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There are a lot of things to take into consideration when considering hospice for yourself or for someone you love. In our previous blog post, we discussed the important topic of who pays for hospice. Now, we want to talk about who makes up the hospice care team.
Ohio Valley Hospice uses an interdisciplinary approach to care. This means all members of the team work together to determine the best plan of care for each individual patient.
It’s a common misconception that you cannot continue to use your primary care physician (PCP) when you choose hospice. This is not true. The patient’s PCP will continue to be as involved in their care as you want them to be, working closely with the hospice team to determine the best care plan options. The hospice team will keep them informed of all the patient’s wants and needs.
A Hospice Medical Director will also be part of the hospice care team. They oversee all clinical aspects of hospice care and provide medical education to community and facility staff. The Medical Director also actively participates in the admission, eligibility, and recertification decisions and provides overall direction to the rest of the hospice team.
Although they receive guidance from the Medical Director, the hospice nurse is the one who manages the patient’s care. The nurse will visit based on a schedule that meets the patient’s individual needs. Their main purpose is to provide pain and symptom management, keeping the patient as comfortable as possible. They will also administer medication as necessary and will tend to any wounds the patient may have.
There is always a hospice nurse on call – 24/7, 365 – to answer any questions that may arise.
A Certified Nursing Assistant (CNA), also referred to as an Aide, plays a pivotal role in the hospice care team. They are trained caregivers who work under the supervision of a registered nurse to assist with personal care and other duties around the home. CNAs will help the patient with things like bathing, dressing, grooming, and feeding. They will also help with light housekeeping.
CNAs also provide education to family/caregivers so they can feel confident in caring for their loved one when hospice is not there. This can include how to safely transfer your loved one from bed to a chair and back or the best way to help them get from room to room.
CNAs provide a special level of care for hospice patients and their family/caregivers.
Dealing with a terminal illness can be delicate and difficult for the patient and family. The hospice social worker is here to provide emotional support for you and your family, as well as to help with things like:
Our pastoral care team is comprised of ordained ministers with various religious affiliations who provide spiritual support to the patient and their family throughout the entire hospice journey. They provide an interfaith forum where the spiritual needs of the individual come first, not the denomination. Services they provide include praying with the patient/family, reading scripture, or even just sitting quietly with the patient. Chaplains can provide or arrange for religious sacraments or other religious rites. They may also help with funeral or memorial service arrangements.
The grieving process doesn’t wait until the patient has passed to begin. It is completely normal to feel grief when facing the impending loss of someone you love. Our bereavement coordinators are here for you and your family whenever you need them most. Their support begins at the time the patient is admitted to hospice and continues for up to 13 months after death. Everyone grieves differently, but no one should ever have to go through it alone. Please know, our team is here for you.
Volunteers are specially trained to support the patient and their family by providing services such as reading, art/music therapy, pet therapy, and so much more. There are also Veteran volunteers for Veteran patients who would like visits from a volunteer who served in the military.
Volunteers can have such a huge impact on a patient’s hospice journey. If you are interested in becoming a hospice volunteer, you can learn more about the program here.
The final and most important part of the hospice is care team is you, the patient’s family/caregiver. You will be involved in your loved one’s care every step of the way. Starting from the very first discussion about our services, our team will coordinate with you throughout your entire hospice journey to care for your spouse, parent, or other loved one as though they are our own.
If you’d like to learn more about the hospice care team, please contact us. We are here to answer any questions you may have.
‘Who pays for hospice?’ It’s a very common question. And it’s a very good question. If you are considering hospice care for someone you love (or maybe for yourself), you have a lotof things to think about. Worrying about how you are going to pay for hospice care should not be one of them.
At Ohio Valley Hospice, we strive to provide exceptional care for our patients and their families. This begins with providing education and resources to ensure everyone involved understands what to expect when choosing our hospice services. That being said, we want to dive into how hospice is paid for.
Medicare Part A covers hospice through the Medicare Hospice Benefit, which states you pay nothing for hospice care. To qualify for hospice care, a hospice doctor and your own doctor (if you have one) must certify that you are terminally ill. This means you have a life expectancy of 6 months or less, should the disease run its natural course. When agreeing to hospice, you will sign a statement that confirms you are choosing hospice care rather than other benefits Medicare covers to treat your terminal illness and related conditions. Simply put, you are agreeing that you are choosing comfort care instead of curative treatment.
Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. It also pays for hospice care for terminally ill individuals in many states. Similar to Medicare, hospice services through Medicaid include:
To qualify, a hospice provider must obtain a physician certification that a patient is terminally ill, and hospice services must be reasonable and necessary for the management of the terminal illness and related conditions. A hospice plan of care must be established prior to services being provided.
The Department of Veteran Affairs (VA) covers hospice care for Veterans who are in the final phase of their lives. They work closely with community and home hospice agencies to provide care in the home. Since hospice is part of the VHA Standards Medical Benefits package, all enrolled Veterans are eligible for services as long as they meet the clinical need for service.
There are no copays for hospice care, whether it is provided by the VA or an organization with a VA contract.
Many private insurance companies provide some coverage for hospice care. Check with your insurer to determine whether hospice is covered. Qualifications and covered benefits vary based on the private insurer.
If you don’t have insurance coverage and cannot afford hospice care, it may be provided free of charge through financial assistance such as donations, gifts, grants, or other community sources.
Please feel free to contact us if you’d like more information about how hospice care is paid for. Our team is always here to answer any questions you may have.
By: Dr. Laura Mantine
The cervix is the organ that provides an opening between the vagina and the uterus. Normally, old or damaged cells in a woman’s cervix will stop dividing and are replaced by healthy, young cells. Cervical dysplasia occurs when these old or damaged cells continue to divide in the superficial layer of the cervix. When cervical dysplasia is not treated, it can grow and spread into the deeper tissues of the cervix, developing into cervical cancer. Cervical cancer is a common malignant tumor of the female reproductive system. In the world, cervical cancer is the third most common type of cancer. However, the use of Pap smear screening has made it far less common in the United States.
Regular Pap smear screening tests can detect cervical dysplasia long before it develops into cancer. Cervical dysplasia is 100% treatable when identified early. Once cervical cancer has developed, the prognosis varies depending on the cancer’s stage of advancement as well as a woman’s age, general health status and comorbid conditions. It generally does not produce any symptoms in its earliest stages. When symptoms do occur, they may indicate that the cancer has progressed to more advanced stages. Symptoms may include abnormal vaginal bleeding or discharge, low back or pelvic pain, pain during intercourse and periods that are longer and heavier than usual.
Treatment of cervical cancer begins with seeking regular medical care throughout a woman’s life. Regular medical care allows a health care professional to best evaluate risks of developing cervical cancer, perform Pap smear screening, and promptly order further diagnostic testing as needed. The goal of cervical cancer treatment is to permanently cure the cancer resulting in complete remission of the disease. Cervical cancer treatment plans are multifaceted and individualized to the type and stage of the cancer with consideration of a patient’s coexisting diseases or conditions. Treatment of cervical cancer or cervical dysplasia may include a combination of surgery, chemotherapy or radiation.
Cervical cancer can lead to life-threatening complications especially if they go undetected and untreated. Complications are caused by an abnormal rapid growth of old or damaged cells in the cervix that can spread to other organs, such as the lungs, bladder, liver and intestines. Over time, the spread of cancer interferes with organ function and vital body processes. Serious complications can include recurring cervical cancer after treatment and infertility due to treatment.
In cases in which cervical cancer has progressed to an advanced stage and has become unresponsive to treatment, the goal shifts away from curing the disease and focuses on symptom management. Hospice care is available to help people in their last phases of an incurable illness live as fully and comfortably as possible. Hospice care for a patient with advanced cancer focuses on quality of life and is designed to address a wide range of symptoms including pain, poor appetite, shortness of breath, nausea and vomiting. Hospice patients with advanced cancer experience fewer hospitalizations, emergency calls and invasive procedures. Hospice patients have lower costs of care and greater likelihood of dying in their preferred setting, compared to patients not referred to hospice. Hospice will provide medications and supplies and provide inpatient care when a patient’s symptoms cannot be managed at home. Hospice can also provide around-the-clock care in the home to manage acute symptoms if needed. Also, a hospice clinician is accessible any time of day or night to ensure symptoms are managed as soon as possible. Lastly, hospice care also provides emotional support that benefits advanced cancer patients and their families. Timely and appropriate identification of hospice eligible patients increases the likelihood that patients and their families will benefit from compassionate, end-of-life care.
National Hospice and Palliative Care Organization, NHPCO Facts and Figures, 2018 Edition. Retrieved from: https://www.nhpco.org/research/
American Cancer Society, Cancer Facts & Figures 2019 Retrieved from: https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2019.html
What are Palliative Care and Hospice Care? 2019. National Institute on Aging. Retrieved from: https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care
Teno, et al. (2004). Family perspectives on end-of-life care at the last place of care. JAMA, 7;291(1):88-93
People often shy away from talking about end-of-life wishes. In fact, the Conversation Project found that although 92% of people feel it’s important to discuss end-of-life wishes, only 32% actually do. But it doesn’t have to be a scary topic that you avoid. In fact, it’s incredibly important to have the discussion.
As your loved one grows older, they may be hesitant to talk about their end-of-life wishes. And you may not want to bring it up because it forces you to face the fact that they won’t be here forever. Trust us, we get it. However, it is incredibly important to talk about it. Here’s why.
End-of-life conversations give us the chance to die well. What does that mean? It means our wishes are known and followed, and we have the opportunity to live our life – right up to the end – the way we choose to.
By discussing their end-of-life wishes, you will have a better understanding of how they want things to happen. This will prevent you from needing to try to guess or figure it out on your own.
That brings us to our next point. Knowing what a person wants makes it easier on those caring for them. If you discuss it with your loved one, you don’t have to worry about making the right decisions on their behalf because you already know what they want. If you don’t discuss it, you may worry if you are doing right by them. Talking about what they want and having a clear plan eliminates this pressure.
It’s also not uncommon – in situations where the patient becomes unresponsive, such as in a medical emergency – for the family to argue over what the right decision is. This just creates added and unnecessary stress and trauma for everyone. All of which can be avoided by knowing and understanding your loved one’s wishes ahead of time.
Your loved one may already know what their end-of-life wishes are. They might just be unsure of how to bring it up. Maybe they just need you to start the conversation. But how do you?
This Conversation Starter Guide is a wonderful tool to help us get the conversation started. It includes prompts to answer to help cover all the bases. Encourage your loved one to fill it out, with you or on their own. Then, you can sit down together and talk about their answers. If you have this guide printed out, you can take your own notes and save it so you are prepared.
It’s important to keep the conversation going. Our wishes can change over time so it’s important to keep one another updated.
End-of-life planning isn’t about dying – it’s about living. Understanding your loved one’s end-of-life wishes allows you to understand how they want to live their last months, weeks, and days. So, start the conversation and keep it going.
A life-limiting illness comes with a lot of difficult decisions to consider. One of those decisions is when it may be time to consider hospice care. This can be an intimidating decision to make, so we are sharing some tips to help you determine when the time is right.
Hospice is an interdisciplinary approach to end-of-life care. When a patient and their family choose hospice, they are choosing to switch the focus from curative treatment to comfort care. This simply means the goal is now to manage the patient’s pain and other symptoms to keep them as comfortable as possible. Symptoms hospice can help treat include pain, shortness of breath, and restlessness.
Many people think hospice is a place. However, this is not true. Hospice care can be provided wherever the patient calls home, including their own home or a nursing facility.
Patients are generally considered to be eligible for hospice when a physician determines they have a life expectancy of six months or less.
One misconception is that when you choose hospice, you are giving up. This is not at all the case. Hospice is not just about the dying process, it’s about the end-stage of the life-limiting illness, as well. When you choose hospice for your loved one, you are choosing quality of life for them. No more treatments that make them feel sick in attempt to buy them more time. Just focusing on making sure they are comfortable and at peace for whatever time they have.
So how do you know it’s the right time to consider hospice? Below are some of the common indicators:
Remember, these indicators are just guidelines and do not replace a physician’s evaluation. If you think it may be time for hospice, talk to your doctor. You can also contact us at anytime to learn more.
The holiday season is here, and what is a time of joy and togetherness for most can be a time full of sadness and grief for others. The holidays are meant to be spent with those we love, so how can you be expected to feel like celebrating when someone you love is no longer there to celebrate with you?
If you are missing a loved one this holiday season, here are some tips to help you take a step back from the grief and survive the holidays.
Let’s be honest, they are everywhere during the holidays. Preparing for these triggers and having a plan for coping with them can sometimes make the triggers more manageable as you encounter them.
Plan to get some space from the holiday chaos if you need it. Being surrounded by family and friends is great, but all at once can be emotionally overwhelming and hard to overcome. Don’t feel guilty about your grief. It is important to be conscious of your limits and take some time to recollect yourself.
The holidays are a time to gather together, eat good food, and share what we’re thankful for. If you’ve recently lost a loved one, it can be hard to feel thankful when you are grieving. Although you may be focusing on the loss, try to remember the good things that relationship brought into your life. Search for that gratitude.
Acknowledge that things will be different this year. Some holiday traditions will remind you of your lost loved one, but it is okay to limit which of these you allow yourself to remember or not. Take time to prepare for which traditions will make you happy and which will overwhelm you.
Although you may normally be the one to host during the holidays, this year may be too much to take on alone after losing your loved one. Accept help when it’s offered. Remember that there is no shame in saying yes. Those who love you want to help.
The holidays can be hard for those who have recently lost a loved one. Grief can be especially unavoidable during these times, but it is important to remember that you can still feel joy through the grief. Taking these tips into account can help you prepare for that grief and make your holidays more enjoyable.
In 2020, an estimated 41.8 million adults in the United States were caregivers of someone 50 years of age or older. That’s one in six Americans. In honor of National Family Caregivers Month, we want to take the opportunity to applaud all these caregivers for all they do for those they love.
You work round the clock to care for someone you love. Maybe it’s a parent. Maybe it’s a spouse or partner. No matter who it is, you are committed to doing the best you can for them because you love them. And because you know they would do the same for you. But it’s not easy. We know that. So, we want you to take a minute to yourself right now to read this. Because this is for YOU.
You have taken on the responsibility of being the primary caregiver for a loved one who is ill. That’s no small task. You are there for them at all hours of the day and night- whenever they may need you.
Being a caregiver can be stressful on its own, but many of you are not only a caregiver. Whether you have a full or part-time job, volunteer, have children to care for, or anything in between – you have other responsibilities also. Juggling all those responsibilities can be overwhelming at times, and with all these things to take care of, you don’t often have time to stop to take care of yourself.
You don’t have to do it all on your own. Lean on friends and family for help and support. When it starts to feel like it’s too much, call a friend or loved one. Ask them for help or just to talk or listen. A strong support system is essential.
Maybe you feel like your friends and family don’t understand what you’re going through, and you want to talk to someone who has a similar situation. There are support groups available for caregivers. Through these, you can meet others who have similar situations as you. You can share stories with them or share tips with one another. At the end of the day, having someone you can lean on is so important.
With everything you need to get done in a day, we understand that it can be easy to neglect yourself and your own needs. However, it’s incredibly important that you take time for yourself. Do your best to carve out time to do something you enjoy. Do something that is for you and no one else. It’s not selfish. You NEED to do it.
It’s important to be able to take some time to do something that helps you decompress. Go for a walk. Read a book. Listen to a podcast. Whatever helps you unwind after a long day- do it! You need this opportunity to recharge so you can be at your best.
We understand it can feel overwhelming at times, but we want you to know you are doing great! You aren’t going to be at 110% every day. You may have an ‘off day,’ and that’s okay. We all have them. Just remember to show yourself some grace. You have taken on a huge role, and it’s not easy. You won’t be perfect – no one is. But each day, you rise to the challenge and do what you need to do to be there for your loved one. That’s what matters.
Don’t give up. And don’t ever doubt yourself. You are amazing!
By: Laura Mantine, MD
Chronic lung disease is the 4th most common cause of death among older adults in the United States. More than 3 million people worldwide died of COPD in 2015, representing 6% of all deaths that year. People dying from COPD frequently experience difficult and uncomfortable symptoms that lead to distress and panic. They commonly have disabling respiratory symptoms including severe breathlessness, limited tolerance for activity, and intractable coughing. They are also usually oxygen dependent, often experience anorexia with weight loss, cachexia, and ultimately become dependent on others for their activities of daily living.
Despite the symptomatic needs of individuals dying from end-stage COPD, only 30% of individuals receive hospice care before death. It is not clear why the rate of hospice use for patients with COPD is so low, but several explanations have been offered. The most important may be that few patients with severe COPD have discussed end-of-life planning with their clinician. Furthermore, many patients and clinicians do not view COPD as a terminal illness and feel it is more chronic in nature. Also, there may be a lack of awareness that patients enrolled in hospice can continue to receive treatments for COPD. Due to the fluctuating course of COPD, it is often difficult to accurately estimate a patient’s life expectancy which may contribute to low hospice utilization rates.
While end-of-life-care is an appropriate topic to discuss with all patients, several factors have been suggested that should prompt a discussion with patients who have severe COPD. One factor is simply that a clinician would not be surprised if a patient with COPD were to die within the next 6-12 months. A clinician should consider hospice referral in a patient with COPD if they are dyspneic at rest or with minimal exertion, have progressed to the point where they spend most of their days at home, have experienced repeated ED visits (one or more each quarter) due to infection or episodes of respiratory failure, have endured repeated hospitalizations (one or more each quarter) and no longer wish to be admitted and the patient no longer wishes to be intubated.
While these laboratory studies may be helpful to the clinician when considering patient appropriateness for hospice services, they are not required for patient admission.
COPD is a significant health issue around the world. It is ultimately a fatal disease and patients are under-referred to hospice care. Hospice, with its strong interdisciplinary approach, has been shown to improve quality of life for patients with end-stage respiratory disorders like COPD.
Please contact us if you have any questions about how our team can help COPD patients.
Hospice Eligibility for Patients with COPD. Serena J. Scott, MD, Barry D. Weiss, MD, Ellyn Lee, MD, College of Medicine, University of Arizona. https://uofazcenteronaging.com. June 2017.
When to refer patients with advanced COPD to palliative care services. Rebecca Strutt. Breathe (Sheff). 2020 Sep; 16(3): 200061.
Referral to palliative care in COPD and other chronic diseases: A population-based study. Kim Beernaert; Joachim Cohen; Luc Deliens; Dirk Devroey; Katrien Vanthomme; Koen Pardon; Lieve Van den Block. Respiratory Medicine. Volume 107. Issue 11, P1731-1739. November 1, 2013.
By: Laura Mantine, MD
It is a fact that only 25% of deaths occur at home while nearly 80% of Americans would prefer to die at home. Unfortunately, many individuals will die in hospitals, while receiving care that is not consistent with their wishes. It’s important for older adults to plan and let their caregivers, doctors, or family members know their end-of-life preferences. In honor of National Hospice and Palliative Care Month, we want to highlight the fact that hospice is not a place- it is an approach to care.
Increasingly, people are choosing hospice care at the end of life in order to remain at the place they call home. Hospice provides comprehensive comfort care as well as support for the family. In hospice, attempts to cure the person’s illness are stopped. However, this does not mean discontinuing all treatment. A good example is an older person with cancer. If the doctor determines that the cancer is not responding to chemotherapy and the patient chooses to enter hospice care, then the chemotherapy will stop. However, other medical care may continue if it is helpful.
Hospice is an approach to care, so it is not tied to a specific place. It can be offered in many types of settings including home, hospitals, nursing homes, assisted living facilities, and dedicated hospice facilities. Most care is provided at home with a family member typically serving as the primary caregiver, but it can also occur in a nursing home or any other place the patient calls home. Hospice staff will make regular visits to the patient’s residence and are on call 24 hours a day, seven days a week. Although hospice provides a lot of support, the day-to-day care of a hospice patient is provided by family and friends. The hospice team coaches family members on how to care for the patient and even provides respite care when caregivers need a break. Respite care can be for as short as a few hours or for as long as several weeks.
Hospice care brings together a team of people with special skills among them nurses, doctors, social workers, spiritual advisors, and trained volunteers. Everyone works together with the patient, the caregiver, and/or the family to provide the medical, emotional, and spiritual support. The hospice team will manage the patient’s symptoms, teach the family how to provide care, and provide bereavement counseling.
Hospice is provided for a person with a terminal illness whose doctor believes he or she has six months or less to live if the illness runs its natural course. Although there is a six-month time designation, hospice can be provided for as long as the person’s doctor and hospice care team certify that the condition remains life-limiting. Many people who receive hospice care have cancer, while others have heart disease, dementia, kidney failure, or chronic obstructive pulmonary disease. Enrolling in hospice care early helps a person live better and longer, decreases the burden on family, and prepares family members for their loved one’s passing. Families of people who received care through a hospice program were more satisfied with their loved one’s end-of-life care. Also, hospice recipients were more likely to have their pain controlled and less likely to undergo tests or be given medicines they did not need.
Remember, hospice stresses care over cure. The goal is to provide comfort during the final months and days of life while providing ongoing support to the patient and family for whatever time remains.
If you would like more information on hospice care and the services Grane Hospice provides, please contact us.
By: Laura Mantine, MD
During periods of crisis, like the COVID-19 pandemic, family members and close friends continue to provide daily care for their loved ones. These caregivers provide the initial response and defense for individuals who are often battling chronic medical illnesses. Like many first responders, caregivers often experience stress due to heavy workloads, fatigue, and anxiety. There are important steps that caregivers can take to help manage and cope with this ongoing pressure.
Caregivers should develop habits and strategies to maintain their own physical health and emotional well-being. A caregiver can reduce transmission of a virus by diligent personal and patient hygiene. Washing hands with soap and water for at least 20 seconds frequently throughout the day has been shown to reduce viral spread. It is also important to wash your hands during food preparation, toileting, and blowing your nose, coughing, or sneezing. To be at your best, be sure to eat healthy, balanced meals, maintain a regular sleep routine, and find chances to exercise whenever possible. There is also a constant barrage of pandemic-focused news that can be overwhelming, so try to limit your intake to a certain time or times each day, and do not mistake social media opinion for fact. Remember to take care of yourself, as your loved one’s well-being relies on your ability to maintain your own.
Over any amount of time, caregiving can be physically, mentally, and emotionally exhausting. Caregiver burnout can happen in any caregiver-patient relationship, but the risk is heightened in times of increased stress like the COVID-19 pandemic. When suffering from burnout, a caregiver may experience hopelessness, overwhelming anxiety, sleep problems, or difficulty coping with everyday tasks. Although caregiving is a major responsibility, it shouldn’t completely overtake an individual’s life. Make time for yourself and take breaks when possible. Use these spare moments to listen to your favorite music, read, or work on a hobby. Also, stay connected to friends and family. Social distancing doesn’t mean total isolation so reach out to friends and family regularly for casual chats and wellness checks. Consider spending time together virtually, whether by watching a movie over a video chat session or playing games together online. If you live with loved ones, find ways to help and support each other.
During these uncertain times, caregivers remain a valuable constant for their loved ones. Please stay physically and mentally healthy as you perform your crucial role.
“Family Caregiving During the COVID-19 Pandemic.” Scott R Beach, Richard Schulz, Heidi Donovan, Ann-Marie Rosland. Gerontologist. 2021 Jul 13;61(5):650-660.
“Ensuring Adequate Palliative and Hospice Care During COVID-19 Surges.” Jean Abbott, MD, MH; Daniel Johnson, MD; Matthew Wynia, MD, MPH. JAMA. 2020;324(14):1393-1394.