New Medicare Rules for Hospice Care

Patients face new regulations

New Medicare regulations regarding hospice care now require that patients who have been through two full rounds of hospice to meet in person with a hospice doctor or nurse practitioner to determine whether they are actually in need of end-of-life care. This presents a difficult issue, because there is no specific way to determine how far someone is from death. A quote, from NewsObserver.com:

In about half of cases, patients consult the service three weeks before they die and a third become patients just one week before death.

Cooper Linton, vice president of marketing and business development with Hospice of Wake County, said it's unusual for patients to be in hospice care for extended periods, but it's not unheard of.

"We're trying to estimate the life expectancy of people, and that's more an art than it is a science," Linton said.  "In our own personal lives, we know of people who did not live as long as we thought they would, and those who live far longer than they were told they would."

It remains to be seen whether this change will be beneficial or detrimental, but with concerns already being raised by providers about possible cost increases, the debate is certainly not over.

How Hospice Helps

Hospice care covers both mind and body

Hospice care is certainly about comfort and pain control at a physical level, but those are not the only aspects that are carefully looked after. This quote from a MyFox Tampa Bay article explains:

"We do have a lot of medicines and treatments to make people comfortable and peaceful at the end of life," said Dr. Michele Marziano, with Lifepath Hospice. "It helps the person who is dying, and helps the family too to see their patients in comfort at the end of life."

That includes medicine to relieve pain, nausea and vomiting, and oxygen to make breathing easier. There's specialized radiation and chemotherapy to ease discomfort.

But Dr. Marziano says there is also a focus on emotional pain.

"Hospice educates the families for what to expect, and that's really helpful," she said. "We have the social workers, chaplains, volunteers -- it's a team approach to help relieve the suffering and pain of families."

As Dr, Marziano stated, hospice takes great measures to meet the needs of patients and their loved ones and, with word of the effectiveness of this type of care spreading, the popularity of hospice care is expected to continue rising at a solid rate.

The Many Facets of Hospice Care

Reasons to choose hospice

Many think of hospice as a program that offers emotional support to those with terminal illness, and it does, but hospice today is an integrated program that offers much more than just emotional support; the list of hospice services covers doctors, nurses, home health aides, medical equipment and supplies, spiritual, dietary and other counseling, continuous care during crisis periods, bereavement services and trained volunteers who help in the home. Hospice isn’t supplementary support for patients who are desperately ill; hospice care actually supplants regular medical care, empowering the patient themselves (along with medical staff) to determine what treatment they want as they near the end of life. This not only improves the patient experience but, according to a 2007 Duke University study of hospice care, reduces end-of-life medical costs by an average of $2,309 per hospice beneficiary.

This quote, from an article in The River Journal, does a fantastic job of describing the many facets of hospice care. In addition to making patients more comfortable, studies are now showing that the benefits of hospice care can actually extend the lives of those patients beyond other with similar ailments who choose to undergo hospital care. Hospice care puts patients in control, creating a program catered to the individual, which ensures the best care possible.

Hospice Gives Hope

Hospice care is about hope, not loss

Hospice care serves many purposes, most of all to make the later stages of life an enjoyable time for patients, friends and family. In an interview for the Colombus Telegram, one hospice social worker explained what her job entails:

"My job is to help individuals and their families to realize that hospice is not always just about dying, but it's an important time of living their lives," said Lisa Weber-Kohler, Columbus Community Hospital social worker. "It can be a time to retain hope, not necessarily for a cure, but to re-establish family relationships, to review their lives and talk about how they want to be remembered."

With advanced pain management and other measures in place to ensure maximum comfort, patients are free to enjoy these renewed connections for as long as possible wherever they desire, be it at home or in a care center.

Maximizing Life

What hospice care is all about

The word hospice is sometimes spoken in hushed tones. It can conjure feelings of sadness, because by its very definition, it involves caring for someone who is terminally ill.

Hospice, however, also has the same word root as hospitality. And who doesn't like hospitality?

Because home typically is a safe haven, many people with life-limiting illnesses, given a choice, would rather be home than in a health-care facility. However, they often need special care.

"It embraces life. Many people view hospice as a death sentence, but on the contrary, hospice is really all about maximizing life," said Vicki Rate, an oncology nurse and president of Friends of Hospice, an auxiliary of the Hatfield-based North Penn Visiting Nurse Association.

This quote, from a Reporter Online article, describes the dark way hospice care is sometimes viewed, but also sheds light on the brighter side, the fact that the real goal is to make the end of life as comfortable and enjoyable as possible. Hospice care consists of entire teams devoted to every aspect of a patient's needs, from pain management to companionship and counseling, making it an ideal choice when compared to cold and intrusive hospital care.

Reasons to Choose Hospice Care

Hospice care has many advantages

Modern medicine works many miracles, but when it comes to the point where it can no longer slow or cure an illness, there are many reasons to seek hospice care. Recently, myOptumHealth.com put together a compelling list:

Reasons for choosing hospice

• Death with dignity. You are not hooked up to machines other than those that might ease pain or symptoms. You're less likely to undergo distressing tests and don't receive treatments that are no longer effective in curing your illness.
• Comfort. Pain management is a priority. Studies confirm that people in hospice are more likely to have pain controlled than those receiving end-of-life care in other settings.
• Quality of life. Hospice addresses emotional and spiritual needs. This helps the ill person come to terms with death and reduces the stress of dying.
• Remaining at home. Most people prefer to die in the privacy of their own homes, surrounded by loved ones and pets. Hospice enables the care team to come to you.
• Financial concerns. Hospice care typically costs less than hospital or nursing home care if you have a terminal illness. Plus, Medicare, Medicaid and private health insurers usually cover most or all of the costs.
• Caregiver support. Families who received hospice care reported a "favorable dying experience" more often than those whose loved one died in a hospital.
• • Hospice counsels families so they know what to expect as an illness advances.
  • Respite care is provided so family caregivers get a break.
  • Caregivers are relieved of paperwork. Hospice often helps coordinate claims and bills for the services provided.
  • Families receive bereavement support for a year after a loved one dies.
• Lack of home caregiver. People living on their own or with someone not up to the demands of caregiving can get compassionate end-of-life care at a hospice located in a hospital, nursing home or other facility.

Literally hundreds of studies, many of them referenced in the pages of this blog, have proven these statements to be true. As always, the decision is up to the individual, but with so many pros and very few cons, hospice is becoming a common choice.

Dartmouth Study Promotes Hospice

Hospice care gains more supporters following telling studies

A new study by the Dartmouth Atlas, a group that specializes in studying medical care, has determined that a full one third of U.S. patients dying of cancer end up pursuing costly and ineffective hospital care as opposed to seeking hospice care. A quote from the researchers, published on MSNBC.com:

"Patients often unnecessarily receive care in the ICU and invasive procedures," said Dr. John Goodman who coauthored the Dartmouth Atlas study of 235,821 patients with federal Medicare health insurance who died of cancer between 2003 and 2007.

"On average, patients ... would much prefer to receive care that allows them the highest quality of life in their last weeks and months and care that allows them whenever possible to be at home and with their families," Goodman told reporters in a telephone briefing.

Joining the list of professional organizations publicly supporting hospice care is The American Society of Clinical Oncology, whose mission is to create guidelines for cancer specialists, citing their belief that it serves to decrease pain and increase quality of life for both patients and their families.

Hospice Care Myths

There are several harmful myths that still persist regarding hospice care

While the public has more knowledge regarding hospice care these days than they ever have before, there are some common misconceptions that still exist. In a recent article for The News Leader, Hal Aslestad listed three of the most persistent, a quote:

I would like to address three myths about hospice care. Some think hospice care is only for the last few days of life. But did you know that hospice patients and families can receive care for six months or longer depending on the course of the illness?

Other individuals think that hospice care means giving up on all medical treatment. But hospice provides high-quality pain management and symptom control. Diseases which are not related to the primary hospice diagnosis can still be treated

Lastly, many think that hospice is only for cancer and AIDs patients. Did you know that today, while 40 percent of hospice patients are fighting cancer, the majority of patients face other terminal illnesses?

Hospice care is about living well, and the more we can share this fact with the public, the better we can combat misconceptions and misunderstandings about the invaluable and highly beneficial services offered.

Hospice Numbers on the Rise

Hospice care enrollment skyrockets

Hospice is a growing and viable option for quality end-of-life care. In 1999, hospice was provided to at least 700,000 patients, up from 540,000 in 1998. Clearly, as Americans learn more about hospice, they are recognizing that it's the kind of end-of-life care they want and need.

As this quote, from an article in The Fort Morgan Times, explains, the number of patients taking advantage of hospice care is growing by leaps and bounds. With a jump of 160,000 participants in just one year, it looks as if attempts to educate the public about the mental and physical benefits of hospice are having a noticeable impact.

Hospice Takes Teamwork

No one person can serve the needs of hospice patients

Hospice care covers a wide spectrum of needs, more than any one person is capable of. Fortunately, this care is broken up among teams of trained professionals. For those who are unfamiliar with just how hospice works, here is the breakdown of a typical team, from a South Town Star article:

A hospice care team includes professionals, paraprofessionals and volunteers who are sensitive and responsive to individual patient and family needs:

• Physicians work with the patient's attending physician and are available for pain and symptom management consultation or house calls, as needed.

• Nurses skilled in assessing and managing pain and other symptoms, as well as providing hands-on care.

• Social workers are sympathetic listeners providing emotional support and help with financial issues and planning.

• Hospice aides help with personal care, such as bathing and mouth care, light housekeeping, light laundry and occasional shopping.

• Chaplains work with the family's clergy, offering spiritual support.

• Volunteers are trained to spend time with the patient when they are needed most.

• Bereavement specialists provide grief counseling, memorial services and other support for family and friends after the patient has died.

As you can see, the team covers the full gamut of services from physical to emotional, and takes into consideration not only the patient, but also family and loved ones as well. It is because of this thorough support that hospice care is consistently found to be one of the most effective forms of care for those living with terminal illness.

Dementia Patients Miss Out

“People with dementia get sicker inch by inch,” said Lin Simon, director of quality at Gilchrist Hospice in Baltimore, the largest hospice organization in Maryland. “Trying to say, ‘Now, she’s ready for hospice’ is much harder.”

Yet doctors serve as the gateway to hospice, which provides palliative care for the dying and support for their families. Medicare regulations require a physician to certify that a patient entering hospice is likely to die of his or her disease within six months. Doctors are more likely to do so when the disease is cancer or heart failure, which have more predictable trajectories.

That’s the major reason that dementia patients — who can benefit from the better pain control, fewer hospitalizations (so often associated with aggressive treatments that confer no measurable benefit) and greater family satisfaction that hospice has been shown to provide — are under-enrolled in hospice programs.

This quote, from a post on The New York Times "New Old Age" blog, by Paula Span, brings to light a frequently overlooked aspect of hospice care. A significantly lower number of dementia patients are admitted to hospice care as opposed to patients suffering from other conditions because of the difficulty in making a precise prognosis of their health, even though the benefits they gain are proven and significant. There is good news, though. Researchers are creating new standards and ways of more accurately diagnosing this often misunderstood disease, and with this research comes the hope of better care and more comfortable living.

Hospice Defined

Hospice care is about living well

Hospice is not a place. It is the provision of services to those who are living with a terminal illness. The services are uniquely designed and based upon one’s requests and expressed needs.

Hospice is not about dying! Rather, hospice promotes dignity, autonomy and the best quality of life possible while living with a terminal illness.

This quote, from an article in the Holyoke Enterprise, defines what hospice care is all about. Many hold a view of hospice as a closed off place where people go to die, while in reality this could not be further from the truth, Whether in a designated care center or your own home, hospice care aims to provide whatever is best for the comfort and happiness of the patient and their loved ones.

Washington To Cut Hospice Funding?

Gov. Christine Gregoire plans to eliminate all Medicaid funding for adult Hospice care in Washington state as of Jan. 1. This cut is supposed to save the state budget $4.6 million.

The savings from the elimination of hospice end-of-life care for the most needy of our neighbors totally ignores the increased costs which Medicaid will endure from those individuals who will wind up in hospital emergency rooms and will be charging Medicaid for all of their medications which Hospice would have paid for.

The sentiments here, from a Port Orchard Independent article by Jim Pledger, are being shared by many as Washington moves to eliminate Medicaid funding for hospice care. With study after study proving that hospice care saves thousands of dollars per patient, while simultaneously improving quality of life, why would you wish to eliminate a major source of funding and, as a result, ultimately cost the state more money than was saved?

Rise in Hospice Care Lowers Costs

Another study has been released exploring the connections between the increased use of hospice care and lowered health care expenses. This one was focused on heart failure patients, who traditionally encounter major expenses in their later months. A couple of quotes, from MedPage Today:

The retrospective U.S. study, encompassing almost 230,000 Medicare heart failure patients, found the use of hospice during the last six months of life jumped from 19% in 2000 to 38% in 2007, reported Lesley H. Curtis, PhD, of Duke University, and colleagues.

and...

The shift toward hospice and palliative care may actually be saving money, they speculated.

"Increasing the availability of alternative venues of care, such as long-term care and home care, may be effective in further reducing hospitalizations and containing costs," Kaul and colleagues wrote.

Financially, emotionally, and physically beneficial, hospice care helps patients to understand their choices and make informed decisions about what is right for them and their loved ones when their time is precious.

Hospice Care Saves

A flood of studies showing the benefits of hospice care to both patients and state finances has been hitting the news reels recently as experts prove what we have known for years. A quote from a Reuters article regarding one such study, authored by Dr. Jonathan Bergman of UCLA:

In his study, Bergman and his colleagues found that while hospice enrollment among dying prostate cancer patients jumped from around 30 percent in 1992 to over 60 percent in 2005, the timing of when they entered hospice didn't change. One-quarter of patients were in hospice for seven days or less, which is "too brief to maximize the benefit of enrollment," the researchers write. Another 10 percent outlived the six-month hospice care guideline.

Bergman and his team did find that hospice patients were about 20 percent less likely to receive high-intensity care, for example admission to the intensive care unit, two or more emergency department visits, or cardiopulmonary resuscitation. They also received fewer imaging tests, which are costly and are known to have no benefit for dying prostate cancer patients.

As we've seen in many of these studies, the effectiveness of hospice care is being limited by the fact that many patients wait far too long to enroll. While even a short stay can greatly increase comfort levels, a week or less is truly too short of a time to create ideal results.

Men Wait Too Long for Hospice

A new study by UCLA researchers has found that, while more than half of all men dying of prostrate cancer do use hospice care, most wait far too long to enroll, thereby missing out on many potential benefits. A quote from their press release, published on NewsWise.com:

For hospice care to be most effective, patients should be enrolled for several weeks prior to their deaths. However, the study found most men enrolled just one to two weeks before they died, said Dr. Mark Litwin, a professor of urology and public health, a Jonsson Cancer Center researcher and senior author of the study.

“It’s important that we maximize quality of life when quantity of life cannot be changed,” Litwin said. “Most men are being referred to hospice too late and that timing hasn’t changed in the last 20 years, which is unfortunate. As cancer specialists, we should offer these patients the best quality of life that we can, and that often means offering them the best quality of death that we can give them.”

While thinking used to be that preserving life at all costs was a doctor's goal, it is recognized that, when the inevitable is at hand, it is often healthier for both patient and family to simply be as comfortable as possible so they can enjoy their time together.

Uganda Seeks Hospice Care

While palliative and hospice care have a strong foothold in the U.S., other countries are not so lucky. A quote, from the Uganda Pulse:

As Uganda joined the rest of the world to celebrate World Hospice and Palliative Care day on Saturday, health service providers and communities have been advised to promote public information and advocacy for palliative care services around the country.

Speaking at the celebrations in Kampala on Saturday evening, the Commissioner, Clinical services in the Ministry of Health, Dr. Jacinto Amandua revealed that the people with HIV/AIDS, cancer, sickle cells and heart problems, among other diseases, are not receiving palliative care that could help them live much longer.

With such serious health problems in the country, the potential benefits from hospice and palliative care are enormous. Not only do these services help humans live better lives, but they save large amounts of money normally spent on intensive and unnecessary hospital care.

Growing Numbers Seek Hospice Care

Hospice care enrollment continues to rise as public recognizes the advantages

In the past, physicians didn't specialize in helping people deal with their final days of life. Instead, they often focused purely on survival, even if a patient was terminally ill.

Over the last four decades, the hospice movement has greatly changed how people die in the United States. Specially trained physicians, nurses and caregivers now devote themselves to helping dying patients find what they are looking for — freedom from pain, nausea, worry and spiritual angst.

Hospice care isn't universally accepted among patients or doctors some of whom push until the very end of life for a cure or remission of illness and avoid the issue of impending death. That hasn't stopped the more than 70 percent of eligible San Diego County residents from going into hospice care, according to the state.

This quote, from a Voice of San Diego article, is another testament to the recent growth and success of hospice care. Thanks to years of efforts, we have progressed from a small offshoot of the medical field to having a plethora of medical professionals and scientific studies supporting the fact that, for many, hospice is the most effective way to care for those nearing the end of their lives. Seeking care and comfort, not only physical but also mental and spiritual, the percentage of those seeking hospice care will likely continue to increase as the subject grabs more public attention.

Politics Hinder Hospice Education

Unfortunate politics cause public to miss out on information about hospice care

Palliative and hospice care have gained more interest from the public in recent years as personal stories and concrete statistics made clear the many benefits of this specialized care. Unfortunately, politics hindered the progression this year, as this quote from a WickedLocal article by Richard Griffin explains:

Surely, few single phrases harmed Americans this year more than did the coinage “death panels.” This label, a thoroughly deceptive ploy fashioned for political reasons, led leaders in Congress to cut out of the health reform bill one of its finest features.

That plan was to pay doctors for explaining treatment to terminally ill patients who needed to know about palliative care, hospice services and other alternatives to medical/surgical intervention.

The opponents of this legislation managed to twist the meaning of the proposal to make it seem like a way of getting rid of sick older people.

The sort of education intended to be provided by the plan is exactly what helps people to make informed decisions about alternatives to the traditional intensive hospital-based medical care. Hopefully, with the subject continuing to attract more attention, future legislation will make this education available to all.

Staying in Hospice Proves Healthier

New study demonstrates the gap between hospice care and traditional care

Studies that prove the effectiveness of hospice are a favorite topic on this blog, and a new one, described here in a quote from an About.com article by RN Angela Morrow, has some telling figures comparing patients who continue or discontinue hospice care:

Cancer patients who disenroll from hospice care  -- meaning they had signed up for, then decided to discontinue, hospice care -- are more likely to be readmitted to the hospital and die there.  A study published in the October 1, 2010 issue of Journal of Clinical Oncology, "Impact of Hospice Disenrollment on Healthcare Use and Medical Expenditures for Patients with Caner", found that:
 

• 33.9% of patients who disenrolled in hospice care were admitted to an emergency department, compared to only 3.1% of hospice patients
      
• 39.8% of disenrolled patients were admitted to the hospital compared to only 1.6% of hospice patients
      
• Disenrolled cancer patients spent an average of 19.3 days hospitalized, hospice patients only spent an average of 6.7 days
   
• 9.6% of disenrolled patients died in the hospital while only 0.2% of hospice patients did
   
• The costs of caring for a disenrolled patient were nearly five times higher than caring for patients who remained on hospice

With such a large difference in all categories, hospice care seems the clear choice for comfort and ease of living at the end of life.

Golf for Charity

Hospice Care Corporation's Dr. D.R. Davis Golf Classic was the subject of more local news coverage, this time from WBOY 12 TV. Here's a sample:

Sunday's fundraiser helps pay for patients who can't pay for care or don't have insurance.

"It's a win-win situation for us, as we raise needed money for our inpatient unit and to take care of patients in North central West Virginia. We're in 12 counties and there's a lot of people that need our help," Cynthia Woodward of Hospice Care Corporation said.

Many thanks to WBOY 12 TV, coverage like this is immensely helpful in spreading the word about ways to help the nonprofit Hospice Care Corporation continue its good work.

HCC Golf Tournament

The Hospice Care Corporation's 22nd annual DR. D.R. Davis Golf Tournament this past weekend received some nice coverage from WDTV. A quote:

Sponsors said this tournament is definitely a worthy cause. "It's a tough thing to have happen in your family," said Steve Decker, the market president at Wes Banco, and a sponsor for the event, "but to have somebody there in a time if need is very important."

This tournament raised more than $10,000 for the 12 Hospice Care Facilities around North Central West Virginia.

The nonprofit Hospice Care Corp. holds several fundraisers in the Western Virginia area throughout the year to help finance its facilities and services, for information stay tuned to this blog or check out the HCC website, http://www.hospicecarecorp.org/.

Choosing Between Hospice Care & Palliative Care - An in Depth Look at Your Options

by Allen Jesson

Recently I wrote an article for family members of patients who could benefit from hospice care and/or palliative care, in which I discussed the factors that physicians must consider in referring hospice or palliative care options to their patients. In this article, I will explore the topic in greater depth, discussing the similarities as well as the differences between the two primary options: hospital-based palliative care and traditional hospice-based palliative care. Hospital-Based Palliative Care Hospital-based palliative care comes into play following a patient's hospital admission, and prior to discharge. For example, if the physician orders chemotherapy, it could be administered in the hospital-but not by the hospice-as chemotherapy is considered a therapy (and precludes hospice admission). It is important to remember that hospitals are acute facilities that strive to restore patients to optimum function. Very simply, this means that they focus on therapeutic, rehabilitative measures. When that is not a viable option due to a patient's terminal or life-limiting disease, the hospital-based palliative care team can assist the physician in structuring a plan of care that strives to maximize quality of life while managing pain and symptoms. In this situation, the palliative care team might suggest an early hospice referral, as the patient would be leaving the hospital setting. Generally, while the patient's doctor and the hospital-based palliative care team make the referral, the patient and family also participate in the decision, so that the outcome best benefits and supports the patient's desires. The physician must be confident the hospital-based palliative care team incorporates holistic care at its very base, including ensuring the patient's physical comfort, providing emotional and psychological support, and supporting shared decision-making. In addition, the patient's physicians should also be confident that the hospital-based palliative care team coordinates the care across different care settings and involves the patient and family as appropriate. A candid prognostic dialogue is paramount, as communication bridges the gap between the patient's needs and the physician's expertise. What to Expect from Hospital-Based Palliative Care The physician should expect the following from the hospital-based palliative care team: Evidence-based symptom palliation and psychological support Shared decision-making that supports both the patient and the family or caregiver Dignity and respect regarding the patient's cultural values Practical, financial and legal assistance for patients and families Coordination of care across the health care setting that helps patients move from one setting to another (e.g., from hospital to home) in a seamless fashion The hospital-based palliative care team can work closely with the local hospice agency once patients have completed all therapies and have a prognosis of six months or less. I have found that when working with physicians, patients and families who are considering hospice care in the last months, everyone appreciates a coordinated health care approach, which helps guide the patient to navigate the system, providing appropriate care at each stage. A hospice nurse on the hospital-based palliative team can advise as to when the patient would benefit more from hospice services, and advocate for the patient and his or her family regarding those services. Hospice-Based Palliative Care Patients who are not hospitalized or are currently undergoing therapy can still access the expertise of the hospice nurse regarding pain and system management. Many hospices provide limited support to patients who are not yet eligible for hospice care or are not emotionally ready for hospice. These are non-reimbursed services that hospices provide as community outreach. Medicare stipulates all curative measures must be exhausted, and all therapies completed, before patients access hospice care benefits. So an early hospice referral from the hospital-based palliative team for these services can establish, and foster, a caring relationship with the case manager and the patient before any hospice care is actually needed. Establishing this relationship and making an early hospice referral helps alleviate fears on the part of the patient and family, and allows for a rapport to develop should the patient access hospice services at a later date. How to Choose a Quality Hospice Agency Physicians who determine it is time for a hospice referral due to patient preference and disease trajectory may wonder how to select a competent hospice organization. Not all hospices are created equal: some are very good, and some are truly excellent. But, like choosing a hospital-based palliative care team, there are guidelines for determining high-quality hospice programs. To begin with, the physician can ask: Is the hospice accredited or certified through a national organization? Are staff members certified in hospice and palliative care medicine? Does each team member use a standardized assessment tool? Does each patient have one case manager and social worker assigned to them? How does the program monitor and improve its quality of care? Most hospice agencies are Medicare certified, as Medicare is the primary source of reimbursement for patient hospice care. But if the hospice is Joint Commission Certified, it is held to a higher standard and level of accountability. The Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) is an independent governing body that oversees hospitals and nursing homes. By voluntarily participating in this outside review and evaluation process, in addition to the mandated (federal) Medicare and state Department of Health annual reporting, a hospice demonstrates a commitment to quality care, continuous improvement and public accountability for the care and service of terminally ill patients and their families. When a hospice agency has this certification, both physician and patient can rest assured they have chosen a truly excellent hospice whose guiding principles focus on delivering competent, compassionate, and coordinated care.

Please visit the Gilbert Guide for the very best in Palliative Care and for more information about Hospice.

A New Way

People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives.

This quote from an article in The New Yorker eloquently describes the struggle currently going on in our health care system. Although many hold on to expensive and uncomfortable medical care far after its usefulness has passed, piling more stress on themselves and their families in the process, hospice care has repeatedly been proven to address the real concerns of dying patients.

Hospital and Hospice

Recent changes to President Obama's health care bill have once again eliminated the possibility of patients receiving both hospital and hospice care simultaneously, a decision that, if it remains unchanged, will hurt the lives of many. A post on The Times Record's blog explains:

Since Reagan-era changes to Medicare reimbursement, seniors haven’t been able to choose hospice unless they give up hospital visits. It was thought that it would be too expensive to offer both.

But it’s not true. A 2004 experiment by Aetna allowed patients to choose both hospital and hospice care. The results contradicted expectations.

Two-thirds of patients chose hospice, rather than the one-third now typical. And hospice participants returned to the hospital far less often, even though they could. They lived just as long as those more frequently hospitalized, and, with certain diseases, longer. Moreover, family members were far less likely to suffer from depression after the patient’s death.

Overall costs were more than 25 percent lower – a huge difference, given that nearly one-third of Medicare spending occurs in the last six months of seniors’ lives.

There have been many studies confirming the same thing, patients who are under hospice care receive far more benefits from their standard hospital care as well because with their mind at ease they are free to do what is best for their body. Add to that the lightened burden on the families of those involved and you see that hospital and hospice care need not cancel each other out, but can instead work hand in hand effectively.

Palliative Care Extends Life

In a study that sheds new light on the effects of end-of-life care, doctors have found that patients with terminal lung cancer who began receiving palliative care immediately upon diagnosis not only were happier, more mobile and in less pain as the end neared — but they also lived nearly three months longer.

The findings, published online Wednesday by The New England Journal of Medicine, confirmed what palliative care specialists had long suspected. The study also, experts said, cast doubt on the decision to strike end-of-life provisions from the health care overhaul passed last year.

This quote, from a NY Times article, is yet another affirmation of a fact that we already know - hospice care improves and extends a patient's final months. Citing a three-year study done on patients with fast growing lung cancer, the article states that those receiving some sort of palliative care immediately after diagnosis managed to live three months longer than the group receiving standard care while reporting less depression and happier lives with fewer worries about problems caused by their illness.

Camp Nabe Lends a Hand

Hospice Care's Camp Nabe received yet more coverage this past week, with WBOY12 News spreading word of the free bereavement camp. A quote:

About 40 kids 7-17 years old attended Camp Nabe in Preston County for an bereavement camp this weekend. All-weekend long, the kids learned how to cope with a death of a loved one through various activities, all for free.

Kids released balloons with special messages written for their loved ones.

"Kids grieve differently, we as adults we know how to grieve, we think we know to grieve. But kids don't how to to deal with the grief, their anger and emotions," Chris Garbart of the Hospice Care Corporation said. "So that's what this camp is about to help kids get through the grief process."

This hugely beneficial camp offers children who have experienced the loss of a loved one a chance to learn to grieve and share in the company of their peers. For more information regarding Camp Nabe, visit the Hospice Care website or call 304-864-0884.

Get Ready for Golf and Fun!

Hospice Care wants to announce its plans and progress for the Tygart Golf Classic. The charity golf tournament will benefit patient care for those with terminal illnesses. It will be held on Saturday, July 24, 2010 at the Tygart Lake Golf Course.

“A lot of people get out and play because they love the game. Why not golf to compete for prizes, have fun, and make a difference in the lives of their neighbors and friends who are seriously ill?” asked Cynthia Woodyard, VP of Public Affairs and Access for Hospice Care Corporation.

There is still time to get involved and participate as a sponsor. We have added a special sponsorship level. You can sponsor a hole in honor or memory of a friend or loved one in the amounts of $25, $50 or $100 per hole.

Hospice Care Corporation would like to thank in advance all of the businesses and individuals that have already pledged their support. To date cash and hole sponsors include: Bartlett Funeral Home, Donald G. Ford Funeral Home, DynA-Mix/Rex Hide, Glotfelty Tires, Harry Green Chevrolet, International Coal Company, LaVerne Sweeney, Mark Zeck – State Farm Insurance, Mountaineer Yellow Pages, The Mitchell Group, LLC, Toothman Ford, and Emily Bolliger - United Security Agency. Waterfront Jeep will be sponsoring the hole in one contest for five par three holes. Prizes range from $22,000 towards the purchase of a new Jeep, Bose Wave Stereo, two $500 Visa Gift Cards, and a set of Nike Golf Clubs. Along with these sponsors, there are many businesses that have donated door prizes.

And, there is still time to sign up to play. Individuals and teams are encouraged to register for a cost of $60 per player. Registration includes: 18 holes of golf and cart, lunch, Goodie Bags, prizes and refreshments. This will be a shotgun scramble with an 8 AM tee time. There will be eligibility to win prizes for the top three place teams, two Closest to the Pins, Longest Drive, Longest Putt and a Hole in One at designated tees.

For more information on sponsorship opportunities or playing, please contact Kim Riley at (304) 864-0884 or kriley@hospicecarecorp.org.

Helping Grieving Children

The loss of a loved one is a difficult time in life, especially for children, who are often confused and unsure of how to express themselves. To lend a hand, Hospice Care hosts a free Bereavement Camp named Camp Knabe every year. WDTV reports:

Jaylan Bohanna lost her brother, Shawn Bunnell, in April.

So she and her brother and sisters came to Bereavement Camp for children to help with his passing.

"When he died he only had half of a heart, so when he died it was his heart problems," said Jaylan Bohanna, grieving sister. " And he was really funny and smart and cool."

This three day event promotes comradery and understanding among its campers.

"This camp is important because I thin kids feel that they are alone in their grief and kids do grieve differently. This camp gives them the tools that they need to go through the grief process, how to handle their anger and their fears, dealing with grief," said Chris Gabart, Hospice Care Project Coordinator.

Though activities and development sessions, the children learn to share their feelings and handle the natural grief and anger that comes after a death in a comfortable and caring environment.

Hospice Care Gives Thanks

Hospice Care Corporation wants to say thank you to the Taylor County Relay for Life committee for such a wonderful event. “We enjoyed being part of the community and giving back,” said Stephanie Hott, Hospice Care’s Relay Captain.

Hospice Care raised over $1,300 for this year’s Relay for Life primarily through its “Hog Raffle” fundraiser. Butch Austin of Grafton won the hog and will receive free processing and packaging. “We want to thank Jennifer and Brian Ross, of Brian’s Custom Meats for their very generous donation of the hog.” said Hott.

Hospice Care Corporation, a 501 (c) (3), non profit organization, is dedicated to serving the seriously ill and their families in the 12 we serve in West Virginia since 1983. In fact, Hospice Care is the only not for profit stand alone hospice serving Taylor County. Hospice Care is an Open Access hospice that doesn’t refuse patients based on the cost of their care, but solely on their right to receive it. For more information on Hospice Care Corporation, go to www.hospicecarecorp.org.

Hospice Offers Comfort

Hospice care continues to grow in popularity as more doctors and members of the public are educated both about their choices and the realities of hospice care. Parade magazine reports:

In 2008, an estimated 1.45 million Americans were treated in 4850 hospice programs--up from only 25,000 patients in 1982, according to the National Hospice and Palliative Care Organization (NHPCO), which estimates that nearly 40% of U.S. deaths in 2008 were in a hospice setting, usually at home. And as Baby Boomers age, "the demographics are going to explode," says Naomi Naierman, president and CEO of the American Hospice Foundation (AHF).

One reason for this massive growth is that in 1983 Congress made hospice care a Medicare benefit (83.2% of hospice patients were 65 or older in 2008, according to NHPCO data). Another is the gradual education of the public. "People still think hospice is a place," Naierman says. "But hospice is actually designed to care for patients at home, and that's where most people want to die."

The continued rise in numbers proves that many have found comfort in hospice care, and we hope they will continue to climb as more seek the invaluable service known as hospice.

Hospice Care to Host Tygart Golf Classic

Once again, Hospice Care Corporation will be hosting its Tygart Golf Classic on Saturday, July 24th at the Tygart Lake Golf Course. All proceeds from the tournament will support the mission of Hospice Care Corporation, which provides vital patient care for the terminally ill and their families.

This year’s event features many interesting opportunities for golfers and sponsors. There will be prizes for the winning teams, as well as a variety of exciting contests and hole prizes including: longest drive, longest putt, two closest to the pins and a hole-in-one prize.

Hospice Care is accepting sponsors at all levels of participation from prize sponsors to snack, meal, cart and hole sponsors. Also, businesses and individuals are encouraged to donate items for door prizes, raffles and goody bags. Every dollar raised stays here in the communities we serve. And, all contributions and donations are tax deductible.

“We are looking to our friends and supporters in the community to help us make this tournament very successful and well attended here in Taylor County,“ said Cynthia Woodyard, Vice President of Public Affairs and Access.

The format is a four-man shot gun scramble. The cost to play is $60 per person or $240 per foursome for 18 holes of golf. The event starts at 7 AM with registration and an 8 AM tee off. All participants will receive a goody bag, snacks and refreshments during play, with lunch and the award presentation immediately following. Individual and Team registration is available by calling 1-800-350-1161. For more information on sponsorship opportunities or playing, please contact Kim Riley at (304) 864-0884 or kriley@hospicecarecorp.org.

Hospice Care - Living With Terminal Illness

by Allen Jesson

Patients and their families are usually overwhelmed when faced with the diagnosis of terminal illness. Many patients are symptom-free until an illness or hospitalization reveals they have a life-limiting condition. Suddenly, everything changes. Feelings of fear, confusion, doubt, and even isolation are common. Major health decisions must be made. Most people are at a loss as to where to turn for guidance. A hospice care team can help you navigate this new terrain.

It is never too early to call hospice to inquire about comfort care. Comfort care involves managing pain and symptoms so patients can live their lives as fully as possible. Generally it follows therapies such as chemotherapy or radiation. The concentration is on quality of life when quantity of life is limited. The patient's primary care physician (or discharge planner, if the patient is still hospitalized) is a good person with whom to start the conversation. You may not feel hospice care is right for you or your loved one now, but the best time to ask about hospice care is before you need it.

What Can I Expect?

The hospice philosophy is a holistic one that embraces the physical, emotional, social and spiritual aspects of every patient. But remember: this journey is not about the patient alone. It involves the patient's entire supportive network. Hospice care is interdisciplinary-including physicians, nurses, social services (social workers, clergy, volunteers and bereavement staff)-and everyone involved is prepared to support you on the road ahead.

Hospice care is synonymous with supportive care. Whether you are the patient or the caregiver, we stand ready to provide practical guidance, training, and nursing supervision so the patient can remain at home as long as possible. We provide state-of-the-art pain management and symptom control. Other resources and services include home health aides, who can assist with care when appropriate; volunteers who can provide respite or companionship; medication relative to the terminal diagnosis; and equipment such as hospital beds. When remaining at home is not an option, hospice services are provided elsewhere: at nursing homes, residential care facilities, or a hospice facility, if your community has one.

Steps to Take

Living with a terminal illness impacts every area of a patient's life as well as a caregiver's. There are new decisions and challenges daily. Everything from your finances to your career, social life and plans for the future will be impacted. The hospice team can help you identify coping strategies. You and your loved one are the important players here; it will be necessary to address end-of-life choices (what you want or don't want) to ensure these decisions are not made during a crisis. Let hospice help you with direction and guidance regarding some of these decisions. The National Hospice and Palliative Care Organization (NHPCO) suggests the following steps:

* Make an appointment with an attorney to prepare/update a durable power of attorney for financial decisions

* Update your life insurance policies as needed

* Provide your family and physician with copies of your advance directive (a document that states what you do and do not want in the event of a health catastrophe)

* Review your health insurance so you know what is covered and what isn't

* Write down important information such as names of banks, where safe deposit keys are, names of attorneys, etc., and share it with someone you trust

* Talk with your employer about disability and other benefits

Take one day at a time. There are many adjustments to be made. While living with terminal illness can be very difficult, the diagnosis can also be a blessing. Knowing that your time is limited puts things into perspective. It can also be a special time to examine relationships and repair them as needed. By electing to begin hospice care, you will acquire an entire team of professionals to help with care and decision-making. You don't need to feel alone. We will help you celebrate the remainder of life, and find some peace, understanding and balance.

Please visit the Gilbert Guide for the very best in hospice and for more information about hospice care.

The Right Choice for Finding Hospice Nursing

by Ben Pate

Being told that you are dying and that you need to have hospice care can be very difficult to handle. This is care that is offered only to those who are dying, and generally have less than six months to live. While it is a hard choice, it can often be a good one to make for you and your family.

This type of care is often used to make sure that you die with dignity and in as much comfort as possible. It allows you to live the last part of your life pain free, and can allow you a better quality of life for what remains with quality health care. This care is personalized to both you and the family, so you get exactly what you need to achieve these goals.

This type of care is very family oriented. It can help to take the burden of care off the family, allowing the family to enjoy time with their loved one without having to worry about the day-to-day care. This type of hospice facility can make it more pleasant for everyone involved. There are often no set visiting hours if you are at a clinic and they do strive to keep the families together for as long as possible.

They hire caring health care professionals and have some of the most sensitive people in the industry. Many of these caregivers truly care about their patients
and work hard to ensure that the care they give is excellent and done gently. In many cases, the staff gives care beyond just performing a duty. They truly care and it shows.

Spiritual care is also attended to. While the facility itself does not offer religious counseling, it can place the patient in contact with members of their own faith to keep them connected to their own individual spirituality. They will help plan for funerals and offer therapy to cope with death and loss to everyone involved.

They try hard to provide this service in your own home. Many people find this to be one of the most appealing things about the care. If you have to be in an extended care hospice, but would prefer to be at home, they will make every effort to move you there if it is at all possible. They will try their best to follow any wishes about your care you may have.

They also provide bereavement help. The surviving family members can take advantage of the comfort and support the staff offers and they can make the process of death easier to the ones left behind. They can put the family in touch with groups that can offer grief counseling, and many times will do this themselves before the patient dies so that the survivors can accept the death.

The meaning of hospice counseling is end of life care, but it can be a comforting choice to make. Families are allowed to spend as much time with their loved ones as they want, and they give a better quality to the life by providing this hospice. From patient care to bereavement care, this can be a good choice to make.

Hospice is for the Living

For most people, the word "hospice" conjures up one thought - death. Yet in the years I have worked for hospice, I cannot ever remember caring for a dead person. The people cared for by hospice are very much alive - and most want to live as fully and as comfortably as possible until the last moment.

This quote, from an article on The Journal, does an excellent job of describing the idea behind hospice. It is important for patients and their families to understand that accepting hospice care is not about giving up hope, but enjoying life and everything it has to offer.

Hospice Care Extends Life

Dealing with the realities of death is often difficult, but when the conditions are right, making the choice to commit to hospice care can extend patient's lives. St. Louis Today reports:

One study at the University of Michigan showed that cancer patients who chose palliative care that relieved their symptoms lived 39 days more than those who continued to receive aggressive care from their oncologist. A study done by the Kaiser Permanente showed that palliative care not only cost less but improved satisfaction during the dying period.

While it is always the choice of the individual and their loved ones, there are many statistics to support the benefits for patients who enter hospice programs.

Curative Hospice Care

Since 2007 Congress and Medicare have realized that, with medical advances such as the CT-Scan, PET-Scan, open heart and by-pass surgery, radiation and chemotherapy that Medicare could not insist that hospice patients cannot take advantage of these possibilities, while fighting his or her disease. Medicare and private insurers adopted an "open access" policy, admitting into hospice-for curative and/or palliative treatment, as long as a doctor said they had no more than six months to live.

Thus hospice has become a comprehensive health care program for the seriously ill, who may or may not be close to death. Indeed, as I have learned, it is not at all rare that a beneficiary can get well enough to graduate from hospice.

This quote from a Huffington Post article describes a major change in hospice care that many are still completely unaware of. No longer must patients choose whether or not to give up curative treatment in return for the comfort and care provided by hospice, they are now able to undergo procedures and treatments that have a chance of improving their prognosis as well. With the ability to provide for physical and mental comfort at home or in a center, combined with the recent changes encouraging curative care as well, hospice is the right choice.

New Hospice Options

Many have been concerned that the changing Medicare programs will cease to provide hospice care but, as this quote from Investors.com explains, the new programs will actually open up more opportunities for patients:

People in hospice care no longer have to give up getting curative treatment, thanks to a new law. It allows Medicaid, the state-federal program for the poor, to cover simultaneous hospice and curative care for children with terminal illnesses. Medicare, which covers seniors and disabled people, will offer 15 similar projects. For example, someone with heart disease can get cardiac drugs while receiving hospice care.

Although some patients may choose to refuse curative treatment, there are many who would like to receive said treatment in the comfort and peace of a hospice rather than a bustling and impersonal hospital.

Hospice Volunteers Make a Difference

Three mornings a week Kelsey Crawford starts her day in the company of an 89-year-old woman with short white hair. As she enters the home of the woman, she sees her sitting comfortably with a blanket snuggly wrapped around her body. Her head barely reaches the height of the chair that Crawford normally finds her in. The woman looks away from the television and greets Crawford with a warm smile. Crawford can think of no better start to her day.

As this quote from a Kansan.com article illustrates, it is not only professionals and their patients who participate in hospice care. Many hospice programs accept and encourage volunteers who share some of their time to entertain and aid their charges. These volunteers add yet another dimension of comfort to the hospice experience that is simply not available in a traditional hospital.

Discussing Care

One issue that prevents some from utilizing hospice care is the simple fact that many doctors are resistant to discussing such issues with their patients until it may be too late to do so. This was the topic of a recent survey, described in the following quote from a NY Times article:

The researchers surveyed 4,074 doctors who took care of cancer patients, instructing them to imagine one who had only four to six months left, but was still feeling well. Then the doctors were asked when they would discuss the prognosis, whether the patient wanted resuscitation or hospice care, and where he or she wanted to die.

The results came as a surprise: the doctors were even more reluctant to ask certain questions than the researchers had expected. Although 65 percent said they would talk about the prognosis “now,” far fewer would discuss the other issues at the same time: resuscitation, 44 percent; hospice, 26 percent; site of death, 21 percent. Instead, most of the doctors said they would rather wait until the patients felt worse or there were no more cancer treatments to offer.

While it is difficult to discuss end of life care, a bit of forethought and planning can make this time as easy and comfortable as possible for both patient and family.

Extraordinary Measures

When Hospice Care Corporation’s Regional Inpatient Care Center opened one year ago, their goal was to provide their patients with the highest level of service in a home-like caring manner. But, you’ll find that the Hospice Care Regional Inpatient Center is quite different from most medical facilities in more ways than one. For example, their visiting hours, policies on food, beverages, children, and pets and even overnight stays for guests are far more relaxed.

However, another difference is not so obvious…it’s their patient beds. The beds were no ordinary purchase, because these are no ordinary beds. Hospice Care spared no expense for high-tech beds made by Völker which stimulate circulation, allow better physical positioning for their users, and just plain look great. The beds were designed to incorporate topical stimulation, along with other features, to have a variety of positive effects on a person’s body and state of mind.

Hollywood has taken notice, and in the 2010 movie release, ‘Extraordinary Measures’ featuring Harrison Ford and Brendan Fraser, the Völker bed is featured. 'Extraordinary Measures' is inspired by the true story of John Crowley, a man who defied conventional wisdom and great odds, and risked his family's future to pursue a cure for his children's life threatening disease.

Patients in rehabilitation centers and nursing homes today arrive with more major health problems and live longer than in previous generations. The need for beds and other equipment that can improve their quality of life has never been greater.

Cynthia Woodward
Hospice Care Corporation

Hospice CNA

by Karen Williams

A hospice is defined as a medical facility providing emotional and mental health care services for patients who are terminally ill along with their families. A CNA providing services in a hospice, is generally referred to as hospice CNA. A CNA with considerable experience and a regular CNA certification can take up job at a hospice, no additional qualifications are needed. A hospice CNA can either get employed at a hospice center or at a patient's home.

A hospice nurse usually provides solace and comfort to patients who are at the end of their life by taking care of them and their respective families too. Thus they provide both emotional and physical support to the patients and families. A hospice nurse usually takes complete care of the patients by administering medications on time and providing massages to provide comfort, if any required. They generally take utmost care of their patients and find every possible way to keep them away from pain.

They even educate the families of patients and teach them the methods of taking care of their loved ones, if the patients prefer to be taken care of, by their families, instead of being in hospital. This way they ensure that the patient's last days are lead in the comfort of their loved ones.

In case, a hospice nurse gets employed to take care of a terminally ill patient, then at times they even prefer to do some simple household chores, so that, the patient's family members get maximum time to spend with the patient. This gives the families some more time to be spent with their loved one, who is on the death bed, counting days.

On an average, a hospice nurse can earn up to $57,280 a year. Being a hospice nurse, is not a child's play. They need to have a lot of patience, need to know how to keep their cool at times of stress, need to be cheerful and pleasant, should be friendly, so that they can easily build a rapport with the patient, should be able to easily communicate with the family members in such a manner that, the family members understand what they want to convey. They need to be able to provide comfort and solace to the family members.

They should be wise enough and able to keep the stress resulting from the job, off their own personal life. Their job is really demanding and an emotional one too. A hospice nurse needs to be an epitome of incredible compassion, spirituality, patience. Also, the ability to work with people from diverse backgrounds is also necessary.

If you are an youngster pursuing education in CNA and are interested in taking up a job in hospice, then, try to utilize the rotation policy of your school and take up work in a hospice setting, this way you can get a feel of the typical life of a hospice CNA.

Karen Williams has worked as a CNA for several years and now runs a CNA Training information website to assist others looking to start or further their careers in the nursing industry. For more information visit: http://www.yourcnatrainingguide.com

10 Things You Should Know about Hospice Care

by Rebecca Sharp Colmer

Hospice provides support and care for persons in the last phases of incurable diseases so that they may live as fully and comfortably as possible. Hospice recognizes dying as part of the normal process of living and focuses on maintaining the quality of remaining life.
Here are ten things you should know about hospice care:

1. Hospice is a special approach to caring for terminally ill patients that stresses palliative care (relief of pain and uncomfortable symptoms) as opposed to curative care.

2. Most hospice care focuses on keeping the patient at home, yet there are hospices located in hospitals, skilled nursing facilities, and home health agencies.

3. Admission to hospice is predicated on the poor prognosis of the patient. This is generally stated as "6 months or less if the disease runs its expected course."

4. There are different "auspices" of programs providing hospice care. Some of these include: an inpatient hospice unit at a hospital or nursing home, a community-based hospice, a free-standing, inpatient hospice, a home care organization that provides hospice care with specially trained home care hospice nurses and volunteers, corporations that provide hospice care, continuing care retirement community hospice programs, and other models like HMOs.

5. The hospice and palliative care team may include: patients and families, clinician, social workers, physicians, dieticians, bereavement counselors, spiritual counselors, volunteers, physical therapists, occupational therapists, speech-language pathologists, home health aides, pharmacists, and others.

6. Pain and symptom management are a specialty area in hospice. Most patients receive a complement of pain solutions.

7. In addition to pain management, some of the hallmarks of hospice care include: knowledge of concepts related to death and dying, stress management skills, sensitive communication skills, a sense of humor, flexibility, and hospice and palliative care knowledge.

8. Many insurers now cover or reimburse hospice programs for hospice services.

9. Hospice team members and their clinical practice are described every day to surveyors, peers, and managers through the review of clinical records. The clinical record is a legal document.

10. Bereavement counseling is a part of the hospice organization's planned intervention program for survivors and is a key indicator of the quality of hospice services.

Today hospice has a major role in the healthcare movement. The terminally ill have options and the quality of their lives can still be within their control.

This article was written by Rebecca Sharp Colmer, a Certified Senior Advisor and the creator of MeAndMyCaregivers, a company who offers management and peace of mind over your loved one’s medical, financial and social well being. Learn more at http://www.meandmycaregivers.com

Hospice Care Makes Sense

What if I told you about an organization you could call when your elderly parent became so seriously ill that it appeared unlikely she’d recover?

What if I told you that this organization would send well trained nurses to see your parent, aides to lend a hand with daily care, a social worker to help the family grapple with the emotional difficulties? That these folks would deliver equipment you might need — a hospital bed, say, or wheelchair — and all your parent’s drugs? What if they’d also send a chaplain if you wanted one? And provide a nurse to call 24/7 when you had questions or problems? And volunteers who would stay with your parent while you took a few hours’ break, even if just for a long, quiet walk?

And what if I told you all this would cost you nothing, that Medicare would pay for it all? You’d pick up the phone, right? It’s what caregivers so often yearn for and so seldom can locate: expertise, compassion, help that they can afford.

Now, what if I told you this organization was a hospice?

This quote from a New York Times blog post provides compelling arguments for why hospice care is the ideal solution to the inevitable issues that come with the end of life. Affordable, professional, and comfortable, hospice provides the attention and care that patients and their families deserve.

What is The Journey of a Dying Patient?

by Samuel Oliver, author of, "What the Dying Teach Us: Lessons on Living"

Hospice patients come to our care after being cut, burned, and poisoned. Surgery, chemotherapy, and radiation treatment are the normative methods of care for most of the patients who enter a life-threatening disease. Hospital staff members are trained to be aggressive about curative care

Hospice care is a phase of care whereby aggressive treatment is no longer appropriate. Palliative care becomes the norm. Patients have been probed physically, mentally, and emotionally. In many ways, patients may be reluctant to any type of care beyond the experiences that led to his/her doctor sharing that no more can be done.

The purpose of this article is to claim that much more can be done. Our Doctors and Nurses are trained to help patients receive medication that stabilizes and even diminishes pain and suffering physically. Social Workers are trained to help patients and families deal with emotional, practical, and legal issues surrounding loss and grief. Spiritual Counselors help with the integration of emotional well being and a sense of faith and hope beyond one's self-awareness.

The Heart of Care

The heart of care centers it's attention on the needs of the patient who is dying. Any attempt to move a patient away from his/her authentic character becomes a war of wills. As we listen and care for a person just as he/she is, we are allowing a person to die the way he/she lived. Our ability to meet a person in unconditional love will draw out the desire to be fully known by the patient. Here, we are given opportunities to meet him/her in grace and mercy.

Patients are not a disease. Patients are awakening into soul. Mary was a strong-willed person who did not want to die. She had a strong personality. She had many roles she carried out in life, and she wanted to hold on to them all. She was a mother, friend, wife, among many other roles.

About two weeks before Mary died, she shared with me that she became aware of two identities: one was her strong personality and the other was a presence of peace she could not explain. The closer Mary came to her dying, the more she could identify with wanting peace over suffering. This identity with her soul became more appealing to her than living in a body that was failing her. She was awakening into her authentic self.

The Heart of Compassion

A dying patient gives up so much in their dying that he/she is tempted to hold on to what is left in their life. Even if holding on means more pain and suffering, some patients do try to do so. As care givers, we need to be sensitive to this aspect of a patient's letting go process. A patient needs support and guidance to simply learn to move from letting go (an act of the will) to letting be (getting into harmony with one's dying). A person offering care will enter into the heart of compassion by giving a patient space to enter into this process of moving from "letting go" to "letting be."

As a person dies, their personality will give way to their soul. In the process, a heart is broken. This desire to escape a painful body and embrace peace (one's authentic-self) is complicated by the desire to remain with those he or she has loved. This built up tension creates a path one has to choose inside them that transcends individual and collective conscious awareness. In essence, this is a matter of survival for the soul. This path moves a person's soul forward.

Funeral services remind us, it is the soul of a person that draw us to face death and not the deceased body. These services serve as a symbol of transition for the loved one who has died and those reflecting on the life of the deceased. A relationship that once was created outside us and in the body of another person no longer applies. Now, relationships with the deceased are internal and completely within us creating an invisible bond forever linking our awareness to a spacial quality within us drawing those left behind deeper into soul.

An Awakened Heart

An awakened heart knows there is more to life than what appears on the surface.

Dying people lead us to this place where eternal relationships are forged into the deepest aspects of our nature. It is our nature to love and feel love. Even grief has the capacity to deepen our sense of sacredness toward those we love.

A year ago, I gave a talk for the National Hospice and Palliative Care Organization in Los Angeles, CA. I was gone about a week. When I returned, my youngest son gave me a big hug. I missed him and he missed me. I could feel him literally fill my heart with love. In a real way, my soul was touched by my son's soul. An awakened heart knows that this is the heart of relationships.

In the landscape of the soul, what matters in life IS NOT matter. When we begin to look through our eyes and not with them, we enter into a view of life from the perspective of soul. Insight, to see from within, enables us to encounter death with hope, with faith, and with love.

As we grow in our capacity to see from within, we enter into the heart of grief. This emergence into the nature of soul will sustain us through death and into life - eternal. May the Creator of us all give us strength for the journey.

Nursing Homes Lack Expertise in Recommending Hospice Care Placing Your Family Member at Risk

Your family member, sick and in pain, is in a hospital or nursing home and no one is available to help because the person is the next room is in critical condition and the entire floor staff is rushing around to help this person. You empathize thinking that if you were in a similar situation you would want everyone rushing around to save you. What you really do not know is that this emergency is due in some cases to financial self interest or lack of staff education regarding critical or end of life care. Most individuals do not fear death as much as the experience of a painful death and many nursing homes and assisted living facility staff do not have the training or desire to educate family members about hospice and palliative care services.

How can we make the stress of having a sick loved one, piled on top of daily stress easier for all involved when hospitals, nursing homes and assisted living locations often provide end of life care? Whether you recently experienced the loss of someone you know or are currently experiencing the decline of a loved one there are steps that can be taken to ease the journey but you must be the one to ask questions because many facility staff lack training in hospice and palliative care.

According to research by Lisa Welch, Ph.D. few nursing homes or assisted living facilities have written procedures for regularly assessing residents' terminal disease status or eligibility for hospice care. Instead, many staff members base their timing and referral of hospice based on their ability to recognize decline, their personal beliefs about hospice services and their initiative in raising hospice as an option. What happens when facility staffs have little or no education relative to palliative or hospice care and family members rely on their level of experience to help their loved ones? The result is often family frustration, little or no pain assessment or management for the loved one and a painful death.

In my work, I have been personally told by facility staff that their administration does not want them recommending outside hospice services because that means that money leaves the building. Or, as the research mentions, if there is no family requiring support, hospice is not recommended and is instead provided by their own staff, lacking hospice background. In these cases, offering hospice becomes a territorial issue founded by concerns over money and staffing. How can family members trust health care providers when the concern for money and self interest overrides the care needs of their family members at an especially critical time of life? This choice should not be a decision made by facility staff but the decision of the individual or family member involved.

"Additionally, timing of hospice referrals is often delayed because staff members believe that hospice is appropriate only for the very end of life. There was often a discrepancy of weeks or months between when staff reported recognizing terminal decline and when referral to hospice occurred." It is clear that training needs exist for staff relative to recognizing declines and understanding the benefits of hospice services. In defense of facility staff, I have experienced instances where fear of breaking rules or regulations or chastisement by a superior prevents staff from doing the right thing. However in these cases mysteriously a phone call or recommendation is made and I become involved to help families navigate the situation.

Until the level of palliative and hospice care education catches up with the need, family members will have a greater level of responsibility navigating the care of loved ones experiencing declines in health. It's never too early to ask about palliative or hospice care; however it can be too late. Too late is when a loved one is days away from passing and has already likely experienced a high degree of pain and discomfort. In the instance you ask and it is not quite time for palliative or hospice care, at least you have been proactive in your own education and when the time does come you'll be more prepared and less reliant on others to recognize the signs or request assistance.

Welch, Lisa C. Ph.D. et. al. Referral and Timing of Referral to Hospice Care in Nursing Homes: The Significant Role of Staff Members. The Gerontologist. Vol 48, No. 4, 477-484.

Pamela D.Wilson, The Care Navigator, specializes in consulting, planning and education for families and individuals experiencing transitions in health care. Contact her at The Care Navigator or visit The Care Navigator Blog for free information

Hospice Care Hosts “Walk or Bike for Hospice”

It’s time to hit the trail. Hospice Care Corporation is once again hosting its Preston County “Walk or Bike for Hospice”. This year’s event will take place on Sunday, May 2nd at the Rail Trail parking lot on Rt. 92 in Reedsville, WV.

By participating you will not only be enjoying the beautiful scenery and weather; but, supporting a very important cause. The “Walk or Bike for Hospice” provides funds to serve patients in our community who suffer from a life threatening illnesses.

“It’s been a few years since we have held this event and people began asking if we were ever going to host the walk again. And, I thought yes perhaps now is the time,” said Kim Riley, Fundraising Event Coordinator.

Participants can walk or bike in memory of a loved one or friend for by collecting sponsorships on behalf of themselves or a group. Certificates will be awarded to the top community group, church, school & business that collect the most money. Everyone that collects or donates $20 or more will receive a t-shirt and a free picnic will follow the event.


Registration begins at 1PM with the walking or biking starting at 2PM. Pre-registration is not necessary, but those under 18 years of age must have a parent signature on their form. Registration forms may be obtained at local banks and businesses. And, if you need more information about being a sponsor or registering to participate, please call Kim Riley at (304) 864-0884 or email her at kriley@hospicecarecorp.org

Hospice Information- Source Of Comfort For The Terminally Ill

Finding a hospice that answers all your concerns could be a challenging affair, both physically and mentally. Hospice information is available in plenty, and the important point is to look for the right care that understands your individual needs.

Initially you will have to invest a lot of time and effort on extensive research. The results could be discouraging in the beginning, however with time you will bear the fruits of your labor. It helps to understand your requirements before looking for a suitable hospice. There are innumerable factors you will need to look into, such as the efficiency of the staff, quality of services provided, quality of treatment, emotional and moral support provided, and lots more. The right information will help you understand and be aware of what you need to look out for.

When looking for a suitable hospice, you could go by the recommendations of qualified medical professionals or people with similar experiences of dealing with hospices. While there are several good hospices, there are also those hospices that have earned a bad name owing to negligent services. You would not want to go to a hospice that does not satisfy your requirements or live up to your expectations. This is why it is important to look around carefully and take the opinion of people who matter.
Searching in the yellow pages or online can also be an effective way to locate a good hospice in your area. You could also get in touch with organizations in your state and get a list of licensed hospices with eligibility certificates. This way you are certain to find proper and useful information that will address all your concerns.

Since a hospice is a place where patients with terminal illnesses go for proper treatment, it is important to choose one that provides quality care. This very concept revolves around caring for the terminally ill, making them much more than commercial medical centers. The main aim is to ease the pain and suffering of terminally ill patients. Therefore, the focus here is not so much on curing but reducing or assuaging the pain of patients with terminal sicknesses.

Hospice information focuses on educating patients and their families on the quality and professionalism required while treating terminally ill patients. In a professional and sophisticated hospice, the main goal is to give comfort to the patient, not just physically but also emotionally. A good hospice takes into account the individual needs of patients and their families. If needed, spiritual, emotional, and physical support is even provided to the family members of the patients.

Since each family is unique and different, information reinforces the need to look for a suitable hospice that can meet all your physical, emotional, spiritual, and social needs. Terminally ill patients require special care and attention, and only trained and skilled medical professionals are well suited for the job. Patients who go to hospices are looking for a caring and homely environment where they can rest and find solace during their last days.

Agencies providing hospice services work towards providing the best service to the terminally ill patients ensuring maximum comfort and minimum inconvenience. Visit the http://www.hospice-info.net/ site for more hospice information.

Hospice: The 4 Levels of Care

by the Caring.com Editorial Team

There are four levels of care provided by hospices in the United States. Every patient receiving hospice services will be on one of these four levels. A hospice patient can move from one level to another and back, depending on the services required to fulfill his or her needs. The need of the patient will determine their individual level of care.

Routine Home Care Patient at home with symptoms controlled

A patient will be placed at this level of care if he or she resides at home (or a long-term care facility) and does not have symptoms which are out of control. These symptoms could include-but aren't limited to-severe pain, continuous nausea and vomiting, bleeding, acute respiratory distress, and unbearable restlessness or agitation. A patient at this level has access to the following services:

Registered Nurse Visits, Social Worker Visits, Chaplain Visits, Home Health Aide Services, Counselors, Medications, Equipment.

The needs of the patient determine the number of visits from hospice staff members. These needs are established and outlined in a plan of care formed by the hospice team and the patient's physician. The care plan serves as a guideline to assist all those serving the patient with care. At this level of care the patient also has access to an on-call hospice nurse twenty-four hours a day.

Inpatient Care Patient in facility with uncontrolled symptoms

A hospice patient may require inpatient care when his or her symptoms have gotten out of hand and can no longer be managed at home. When these symptoms cannot be controlled on routine home care, then the patient requires extra attention until these symptoms subside. Hospices take aggressive actions to control the symptoms and make the patient comfortable. In order to do this, the patient may be temporarily placed in a hospice home or an acute care hospital. At this level of care, a moment-to-moment assessment of what's happening and what needs to be done takes place. The hospice team and the patient's physician work together to ensure the patient obtains and maintains a tolerable comfort level. Once this has been achieved, the patient will return home and back to routine home care.

Respite Care Patient at facility with symptoms controlled

A patient may be moved to respite care when the caregiver needs a break. Many hospice patients live at home, with their family providing most of the care, sometimes around the clock. Caring for their loved one can be exhausting and very stressful. The family members and/or caregivers need time to themselves and it's important that they take that time. Respite care allows a patient to be temporarily placed in a facility with 24-hour care so the family can rest. If the patient is willing and the family requests it, hospice must provide placement in a facility or a hospice home for the patient. The patient will be transferred to the facility, and according to Medicare regulations, can stay for up to five days before being transferred back home.

Continuous Nursing Care Patient at home with uncontrolled symptoms

A patient would receive continuous nursing care if he or she has symptoms that are out of control and choose to stay at home. This is similar to inpatient care, except that the patient remains in his or her home instead of being placed in a facility. A hospice nurse is required to provide continuous around-the-clock nursing care if the symptoms cannot be controlled while on routine home care. According to the Hospice Patients Alliance, there is only one exception to this requirement: if the hospice has fewer than seven employees, is in a rural or nonmetropolitan area, and does not have the staff to provide continuous nursing care in the home. However, most hospices are required to provide this level of care if it is needed.

Caring.com features original content focused exclusively on eldercare matters. Our 20+ editors and writers research and fact-check every article meticulously, and our advisory board reviews the site regularly to assure the accuracy and relevance of the material we publish. We have hundreds of articles and checklists on health, housing, finance, legal and family issues, and other caregiving concerns, and we're adding new articles and other resources every day

Hospice & Palliative Care: Where's the Common Ground?

By the Caring.com Editorial Team

Receiving "The News" A person faced with a new diagnosis that is life-limiting is generally overwhelmed. Everything has changed, and nothing will ever be the same. All of the grief stages can come into play: denial, anger, bargaining, depression and ultimately, acceptance. The person might wonder, Why me? Why now? Can I beat this? The situation can become overwhelming when coupled with confusing medical jargon about palliative care and hospice care. Let's start by clarifying the care options that are available.

Palliative care for life-limiting disease naturally follows curative treatments.

Treatments can include chemotherapy, radiation, blood transfusions, dialysis, physical therapy and more. The goal is to achieve the highest quality of life for the patient while trying to control or eradicate the disease process. This is a time for hope and challenge for the patient and family. It is generally only when all treatment options fail or have been exhausted that the physician may suggest comfort care, which is also known as hospice care.

Similarities & Differences Hospice care and palliative care both provide compassionate care for patients facing life-threatening illnesses. Both share a team-oriented approach to medical care: pain management, symptom management, and emotional and spiritual support that are patient-specific. Both share a common core belief as well: that every patient deserves the very best care possible, and that each of us has the right to die with dignity and respect, pain-free. In fact, the word palliate refers to giving comfort (but not cure). The differences between the two disciplines are subtle. While all hospice care is palliative or comfort care, not all palliative care is considered hospice care. Confused?

Let's look at it another way. The focus of hospice is on caring, when curing is no longer an option. To be eligible for hospice care, two physicians (the primary physician and the hospice physician) must certify the patient's prognosis to be six months or less, should the disease run its natural course. The hospice philosophy embraces death as a natural part of life, and encourages a patient's desire for dignity, respect, and autonomy over his or her own care. Aggressive symptom management and pain control support this philosophy.

Most hospice care is provided in the patient's own home. Some care is also provided in nursing homes, residential care facilities and hospice facilities. Services are provided regardless of religion, race, age or illness. The patient care goals are centered on quality of life as opposed to quantity of life. Hospice care is covered under the Medicare Hospice Benefit, Medicaid, most private insurance plans, HMOs, and other managed care plans. All charges related to the terminal diagnosis, such as medications, durable medical equipment (e.g., a hospital bed), and nursing and supportive services, are paid by the benefit. Hospice care, therefore, is both a philosophy and a method of health care financing for terminally ill patients and families.

Palliative care is very similar to hospice care, but with a broader population. It is not time-restricted-indeed, it can last for years-and no specific therapy is excluded if it can improve the patient's quality of life. Palliative care helps meet the needs of patients and families who are not yet eligible for hospice services as well as those who still want to pursue more aggressive treatments not covered under the hospice reimbursement system. Payment for palliative services is generally paid by the patient's insurance, Medicare or Medicaid (but not under the hospice benefit). Goals of care focus on improving quality of life and helping support patients and families during and after these treatments. Whereas palliative care is appropriate from terminal diagnosis on, when prognosis is uncertain, hospice care focuses on supporting patients with a life expectancy of months, not years. From that standpoint, palliative care should naturally follow curative care, and then evolve into hospice care as the disease process progresses.

Looking to the Future The hospice benefit is written for comfort care only, and is intended for patients with terminal illnesses who have exhausted all curative and therapeutic treatments. In that sense, it can be abrupt and frightening, and generally results in very late hospice referrals from physicians. The challenge for hospices is to find a way to transition from one discipline to another. Patients should have a safe place to explore care options while still receiving palliative treatments-without pressure to enroll in the hospice program later on. This is an important step in patient continuity of care, and one that warrants further attention.

Currently, hospice and palliative care are separate disciplines. Helping patients and families deal with terminal diagnoses and navigating the various palliative therapies available is the goal of both. Finding a way to blend the two would help alleviate the confusion many patients and families experience and help motivate physicians to discuss end-of-life care options earlier in the disease trajectory.


Caring.com features original content focused exclusively on eldercare matters. Our 20+ editors and writers research and fact-check every article meticulously, and our advisory board reviews the site regularly to assure the accuracy and relevance of the material we publish. We have hundreds of articles and checklists on health, housing, finance, legal and family issues, and other caregiving concerns, and we're adding new articles and other resources every day