Tuesday, April 13, 2010
What is the Difference Between Hospice and Palliative Care?
American hospice service started with the Connecticut Hospice in March 1974. Today, there are over 2,884 Medicare-certified hospices, and an additional 200 volunteer hospices in the U.S., with as many as 1.5 million Americans seeking hospice treatment in recent years. As a program designed to facilitate palliative care for terminally ill patients and their families, many people wonder, what then is the difference between hospice and palliative care, or are they one in the same?
While palliative care addresses patients with life-threatening illnesses, anyone, regardless of life expectancy, can receive this type of care. Hospice, meanwhile, provides for patients who can no longer benefit from regular medical treatment, per a doctor's determination, and are in the last stages of a terminal illness. Hospice and palliative care share the philosophy of maintaining and managing the patient's quality of life. Palliative care programs generally address the physical, psychosocial, and spiritual needs and expectations of a patient with a life-threatening illness, at any time during that illness, even if life expectancy extends to years.
Palliative care does not preclude aggressive treatment of an illness, and provides comfort to patients and their loved ones. Patients receive palliative care from a team of doctors, nurses, social workers and clergy in their home or a hospital, but also in nursing or assisted living facilities. Hospitals, hospices, skilled nursing facilities and health care clinics provide these services, which may include a monthly visit to a doctor, or weekly home visits from a social worker or nurse to help manage pain and symptoms. The goal of hospice care is to keep pain and suffering of a person with a terminal diagnosis to a minimum, and not to cure the illness. Provided in the patient's home or in hospice centers, hospitals, skilled nursing homes and other long-term care facilities, hospice is based on the belief that every person has the right to die pain-free and with dignity, and with family and friends nearby.
Like palliative care, a hospice team is comprised of doctors, nurses, caregivers, social workers and trained volunteers who manage the patient's pain and symptoms; assist with the emotional and spiritual aspects of dying, provide needed medications and supplies, coach the family on how to care for the patient, and, provide bereavement counseling to surviving loved ones. While Medicare, Medicaid, most private insurance plans, HMOs, and other managed care
organizations provide hospice coverage, Medicare or Medicaid does not currently cover palliative care.
Some private insurance companies cover the costs of care, but it is important for you to ask the palliative care provider how or if the services will be covered and what, if any, costs you will be asked to pay. The goal of hospice care is to keep pain and suffering of a person with a terminal diagnosis to a minimum, and not to cure the illness. Provided in the patient's home or in hospice centers, hospitals, skilled nursing homes and other long-term care facilities, hospice is based on the belief that every person has the right to die pain-free and with dignity, and with family and friends nearby.
Please visit the Gilbert Guide for the very best in Hospice Care and for more information about Palliative Care.
Monday, April 12, 2010
Recipes from the Heart
For more information, contact Kim Riley at 304-864-0884 or e-mail kriley@hospicecarecorp.org
Saturday, April 10, 2010
Funeral Pre-Planning: How To Discuss Wishes With Family
Many people find it unpleasant to think or talk about their own deaths, but preplanning your funeral is one of the best things you can do for the loved ones who will be carrying out your final wishes. As your family gathers to celebrate the holidays, it's a good time to think about discussing your final wishes with those closest to you.
Benefits of preplanning a funeral
Although it may be uncomfortable, planning your funeral is beneficial for several reasons:
1. You will relieve your grieving loved ones of much of the stress associated with planning a funeral.
2. You will have the chance to decide what aspects of your service are important to you.
3. You can ensure you and your remains are treated in accordance with your own values regarding life and death.
4. You'll minimize disputes between family members.
End-of-life care
Funeral preparations aren't the only decisions you should consider making ahead of time. In the event that you become terminally ill, it's a good idea to let your family members know what type of care you wish to receive during your final days. Things you might want to think about include:
1. Who should make your health care decisions if you become unable to make them for yourself.
2. What medical treatments you wish to receive. You can decide whether to be given pain medication, artificial nutrition, and hydration.
3. Whether you wish to be resuscitated if your heart stops or you stop breathing.
4. Where you wish to spend your final days. You may wish to stay at home rather than be hospitalized, for instance.
Broaching the subject
When discussing your final wishes, you should begin by having a conversation with yourself in which you look closely at your desires and begin articulating your choices. Do you want to be buried or cremated? Would you prefer a traditional funeral service or something different? How would you like to be remembered?
It's a good idea to speak with funeral directors at this stage to get a feel for the available options and what they cost. They can help you determine what decisions need to be made.
Once you've figured out your own preferences, it is time to broach the subject with your family. Be open to their input, but be clear and firm about what you want. It can be a difficult and emotional conversation, but making sure everyone is on the same page is an important part of the funeral planning process. It can sometimes be helpful to include outside experts, such as a clergy member or your family physician.
When you're ready, put your specific wishes in writing and leave a copy with at least one trusted loved one. This will help alleviate confusion or disputes later on. However, keep in mind that any verbal or informal conversations you have about your decisions may not be enforceable. In order to legally ensure your wishes will be carried out, you'll need a legal and witnessed document such as a will, a living will, or a medical directive.
Once you've made your wishes clear, you can enjoy peace of mind of knowing you've done everything you can to make your funeral and final days as easy as possible for those who are left behind.
Friday, April 9, 2010
Living Wills and Health Care Directives - "What is Involved?"
The following is an example of a Health Care Directive (many people still refer to this as a Living Will). It is broken down into 3 basic parts. 1) Appointment of the Health Care Agent. 2) Health Care Instructions. 3) Making the Document Legal. Like most legal documents, it can be a bit confusing and overwhelming. The purpose for making this easily available to the public is simple. To help people know what to expect before contacting a lawyer and having him or her draft a directive for them. Nobody likes thinking about their demise or incapacity. However, dealing with such issues is a necessary part of life.
This example should not be used as a substitute for getting solid legal advice from a licensed attorney. Every individual is different. Please consult a lawyer in your area to discuss your specific estate planning needs.
HEALTH CARE DIRECTIVE
I, ___________________________________, understand this document allows me to do One or both of the following:
PART I: Name another person (called the health care agent) to make health care decisions for me if I am unable to decide or speak for myself. My health care agent must make health care decisions for me based on the instructions I provide in this document (Part II), if any, the wishes I have made known to him or her, or must act in my best interest if I have not made my health care wishes known.
And/or
PART II: Give health care instructions to guide others making health care decisions for me. If I have named a health care agent, these instructions are to be used by the agent. These instructions may also be used by my health care providers, others assisting with my health care and my family, in the event I cannot make decisions for myself.
PART I: APPOINTMENT OF HEALTH CARE AGENT
This is who I want to make health care decisions for me if I am unable to decide or speak for myself (I know I can change my agent or alternate agent at any time and I know I do not have to appoint an agent or an alternate agent)
NOTE: If you appoint an agent, you should discuss this health care directive with your agent and give your agent a copy. If you do not wish to appoint an agent, you may leave Part I blank and go to Part II.
When I am unable to decide or speak for myself, I trust and appoint ___________________ to make health care decisions for me. This person is called my health care agent. Relationship of my health care agent to me: ___________________
Telephone number of my health care agent: _________________________
Address of my health care agent: _________________________
(OPTIONAL) APPOINTMENT OF ALTERNATE HEALTH CARE AGENT: If my health care agent is not reasonably available, I trust and appoint _________________ to be my health care agent instead. Relationship of my alternate health care agent to me: ___________________________Telephone number of my alternate health care agent: ___________________________ Address of my alternate health care agent: ___________________________
THIS IS WHAT I WANT MY HEALTH CARE AGENT TO BE ABLE TO
DO IF I AM UNABLE TO DECIDE OR SPEAK FOR MYSELF (I know I can change these choices)
My health care agent is automatically given the powers listed below in (A) through (D).
My health care agent must follow my health care instructions in this document or any other instructions I have given to my agent. If I have not given health care instructions, then my agent must act in my best interest. Whenever I am unable to decide or speak for myself, my health care agent has the power to:
(A) Make any health care decision for me. This includes the power to give, refuse, or
withdraw consent to any care, treatment, service, or procedures. This includes deciding whether to stop or not start health care that is keeping me or might keep me alive, and deciding about intrusive mental health treatment.
(B) Choose my health care providers.
(C) Choose where I live and receive care and support when those choices relate to my
health care needs.
(D) Review my medical records and have the same rights that I would have to give my
medical records to other people.
If I DO NOT want my health care agent to have a power listed above in (A) through (D) OR if I want to LIMIT any power in (A) through (D), I MUST say that here:
______________________________________________________________________
My health care agent is NOT automatically given the powers listed below in (1) and (2). If I WANT my agent to have any of the powers in (1) and (2), I must INITIAL the line in front of the power; then my agent WILL HAVE that power.
______ (1) To decide whether to donate any parts of my body, including organs, tissues, and eyes, when I die.
______ (2) To decide what will happen with my body when I die (burial, cremation).
If I want to say anything more about my health care agent's powers or limits on the powers, I can say it here: ________________________________________________________________________
PART II: HEALTH CARE INSTRUCTIONS
NOTE: Complete this Part II if you wish to give health care instructions. If you appointed an agent in Part I, completing this Part II is optional but would be very helpful to your agent. However, if you chose not to appoint an agent in Part I, you MUST complete some or all of this Part II if you wish to make a valid health care directive.
These are instructions for my health care when I am unable to decide or speak for myself.
These instructions must be followed (so long as they address my needs).
THESE ARE MY BELIEFS AND VALUES ABOUT MY HEALTH CARE
(I know I can change these choices or leave any of them blank)
I want you to know these things about me to help you make decisions about my health care:
My goals for my health care: ________________________________________________________________________________________________________________________________________________
My fears about my health care: ________________________________________________________________________________________________________________________________________________
My spiritual or religious beliefs and traditions: ________________________________________________________________________________________________________________________________________________
My beliefs about when life would be no longer worth living:
________________________________________________________________________________________________________________________________________________
My thoughts about how my medical condition might affect my family:
________________________________________________________________________________________________________________________________________________
THIS IS WHAT I WANT AND DO NOT WANT FOR MY HEALTH CARE
(I know I can change these choices or leave any of them blank) Many medical treatments may be used to try to improve my medical condition or to prolong my life. Examples include artificial breathing by a machine connected to a tube in the lungs, artificial feeding or fluids through tubes, attempts to start a stopped heart, surgeries, dialysis, antibiotics, and blood transfusions. Most medical treatments can be tried for a while and then stopped if they do not help. I have these views about my health care in these situations: (Note: You can discuss general feelings, specific treatments, or leave any of them blank)
If I had a reasonable chance of recovery, and were temporarily unable to decide or speak
for myself, I would want:
________________________________________________________________________________________________________________________________________________
If I were dying and unable to decide or speak for myself, I would want:
________________________________________________________________________________________________________________________________________________
If I were permanently unconscious and unable to decide or speak for myself, I would want:
________________________________________________________________________________________________________________________________________________
If I were completely dependent on others for my care and unable to decide or speak for
myself, I would want: .....
________________________________________________________________________________________________________________________________________________
In all circumstances, my doctors will try to keep me comfortable and reduce my pain. This is how I feel about pain relief if it would affect my alertness or if it could shorten my life:
________________________________________________________________________________________________________________________________________________
There are other things that I want or do not want for my health care, if possible:
Who I would like to be my doctor:
________________________________________________________________________________________________________________________________________________
Where I would like to live to receive health care:
________________________________________________________________________________________________________________________________________________
Where I would like to die and other wishes I have about dying:
________________________________________________________________________________________________________________________________________________
My wishes about donating parts of my body when I die:
________________________________________________________________________________________________________________________________________________
My wishes about what happens to my body when I die (cremation, burial):
________________________________________________________________________________________________________________________________________________
Any other things:
________________________________________________________________________________________________________________________________________________
PART III: MAKING THE DOCUMENT LEGAL
This document must be signed by me. It also must either be verified by a notary public
(Option 1) OR witnessed by two witnesses (Option 2). It must be dated when it is verified or witnessed.I am thinking clearly, I agree with everything that is written in this document, and I have made this document willingly.
___________________________________
My Signature
___________________________________
Date signed:
___________________________________
Date of birth:
___________________________________
Address:
If I cannot sign my name, I can ask someone to sign this document for me.
_____________________________________________________
Signature of the person who I asked to sign this document for me.
________________________________________________________
Printed name of the person who I asked to sign this document for me.
Option 1: Notary Public
In my presence on___________________________________ (date), __________________________________________ (name) acknowledged his/her
signature on this document or acknowledged that he/she authorized the person signing this document to sign on his/her behalf. I am not named as a health care agent or alternate health care agent in this document.
___________________________________________
(Signature of Notary)
(Notary Stamp)
Option 2: Two Witnesses
Two witnesses must sign. Only one of the two witnesses can be a health care provider or an employee of a health care provider giving direct care to me on the day I sign this document.
Witness One:
(i) In my presence on _______________________ (date), ________________ (name) acknowledged his/her signature on this document or acknowledged that he/she authorized the person signing this document to sign on his/her behalf.
(ii) I am at least 18 years of age.
(iii) I am not named as a health care agent or an alternate health care agent in this document.
(iv) If I am a health care provider or an employee of a health care provider giving direct
care to the person listed above in (A), I must initial this box: [ ]
I certify that the information in (i) through (iv) is true and correct.
______________________________________
(Signature of Witness One)
Address: ________________________________________________________________________________________________________________________________________________
Witness Two:
(i) In my presence on ________________________ (date), _________________ (name) acknowledged his/her signature on this document or acknowledged that he/she authorized the person signing this document to sign on his/her behalf.
(ii) I am at least 18 years of age.
(iii) I am not named as a health care agent or an alternate health care agent in this document.
(iv) If I am a health care provider or an employee of a health care provider giving direct
care to the person listed above in (A), I must initial this box: [ ]
I certify that the information in (i) through (iv) is true and correct.
________________________________________
(Signature of Witness Two)
Address:
________________________________________________________________________________________________________________________________________________
REMINDER: Keep this document with your personal papers in a safe place (not in a safe deposit box). Give signed copies to your doctors, family, close friends, health care agent, and alternate health care agent. Make sure your doctor is willing to follow your wishes. This document should be part of your medical record at your physician's office and at the hospital, home care agency, hospice, or nursing facility where you receive your care.
Some of this information was taken from Minnesota statute section 145C.16. This should not be considered legal advice, it is provided as a public service.
Written by Blake Vanderhyde. Learn more at http://www.yourminnesotalawyer.com and http://www.minnesotaestateplanningguide.com
Thursday, April 8, 2010
Planning for Tomorrow
Q. Why should we plan for tomorrow now?
A. Possible situation... I have vision difficulties but can still live without assistance. However, a year from now I may need help with cooking, cleaning, shopping, driving and paying bills.
Medications can be placed in a pre-programmed medication dispenser with monitoring company assistance. If the medication is not taken in a reasonable period of time, the company will call my son. Non-medical in-home care will be hired to attend to all these needs.
If I fall on the coffee table and spend a week in the hospital, the geriatric managers may recommend a rehabilitation center for treatment.
Whether I am able to return home or must move to a living facility, my family will hire an organizer to come in and rearrange furniture, lower items in the kitchen so they can be reached, removed unwanted items, and boxed up rarely used items.
A real estate agent will already be chosen, but not hired, just in case I must sell the home. Again, that is planning for the unknown. Whatever the outcome, the stress of last minute decision-making has been reduced.
Remember that part of this relocation process is finding a reliable moving company, and now there are companies that, for a fair rate, will pick up unwanted items.
Now, there are Adult Day Care Centers for individuals with mental challenges. Our senior center has one that gives family caregivers some respite time --providing the social interaction they need.
If I cannot return home because of extra caregiving needs, it may be appropriate to move into an Assisted Living facility, which is private pay. Assisted living facilities allow residents to feel more independent while having 24/7 caregiving when needed. Having social interaction with peers can reduce depression and keep the mind more alert. There are Continuing Care Facilities that have Independent, Assisted Living and Nursing Care all on the same property -- for easing into each other while being accessible to friends created on-site.
Spending time in the elder care field, I planned ahead by contacting a Long Term Care Insurance Specialist.
Next, my son was made legal guardian with all my finances in both of our names (Elder Care Attorney). In addition, my Financial Planner has made wise investments for me over the years. I made sure my son and other family members have copies of all paperwork. Each child understands the reason for my decision-making.
My friend did not plan ahead of time, has no money for care, and applied for Medicaid. This is why I am so passionate about planning ahead. This may mean that she will have to go into a nursing home rather than the assisted living facility.
A small amount of Assist Living facilities qualify for Medicaid Waiver programs. This means that Medicaid would pay some of the cost, which is great for those with financial difficulties. However, the waiting list for an opening could take years. Talk with a government agency about the options available in the meantime.
Another option is to live at home with 24/7 care, and use the equity of the home for a Reverse Mortgage. This option is a safety net, allowing for quality care in the comfort of your own home. There are advantages and disadvantages with using a Reverse Mortgage, so check with the Reverse Mortgage Specialists before making a decision. The key is to learn about it now. If you don’t use this, pass the information to others later.
In some states there are Senior Foster Homes, which are residential homes with 24/7 on-site care. With only four bedrooms, each resident receives personal care and can participate in responsibilities -- such as setting the dinner table. These homes can take the place of an assisted living or even nursing home. Professional staff is hired or the owner could be a licensed nurse. This is a great option but also requires private pay.
Hospice care is now provided in the home, the care facility, or their own hospice faculties. The requirement is usually a paper from the doctor saying it is predicted a person’s life will end within six months. Naturally, if this does not happen, the care should still be available. Different states may have different requirements for keeping hospice beyond that time. This is a service that is sadly underutilized. To my knowledge, there is no cost to the family for this service.
James Armstrong also serves as the Editor of NowWhatJobs.net, the resource for job and career transitions for workers 40 years old and over, Baby Boomers and Active Seniors. Read NowWhatJobs.net for skills training, relocation options, job opportunities and much more. In addition, James is the author of "Now What? Discovering Your New Life and Career After 50" and the President of James Armstrong & Associates, Inc., a media representation firm based in Suburban Chicago.
Monday, April 5, 2010
Hospice and the Family Caregiver
There is a sense of loss and sadness that begins when a family learns of a serious or life-limiting diagnosis, and the levels of stress can continue to grow throughout an illness. There can be a financial toll that caring for a dying loved one brings. Even when the role of caregiver ends, there are new issues that arise as the person incorporates the loss in their life as faces living without their loved one.
For family members thrust into the role of caregiver without warning or little preparation, the experience can be frightening.
Yet care exists that address many of these concerns: Hospice.
Hospice care provides high-quality care and services to the patient while offering invaluable support to the family caregivers. Through bereavement care and services, ongoing assistance for family caregivers continues even after the death of their loved one.
In addition to expert medical care and pain management, hospice focuses on the quality of life for patients and families. They help the people they serve live life to its fullest. The wishes of the patient and family are always a priority and hospice brings hope, dignity and peace to all they care for.
Support, caregiving training and assistance are made available by hospice professionals and trained volunteers. The entire hospice team brings compassion and empathy when they are needed most.
Many families concerned with the costs of care are often surprised to find out that hospice is fully covered by Medicare. Medicaid, most private insurance plans and HMOs also provide for hospice care. Yet hospices care for all in need, regardless of ability to pay.
Many people do not understand the support and comfort that hospice provides to patients and families at the end of life’s journey. A partnership is created between family caregivers and hospice staff that most noted for its deep compassion and caring.
Community hospices are ready to help family caregivers learn more about care options and available services. Helping patients and families during one of life’s most challenging journeys is what hospice does every day.
For more information, contact 1-866-656-9790 or visit http://hospicecarecorp.org/.
Saturday, April 3, 2010
Don't Wait
Far too many people wait until they are in the midst of a health care crisis before thinking about what options are available or what care they or their loved ones would have wanted. Hospice professionals deal with these challenging situations every day – that’s what they are trained to do.
When a family is coping with a serious illness and a cure is no longer possible, hospice provides the type of care most people say they want at the end of life: comfort and dignity. Considered to be the model for high-quality, compassionate care for people with a life-limiting illness, hospice care includes expert medical care, pain management, and emotional and spiritual support. Care is provided by an inter-disciplinary team of professionals and trained volunteers. The wishes of the patient and family are always at the center of care.
Most hospice care is provided in the home – where the majority of Americans have said they would want to be at this time. Care is also provided in nursing homes, assisted living facilities, and hospice centers.
Care is paid for by Medicare, Medicaid, and most private insurance plans and HMOs.
The National Hospice and Palliative Care Organization reports that more than 1.4 million people received care from our nation’s hospices last year.
Hospice providers can help with information about care options and choices and ensure you live as fully as possible throughout your entire life. They will make sure your loved ones receive support as well.
One of the best ways to make sure you and your loved ones benefit fully from hospice, should you ever need this care, is to talk about it before it becomes an issue.
For more information, contact 1-866-656-9790 or visit http://hospicecarecorp.org/.