them to avoid institutionalization. This program reimburses for a broad array of services that may be provided by assisted living facility staff or home health contractors.
PACE provides these services:
• Personal care services and home healthcare
• Adult day healthcare
• Medical care
• Coverage for all necessary prescription drugs
• Hospital and nursing home care when necessary
• Social services
• Caregiver respite

Who is Eligible?
• Individuals aged 55 and older who are nursing home-eligible
• People who live in an area covered by PACE services
• Those who can live safely at home or in an assisted living community
Private payment is accepted for individuals not receiving Medicare or Medicaid and fees for these participants will not exceed average costs for nursing home care in Texas. However, space in the program is limited, and preference is given to applicants who have greater medical and financial needs. Most recipients of PACE are dually eligible for both Medicaid and Medicare. All applicants must have family or caregivers who can provide limited support during short intervals of respite.

How to Apply
To find out if you’re eligible and to learn about what PACE offers, contact your local HHS office by dialing 2-1-1, or 7-1-1 for the hearing impaired. You can also consult your local Area Agency on Aging for more details and application assistance. Find your local Area Agency on Aging by searching the directory included in this guide.

More Ways to Finance Assisted Living
Some additional ways to finance assisted living costs include:

Free Assisted Living Resources in Texas
Texas is home to hundreds of nonprofits and government resource providers that assisted living residents can look to for added support. Some of these organizations, like the Area Agencies on Aging, operate in every state across the country, while others are dedicated only to specific regions in the state of Texas. All of these services are free to use. However, some organizations listed here may have income and health-related requirements intended to preserve resources for those who are most in need.

The Aging & Disability Resource Center
This center was opened by the HHS as part of the national No Wrong Door initiative, and it is intended to streamline public access to resources and information concerning long-term services and supports. The Aging & Disability Resource Center helps to reduce confusion and facilitate access to care for long-term care recipients in all 254 counties of Texas. Contact them by calling (855) YES-ADRC, or (855) 937-2372. Find out more online by visiting hhs.texas.gov.

The Long-Term Care Ombudsman Program
Most states have a Long-Term Care Ombudsman program which organizes volunteers to act as advocates for recipients of LTC benefits. Ombudsmen periodically visit residents of ALFs and nursing homes to verify the quality of their care and environment, field complaints and concerns, help them protect their rights, and keep them in touch with the service providers and authorities they may rely on. The services of ombudsmen are always free and confidential, and their organizations avoid conflicts of interest by remaining unaffiliated with service providers and government agencies. The Texas LTC Ombudsman program can be reached via e-mail at ltc.ombudsman@hhsc.state.tx.us and toll-free at (800) 252-2412.

211 Texas
The Texas Health and Human Services Commission provides 211 Texas as an anonymous social service hotline with 25 information centers across the state. They are available to take calls 24/7, and can help citizens understand and gain information on any programs administered by Health and Human Services, which includes long-term care facilities like assisted living and other supports for seniors.
Reach 211 Texas by simply dialing 2-1-1, or visit them online at 211Texas.org.

Area Agencies on Aging
The AAA is a national, federally funded organization. It acts as a central agency, unifying hundreds of community outreach programs and supports for citizens over 60 years of age. Texas hosts 27 Area Agencies on Aging, making this a convenient resource for people in all regions of the state.

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Arrangements to Make When You or a Loved One Has Terminal Illness

If you or a loved one has been diagnosed with a terminal illness, you are likely to be flooded with emotion and may be unsure of the next step to take. It’s overwhelming to receive such life-changing news. Take the time you need to digest and process this information, then begin to prepare for the next steps. There are practical arrangements that need to be made to help make the coming days easier. Let’s discuss a few important arrangements to take care of that can benefit not only you but also your surviving loved ones.

Determine Plan of Care
When you have received the terminal diagnosis, one area to consider is your plan of care. First, talk to your doctor regarding available treatments and whether they are in your best interest. They may not save your life, but they may extend it. You also want to consider whether you would like to receive palliative care. According to Verywell Health, palliative care can begin at diagnosis, unlike hospice, and will help improve your quality of life and ease your symptoms. Patients receiving palliative care often live longer, experiencing relief from ailments and discomforts. Research which company you would like to receive care from and discuss the anticipated timeline of care with your doctor and loved ones.

Get Legal Matters in Order
In addition to making important medical decisions, it is also beneficial to get your legal matters in order. Most people are familiar with a traditional will, detailing the recipients of your estate and possessions. According to CNBC, there are other documents that you should draw up in order to ensure your wishes are respected. A living will is an important document, as it will direct your loved ones about which medical treatments you want, relieving them of the burden to decide. You can dictate what life-saving measures you are comfortable with and whether you would like to donate your organs. You need to assign both medical and financial powers of attorney to make decisions on your behalf for when you are no longer able to make them. The goal is to have all your legal documents fulfilled to make things easier on your loved ones.

Ensure Financial Security
Your legal documents help determine financial distribution, but it’s also helpful to secure proper insurance to cover expenses rather than relying on your personal finances. Burial insurance, for example, can be purchased to pay for funeral expenses (funeral home services, casket, gravestone, transportation, etc.) and any remaining medical or legal bills. The average cost of a funeral is over $11,000, and with proper insurance, you will be saving your family a large financial burden. Hopefully, you have already outlined detailed funeral instructions in your will if you have any funeral or burial preferences.

Photo by Unsplash

Check Off the Bucket List
With all documents in order, the last arrangement to be made is to enjoy your final days. Choosing to enjoy life rather than embracing death. Make your dream bucket list and enlist your friends and family in helping you check it off. Swim with dolphins. Attend the concert of your favorite band. If you dream of travel, plan a trip to your favorite destination. Studies have shown that travel is very beneficial for those diagnosed with a terminal illness. Touring new cities can result in deep spiritual meaning in addition to boosting self-confidence.

When you receive a terminal diagnosis, determine your plan of care, ensure your legal documents are in order, purchase burial insurance, and create a bucket list. Spend as much time with loved ones as you can and gain peace knowing that you have lived a life full of love.

 

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National Nurses Week Spotlights Most Trusted Profession

Published in nurse.com by Eileen Williamson, MSN, RN

You are celebrated during National Nurses Week for the many contributions you make to the nursing profession and the healthcare of our nation. The word “excellence,” in fact, is one we hear more than any other during Nurses Week.

Hospital executives and administrators, board members, physicians and various healthcare professionals join in the celebrations because they know that without you, their patients would not receive the same level of care.

At each event, you are recognized and applauded for your numerous achievements and accomplishments by your fellow nurses and other healthcare professionals who work closely with you and understand firsthand the excellence you bring to all you do.

Newspapers and TV stations run stories on outstanding nurses and nurse heroes who have gone above and beyond in their patient care.

Grateful patients and family members post their gratitude on social media. Even Hallmark sells nurse-themed greeting cards. My memories and recollections of Nurses Week I can’t recall a May during my four decades of nursing that didn’t include a National Nurses Week celebration. Over the years, the week became an important one for nurses across America, and each of them celebrated in some way, for the same types of reasons, at the same time.

I recall the planning that went on in anticipation and the special camaraderie and professional collaboration we all felt because we were working together. There were special gifts and meals, and each event was important. Everyone got involved and took on some type of assignment to make each event meaningful and memorable.

I remember how much it meant to all of us, and how each one of the days of our celebrations had programs to recognize different things. Who was in charge on what day was an important detail.

Celebrations took place on different shifts, and members of hospital administration came in at different times around the clock to visit patient care units and meet, greet and thank the nurses on duty. There were programs at which awards were given for research projects, poster presentations, advances in safety, recognition of special accomplishments in patient care and leadership, and more. Nurses were honored for leading special initiatives, spearheading change and heading up important projects.

I remember, too, that each year the art and science of nursing was recognized in some way. Since the time of our founder — Florence Nightingale — the art and science of nursing have been defined in different ways, and I think many of us have our own definitions.

To me, the art of nursing is the unique and individual piece of self each of us brings to our practice. The knowledge, theory, skill and experience we share with our patients is the science. Celebrations have changed over time, but the recognition of nurses’ scientific achievements and creative accomplishments have remained.

The two always worked beautifully together and were celebrated — together and beautifully as part of each Nurses Week.

Let’s revel in the meaning of Nurses Week together This week there will be many excellence programs and award ceremonies in healthcare facilities across the country, and each one will reinforce that our nursing careers are gifts for us to hold on to, treasure and nurture.
As you reflect on the meaning of this special week, we hope you will read our special National Nurses Week issue as a keepsake.

Read it, share it, refer back to it and take in all it has to offer.

Nurses, always remember to:
• Stay involved, current and abreast of professional research and advancements.
• Participate in your nursing organizations, conferences, conventions and seminars.
• Advance your education and professional certifications.
• Continue to work and learn together.

In the celebration of each Nurses Week over the course of my career, I’ve seen nurses move from rendering care to planning and designing it. In so doing that, nurses have changed the face of our profession and of healthcare. I’ve seen the public come to know us better as they met us in almost every healthcare encounter they had. It’s not just in the emergency room, operating room, delivery room or patient room, but also in physicians’ offices, ambulatory care, urgent care centers, board rooms, courtrooms and more.

I saw that in the end, the people have come to see us as the most trusted and ethical profession of all. And that gives all of us something really big to celebrate this week.

Happy National Nurses Week!

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Hospice Care & Palliative Care – When to use them

Published in parentyourparents.com by Petr Horcik

Hospice a word that is synonymous with “end of life” care. Palliative – a little more confusing and often confused with ‘end of life’. The two are very different therapies but Palliative Care is an offshoot of Hospice.

Hospice is a service for patients who are terminally ill and have decided not to take any more medication that might “cure” them (i.e. chemotherapy for a cancer patient). The focus becomes relief from pain and symptoms and not a cure. There are some who say that going into Hospice means you’re giving up or that you will no longer receive the medical care you need. That is not true – you have chosen to focus on your quality of life not the quantity and the medication used is to do just that. 

A Hospice team usually includes a doctor, nurse, social worker and chaplain (if you wish). They work together to meet the patients physical, emotional and spiritual needs. This team also cares for the family who can be against the choice to, in their eyes, “give up.” There is counseling, hugs and support from a good Hospice team – my Mother’s team was unbelievable and supported and counseled our entire family through the last three days of her life.

To qualify for Hospice your doctor must state that the patient’s death is expected in 6 months or less. If a patient chooses Hospice then changes his or her mind it isn’t an issue. The patient simply goes back into the curative therapy with their doctor. You can also change your mind again and be readmitted . . . there is no pressure – it’s about what you, the patient want.

Palliative Care (pronounced pal-lee-uh-tiv) is specialized medical care for people with serious illness. This type of care is focused on providing relief from the pain, symptoms and stress of a serious illness for both the patient and family.

Again, it’s a team of specially-trained doctors, nurses and other specialists who work in partnership with the patient’s other doctors to provide an extra layer of support. It can be used at any age and at any stage in a serious illness. The services are offered in tandem with the curative treatment. A good example of Palliative Care use is in Parkinsons or Multiple Sclerosis when there are flare ups.

Both Hospice and Palliative Care are paid for by most insurance companies including Medicare and Medicaid. Both are offered in your home, nursing homes, assisted living centers, hospitals and provide respite care when the caretaker family needs a break. What these two services offer us are choices in treatment for serious illnesses.

We each have our own journey and whilst none of us hope it comes to either of these services, we can make informed decisions for us or our loved ones knowing that they exist. No matter how strong you are physically and emotionally – watching a loved one suffer is often intolerable. There are teams out there to support and comfort. Use them if you need them.

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Study: Hospice Concurrent With Cancer Treatment Reduces Costs

Published in hospicenews.com by Jim Parker

A study of more than 13,000 veterans in Veterans Affairs Medical Centers (VAMCs) found that patients receiving hospice care concurrent with chemotherapy or radiation therapy were less likely to use aggressive treatments or be admitted to intensive care compared to similar patients who were not enrolled in hospice, significantly reducing medical costs.

Unlike organizations reimbursed through the Medicare Hospice Benefit, the Veteran’s Health Administration (VHA) does not require hospice patients to forgo curative care, making VAMCs a prime environment for researching concurrent treatments.

Currently, Medicare beneficiaries must opt out of or revoke the hospice benefit in order to receive curative treatment such as chemotherapy and radiation therapy. However, many hospice organizations provide services similar to hospice through palliative care programs. Beneficiaries are eligible to pursue curative treatment while receiving palliative care, which is also designed to alleviate symptoms, such as pain, as well as the emotional stress associated with serious illness.

“When hospice became a more widely available and referred service in the VHA, there was no requirement that patients stop receiving any other treatment,” study co-author Vincent Mohr, Professor of Health Services, Brown University School of Public Health, told Hospice News.” Our study took advantage of the fact that hospice use expanded without any prohibitions on receiving other services.”
In addition to fighting cancer, radiation and chemotherapy can help providers achieve goals of hospice and palliative care, such as pain reduction.

“There are many instances in which radiation therapy is used to alleviate bone pain due to bone metastases. Also, there are now many chemotherapeutic agents that may reduce the pressure that the tumor is placing on vital organs,” Mor said. The study focused on patients who suffered from newly diagnosed end-stage lung cancer in 133 VAMCs who had received hospice care, cancer treatment, or both concurrently during the last month of life. The study authors aggregated data obtained from inpatient and outpatient records, pharmacy claims, and similar sources.

“Stage IV non–small cell lung cancer has a very short life expectancy,” Mor explained. “About 60% or more die within 6 months of diagnosis. We chose this diagnosis precisely because all had a very short expected life span.”
Though beneficiaries enrolled in the hospice benefit currently must forgo curative treatment, the U.S. Centers for Medicare & Medicaid Services is exploring alternatives to that policy through the test of its Medicare Care Choices Model, which the agency launched in 2016 and plans to conclude in 2020.

The model allows participating hospices to provide services that are currently available under the Medicare hospice benefit, but cannot be separately billed under Medicare Parts A, B, and D, while enrollees are also pursuing curative treatments. CMS pays participants a fee ranging from $200 to $400 per patient, per month while they are delivering services under the model, including care coordination, case management, symptom management, and other support for beneficiaries and families.

Following the conclusion of the program CMS will begin an evaluation phase expected to last two to three years. In addition to assessing the impact on costs, CMS is studying the impact of the model on patient satisfaction and the quality of care.

Currently 96 hospices nationwide are participating. Though participants hospices reported that they were losing revenue via the program in the early phases, CMS theorizes that losses could be offset by increased utilization.

“Having to forgo Medicare payment for treatment aimed at curing the terminal condition may impede the choice of electing hospice care,” the agency indicated in a 2017 announcement of hospices the agency selected as participants. “[The model] tests whether eligible Medicare and dually eligible beneficiaries would choose to receive hospice support services, if they could also continue to receive treatment for their terminal condition.”

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Advanced, palliative care plans important part of life


Published in Cleveland Jewish News by Becky Raspe

It’s best to be prepared in every situation, especially when it’s health-related.
According to Rabbi Akiva Feinstein, director of spiritual care at Montefiore in Beachwood, and Dr. Beth McLaughlin, chief medical officer at Hospice of the Western Reserve in Cleveland, creating a plan for advanced and palliative care makes decisions easier.

“Advanced care planning is important because any of us can have a major life change at any time,” McLaughlin stated. “It’s nice to have family and loved ones know what your wishes would be in that situation.”
Feinstein noted during one’s health journey, there are a lot of choices but the medical system is “not always good at pointing out the forks in the road.”

“Most times, patients are pushed towards more treatment and more surgery, and that approach is fine for some,” he said. “But, most people get to the point where they’ve endured a lot of difficult decisions. But with planning, as one learns about the disease and prognosis, it’s important to ask your healthcare provider about what you can do and your choices.

He added, “The plan isn’t always so much about what you’re going to do, but what you want and how people can help you get that along the way.” McLaughlin said advanced and palliative care planning has two components – completing legal documents, then communicating your wishes to family members.

“Both are important to do,” she explained. “Advanced care planning is anything you do ahead of time to plan for future health. There are resources online to help guide a conversation with family, like general things to talk about. And then, there are legal documents that are recognized in the state of Ohio like the living will, the health care power of attorney and the DNR form.” Since an individual can’t expect to make decisions about their health in real time during a crisis, preparation is important. Feinstein said plans begin with appointing a healthcare proxy.

“They can listen to your wishes and make those decisions for you when you can’t anymore,” he said. “The subsequent stuff is working with your doctor on what he or she thinks about what could happen and what their goals are with the treatment.” Feinstein said the last part of the process is discussing hospice.

“Many people don’t understand what hospice is,” he noted. “They think it’s either much worse than it is or they can’t perceive it as relevant at all. In America, understanding you do have an option and choices helps you make better medical decisions along the way.” McLaughlin said there is merit in involving the family in the planning process. “If something happens, the person who is making these decisions and plans isn’t going to usually be able to explain what their wishes are at that time,” she explained. “So, it’s important for the family to know what their wishes are. When that happens, the medical team will turn to the family for decisions.”
Feinstein added if the family can’t be involved, it’s critical to confide in someone.

“Culturally, I find that some families make decisions as collective groups,” he said. “But some people value autonomy. The main thing is finding a person you can go through the process with. Sometimes, it’s having that sounding board when you get information from doctors and make those decisions together.”

Though it’s best to make plans, Feinstein said many families don’t plan for crises. “They usually end up in the midst of a serious illness and suddenly wake up one day and realize they can’t do it,” he noted. “The typical family always find out they need to plan when it’s too late. It’s not about making people plan when it’s difficult. It’s about thinking about their values when it matters most.” But McLaughlin said even starting a plan can reduce a bit of the stress that comes along with medical crises.

Anytime someone is dying, it is very stressful and sad,” she explained. “There are often lots of medical decisions that have to be made. That is very overwhelming. It’s helpful to have these plans in place. It takes one bit of confusion and stress out of the equation.”

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What you can expect from hospice care

Published in considerable.com by Walecia Konrad
This service can bring dignity and grace to the end of life

When Gina Raiford, 54, enrolled her 95 year old grandmother into hospice care two years ago, she was heartbroken. Her grandmother was coping with serious heart failure and had suffered several episodes during which she became non-responsive and needed hospitalization. Eventually hospital staff suggested hospice.

That upset Raiford even more. “You hear the word hospice and you think to yourself, this person is going to die and I don’t want that,” she says. “Worse, you think by agreeing to hospice you’re helping the person die.”

Those feelings are not uncommon, says John Mastrojohn, chief operating officer of the National Hospice and Palliative Care Organization. “Most people don’t fully understand what hospice really means,” he says.

While people’s fears about hospice are understandable, quality hospice care is what many caregivers and health care professionals have come to believe is the most dignified and graceful way to deal with a terminal illness. It can offer physical and emotional support to the entire family, not just the patient. But all too often, patients and caregivers are introduced to the idea of hospice during a time of high emotions, says Mastrojohn. That’s not the best time to make decisions—or do the necessary due diligence to find the highest quality care.

What hospice is—and isn’t
Hospice care is offered to individuals considered to be in the terminal phase of an illness with a life expectancy of six months or less. It doesn’t necessarily take place in a stand-alone facility: Patients may also receive services in a hospital or at home. The goal is to provide the patient with comfort from pain, management of symptoms, and emotional and spiritual support at a time when curative treatment is no longer beneficial.

Patients can also move out of hospice care if their condition improves, with the understanding that services can be re-instated when needed. Gina Raiford’s grandmother, for instance, has moved in and out of hospice for the past two years. Last month she celebrated her 97th birthday with her granddaughter, son and entire hospice team.

A wide range of services
According to the guidelines provided by Medicare, hospice services include almost anything related to pain and symptom management, including on-call care to manage acute pain episodes. It also extends to spiritual care, bereavement and counseling services, and in many cases art and music therapies. Private insurers generally cover all this, too. Many caregivers and health care professionals believe hospice is the most dignified and graceful way to deal with a terminal illness.

Because hospice is designed to support family and caregivers along with patients, respite care is often covered as well. With this service the patient may be admitted to a hospice facility or hospital for a certain number of days to provide a break for the caregiver. In Raiford’s case, her grandmother responded well to hospice services and they helped support her as a caregiver, during what became a very tough time. “My mother died and I had to tell my grandmother her oldest daughter had passed. The entire hospice team—everyone including the chaplain, the nurse, the social worker—helped me tell her. They helped me so much with everything during that time.”

Finding quality care
Unfortunately growth in the hospice industry has led to troubled providers with faulty management entering the field. The result can be large gaps in service, inadequate care and even outright fraud.

Be alert to anyone offering extra caregiving or pain management services without using the word hospice.
Last year the Office of the Inspector General (OIG) released a government report documenting lapses in care that sometimes left patients in pain for days. In other cases, service on weekends was rare and routine visits were often skipped. If you’re looking for hospice services for a loved on, be alert to anyone offering extra caregiving or pain management services without using the word hospice or explaining hospice rules.

You should also check on the following:
What services are offered. Quality hospice should offer, at minimum, 24-hour on-call service, in-person visits, medical equipment, related medications, inpatient care to manage acute bouts of pain, and continuous care in the home. The most recent satisfaction survey. Most hospice facilities conduct satisfaction surveys. Ask to see this data, says Mastrojohn. You’ll get a sense right away of how well the program is functioning.

Accreditation. Any hospice you are considering should be approved as a Medicare provider. In addition look for extra accreditations from NHPCO and other industry organizations.

The 24 hour on-call service. Even if the facility says they provide it, you need to dig deeper. One of the most common complaints found in the OIG report concerned patients and caregivers who needed help during an acute episode. But no one from hospice showed up, leaving both the patient and caregiver in a panic. That’s exactly the scenario hospice is designed to avoid.

So ask: Does the hospice guarantee calling back within a certain amount of time? Ask how many people are on call during the daytime, evening, night and weekends. Is there’s a back-up person or people to cover when assigned staff is busy?

There’s no reason to be afraid of good quality hospice care, says Raiford. “It has made my life and my grandmother’s life better in ways we never expected.”

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How to Become a Social Worker

Every day, the nation’s 680,000 social workers work to empower and elevate millions of people, including some of the most vulnerable in our society.

National Professional Social Work Month in March 2019 is an opportunity for social workers around the nation and world and their supporters to educate the public about the invaluable contributions of the profession. 

Being a social worker is a rewarding profession. Following are tips on how to get into the field and the academic background needed.

According to socialworklicensure.org, there is no better time than now to become a social worker. Professionals in the field address social ills through diverse specialties. Whether you want to work with children in public schools, with elderly individuals in care facilities, or in various healthcare branches, social work provides several fulfilling employment opportunities.

The Bureau of Labor Statistics projects 16% employment growth for social workers between 2016 and 2026, much faster than the 7% projected growth rate for the economy as a whole. This projected growth is partially attributable to the continuing demand for social workers who specialize in working with children and families. Moreover, the increase in healthcare facilities around the country has stoked demand for social workers to assist aging populations, mental health patients, and substance abuse patients.

What Does a Social Worker Do?

It is helpful to think of the various responsibilities social workers have. All social workers deliver specialized care, helping individual patients address a particular challenge or obstacle in their lives. At the macro level, social workers may also institute large-scale organizational change.

Typical day-to-day social work duties include identifying, evaluating, and addressing client needs in individual, group, and community settings. Client care often involves helping people cope with daily challenges, and many social workers work with mental health specialists, such as counselors and psychologists.

School social workers often collaborate with teachers, parents, and administrators to improve students’ academic performance and support their social development. Healthcare and mental health social workers find employment in hospitals, clinics, and clients’ homes. Social work careers often center on helping clients transition from care facilities back to their daily lives.

Bachelor’s Degree in Social Work

A bachelor’s degree in social work is the field’s minimum credential. Social work bachelor’s programs provide a comprehensive overview of the field. Students typically learn about case management, community and program organization, and utilizing community resources. Undergraduate social work students acquire essential skills for client advocacy, crisis response, and treatment design.

Students who earn an online degree in social work often focus on one area of specialization. Commonly offered specialties include child and family services, geriatrics, hospice, and school social work.

Many states require social workers to hold a master’s, so it is important to determine your state’s licensing requirements when choosing an online bachelor’s degree in social work. That said, some social workers may practice without licensure.

After completing an on-campus or online bachelor’s degree in social work, graduates find employment in school settings, child and family case management, mental health, and substance abuse recovery.

 

 

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Learning Has Shaped Oncology Nurse’s View of Patient Care

Published in oncnursingnews.com by Jean Sellers, MSN, RN

There is an old proverb I’ve heard many times, attributed to several sources: “When the student is ready, the teacher will appear.” Although I was anything but ready to face the concepts of death and dying, in 1990, my teacher appeared. He was 59 years old and presented to the emergency department with sudden onset nausea and vomiting, along with a severe headache. I vividly remember standing outside the thin curtain separating his stretcher from where I stood, dumbfounded, as the doctor introduced the words “temporal mass” and “cerebral edema” into my life.

I wasn’t a nurse then. I was a mother to 2 young girls, and I was not prepared to take care of the man behind the curtain. He was the greatest man I had ever known, the same man whom I would forever refer to as my first patient. My father. His diagnosis was an aggressive glioblastoma, and he lived 9 months from that day. I was forced into a crash course on surgery, radiation therapy, and end-of-life care. His final 2 months were spent in my home. The man who defined a “good day” as 18 holes on a golf course was now confined to a hospital bed in my guest bedroom, wearing diapers.

My family came together with the best of intentions, but we never quite had the conversations we needed to have. Some family members refused to acknowledge he was dying, and others viewed hospice care as giving up. Some did not want to treat his pain with narcotics for fear he would become addicted. I was desperate to find anyone who could help me ensure that my father would not suffer, which finally led me to call the hospice answering service—and brought another teacher in to my life.

The hospice nurse returned my call later that evening. Nothing could have prepared me for the way it felt to feel so completely heard and understood in the midst of that terrifying time. She listened to my concerns, fears, and confusion. She became my lifeline and helped my family to have the difficult conversations exploring what a “good death” could look like and what my father would want.

These lessons started me on the path I still walk today, that of an oncology nurse who advocates for quality cancer care throughout the healthcare continuum. Caring for my father opened my eyes to what was missing and I believe is still lacking today: effective palliative care.

Palliative care addresses not only symptom management but also the emotional devastation that affects both patients and their families. Today, research shows that when palliative care is integrated earlier in the disease process, outcomes improve.1 Our ability to achieve better outcomes lies in how we engage in difficult conversations. This includes an understanding of what quality of life is and, most importantly, what it means to the patient.

Nursing continues to be ranked as the most trusted profession. It should not be a surprise, as many of us are able to share a sacred space the moment we enter into the darkness with our patients. Having difficult conversations is more effective when empathy is included. Theresa Wiseman, RGN, BSc(Hons) Psych, RCNT, RNT, PGDE, a nursing researcher and scholar at the University of Southampton in the United Kingdom, says that although providing empathy is not always easy, it is a skill that can be mastered.2 It requires that we:

1. See the world as others see it
2. Be nonjudgmental
3. Understand another person’s feelings
4. Communicate understanding of what was shared

Brene Brown, PhD, LMSW, a research professor at the University of Houston Graduate School of Social Work, says empathy reminds us that we are not alone. Her research focuses on authentic leadership and the healing power of listening while allowing someone to feel they are truly heard and valued. She speaks to the basic elements of what we need to master if we, as nurses and human beings, hope to provide compassionate, empathetic care. Understanding our own vulnerabilities is a critical first step.3 Our ability to foster difficult conversations can be instrumental to breaking through feelings of isolation and loneliness that our patients and families face. This can be hard work. By acknowledging the difficulty, we take the first step toward meeting them where they are.

We may not always be ready when our teachers appear. However, I have found that when I seek to learn and enhance my ability to be there for others, I’m surrounded by many experts. I’ve lost count of the number of teachers I have been grateful to meet along the way. My teachers include nursing colleagues, physicians, researchers, and especially patients who have trusted me with their deepest thoughts. I use every opportunity I can now to urge nurses to always remember the reasons they chose this career and to remember their teachers. I urge them to never stop learning.

Jean Sellers is an administrative clinical director at UNC Lineberger Comprehensive Cancer Center in Chapel Hill, North Carolina.

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