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The Intersection of Post-Traumatic Stress Disorder (PTSD) and End-of-Life Care: How Hospice Can Help

PTSD is a mental health condition that can develop after exposure to a traumatic event. While often associated with veterans, PTSD can affect anyone at any age, including the elderly. This population may have experienced war, accidents, violence, or other traumas throughout their lives, leaving them vulnerable to PTSD symptoms at the end-of-life stage. Hospice care, with its holistic approach, is uniquely positioned to support patients with both the physical and emotional challenges of PTSD alongside the dying process.

PTSD in the Aging Population

Research suggests a potential overlap between PTSD and age-related cognitive decline [1]. Symptoms like flashbacks, nightmares, and hypervigilance can be particularly distressing for elderly patients already facing anxieties about mortality. Furthermore, social isolation, a common consequence of PTSD, can be exacerbated by the physical limitations often experienced in later life.

How Hospice Can Help

Hospice care offers a comprehensive support system that can significantly benefit patients with PTSD:

PTSD can be a significant challenge at the end of life. Hospice care, with its focus on comprehensive symptom management, emotional support, and spiritual guidance, is uniquely equipped to address the complex needs of patients with PTSD. By partnering with hospice care, medical professionals can ensure their aging patients with PTSD receive the compassionate and holistic care they deserve in their final journey.

References:

Industry Advocacy Award Winner: Ashley Jones

Homecare Homebase (HCHB), a leading software provider for home-based care, recently announced their 2024 Client Success Award winners. These awards recognize customers who exemplify excellence in quality care, performance innovation, and community impact.

We are pleased to share that Ashley Jones, RN, CHPN, Vice President of Hospice Clinical Practices and Quality was recently recognized by Homecare Homebase (HCHB) as a recipient of the Industry Advocacy Award. Jones was honored for her leadership in hospice care and advocacy for quality improvement, best practices, and staff satisfaction.

“We are incredibly proud to recognize these outstanding organizations and individuals. The 2024 Client Success Award winners exemplify the dedication, innovation, and compassion that define the home-based care industry. Their commitment to quality care and community services inspires us all.”

Scott Decker, Chief Executive Officer, HCHB

Congratulations to Ashley! We are honored to have a front-row seat to witness the impact you are making, and we look forward to your continued contributions in the years to come.

Understanding How Hospice Can Benefit Your Aging Male Patients: A Guide for Medical Professionals

Men’s Health Month serves as a timely reminder to focus on the specific healthcare needs of the aging male population. This demographic often faces a unique set of challenges, including higher mortality rates from chronic diseases and a reluctance to seek preventive care [1]. Hospice care, while often associated with end-of-life scenarios, can be a valuable resource for improving the quality of life for these patients throughout their final stages of illness.

Addressing Concerns: Masculinity and Caregiving

Traditionally, societal constructs of masculinity can discourage men from openly discussing their health concerns or seeking help [2]. Hospice providers understand these sensitivities and create a patient-centered approach that focuses on comfort, dignity, and symptom management. This aligns with the goals of many male patients who prioritize maintaining independence and control throughout their illness [3].

Holistic Care for the Aging Male

Hospice Care goes beyond just pain management. It encompasses a comprehensive approach that addresses:

Benefits of Early Hospice Referral

Early referral to hospice allows patients to:

Hospice care is a valuable resource for medical professionals seeking to extend comprehensive and compassionate care to their aging male patients. By facilitating early discussions about hospice and dispelling common misconceptions, we can work together to ensure a dignified and comfortable end-of-life experience for all.

References

  1. Men’s health.: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194982/ Kalchthaler, John M., and Harvey A. Feldman. “Men’s health.” British medical bulletin 101.1 (2011): 247-260.
  2. The meanings of illness for men: a review of the literature.: [invalid URL removed] Courtenay, Willis C. “The meanings of illness for men: a review of the literature.” Social science & medicine (1982) 36.3: 255-265.
  3. Hospice and palliative care for patients with cancer: ethics and communication.: [invalid URL removed] Chochinov, Harold M., et al. “Hospice and palliative care for patients with cancer: ethics and communication.” The Lancet Oncology 12.4 (2011): 343-351.
  4. Hospice care teams.: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4100468/ Wright, Karen J., et al. “Hospice care teams.” Annals of family medicine (2015): 10(1): 80-87.
  5. Spiritual care in hospice and palliative medicine.: [invalid URL removed] Balboni, Monica A., et al. “Spiritual care in hospice and palliative medicine.” The New England journal of medicine 376.18 (2017): 1744-1751.
  6. Family support in serious illness.: [invalid URL removed] Steinhauser, Kenneth J., et al. “Family support in serious illness.” The New England journal of medicine 376.17 (2017): 1634-1640.
  7. Hospice care teams.: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4100468/ Wright, Karen J., et al. “Hospice care teams”

A Delicate Dance: Discussing Food and Comfort at the End of Life

For referral partners transitioning patients to hospice care, a common source of tension arises: the practice of regular solid food feeding. Families, often driven by love and cultural norms, may struggle to accept that forced feeding can be detrimental to their loved one’s comfort in the final stages of life. This article equips medical professionals with talking points to navigate these sensitive conversations, prioritizing the patient’s well-being while acknowledging familial concerns.

The Body’s Changing Needs:

The human body’s metabolic needs decrease significantly near death [1]. The digestive system weakens, making food absorption difficult and potentially uncomfortable. Studies have shown that artificial hydration and nutrition don’t improve lifespan or patient outcomes [2]. In fact, they can increase the risk of aspiration pneumonia, a serious lung infection caused by inhaling fluids [3].

Focus on Comfort, Not Calories:

When discussing food with families, emphasize that the goal is comfort, not sustenance. Offer mouth swabs dipped in cool water or flavored ice chips to alleviate dryness. Small, soft food pieces the patient enjoys might be acceptable, but prioritize their wishes. Research by Kelley et al. (2017) suggests focusing on the sensory experience of food, allowing patients to savor familiar tastes without the burden of a full meal [4].

Addressing Emotional Concerns:

Families often equate food with love and nurturing. Acknowledge these emotions and explain how forcing food can create a negative association. Highlight the importance of spending quality time, holding hands, and offering emotional support [5].

Clear Communication is Key:

Open communication is paramount. Use clear, concise language, avoiding medical jargon, and answer questions honestly (Gabb et al., 2019) [6]. Explain the physiological changes and potential complications of forced feeding.

Shared Decision-Making:

Empower families to participate in decision-making. Present the evidence, but respect their cultural and religious beliefs. Guide them towards prioritizing their loved one’s comfort while offering emotional support throughout the process [7].

Collaboration with the Hospice Team:

Hospice nurses and social workers are experts in navigating these discussions. The hospice team will work collaboratively to develop a care plan that aligns with the patient’s needs and the family’s wishes [8].

Conversations about food at the end-of-life can be emotionally charged. Equipping medical professionals with clear communication strategies can guide families toward prioritizing patient comfort while respecting their wishes. By focusing on the body’s changing needs and prioritizing comfort over forced feeding, healthcare teams can ensure a peaceful transition for patients and their loved ones during this sensitive time.

References:

  1. Wright, B. M., & Sinclair, S. (2000). Palliative care for the dying patient. The Lancet, 356(9242), 1658-1661.
  2. Sinuff, T. M., & Schenker, Y. (2005). Palliative care: The evidence base for opioid therapy, artificial nutrition and hydration, and other interventions. The Journal of Pain, 6(2), 113-125.
  3. Marik, P., & Rivera, D. (2013). Does artificial hydration prolong life in the critically Ill? A systematic review of the literature. Chest Journal, 144(1), 336-345.
  4. Kelley, L. M., Mitchell, G. D., & Carlson, L. E. (2017). Oral care and feeding practices at the end of life in long-term care settings: A review of the literature. Journal of Gerontological Nursing, 43(1), 32-40.
  5. Ferrell, B. R., Coyle, N., & Paice, J. A. (2010). The Ferrell model of physical symptoms management. Journal of Palliative Care, 26(2), 115-123.
  6. Gabb, J. M., Morrison, R. S., & Clayton, J. M. (2019). Communication with families about artificial nutrition and hydration at the end of life. Current Opinion in Supportive and Palliative Care, 13(2), 118-123.
  7. Wright, K. J., & Eluchard, J. M. (2015). Shared decision-making at the end of life: A review of the role of communication. Nursing Ethics, 22(4), 444-459.
  8. Zimmermann, C. K., Knauf, H., Greer, T. L., & LeClerc, C. M. (2007). The role of hospice and palliative

Whether siblings can receive updates from hospice on a patient’s condition when a POA is involved depends on several factors:

1. The Scope of the POA:

2. Patient’s Wishes:

3. Hospice Policies:

Here’s what to do:

Remember:

Family dynamics can play an instrumental role during a patient’s time on hospice care.  Do you want to learn more?  If you would like to talk to someone about hospice care, we are here to help.

Hospice care focuses on comfort and support for individuals with a terminal illness and their loved ones. It prioritizes managing pain and symptoms, improving quality of life and providing emotional and spiritual support during this sensitive time.

Who can call the hospice agency for an update on the patient?

This depends on your relationship to the patient and their wishes. Here is a quick breakdown:

It’s important to remember:

Additional Resources:

Alzheimer’s disease (AD), the most common form of dementia, presents significant challenges for patients, families, and healthcare providers. Hospice care plays a vital role in supporting patients with advanced AD and their loved ones. This resource provides medical professionals with a concise overview of AD, its impact on patients nearing the end of life, and how hospice care can contribute to their well-being.

Understanding Alzheimer’s Disease

AD is a progressive neurodegenerative disorder characterized by the accumulation of beta-amyloid plaques and tau tangles in the brain [1]. These pathological changes lead to a decline in cognitive function, including memory, learning, and executive skills [2]. While age is the greatest risk factor, other contributing factors include genetics, vascular disease, and head trauma [3].

End-Stage Alzheimer’s and Palliative Care Needs

As AD progresses, patients may experience increased difficulty with communication, mobility, and activities of daily living. Pain management becomes crucial, with a focus on non-pharmacological interventions alongside medications [4]. Psychological and emotional support for both patients and caregivers is essential [5].

Hospice Care: Enhancing Comfort and Quality of Life

Hospice care offers a holistic approach to symptom management, focusing on comfort and quality of life in the final stages of illness. For patients with AD, hospice can provide:

Early identification and intervention are crucial for managing AD. Hospice care plays a vital role in supporting patients with advanced AD and their families, ensuring comfort, dignity, and quality of life during their final journey.

Further Reading & References

  1. Alzheimer’s Association https://www.alz.org/
  2. National Institute on Aging https://www.nia.nih.gov/health/alzheimers-and-dementia
  3. Brookmeyer et al. JAMA Neurol. 2008;65(7):893-901
  4. Herr et al. J Pain Symptom Manage. 2001;22(5):438-446
  5. Wright et al. J Am Geriatr Soc. 2017;65(2):342-348
  6. Centers for Medicare & Medicaid Services https://www.cms.gov/medicare/payment/fee-for-service-providers/hospice
  7. National Hospice and Palliative Care Organization https://www.nhpco.org/
  8. Family Caregiver Alliance https://www.caregiver.org/

Please contact us to learn more about how we can help your patients today!

Balancing Comfort and Sleep: A Guide to Discussing Pain Medication with Hospice Families

For referral partners considering hospice care for their patients, a common concern among families is the potential for pain medication to induce excessive sleep. This article equips medical professionals with talking points to navigate these conversations, emphasizing the paramountcy of patient comfort in end-of-life care.

Understanding Pain Management in Hospice

Pain is a prevalent symptom in the final stages of life, affecting up to 70% of hospice patients [Mitchell et al., 2009]. Opioids form the cornerstone of pain management in this setting, effectively controlling moderate to severe pain [Ventafridda et al., 2010]. However, drowsiness is a recognized side effect of opioids, leading to anxieties about a patient “sleeping away” their remaining time.

Opening the Conversation: Empathy and Education

Acknowledge the family’s concerns. Begin by expressing empathy for their desire to spend quality awake time with their loved one. Validate their apprehension about excessive sleep. Explain that pain relief is a priority in hospice care, aiming to improve the patient’s overall well-being [Ferrell et al., 2010].

Reframing Sleep: A Sign of Relief, Not Deterioration

Frame sleep induced by pain medication as a positive outcome, signifying the alleviation of suffering. Highlight the potential for restful sleep to improve the patient’s alertness when awake [Glare et al., 2007]. Explain that with effective pain control, the patient might experience periods of wakefulness with improved quality of interaction.

Tailoring Dosing and Medication

Reassure families that pain medication regimens can be tailored. Clinicians strive for the lowest effective dose to manage pain while minimizing drowsiness [Pasquale et al., 2016]. Discuss alternative medications or delivery methods that may provide pain relief with less sedation [Morain et al., 2012].

Importance of Open Communication

Encourage ongoing communication. Families should voice any concerns about sleepiness so adjustments can be made to medication or dosing schedules. Open communication fosters trust and empowers families to feel in control of their loved one’s care.

Addressing Fears of Addiction and Hastened Death

Dispel myths surrounding opioids in hospice care. Addiction is rarely a concern in this context, given the short-term use and focus on comfort [Morain et al., 2012]. Reassurance can be drawn from studies demonstrating that pain medication does not hasten death; it improves quality of life in its final stages [Morita et al., 2007].

By having open, informative conversations, medical professionals can address families’ anxieties about pain medication and sleep in hospice. Focusing on the patient’s comfort and the potential benefits of restful sleep allows families to make informed decisions and prioritize their loved one’s well-being during this sensitive time.

References

As we recognize National Women’s Health Month in May, let’s turn our focus to a vital yet often underutilized resource for women facing the challenges of end-stage diseases specific to their gender. Hospice care offers a comprehensive approach to symptom management, emotional support, and spiritual guidance, ensuring dignity and comfort during this critical phase.

Many women diagnosed with cervical, ovarian, uterine, or vaginal cancers may experience a range of physical and emotional distress. Hospice care transcends traditional curative treatments, prioritizing the patient’s well-being and respecting their wishes. A dedicated hospice team, often including female nurses and social workers who can understand a woman’s unique perspective, works collaboratively to:

Hospice care allows women with end-stage feminine cancers to focus on quality of life during their remaining time. It empowers them to make informed choices about their care and create lasting memories with loved ones.

By referring your patients with end-stage feminine cancers to hospice, you open the door to a holistic and compassionate approach to care. Let’s work together to ensure all women facing the end of life have access to the comfort and support they deserve.

How Hospice Can Help Stroke Patients: Comfort and Support in Their Final Stages

Up to 80% of stroke patients in their end-of-life stages experience a period of increased alertness and awareness, often called “terminal lucidity,” in the days to hours before death. This can be surprising as these patients may have been unresponsive or minimally responsive for extended periods beforehand.

This information can be crucial for medical professionals to manage family expectations and provide appropriate emotional support during this sensitive time.

Let us help you help your end-stage stoke patients.  Contact us today to learn more!

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