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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Help Your Employees Deal with Grief

Published in MultiBriefs By Lisa Mulcahy

It’s a common scenario, unfortunately. One of the best members of your team suffers the loss of a spouse, parent, sibling or child. Corporations, of course, allow for some bereavement time, but experts say the process of working through the initial stages of grief can last on average between six months and a year, and in some cases even longer.

How do you handle it if this employee breaks down in tears in a meeting? What if his work is temporarily not up to par? How can you best encourage your staff to show compassion and support for her at this difficult time?

Here are five compassionate strategies for helping your workers cope emotionally as they navigate their duties as productively as possible through a profoundly difficult time.

  1. Send condolences

First, it’s a must to send appropriate condolences to your employee in the early days of her initial bereavement. This means a heartfelt sympathy card and flowers sent on behalf of your entire staff. Your employees should also be allowed and encouraged to express their individual sympathy as well.

If a wake and/or funeral is open to the public, attending these services is a strong and supportive gesture you and your employees can also make to show care and respect.

  1. Have a productive face-to-face

The day your employee returns to work, ask him to sit down with you in your office. Express your condolences with sensitivity, and express your sincere desire to support him as he re-acclimates to the workplace.

Ask him directly what he needs. Is it a gradual re-entry into his responsibilities? If so, delegate some of his project work temporarily. Is it more time off? Work with him to see if personal days or vacation time could be used for this purpose.

Listen to what he tells you, and let him know you are here to make things as easy as possible. The Society For Human Resource Management has published some helpful information regarding respite time for grieving workers.

  1. Implement a kindness policy

Encourage your staff to show compassion and offer assistance openly to this employee — and let everyone know this policy will apply to anyone dealing with a loss in the future as well. Grieving professionals repeatedly report in studies that compassion shown by co-workers has a powerful effect on their psyche as they heal, and lets them feel supported so they are as productive as possible. Two interesting pieces of research touch on this concept.

Your employee may become emotional at times during her workday, maybe even crying openly because she can’t help herself. Never judge this understandable behavior — instead, let her know it’s perfectly fine to excuse herself for a short time whenever she needs to. Encourage her co-workers to lend her a hand with supportive words whenever they think she’s struggling, too.

  1. Double-check without judgment

Take the time to follow up on your employee’s work to make sure there are no major mistakes (there will probably be minor ones), but don’t make a big deal out of doing so. If bigger mistakes happen, reassure your employee that you understand this is a temporary situation, and assign a second worker or workers to kindly help him with tasks. This technique can quickly get him back on track without any awkwardness.

  1. Praise her strength

Grieving people can use all the positive feedback you can provide. Don’t hold back on a compliment as to how well she handled a presentation — this will give her confidence as she tackles her next task. At the same time, don’t overdo your praise — your employee doesn’t want to feel singled out as “the griever” in your office who needs to be handled with kid gloves.

Treat her kindly but normally. You’ll be helping her feel more like herself, so she can concentrate well, accomplish more and continue to feel better.

Lisa Mulcahy is an internationally established health writer whose credits include the Los Angeles Times. Redbook, Glamour, Elle, Cosmopolitan, Health, Good Housekeeping, Parde and Seventeen.

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Home Health and Hospice Admissions, Utilization Trending Up

Author: Amy Baxter, Home Health Care News

Home health care and hospice admissions and utilization are both on the rise, according to the latest data report from Excel Health.

Hospice admissions grew 4.6% from the third quarter of 2016 to the third quarter of 2017, rising to 313,500, according to the report, which is based on 100% of the most recent Medicare Part A and B claims data. Excel Health offers on-demand, cloud-based data solutions and has robust medical databases.

Over the same year-to-year time period, hospice utilization grew, with 48.8% in the third quarter of 2017 being the highest utilization to date, and 1.7 percentage points greater than in the third quarter of 2016. Utilization is measured as the number of decedents that had hospice care over the number of total decedents.

Hospice admissions grew year over year in all states except five—Maine, North Carolina, New Jersey, New York and Iowa. Wyoming experienced the highest admissions growth, rising 19.2% year over year.

Nearly all states also had higher utilization rates, with only two states—North Carolina and Arkansas—seeing a slight drop in utilization year over year.

Home health care admissions grew 0.7% in the second quarter of 2017 from the same three months in 2016, reversing a negative trend seen over the previous few quarters. Fourteen states saw a decline in admissions year over year. Wyoming had the highest growth in admissions—13.2% year over year.

Utilization remained near its constant rate, around 1.6% for all Medicare beneficiaries in the second quarter 2017, according to the report. All states saw higher utilization of home health care services, with both Massachusetts and Mississippi growing 2.4% year over year.

As more baby boomers age into Medicare eligibility, the proportionate demand for home health care has dropped, as the average age of Medicare beneficiaries declines. Demand will likely rise again as a proportion of the Medicare population as baby boomers age.

The growth of home health care and hospice services is not totally surprising, as 10,000 baby boomers turn 65 every day.

From the third quarter of 2016 to the same period in 2017, the total number of Medicare beneficiaries rose 2.3%, from 56.1 million to 57.5 million, according to the report. And the growth of beneficiaries also means spending will rise. By 2027, the rate of Medicare spending as a percentage of total federal spending is expected to rise to 17.5%.

 

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Another Reason to Avoid Heavy Drinking? Dementia

Dr. Arefa Cassoobhoy, a practicing internist, Medscape advisor, and senior medical director for WebMD in a recent Medscape Morning Report 1-minute news story for primary care, reported that heavy drinking can lead to many health issues. 

Dr. Cassoobhoy shared a new study[1] that looks at alcohol use and dementia. The French observational study included over 1 million adults diagnosed with dementia between 2008 and 2013. It found that of 57,000 cases of early-onset dementia, 39% were due to an alcohol-related condition like Wernicke-Korsakoff syndrome, liver disease, epilepsy, or head injury. And 18% had an additional diagnosis of alcohol-use disorder.

Overall, alcohol-use disorders were associated with a three-times greater risk for all types of dementia.

The researchers concluded that heavy drinking is the strongest modifiable risk factor for dementia. Dr. Cassoobhoy says this should motivate us to focus on early screening, brief interventions, and treatment to help our patients.

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Waiting Rooms Encouraged to Show Video with New Medicare Cards

Click for new video featuring the replacement IDs

Originally published in AARP’s Health Medicare Resource Center By Dena Bunis, AARP, March 2018

Medicare is asking doctors to play a new video in their waiting rooms to remind patients that the federal government will begin mailing them new identification cards next month.

The video gives beneficiaries a glimpse at what the new card will look like and explains why and how it was modified. Instead of a Social Security number, the cards will display an 11-digit Medicare beneficiary identifier, and they will no longer include gender and a signature.

Eliminating the personal details, Centers for Medicare and Medicaid Services (CMS) officials say, will better protect an enrollee’s identity and guard against fraud.

The Social Security Administration (SSA) urges Medicare enrollees to make sure the agency has their correct address on file. You can go to socialsecurity.gov/myaccount or call 800-772-1213 to update your address.

Scammers with various ploys have already started to target the 58 million individuals who will be getting new cards. The Federal Trade Commission (FTC) reports that con artists are calling beneficiaries and pretending to be from Medicare, then trying to talk them into paying for the revised card. Medicare will never call and ask for any personal identification or money for the new cards. The cards are free and will be mailed to members’ homes.

Medicare beneficiaries in Delaware, the District of Columbia, Maryland, Pennsylvania, Virginia and West Virginia will be the first enrollees to receive the replacement cards. The mailings will continue through 2019.

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Family is biggest influencer of older adult housing and care preferences: study

Author: Lois A. Bowers, Senior Editor, McKnight’s Senior Living

Family support is the biggest influencer of housing and care preferences among older adults, according to a study published Wednesday (March 7, 2018) in the Journal of the American Geriatrics Society.

Often, the authors found, older adults changed their preferences based on the concerns of family members or a wish to avoid “being a burden” to others. This basis was especially true for preferences regarding the places where people wished to receive care — for example, at home or in a residential care setting, they said.

The researchers, all of whom were affiliated with the Cicely Saunders Institute of Palliative Care Policy and Rehabilitation at Kings College London, examined 57 previous studies about the preferences of older adults with advanced illness. They included research that investigated preferences for where people wanted to be cared for, the kinds of communication and decision-making they wanted and the quality of life they hoped to have over time.

Family involvement is key in care decisions

Although support from family was the most important influence on their care preferences, older adults usually formed their preferences based on several other factors, too, including their experiences related to previous illness and caring for others as well as having a serious illness, according to the study.

 

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The Other Side of the Conversation

Author: Christopher M. Thompson, MD, HMDC

This article originally was published in Winter 2017 NewsLine.

In this post, a physician connects his personal and professional caregiver roles.

As palliative care providers, we spend our careers talking about end-of-life care and helping families make difficult choices about life and death. Have you ever been on the other side of the conversation, answering questions and making decisions for your own loved ones? I have cared for thousands of patients at the end of life, but recently I’ve been on the other side of that conversation – twice.

My first conversation began with “Momma,” my wife’s 91-year-old paternal grandmother. Her decline started with a kidney stone, which then led to urinary tract infections and tremendous pain. Momma made the decision to have lithotripsy. During the procedure, she had respiratory distress and required intubation. Her heart was not strong enough to tolerate this “routine” procedure. She developed right-sided heart failure and pulmonary edema. Doctors were able to extubate her; however, she continued to have more respiratory distress. She was not doing well. They placed her on Bi-pap but she did not tolerate this. She was in the hospital, agitated, dyspneic, and did not want to be re-intubated.

So now what? Our family had to begin those difficult discussions. Do we continue to push aggressive care? Momma told the family she was tired and ready to die. It was hard for our family to acknowledge what this meant even knowing her wishes. Added to that, it was two weeks before Christmas and my family lived six hours away from Momma. We decided my wife and our three-year-old daughter would travel to Georgia while I stayed home to work. I wanted my wife to be there for the conversation in person and to see her grandmother, as I knew this might be her final days on earth. After discussing options, the family agreed to inpatient hospice care.

I was too involved with work and like many times before chose work over family. My wife was at Momma’s bedside for less than 24 hours when she called me telling me that Momma was asking for me, “The Doctor.” I pulled myself away from work in the middle of the day and headed to Georgia.

I was now being asked medical questions as well as “what about Christmas?”, “what do we tell the great-grandchildren?”, and “is this the right thing to do?” I did not have answers. I had memories and emotions for this woman I loved; I did not want to think, “Momma is dying.”

All the signs were there; it was her time to die. The family began the journey with Momma. I have worked in three different inpatient hospice facilities. It’s easier for me to study the staff, their workflow, their EMR, their census, their medical director – this is what I know. My wife reminded me that this time, I was there for Momma and our family. I was not “The Doctor” now; I was family.

Staff managed Momma’s symptoms quickly and she had two good days talking and interacting. We had made the right choice, albeit not an easy one. Long days and nights at the hospice home wear a family down. Hospice staff participate in these experiences daily. We think how hard it must be for the patients and families. When you are on the other side, you feel the sorrow and you learn a lot about the value of hospice care.

Momma died peacefully four days later. We returned home to North Carolina, only to receive a phone call that “Granny” was in the hospital. Granny was my wife’s 78-year-old maternal grandmother. She had Alzheimer’s disease, had fallen at home, and had developed altered mental status. She was not eating, she had a UTI, and a CT scan showed a small hemorrhage in the frontal lobe. Granny was agitated, not eating, and declining. So now what?

Just three weeks earlier we had lost Momma. Now our family was deciding on inpatient hospice for Granny.
My wife, daughter, and I packed the car and headed for Florida. I took the time from work, but I was still on call and was on the phone, giving orders the entire trip. Once again, it was easier for me to do my work as a hospice physician than confront what I had no control over. We were losing both our grandmothers within three weeks.

As we arrived in the middle of the night, we received a call letting us know Granny died. She had declined quickly. That was truly a blessing. After all the heartbreak and tears, we went to Granny’s house and celebrated her life. This is what she would have wanted.

Those two experiences remind me how hard end-of-life conversations are for families. We as palliative care providers need to remember it is different when there are memories and emotions involved. No matter how informed our families are, these decisions are not easy. And, it’s hard being on the other side. We are no longer medical professionals, we are family. All our medical training leaves our mind and we become an emotional basket case. We find it hard to think straight or make rational decisions. It’s difficult living with the decisions and through those choices.

I’m 40 years old, my parents are approaching retirement, and my grandparents are dying. I have friends who are struggling with acute and chronic illnesses. All of this has made me a better hospice and palliative care physician and I’m glad I can reflect on my training and life experiences to help my patients and families. I make the conversations personal and emotional. I have more empathy during family meetings. I think this adds a new dimension to the work I do, the work I’m proud to do.

These two experiences brought our family closer together and I’m grateful I could help in the decision-making process. My family saw firsthand how our jobs as hospice and palliative care providers are intensely emotional. We all need to realize the impact we have on the families we care for, how a well-trained hospice and palliative care staff can have an impact on a family.

During our trip home from Florida, my wife looked at me and asked, “How do you do this day after day? I am proud of you and now understand your job even more and how rewarding it must be.”

———–

Christopher M. Thompson, MD, HMDC, assisted in developing the palliative medicine programs at two hospitals prior to joining Transitions LifeCare as Medical Director for Transitions Kids, Transitions LifeCare’s pediatric hospice program. Dr. Thompson is board certified in Family Medicine. After completing his Fellowship, Dr. Thompson became board certified in Hospice and Palliative Medicine with the added qualification of Hospice Medical Director Certification.
 

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March Celebrates Social Work

Professionals who care. Helping improve people’s lives is at the heart of social work

In honor of National Social Work Month in March, below are facts about social workers from the National Association of Social Workers:

About Social Workers

Social workers seek to improve the lives of others.

Social work is a profession for those with a strong desire to help improve people’s lives. Social workers assist people by helping them cope with issues in their everyday lives, deal with their relationships, and solve personal and family problems.

According to the Bureau of Labor Statistics, there were almost 650,000 social workers in the United States in 2014. With an expected growth in jobs of 12 percent by 2024, social work is one of the fastest growing professions in the United States.

Who are social workers?

Social work is a profession for those with a strong desire to help improve people’s lives. Social workers assist people by helping them cope with issues in their everyday lives, deal with their relationships, and solve personal and family problems.

Some social workers help clients who face a disability or a life-threatening disease or a social problem, such as inadequate housing, unemployment, or substance abuse. Social workers also assist families that have serious domestic conflicts, sometimes involving child or spousal abuse.

Some social workers conduct research, advocate for improved services, engage in systems design or are involved in planning or policy development. Many social workers specialize in serving a particular population or working in a specific setting.

What do social workers do?

Who employs social workers?

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Preventing the Flu: Good Health Habits Can Help Stop Germs

From the CDC and nurse.com

The single best way to prevent seasonal flu is to get vaccinated each year, but good health habits like covering your cough and washing your hands often can help stop the spread of germs and prevent respiratory illnesses like the flu. There also are flu antiviral drugs that can be used to treat and prevent flu.

  1. Avoid close contact.

Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.

  1. Stay home when you are sick.

If possible, stay home from work, school, and errands when you are sick. This will help prevent spreading your illness to others.

  1. Cover your mouth and nose.

Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.

  1. Clean your hands.

Washing your hands often will help protect you from germs. If soap and water are not available, use an alcohol-based hand rub.

  1. Avoid touching your eyes, nose or mouth.

Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.

  1. Practice other good health habits.

Clean and disinfect frequently touched surfaces at home, work or school, especially when someone is ill. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

A nurse.com article by Sallie Jimenez focused on item #4 and shared a study concluding that hand washing decreases chances for the illness to result in deaths. Jimenez writes that “In the midst of what may be one of the worst flu outbreaks in a decade, new research reinforces the importance of proper hand hygiene protocol.”

Her article references the following: A study published in the February issue of the American Journal for Infection Control found hand washing saves lives — not just in hospitals — but all healthcare facilities, including nursing homes. Researchers looked at 26 French nursing homes from April 1, 2014, to April 1, 2015, discovering consistent measures encouraging staff and visitors to wash their hands reduces mortality and antibiotic prescription rates, according to a news release from the Association for Professionals in Infection Control and Epidemiology highlighting the results.

During the course of the study, which included 13 nursing homes randomly assigned to an intervention group and 13 assigned to a control group, a program was implemented targeting nursing home staff, visitors and outside care providers, the news release said.

As part of the program, hand sanitizer became more readily available in both pocket-sized containers and dispensers and the idea of proper hand hygiene was promoted through posters, events, work groups and education.

“The measures resulted in a lower mortality rate of 2.10 deaths per 100 residents, versus 2.65 in the control group, with a notable 30% decrease in the mortality rate during France’s major influenza outbreak in early 2015, according to the news release.”

Although the CDC stresses the single best way to prevent the flu is to get vaccinated, proper hand washing and cleansing — either with soap and water or an alcohol-based hand sanitizer if soap and water are not available — also is recommended.

 

 

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The Road to Healing Takes Time

Originally Published in Pocketful of Chelles Blog

By Michelle Kohlhof / February 19, 2018

Last week was tough. The world witnessed a tragedy that has become all too familiar, another school shooting. A day that was supposed to be about love and peace, turned dark and cold for so many. On the day after, when I dropped my little dude, Jason, off at his school, he dashed into his classroom shoving his backpack into his cubby, and my heart just broke into pieces for the families of the victims in Parkland, FL.

How could one person take seventeen beautiful souls, most of them being children? We ask ourselves why did this have to happen, we say prayers for the families who now have to learn how to move on without their child, and we call on congress for change, yet again. It’s hard to imagine how you go on after such a devastating tragedy. Simple things like going back to work, seem like mountains to climb. While we look for answers, one thing is for sure; time doesn’t stand still for the ones who need it to the most. Instead, you learn how to compromise with time, and make the most of what he gives you. We find ourselves pleading for time to just stand still, to have just five more minutes with the ones we love. But you see, time doesn’t wait for no one, and this is why there is more to life than the nine-to-five grind.

We find our humanity—our will to live and our ability to love—in our connections to one another.― Sheryl Sandberg, Option B: Facing Adversity, Building Resilience, and Finding Joy

As I mentioned at the beginning of this post, last week was tough. Sometimes you don’t get a “do over”. What you do get is a chance to put things in perspective, and not take the life you’ve been blessed with for granted. So on a whim, my husband, Travis, says to me, “you know, we can take a road trip, South, and hang out with your parents”. So, we took advantage of the long weekend (President’s Day), loaded up the truck, and off we went! And as you can imagine with a nine hour drive, I had time to reflect, time to think, and time to write…

All this time got me thinking, how can employers and HR support employees through grief and loss? Are bereavement leave policies enough? I started to research this and one article from SHRM stood out. Click here to read more. In a time of unspeakable loss, what are some big things that HR can do to support their employees and organization?

1) It’s more than policy – It’s about having a plan:

To my fellow HR professionals, let’s work together with management and executives to create a plan to support employees in their time of need. We should do more than just contact the employee and share information about our organization’s bereavement policy. One great example is what Ernst & Young did last year. They provided dedicated HR support to the family of one of their employees who was critically hurt in the Las Vegas mass shooting tragedy. Thankfully, this EY employee survived, and her story showed us that having a plan can lessen the burden on the employee and her family. It shows us that an employer can really champion for their employees when they need us to the most.

2) It’s time to lead the way:

What can we do to prepare fellow employees for a grieving employee’s return to work?  There are a lot of emotions that the employee will still be dealing with upon his return. There will be lack of focus, and difficulty with concentrating, even on the simplest of tasks. We as HR professionals have to partner with management on creating a smooth path for the grieving employee as they return to the workplace. We need to lead the way in helping the grieving employee navigate back into the environment. It is vital for his success.

3) Give some space – It takes time:

I think the single most important thing we can do to help a grieving employee return to work is to give space. What if we created a private place where the grieving employee can go to take a break when she is feeling overwhelmed with emotions? These emotions will come in waves and it is important to give space.

Some “Chelles” find their way to shore, while some live in the sea for eternity. ― Michelle Kohlhof

My closing thought, take the time to set eyes on the ones you love, and are blessed to still have in your life. It’s another chance to fill your pocket full of “Chelles”.

 

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