Care Giving

How to take the worry out of providing long-distance care to seniors

By caringfromafar.com

Photo by Pexels

Are you taking up the role of caregiver for a parent or older loved one? Wondering how to provide that care when you live far away? Long-distance caregiving doesn’t have to be so stressful if you take care of the following essential steps.

Get Familiar with Your Loved One’s Medicare Options

The number one concern for seniors is their health, and the number one source of senior healthcare coverage is Medicare. If you are providing care for a loved one from afar, you need to spend some time making sure they have the best Medicare coverage for their situation. Learn the pros and cons of coverage and supplemental plans, as well as important deadlines.

Primarily, you both should know that the Annual Election Period for coverage started on October 15, and you have until December 7 to help your family member make their choices. This crucial enrollment period is the only time you can make changes to current plans, and the deadline is fast approaching, so sit down with a checklist so you can go over all the options in detail. Pick a time when you can visit in-person so that you can have your family member’s Medicare card, copies of the previous year’s medical bills, and a list of any pertinent healthcare information (provider names, prescriptions, etc.). If you can’t do this in-person, use a video call service to connect and have your loved one show or scan you copies of needed materials.

Make Sure Your Family Member Is Safe at Home

Did you know that falls send more seniors to the hospital than any other injury? More importantly, most serious falls happen at home when seniors live on their own. This statistic is not meant to make you feel guilty, but rather to stress the importance of making sure your loved one’s home is free of any fall hazards, both inside and out. If you can make a trip, take a walk around your loved one’s home and look out for issues that could cause them to slip or trip. Clutter can be a recipe for disaster, so make sure any random objects are safely stowed off the floor and out of the path of your family member.

Bathrooms are another sore spot in senior homes, so you may want to help your loved one make changes, such as installing grab bars or putting a seat in the shower. When you need to make these upgrades from afar, you’ll need to find a contractor you can trust. Check reviews online, or ask friends for referrals, so you can find reliable, affordable help to assist your senior loved one with these projects, as well as future issues they may have in their home.

Stay in Touch with a Local Network of Help

When you are providing care from a distance, there will likely come a day when your loved one will need some help and you may not be immediately available to assist them. This is why it is important to build rapport with any neighbors, friends, or community members who may be able to help your family member in their time of need. It’s a major step in effectively providing care for loved ones without adding more stress to your life.

Don’t be afraid to ask neighbors to check in with your parent or loved one, or at least let you know if there is cause for concern. This may include severe weather, odd behavior, or anything else out of the ordinary. Your network can help your loved one get prepared for emergencies, get help when needed, or simply connect with you. As an added layer of protection and connection, look into medical alert services for your parent as well.

Providing care to a senior loved one, when you do not live nearby, can be nerve-wracking. But if you can do some planning, connect with locals, and find ways to keep them safe at home, you can take a lot of the guesswork out of being an effective long-distance caregiver.

 

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NHPCO Highlights Importance of Hospice in Healthcare Since 70s

November begins National Hospice & Palliative Care Month. National Hospice & Palliative Care Organization (NHPCO) writes that hat began as primarily a volunteer-driven, grassroots movement in the 1970’s, is now an integrated part of our nation’s health care delivery system that provides care to more than 1.43 million Medicare beneficiaries and their families every year.

“Enacted as a demonstration in 1978 and a Medicare benefit in 1982 as our nation’s first coordinated care model, hospice programs have served millions of Americans and their families with compassionate care to relieve pain, manage symptoms, support patients and their family caregivers, and provided bereavement services for individuals following the death of a loved one,” said Edo Banach, president and CEO of NHPCO. “The benefit has been invaluable to patients and lifesaving for families.”

NHPCO offers a snapshot of hospice care with representative statistics from the current edition of its report, Facts and Figures: Hospice Care in America (PDF):

NHPCO provides a valuable abundance of resources with data and statistics on hospice. The organization is integral to a broad spectrum of efforts in leading the public’s understanding of hospice and palliative care and advancing the ever more vital role of hospice across the healthcare industry.

In addition, this month honors the home care and hospice community including the millions of nurses, home care aides, therapists, and social workers who make a remarkable difference for the patients and families they serve.

These heroic caregivers play a central role in our health care system and in homes across the nation.
  • In 2018, home care providers will travel about 8 billion miles to deliver the best health care in the world’
  • Ninety percent of Americans want to age in place, and home care is the preferred method of health care delivery among the disabled, elderly, and chronically ill; and
  • Home care provides high-quality, compassionate care to more than 5 million Americans annually.

As we approach the giving season, November is the perfect time to recognize their efforts.

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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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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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