Archive for June, 2018

Better Sleep for Stressed-Out Caregivers

Those who care for people at the end of their lives tend to struggle to sleep well. Lack of sleep makes it challenging to care effectively, respond appropriately to emergent situations, and give loving care. When you are a caregiver or working with caregivers, it’s important to consider sleep.

Caregivers May Struggle to Sleep

While anecdotal evidence suggests that almost all caregivers of end-of-life patients struggle with sleep, there’s not a lot of research available on how to effectively help them. The general consensus seems to be that (1) caregivers usually don’t sleep well, (2) current strategies for helping people sleep often aren’t effective for them or aren’t something they can implement because of their caregiving situations, and (3) there’s a need for more research to help this population.

Another study suggests some reasons why caregivers might struggle with sleep. These include a disturbed sleep routine, because many caregivers are up with their patients in the night, attending to their needs or simply checking on them.

Caregiving can also be a burden, and many caregivers end up in a depression. It’s difficult to watch a loved one deteriorate before your very eyes. Finally, many caregivers struggle with physical health issues of their own, often due to their caregiving tasks. They may be too sedentary, eat poorly or have other underlying health issues that affect their sleep.

Simply understanding why caregivers don’t get enough sleep may be the first step toward helping them rest. Here are some tips that may promote sleep.

Getting Better Sleep

Getting good rest can be tricky for caregivers, but here are some things that can help.

Re-think the sleep schedule. If the patient always wakes or needs checking in the night, a caregiver can do their best to try to get at least 3 hours of sleep on each side of a wake-up. This schedule can mean going to bed earlier or sleeping in but will help caregivers get the deep sleep and the REM sleep that they need to function well.

Get a comfortable bed. There’s not much worse than trying to sleep on a poor-quality mattress. While a caregiver’s time and money are valuable, it’s worth the effort and expense to find a mattress that they want to fall into at night.

Make the bedroom dark and quiet. This setup promotes sleep and makes it less likely that the caregiver will wake up prematurely or lie awake in bed, unable to sleep.

If you are a caregiver or you are working with caregivers, know that sleep shouldn’t be negotiable. Somehow, caregivers need to figure out how to get the rest that they need.

 

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Understanding Veteran Emergency Medical Care

Published in Camp Lejeune’s The Globe by Ena Sellers Managing editor

This week we would like to highlight essential facts to help you understand emergency medical care for veterans. But first and foremost, if you are experiencing a medical emergency and believe your life is in danger, please go to the nearest emergency room.

According to the Veterans Health Administration Office of Community Care, veterans can seek emergency care and call for an ambulance during a medical emergency before checking with the VA. The key is in acting promptly and notifying the VA within 72 hours of admission.

“This allows VA to assist the veteran in coordinating necessary care or transfer and helps to ensure that the administrative and clinical requirements for VA to pay for the care are met,” according to the U.S. Department of Veterans Affairs.

Now that we have the most important part out of the way, let’s review service-connected emergency care and nonservice-connected emergency care to assist you navigating through the process.

SCEC covers an urgent medical condition that has been adjudicated by the Veterans Benefits Administration as related to the veteran’s service and granted a disability rating. In order to meet the requirements for the SCEC, a veteran must meet the following criteria: the veteran’s medical emergency was perceived, by the veteran or another person without medical training, as life-threatening and immediate medical attention was needed. The veteran is receiving emergency care for a service-connected, or adjunct condition in a community emergency department; the veteran is disabled as a result of a service-connected condition or the veteran is participating in a VA Vocational Rehabilitation Program, and requires emergency treatment to expedite their return to the program.

For a service-connected emergency to be eligible, the emergency must meet five specific requirements. First, the veteran must have received the medical care at a hospital emergency department; second, the emergency was of such nature that the veteran or another person — without medical training, perceived it as life-threatening. Third, a federal facility was not reasonably available to provide the care. Fourth, the veteran has received care within a VA facility during the 24 months before the emergency care. Fifth, the veteran is financially liable to the emergency treatment provider.

Remember that time is of the essence, especially when it comes to submitting a medical claim. According to the VA, veterans who were treated for a service-connected emergency have up to two years from the date the emergency care was provided. Those who were treated for a nonservice-connected emergency have up to 90 days from the date of discharge.

Keep in mind that in order for your claim to be processed, you must allow enough time for the VA to receive and review your documentation. If your documents are incomplete or need further clarification, the processing of your claim might be delayed.

For more information about emergency medical care for veterans, eligibility and claims, visit www.va.gov/communitycare.com.

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Healthcare services, policies for end of life misunderstood says hospice leader

Reform burdensome Medicare regulations to improve end-of-life care

Published in The Hill By Norman McRae, opinion contributor – The views expressed by contributors are their own and not the view of The Hill

Research shows that more than a quarter of Americans have given little to no thought about how they want to die – or how they prefer to be cared for in their final days. As a hospice care provider for more than 32 years, sadly, this is not a surprise to me.

What too many don’t realize is that with heartfelt consideration and careful planning, death can be a profound, peaceful and personal journey. That is why it is so important that patients and their families have timely access to high-quality hospice care.

Given how warily our culture approaches death and dying, health care services and policies surrounding the end of life are often misunderstood. At the expense of comfort, precious time and countless dollars are spent chasing an elusive cure rather than approaching an end of life illness with peace and reflection.

Hospice care provides a holistic experience that focuses on the wishes and needs of the individual. The hospice model involves an interdisciplinary, team-oriented approach to treatment that includes expert medical care and comprehensive pain management but also includes emotional and spiritual support for the patient AND their family. It’s this philosophy that drew me to this field and what I and our team at Caris continue to practice and uphold today.

For more than 35 years, the Medicare Hospice Benefit has ensured older Americans at the end of life could access this philosophy of care. As Medicare’s original coordinated care model, hospice is a program that works.

While those in the hospice community have grown and adapted to meet the needs of those we serve these last 30-plus years, many of the regulations imposed on the Medicare Hospice Benefit are still outdated relics of the 1980s. Thankfully, members of Congress recognize the need to modernize and changes are on the horizon. We welcome updates to burdensome regulations that will improve the delivery of patient care, including the reduction of existing requirements that create needless and time-consuming administrative work for hospice programs. One positive example of this recently discussed on Capitol Hill is the Center for Medicare & Medicaid Services’ (CMS) proposed rule to give more flexibility to physician assistants to re-certify patients who have been in hospice care for more than 180 days – a change broadly supported by the hospice community. We applaud efforts underway in Congress – including the Ways and Means Committee’s efforts to address and cut red tape in the Medicare program.

Policymakers should also consider reforms to make palliative care more widely available and hospice care available in a more timely fashion. This means that they must ensure that any proposed payment reforms do not threaten the integrity of the Medicare Hospice Benefit and the principles on which hospice care was founded.

During my tenure, I’ve seen plenty of change, and I imagine I’ll see more, maybe even policy changes to the Medicare Hospice Benefit. What all involved must remember is that any changes must compassionately consider protecting timely access to care while making sure that regulations are less rigid, duplicative and costly. Failure to implement commonsense reforms could unintentionally disrupt or delay patients’ access to high-quality end of life hospice care. Any new policies must continue to support the basic human right of quality end of life care and protect the values of hospice, the right of patient choice and the integrity of our care philosophy.

Norman McRae is on the board of the National Hospice and Palliative Care Organization (NHPCO), chair of the Hospice Action Network (HAN) and the founder of Caris Healthcare in Knoxville, Tenn.

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