Care Giving

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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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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Tips and Benefits of Journaling for Therapy

For centuries, journaling has been a tool for self-discovery. With reflective writing, your words do not have to be carefully arranged. It’s your private world and your private thoughts. You can ramble. Mention the unthinkable. Explore ideas with no worry about the consequences.

Writing as personal therapy

Journaling can help us turn a jumbled set of feelings into a coherent story. It can give us a better sense of ourselves as the author of our lives rather than a victim of circumstances. Research on writing as “expressive therapy” has revealed that it can:

Some guidance

You or your loved one may wish to try journaling. Great! A few caveats. Studies have shown:

How to get the most out of journaling

 

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HOSPICE SERVICES SUPPORT THE LOVING CARE OF FAMILIES

As our population ages, medical professionals are finding that cultural factors influence the decisions of the patients and their families as their illnesses progress. End of life care involves a time of

Dr. Hanh Trinh

Dr. Hanh Trinh

medical, financial, and emotional changes for patients and their families. Patients can be referred to hospice when they are diagnosed with a terminal condition with a prognosis of 6 months or less. Hospice provides a team-oriented method of addressing not just physical pain, but also spiritual and emotional pain.

The cost of hospice care is covered entirely by Medicare and Medicaid for patients with these benefits. For those patients with private insurance, verifying benefits with the insurance company is important prior to signing on. The hospice team can provide services wherever the patient lives, whether that is in a home, an assisted living facility, or a nursing home. In the case that the patient has uncontrolled symptoms of pain, nausea, shortness of breath, or restlessness, hospice has inpatient facilities which may provide a higher level of care.

Having a hospice team to address their concerns and a 24-hour hospice nurse to call can provide families with the peace of mind that they are not alone, even in their most trying times. The hospice team can follow patients and families on their journey through illness; from the time their active treatments are no longer beneficial, to comforting moments enriched by hospice’s supportive care when patients can be among their loved ones. To learn more about hospice comfort care visit www.houstonhospice.org or call 713-467-7423 (713-HOSPICE).

Thuy Hanh Trinh, MD

Thuy Hanh Trinh, MD, MBA, FAAFP, FAAHPM, WCC, is an Associate Medical Director at Houston Hospice in Houston, Texas. She received her medical degree from Louisiana State University Health Science Center in New Orleans and trained in family medicine at Baylor College of Medicine. Following residency, she completed her geriatric fellowship at Baylor College of Medicine and her palliative medicine fellowship at M.D. Anderson Cancer Center. She joined Houston Hospice in 2007 and serves as the Education Liaison.

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A Bucket List Fishing Tale

FishOne day late last summer, the Houston Hospice Intake Team was answering calls as usual on a Wednesday morning when my colleague, Marcy Antiuk, received an unexpected call, and an unusual request. A doctor phoned to tell us that her patient wanted to be admitted to our inpatient hospice care center, but he had one last desire before discontinuing treatments and surrendering to his disease. You see, this man’s disease had progressed to the point that ceasing treatment would decrease his life expectancy to a matter of days. He needed to be transitioned to hospice services that day due to symptom management issues, but first, he wanted to go on one last fishing trip. In fact, . Working in the hospice field, we’re accustomed to satisfying end-of-life requests, and we often grant day passes out of our facility for this purpose. These are typically outings to visit other family members or to have a meal out. Journeying to the edge of our coverage area for several hours was not an issue. However, this man had a severe and painful wound at the base of his spine that made moving him difficult — transportation would be the key to successfully executing this bucket list wish. The family had already inquired about private-pay ambulance transport, but the quote they received was overwhelming — several hundred dollars, maybe even a thousand. Gathering a team of individuals (Larissa Williams, Dr. Elizabeth Strauch, Jayne O’Brien and me), we discussed the patient’s condition and possible complications. We determined that the request was reasonable as long as the patient was safe, and stable enough to make the trip. An evaluation by our Admitting Nurse, Debbie Breaux, confirmed that the patient’s symptoms were manageable, however it also revealed that pain management was a concern. Because of the expensive private ambulance quote, the man’s family had decided to transport him to the fishing pier in a family vehicle. He desperately wanted this last fishing trip, but we feared the car ride would cause excruciating pain. The only safe option was transportation via ambulance, so we started calling our contracted ambulance companies asking if they would consider a full or partial charity transport. Orion EMS came to the rescue. After gathering only a small amount of information, they immediately agreed to cover all transportation expenses in order to fulfill this last request! Arrangements were made to pick up the patient the very next day. Houston Hospice provided a wheelchair and oxygen for the patient to use during the trip. Hollie Sims and I assisted while Orion EMS transported the patient to his fishing pier. The water, the pier, the landscape—everything was perfect. The late summer sunlight shimmering from the water was matched only by the twinkle in our patient’s eyes. After he finished fishing, Orion EMS provided a safe and comfortable ride to the inpatient unit. This was a great collaborative effort by many people with a triumphant blessing as an end result—just another reason why we love this work so very much.

Thomas Moore, Houston Hospice Patient Care Manager

 

 

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Lessons from a Butterfly Family: Parenting a Dying Child


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National Hospice Month: Kathy Flinn and Tiffany Livanec

Kathy Flinn and Tiffany Livanec

Featured for National Hospice Month for the week of November 26 are Tiffany Livanec and Kathy Flinn. Tiffany is a Professional Relations Liaison and has been working at Houston Hospice El Campo office for five years. Kathy Flinn is the RN, PCM-IPU and has been working with Houston Hospice at the Texas Medical Center location for the past 14 years.

(Tiffany) What do you love most about working at Houston Hospice?
I love educating the community about hospice and knowing that many will have a much greater quality of life due to our efforts. 

 

(T) What draws you to your position?
My grandmother was on our services several years ago. The GIFT of hospice to our family is so dear to my heart that I feel incredibly blessed to have the opportunity to work for such an amazing organization.

(T) What have you gained from working at Houston Hospice?
I have gained a greater appreciation for life, even less fear of death, and an increased faith!

(T) If you hadn’t become a Professional Relations Liaison, what might you have become?
If I weren’t called to be a liaison, I would like to be a chaplain.

(Kathy) What has been a pleasant discovery for you in the hospice community? 
Meeting the dedicated people who do this work because they perceive it as a”calling”… not just a job.

(K) What impact has hospice had on your life?
It reminds me that this life is temporary. It’s the next life that is really important.

(K) If you hadn’t become a nurse, what might you have done?
A travel journalist.

(K) Who was the person who most influenced you, and how?
Jane Sidwell.  She was PCM of the Inpatient Unit in 1996 when I oriented to my role as on-call nurse. I spent a 3-week rotation in the PCC (Patient Care Center) as it was called back then. Jane is the epitome of what I perceive to be an effective manager.

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National Hospice Month: Robynette Hall & Elizabeth Erwin

Robynette Hall & Elizabeth Erwin

 

Elizabeth Erwin & Robynette Hall share their hospice experiences for National Hospice Month. Robynette Hall has worked with Houston Hospice for the past five years as an RN for the On-call Team and works throughout the city.  Elizabeth Erwin, Senior Accountant has worked at Houston Hospice in the Texas Medical Center for the past 15 years.

 

 

(Elizabeth) What has been a pleasant discovery for you in the hospice community?
There are some who don’t know what hospice is all about and then there are others who look at me with admiration when they hear I work at Hospice.

(E) What draws you to your position?
I love Accounting!

(E) What have you gained from working at Houston Hospice?
Respect for what the nurses and doctors do on a daily basis. And let’s not forget the Finance staff who book and report the results of their work!

(E) If you hadn’t become a Senior Accountant, what might you have done?
Forest Ranger – I love nature – the backyard outside my window helps with the forestry side of my accounting!

(Robynette) What do you love most about working at Houston Hospice? 
I love the Team work and how much everyone truly cares for the patients and their families.  I also like how many Disciplines are involved taking care of our patients and their families.  It takes an army to care for them.

(R) What has been a pleasant discovery for you in the hospice community? 
This is where I belong, working Hospice and how rewarding it is to be able to help the patients and their families.  I feel truly blessed.

(R) What impact has hospice had on your life?  
The company is terrific and growing, the Team work has been the best I have ever witnessed and I feel everyone really cares about each other.  Knowing how much impact you have on the patients and families is a great reward unto itself.  As well as being able to work for one of the only nonprofit hospices in the Houston area.

(R) If you hadn’t become an RN, what might you have done? 
This is my third career and my second career move as a nurse.  I think I am hooked as a hospice nurse however.

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National Hospice Month: Sharon Hempler and Sonja Payne

Sharon Hempler and Sonja Payne

 Houston Hospice employees Sharon Hempler and Sonja Payne talk about their experiences at Houston Hospice for National Hospice Month. Sharon has been an RN-PCM on the Blue Team in the West Office for the past five years. Sonja Payne, Receptionist, at the Texas Medical Center location has been working with Houston Hospice for 20 years.

(Sharon) What has been a pleasant discovery for you in the hospice community?
Inspite of the difficulty of our work, we support & uplift each other.

(Sh) What impact has hospice had on your life?
Not only was I able to assist patients and families, but Houston Hospice supported me through my husband’s death.

(Sh) If you hadn’t become an RN-PCM, what might you have done?
If I hadn’t become a PCM, I would still be out seeing patients and families.

(Sh) Who was the person who most influenced you, and how?
Cheryl Holbert was my PCM and set a high standard for me to follow. She is knowledgeable and was a good mentor and teacher. Ruth Landauer was a friend of a friend who recommended Houston Hospice to me. She is a calming influence and supportive of staff and our clients.

(Sonja) What has been a pleasant discovery for you in the hospice community?
What has been a pleasant discovery for me is the spiritual bindings that hold me to Houston Hospice.  No matter how I look at my position here, I can always find myself spiritually connected to the organization. 

(So) What impact has hospice had on your life?
The impact hospice has had on my life is tremendous.  I am grateful for all the years and experience that I have endured here.  I don’t take hospice or the people here for granted. I am aware of other people’s feelings and believe everyone here at Houston Hospice is on a journey. 

(So) What have you gained from working at Houston Hospice?
Compassion and patience are two things I did not necessarily exude before coming to work here.  I knew about compassion and I had heard about patience. However, had I not come to work here I would probably not have gained either.  It prepared me for the grief I suffered in losing my brother and helped me support my family during our losses. Many of my friends and family say that I have two lives; one before hospice and the one I have now, after hospice.

(So) Who was the person who most influenced you, and how?
The person who influenced me the most at Houston Hospice would be Ruth Landauer, Director of Volunteers.  I learned from Ruth’s warmth and dedication from the very beginning.  She embraced me very delicately and made me feel ‘right at home’ on my very first day at hospice.

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National Hospice Month Insight from Nora Heflin and Jodie Gonzalez

Nora Heflin and Jodie Gonzalez

 

For National Hospice Month, Houston Hospice employees shared insight into compassionate, end-of-life care. Featured for the week of November 5 are Jodie Gonzalez and Nora Heflin. Jodie is a social worker on the Blue Team, which is based out of the West Office and has been working with Houston Hospice for one year. Nora Heflin has been a Certified Patient Care Aide for the past four years and is working at the Texas Medical Center location.

 

(Jodie) What do you love most about working at Houston Hospice?
My co-workers! Everyone on my team gives 100% to every patient/family and truly believes in the work we do.

(J) What draws you to your position?
The ability to walk alongside families during the most difficult time in their lives.

(J) If you hadn’t become a social worker, what might you have done?
A champion flamenco dancer…of course!

(J) Who was the person who most influenced you, and how?
Elisabeth Kübler-Ross did amazing work with terminally ill patients and really opened the world’s eyes to the needs of dying patients and discussions of death/dying. As long as professionals understand that there are no “5 stages of grief,” her work is still inspirational to those of us trying to increase our culture’s comfort level with death.

(Nora) What has been a pleasant discovery for you in the hospice community?
I discovered that we all face pain in life; it’s what you do with it.

(N) What impact has hospice had on your life?
Hospice has had a great impact on my life, losing my sister to cancer in 2010. I trusted my loved one to the care of Houston Hospice.

(N) Who was the person who most influenced you, and how?
Dr. Trinh, She taught me even in the worst of times, there is always another way to look at the situation. Even under tremendous amount of stress she still can manage to find some good in every situation.

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