Caregiving

Are You One of the 40 Million Americans Who Are Taking Care of a Loved One? Here’s What You Need to Know

It isn’t easy, but it’s important
Published in thriveglobal.com by BJ Miller, MD and Shoshana Berger

All over this country there are people like you who are driving out of their way to pick up a prescription after work, using coffee breaks to visit someone and make him lunch, missing out on dates with friends in order to make sure someone is safe before they go to bed, or taking trips to the hospital.

We see you (we are you), and you are not alone. In the United States at any one time, 40 million adults are caregivers. You are more likely to be a woman — especially if you’re doing the difficult work of bathing and toileting — though the percentage of male caregivers is on the rise: in 2009, 34 percent of caregivers were men; as of 2017 that number was 40 percent. On average you provide more than twenty hours per week of care for four years. It’s a hard job, but when they look back on the experience most people say they wouldn’t trade it for the world.

Courtesy of Africa Studio / Shutterstock

But, as the airline industry reminds us: in order to help others, we need to put on our own oxygen masks first. We’ll go even further — since someone in a predicament is relying upon you: it’s selfish to not take care of yourself. Self-care is a muscle you need to learn to flex so it becomes part of your routine, instead of a rare treat. It means paying attention to yourself, even when the only thing you want to pay attention to is your beloved.

Here are some ways to care for yourself.
• Take time for yourself. Foster a contemplative practice of some sort. This means prayer, meditation, yoga, the gym, hiking, biking, dancing, gardening, writing. Find some way to connect with yourself, body as well as spirit.
• Share. Have a short call list of people who will listen, without judgment and talk about anything: colleague, spouse, friend, therapist. It doesn’t need to be a shrink, though they can be helpful, too. Venting over coffee with someone you trust might be enough. One way or another, unbottle yourself.
• Pace yourself. If your loved one is already in the late stages of illness, it’s likely a matter of a few weeks of serious effort. A sprint. If she seems to have months or years to live, you’re in for a marathon. Don’t make the mistake of trying to hold your breath until it’s all over.
• Distract yourself. Movies, golf, books, howling at the moon — whatever transports you for a bit. A glass or two of wine is not a bad idea, but be careful not to slide into coping mechanisms that will hurt you over time.
• Seek respite. For yourself. This might mean finding someone to take your place for a time, finding an adult day care program, or, if on hospice, arranging for your loved one to stay for a few nights in a hospice house or nursing home. Take small breaks as often as possible and longer breaks now and again.
• Watch your health. Be sure to factor in your own health and limitations. Do you need to see a doctor? Are you aching somewhere? Are you keeping current with your meds? Let an honest answer inform how you set up living arrangements for your loved one and when to seek home care or elect hospice.
• Recruit hospice and palliative care. It’s the explicit philosophy of both services to support caregivers. Yes, your own wellbeing is reason enough to invite hospice in.
• Find other people in a similar situation. Just as there are support group for patients with different illnesses, there are support groups for different types of caregivers. Are you the husband of a patient with Alzheimer’s? The daughter of someone with ALS? There’s a group for you. Conduct an online search for “caregiver support” + “(type of illness)” to find those resources.
• Reach out to friends. They probably don’t know how to help you and will be so grateful if you can simply tell them what you need. You can even prompt them: Help me think about anything other than illness.
• Engage HR. Make sure to check with your HR department about whether you qualify for, and how to best utilize, the Family and Medical Leave Act (FMLA). FMLA may not cover you if you work for a smaller business, but you should definitely inquire. FMLA protection or not, if you have a good and trusting relationship with your boss be sure to talk to her about your situation; often enough, there are creative ways to make it all work for everyone.

Taking care of someone requires taking care of yourself; you two are directly and intimately linked. Try to remember the gifts of caregiving: purpose, perspective, love. They won’t always make the toil pleasant, but they will help you keep your sanity. You are engaged in some of the most important and under-appreciated work there is. For all that gets sacrificed to make room for caregiving, many come to feel that the world they entered is more true and rewarding than the one they left behind. Hard and painful though these days can be, someday you might look back and miss them.

From The Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death by BJ Miller, MD and Shoshana Berger.

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How to Make My Uncle Comfortable in Hospice Care?

Published in Collegian by Jacob Maslow
My uncle has a terminal disease, and after years of fighting, he has been given just a few months to live. He is going to be put in hospice care at-home, and I would like to make him as comfortable as possible. Do you have any recommendations on what I can do to make sure his last days are comfortable?

Hospice doesn’t mean that your loved one will be gone in a month or two. In general, hospice means that a patient will live for six months or less. But we’ve all heard stories of a person living for much longer than their doctors suggest. Doctors often underestimate the time a person has left to live, and if the person lives longer, no one generally complains.

The goal will be to keep your loved one comfortable.

Hospice care will help with pain management, and this is best left to the professionals. Hospice caregivers will come to the home and ensure that your loved one is giving the best pain medication and following their treatment plans. But you can help in other ways. As a person becomes weaker, they’ll have trouble with everyday tasks, even including eating and balancing. Independent living aids can help a lot.

“With independent living aids and other products including reachers, grab bars, eating utensils, thickening powder and more, you can make simple changes in your home that will make your loved ones feel safer, more independent and, most importantly, more at home,” explains AvaCare Medical.

Lack of preparation has been associated with:
• Anxiety
• Depression
• Grief

Discuss your uncle’s needs with his doctor. The doctor will be able to alert you of any items that you can purchase or have in the home that will best help your uncle.

Bed placement will be equally important. The bed, if your uncle is bed ridden, should be accessible by friends and family. Your uncle doesn’t want to be locked away in a room alone at all times. Family time, sharing memories and doing things will keep his spirits up.
If he is stable enough and can walk or be put in a wheelchair, bring him out to a ball game or to a restaurant.

Family time can lift a loved one’s spirits.

One of the things I remember my mother complaining about towards the end of her life was that she was so bored and wanted to do things. She was on oxygen, so she was slightly limited in her ability to go out for long periods of time.

Find activities to do with your uncle even if that means watching his favorite movies or going for a stroll around the neighborhood. If he is stuck in the home with nothing to do, depression will start to set in. Comfort is also important, and this means ambient lighting and soothing sounds. Try your best not to disturb your uncle, and also make it a point to keep the room at a temperature that is comfortable for him. He may have hot flashes, or medication can make him feel cold. Cater to these needs as best as you can.

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

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

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

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

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

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

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

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

Early adoption of hospice makes all the difference

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

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

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

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

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

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

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

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

 

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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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‘They Deserve It’: In Foster Homes, Veterans Are Cared For Like Family

By Patricia Kime for Kaiser Health News

With the motto “Where Heroes Meet Angels,” a small Veterans Affairs effort pairs vets in need of nursing home care with caregivers willing to share their homes.

Ralph Stepney’s home on a quiet street in north Baltimore has a welcoming front porch and large rooms, with plenty of space for his comfortable recliner and vast collection of action movies. The house is owned by Joann West, a licensed caregiver who shares it with Stepney and his fellow Vietnam War veteran Frank Hundt.

“There is no place that I’d rather be. … I love the quiet of living here, the help we get. I thank the Lord every year that I am here,” Stepney, 73, said.

Caregiver Joann West calls taking care of veterans Ralph Stepney (left) and Frank Hundt at her home in Baltimore a “joy.” “They deserve it,” she says. (Lynne Shallcross/KHN)

It’s a far cry from a decade ago, when Stepney was homeless and “didn’t care about anything.” His diabetes went unchecked and he had suffered a stroke — a medical event that landed him at the Baltimore Veterans Affairs Medical Center.

After having part of his foot amputated, Stepney moved into long-term nursing home care at a VA medical facility, where he thought he’d remain — until he became a candidate for a small VA effort that puts aging veterans in private homes: the Medical Foster Home program.

The $20.7 million-per-year program provides housing and care for more than 1,000 veterans in 42 states and Puerto Rico, serving as an alternative to nursing home care for those who cannot live safely on their own. Veterans pay their caregivers $1,500 to $3,000 a month, depending on location, saving the government about $10,000 a month in nursing home care. It has been difficult to scale up, though, because the VA accepts only foster homes that meet strict qualifications.

Read full story

 

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How the Hospice Benefit Could Be Redefined

Published in Home Health Care News By Amy Baxter

As recent changes across the health care system over the last few years indicate that person-centered, interdisciplinary care can improve clinical outcomes, boost patient satisfaction and potentially lower overall costs, hospice care could see an evolution ahead.

Hospice has become known as the first truly interdisciplinary benefit, bringing together many types of care under one roof. As more alternative payment models (APMs), managed care organizations and Medicare Advantage plans seek more flexibility in caring for patients with a person-centered approach, hospice is similarly looking for a way into these increasingly popular care models.

Home Health Care News caught up with Edo Banach, CEO of the National Hospice and Palliative Care Organization (NHPCO), to discover how the association is helping push the boundaries of hospice care with a new advertising campaign aimed at consumers and lawmakers, and efforts to redefine the benefit. Banach, who has been at the helm of NHPCO for more than a year, has an extensive background of working closely with the regulations and innovations departments at the Centers for Medicare & Medicaid Services (CMS) before the hospice industry “came calling.”

Here’s where Banach believes hospice is going.

Overall, what are the biggest changes you’ve seen during your career in health care?

Banach: One thing that is positive is when I started working in health care 16 years ago, it was really hard. What I’ve seen is, back then, managed care companies weren’t falling all over themselves to manage coordinated care. You had a really more siloed system than you have now, pre-Affordable Care Act (ACA), pre-[Medicare] Part D.

Managed care companies can now pay for less medical benefits [by supplementing with non-medical benefits]. We’re getting more integrated. We are moving in the right direction. I want to make sure that the integration and technology is used as a tool to help supplement real, compassionate interdisciplinary care, not one-step-removed care.

So, you talk about hospice being a movement. Where do you see hospice moving to?

One way we see it moving is upstream, but it is an absolute shame that people have to give up so-called curative care in order to get palliative care, hospice. It shouldn’t be a choice. You should be able to get both.

I think when people get both, they often see the value of palliative care. There is a demonstration now called the Care Choices model, which is testing out if curative and palliative care saves money or not, [if it] is an improvement on quality or not, and that will be very helpful and telling.

My goal in the next couple years, if not the next couple months, is to create a pre-hospice palliative care benefit that will allow folks to benefit from person-centered interdisciplinary care, that you see in hospice, earlier. When they have a serious illness, [palliative care is] a pathway and a glide path to receive the full-on hospice benefit that they will eventually receive.

Most people are on hospice now for only a couple of weeks, if not a couple days.

Just like former First Lady Barbara Bush.

Yes, she took comfort care and passed away two days later. And I think that’s not enough time for the system of care to actually have the impact that it needs to have.

Part of it is the choice that people make. Do you want curative care or do you want palliative care? You should be able to get both, and I think that’s crucial. That’s something that we will get to.

What are your other top priorities?

The other thing is about the length [of stay]. The problem with Medicare fee-for-service [FFS] now is these black lines—if you’re on one side, it is OK, and on the other side it’s not. For home health it’s skilled, homebound, these are the things we talk about and auditors look at a lot. In hospice, it’s [about if] you have a prognosis of less than six months and a need for hospice care.

That six-month limitation is treated as a clinical issue. It’s not a clinical issue; it’s a budgetary issue. It doesn’t make sense anymore. Ideally, in a couple years we will have much more of a glide-path between [when a person is] going along swimmingly and getting whatever is medically necessary under Medicare and receiving interdisciplinary person-centered care under hospice.

And my hope is that interdisciplinary person-centered care actually becomes the rule rather than the exception. That’s how this movement will have worked. I don’t just want to reshape the hospice benefit, I want to reshape health care.

Seems like a big uphill battle to me, as new Medicare benefits really come along quite infrequently.

Yes and no. For this, it’s not actually as radical as it sounds. This is an APM that I expect will actually happen. There’s interest in it, we’ve had meetings about it. I am hopeful this is something that can be done.

You’re right, Medicare benefits come infrequently. But we are not talking about a new benefit here. We’re talking about flexibility to provide more person-centered care that is not the poked-and-prodded variety. And that’s exactly what is happening over at ACOs and in Medicare Advantage land. As that is happening and plans can now pay for supports and services, it will seem even less logical for FFS Medicare to be in this box. So I think it is imminent.

 

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Advance Care Planning: Reminder for YOU to Have the Conversation

By Cozzie M. King, National Coalition for Hospice and Palliative Care

The scenario generally plays out the same. A person becomes ill…too ill to make decisions for themselves…too ill to communicate with the attending medical staff. Nearby family rush to the hospital bedside. The physician explains what’s happening to the family. Things aren’t looking good or the medical terminology is not easy to understand. After some time, the family is left to make decisions for their seriously ill loved one. Decisions that have not been discussed or thought about prior to this point. What do we do? Who has the final say? Things normally go downhill from here. You’ve seen it. I’ve seen it. Medical staff dread it. No one wins. Making healthcare decision at the hospital bedside is not the right time. These conversations need to happen before the crisis, not during.

Speak Up

As a mom, sister, daughter, past and future caregiver, I understand the importance of having conversations about my future healthcare decisions with my family and friends. These conversations can be hard to begin. However, there are many resources, tools and games that help families have these talks in creative ways. Over the years, I have facilitated several talks on how to plan and communicate your future healthcare decisions.  One of my personal favorite resources is the Speak Up video. This video is one of the tools I consistently use when explaining why it’s so important to have the conversation and complete an advance directive.  I encourage you to post and share this video with your family and friends on Facebook. They’ll thank you later. The message is short and simple.  Check it out:

Click to watch NHDD Speak Up Video

As we advocate for more families to participate in advance care planning, keep it simple. I remind my family and friends that advance care planning is much more than completing a form. It really is more about the conversations you have before and after any document is completed.

Lead By Example

April 16th is National Health Care Decisions Day (NHDD) and this year’s theme is, “It always seems too early, until it’s too late.” NHDD is a call to action for EVERYONE to:

→Think about your beliefs and values,
→Write them down,
→Choose a healthcare proxy (someone who speaks for you if you are not able),
→Complete an advance directive, and
→Share with your healthcare proxy, family and doctors.

The purpose of NHDD is to inspire, educate and empower the public and providers about the importance of advance care planning – and most importantly, to encourage people to express their wishes regarding healthcare and for providers and health care organizations to respect those wishes, whatever they may be. As someone in the health care field,  be sure to complete your advance directive and encourage your colleagues and loved ones to do the same. Practice what you preach. Read related story in TMC News

 

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