‘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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Tips to cope when you’re juggling several chronic health issues

Be proactive by learning about and tracking your conditions and medications, and by speaking up when you have concerns.

Published in Harvard Health Letter

We don’t want our golden years to be spent juggling a long list of health issues. But that’s the reality for most older adults in the United States.

The CDC reports that 75% of Americans ages 65 or older have several chronic health problems. And a 2013 analysis of Medicare claims published online by Preventing Chronic Disease found that 68% of beneficiaries had two or more chronic conditions and 36% had at least four.

“Having multiple chronic diseases is common because people are living longer. The older we are, the more chronic diseases we accumulate,” says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center.

The challenges

Advances in medicine have improved treatment for many diseases and lengthened life. But those same advances mean that today’s medical care often involves seeing more types of doctors, having more tests, and getting more treatments than in earlier times. In other words, medical care in our golden years is better, but also more complicated.

“People take more medications, both prescription and over-the-counter, to manage these conditions. That’s because there are more effective medicines now than there used to be. However, medications can interfere with each other,” Dr. Salamon explains. In addition, treatment for one problem may make another problem worse. “For example, if you have high blood pressure and a history of falls, and lowering your blood pressure makes you feel lightheaded, your fall risk will increase,” says Dr. Erin Stevens, a geriatrician and palliative care physician at Harvard-affiliated Massachusetts General Hospital.

Doctors do their best to avoid prescribing medicines that are likely to cause problems, but the risk cannot be perfectly predicted. Bad things that are unlikely still can happen. “Another problem is that people get tired of taking medications, or find them too expensive — and so they don’t take them. This can lead to problems of untreated hypertension, diabetes, and other conditions,” Dr. Salamon explains.

Why do we accumulate chronic conditions?

Many factors play a role in the accumulation of health problems. Most diseases involve a combination of genetics and lifestyle. Being born with certain genes can make you more vulnerable than other people to certain diseases. An unhealthy lifestyle can further increase the risk.

Some genes, and some lifestyle factors, influence the risk for multiple diseases. And having one disease can increase your risk for another. “One disease can affect an organ system which then affects another. For example, diabetes can damage nerves, which can lead to loss of sensation in the extremities, which can lead to imbalance, a fall, and disability,” explains Dr. Erin Stevens, a geriatrician and palliative care physician at Harvard-affiliated Massachusetts General Hospital. Or you may have high blood pressure that damages blood vessels, which leads to a stroke.

And sometimes health conditions just go hand in hand, and we don’t know why. For example, depression often accompanies heart disease, diabetes, or Parkinson’s disease. Autoimmune diseases also can run in clusters. “So if you have thyroid disease, you may be predisposed to another autoimmune disease, like rheumatoid arthritis,” Dr. Stevens says.

Taking back control

To avoid missteps, be proactive in your health care with these strategies.

Get educated about your conditions. Talk with your doctor about what you can do (like exercise or eat a healthy diet) to take to control of any conditions you already have and to prevent conditions you worry about getting.

Become a medication expert. Find out what each of your medications does, why you need it, what side effects you should particularly watch for, and how it may interact with other drugs. You can get such information from your pharmacist or from online sources (such as the AARP website).

If you see many doctors, be sure each of them knows what medicines the other doctors have prescribed (they will, if they are all part of a hospital or health care system that shares electronic health records).

To be safe, Dr. Stevens recommends bringing all of your medications to each doctor appointment, including over-the-counter pills. “Then we can be sure the medication list on the computer matches the pills and doses that you’re taking,” Dr. Salamon says.

Keep track of your symptoms and treatments. If you’re having symptoms you think may be side effects of a medicine or an adverse interaction between drugs, use a notebook or a computer to record when you take medications, when symptoms develop, and how long the symptoms last.

Get a good CEO. Just as a corporation needs a chief executive officer to oversee its many departments, you may need a primary care physician to look at the big picture and help you make sure treatment for numerous conditions is well coordinated.

Consider palliative care. It’s a misconception that palliative care is only for the end of life. When you have serious degenerative illness — like heart failure, Parkinson’s disease, or a breathing disorder — your quality of life suffers. A palliative care physician can help you manage those conditions, maximize your function, and preserve as much quality of life as possible. “We want to meet people early on, not in crisis mode,” Dr. Stevens says. “Maybe we can prevent a fall or address pain. We can talk about what to expect, so when something happens over time, it won’t be a surprise.”

Be your own advocate. Finally, remember that no one understands how you’re feeling better than you do. Ask questions about your treatment, and don’t be afraid to speak up if you’re having trouble managing your conditions or if you’re concerned about the way your doctors are doing the job.

 

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How do you celebrate your calling during National Nurses Week?

Published in Nurse.com by Jennifer Mensik, PhD, RN, FAAN

Make a Nurses Week resolution to recognize each other every day.

One of my favorite sayings about nursing is our ordinary is actually extraordinary. We provide an amazing service to the public, whether in hospitals, clinics, long-term care or in the community.

Being a nurse is not something we turn off completely at any time. It doesn’t stop at the end of our shift like many other professions.

We are there to help at a moment’s notice because we care. That perspective of caring is always with us and we believe we are doing what any other person might do in the same situation — that it was our job.

We have become so accustomed to the caring we do and the miracles we assist with daily, that what we and our colleagues do “daily feels” as if it is our job. As nurses, we also don’t like to take credit as we should for the healing that we assist with. Absent our caring, people would not heal and get well, and that is special.

Enter Nurse’s Day and Nurses Week. Celebrated since 1965, the original intent was to raise awareness of the important role of nursing, which mark our contributions to society. Nurses Week was first unofficially observed in October 1954, the 100th anniversary of Florence Nightingale’s mission to Crimea.

It was later changed to May 6 and officially recognized by President Ronald Reagan in 1982. The American Nurses Association expanded the holiday into National Nurses Week, celebrated from May 6 to May 12, in 1990. Over time, this week became the one time of year we as nurses truly expect we should receive external recognition for our contributions.

Organizations may do a variety of things to recognize nurses, ranging from giveaways to receptions. But does this serve the original intent of this week?

Have we all moved away from recognizing the important role in nursing that the outcome of our caring results in one week of food or tchotchkes a year? I am speaking here for administration and all nurses alike.

Let’s make a Nurses Week resolution to recognize each other more than once a year

What if each week throughout the year, you, your unit, department or organization decided to recognize yourselves? What if we recognized each other and ourselves daily? How do we give our gratitude to other nurses? How do we show our caring to others? How might this type of recognition look?

I asked many of my nursing friends how they should celebrate themselves and each other and here are some ideas:

Nursing retreats designed just for nurses by nurses. My colleagues and friends at the Arizona Nurses Association have organized this retreat for four years straight!

The DAISY recognition program is a formal program healthcare organizations can participate in to recognize the work of nurses. This program exists in all 50 states and 18 countries!

In our daily manager and administrative huddles at Oregon Health and Science University we discuss staff who deserve recognition. Clinical and non-clinical staff and managers know to escalate stories so individuals are recognized. There always are several staff members mentioned daily during these huddles.

Celebrate little victories, such as when a patient finds solace in music or speaks for the first time after visiting with a therapy dog. This might be just part of your routine day, but it is yours to celebrate. Take a moment to reflect on how your caring was part of this patient’s victory.

Write a letter to the editor in a non-nursing-related newspaper or magazine that reflects positively on the nursing profession.

Have a nursing school reunion.

Attend your state nursing association conference.

When we do not stop to recognize ourselves and others, we are not supporting ourselves or each other. When we don’t support each other, individually we can burn out and experience compassion fatigue, which makes it harder to provide a healing environment for those in our care.

Patients and families can tell when we don’t or can’t care any longer. Worse yet is we start to exhibit bullying behavior to others, instead of compassion and caring our colleagues and fellow nurses need just as much.

Nurses Week shouldn’t and can’t be just the only time we recognize, celebrate and demonstrate the importance of nursing. Each of us need to commit to a Nurses Week resolution to celebrate our profession, ourselves and each other each day!

Jennifer Mensik, PhD, RN, NEA-BC, FAAN, is division director of care management at Oregon Health and Science University and instructor for Arizona State University College of Nursing and Health Innovation DNP program. She also is treasurer for the American Nurses Association. Formerly, Mensik was vice president of CE programming for Nurse.com published by OnCourse Learning. A second-edition book she authored, “The Nurse Manager’s Guide to Innovative Staffing,” won third place in the leadership category for the American Journal of Nursing Book of the Year Awards 2017.

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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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How will population ageing affect future end of life care?

By Anna Bone

Increasing population ageing means that deaths worldwide are expected to rise by 13 million to 70 million per year in the next 15 years. As a result, there is an urgent need to plan ahead to ensure we meet the growing end of life care needs of our population in the future.

Understanding where people die, and how this could change in the future, is vital to ensuring that health services are equipped to support people’s needs and preferences at the end of life. As researchers at the Cicely Saunders Institute, King’s College London, we investigated trends in place of death in England and Wales, and found that deaths occurring in care homes could more than double in the next 25 years if recent trends continue.

Using official records on over five and a half million deaths, as well as population forecasts, we estimated the number of people who will die in a range of different settings in years to come. The intention behind this study is that it will help to guide future planning of health and social care. From 2004 to 2014, the proportion of deaths occurring in care homes increased from 17% to 21%, with numbers rising from 85,000 to 106,000 per year. If this trend continues, the number of people dying in care homes will double to over 220,000 per year by 2040, and care homes will overtake hospitals as the most common place to die. Home deaths are also projected to increase over this period to over 216,000 deaths a year. Together, this means that deaths in the community are expected to account for over two-thirds of all deaths by 2040.

We also know that, increasingly, people are living and dying with multiple illnesses and frailty, which adds complexity to their care needs. The rising number of people with complex illness in the community is a challenge for end of life care. A recent study has shown that palliative care needs are expected to increase by 42% by the year 2040. We need greater integration of specialist palliative care into primary care services, as well as more training in palliative care for general health professionals, to ensure that those with palliative care needs can access services they require.

The projected rise of deaths in care homes and in peoples’ own homes is striking. We must ask care home and community services whether they are equipped to both support such an increase in demand and provide high quality end of life care. How can we provide the workforce needed to care for this growing patient group? To enable people to die in their preferred place in future, we need to ensure adequate bed capacity, resources, and training of staff in palliative and end of life care in all care homes in the country. These projections warn of the urgent need to invest more in care homes and community health services. Without this investment, people are likely to seek help from hospitals, which puts pressure on an already strained system and is not where most people would prefer to be at the end of their lives.

The time has come to test new approaches to care in order to ensure that we address this growing need of our population in the years to come. There are promising examples of innovations in care to increase the reach of palliative care services in community settings, for example project ECHO, which facilitates knowledge-sharing between specialist palliative care services, such as hospices, and general health care professionals such as those in care homes. In an era of increasing need alongside constrained health and social care budgets, developing and testing innovative ways to provide high quality care with minimal resources is imperative.

In the words of Cicely Saunders, the founder of the modern hospice movement, “how people die remains in the memory of those who live on.”The inevitable population changes described here will affect all of us, directly or indirectly, in the years to come. It is time for us as a society to have an open discussion about how we want health services to be delivered to people towards the end of life. Crucially, we need better evidence on how we can best support a growing number of older people as they reach the end of their lives.

Anna Bone is a PhD Training Fellow at the Cicely Saunders Institute, King’s College London. The themes from this blog post come from The Changing Face of Volunteering in Hospice and Palliative Care, published by Oxford University Press.

 

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8 Things to Know About VA Healthcare

Published in Newsmax By Jerry Shaw  

Healthcare benefits from the Department of Veterans Affairs are available to all those who served in the active military, naval, or air service. You can qualify under any discharge condition other than dishonorable.

The first step is enrollment for VA health benefits. Veterans may apply by phone or by contacting their local VA facility. They will be asked to choose a preferred VA center, usually one close to their residence. If the particular medical center cannot provide the healthcare needed, the VA helps make arrangements for your specific health needs. 

Here are eight things to know about VA healthcare:

  1. Provider — The VA does not have to be the exclusive healthcare provider. You can receive care from the VA and a local provider, but the VA encourages vets to coordinate with all parties for one treatment plan for health and safety reasons.
  2. Billing private providers — VA healthcare is not considered a health insurance plan and bills private health insurance providersfor medical treatment and prescriptions for treatment of nonservice-connected conditions. The VA doesn’t usually bill Medicare but can bill Medicare supplemental insurance for certain services.
  3. Responsibility — Vets are not responsible for any unpaid balances not covered by a third-party health insurance provider. However, copayments may be required for non-service related care. Copayments are sometimes offset by payments made to the VA by private insurers.
  4. Preventive care services — The VA covers health exams, health and nutrition education, flu shots and other immunizations, and counseling for hereditary diseases.
  5. Hospital services — Inpatient VA healthcare treatment includes surgeries, short-term treatment for illness and injury after surgery, kidney dialysis, and specialized care, such as mental and physical conditions, traumatic injuries, and organ transplants.
  6. Emergency care — Vets under the VA program can receive emergency care in VA hospitals, outpatient clinics, and vet centers. Emergency care in non-VA facilities is allowed under certain conditions.
  7. Mental health treatment — VA services include treatment for post-traumatic stress disorder (PTSD), depression, substance abuse, military sexual trauma, and other conditions.
  8. Vision, dental, and assisted living care — Routine eye exams and preventive tests are provided as well as eyeglasses or vision disability rehabilitation in some cases. Dental care is provided, depending on individual cases. The VA can help veterans find assisted living, live-in, or home healthcare.

 

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Tara Graham: When the unexpected happens, what’s your plan?

Editor’s note: This commentary is by Tara Graham, MSW, LICSW, LNHA, who is executive director of the Hospice and Palliative Care Program of the VNA of Chittenden and Grand Isle Counties, Vermont’s oldest and largest non-profit home health and hospice agency.

It’s National Healthcare Decisions Week. Who’s Your Person? What’s Your Plan?

It’s a simple yet vitally important question all Vermonters over 18 should be able to answer. If you are unable to speak for yourself due to incapacitating illness or injury, who will speak for you? Who will ensure the treatment you receive – or decline – reflects your beliefs and preferences?

In my work as Executive Director of the Hospice and Palliative Care Program at the VNA of Chittenden and Grand Isle Counties, I engage with individuals and families facing life-limiting illness every day. Conversations about wishes, values and preferences at the end of life are a necessary part of the hospice philosophy of care. These conversations can be at once routine and profound. The process of dying is a daily part of my life and I realize that this is not true for most people – it isn’t even consistent among those closest to me personally.

For many, talking about debilitating illness or injury and death is completely foreign and something to be avoided. It’s uncomfortable, some may even say a little morbid. But here’s the thing: I believe it is a person’s innate right to choose the direction of their lives until the moment he or she dies, regardless of their ability to communicate their needs. We all hope to never have a serious car accident, but we purchase car insurance so we are prepared should the unexpected happen. Advance care planning – making your healthcare wishes known – is like an insurance policy against unwanted medical treatment and interventions during times of tremendous stress and uncertainty.

Despite recent gains in public awareness of the need for advance care planning, studies indicate the majority of Vermonters, and in fact most Americans, have not exercised their right to make decisions about their healthcare in the event they cannot speak for themselves. By normalizing conversations around advance care planning, and making our wishes known to loved ones and our healthcare providers, we can all be better prepared to deal with the unexpected.

I have had the privilege of hearing about people’s fears throughout my career as a social worker. Over and over again, the theme of losing capacity or loss of control is consistently at the top. Even my dad, when faced with a terminal diagnosis of glioblastoma, who knew intuitively when he no longer wanted to pursue curative treatment, so he could focus instead on quality of life for his remaining days, found himself having to explain his decision to family and friends. My dad was able to make his wishes known. Thankfully, he also had an advance directive in place in the event he became unable to speak for himself and my mother and sisters needed to make healthcare decisions for him. He gave us the gift of certainty.

Imagine if we could chart a path, lay out scenarios and share with those that love us about how to represent us at a time when we might not be able to represent ourselves? This is a very real, obtainable possibility.

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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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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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