Pathways participates in SVGives May 6th Campaign

Pathways Home Health & Hospice is participating in the one-day SVGives campaign. You should start seeing social media promotions from numerous non-profits that serve residents in the San Francisco Bay Area about this event. SVGives is scheduled for May 6^th.   

Here is a brief video that explains what SVGives is and how through the power of coming together, we can bring services and comfort to those who need it the most in our communities.

Learn More about SVGives

Tales of Love and Loss: Sharing the Past with Jeannine

"With calm conviction, and a touch of regret, she looked me in the eye and declared that everyone has a story to tell. She felt that such a significant task as preserving that knowledge should never be delayed until it is too late."

Hospice volunteers often listen to patients and their stories. One Pathways volunteer, Christy Yuen, chronicled the story of Jeannine. 

This week is volunteer appreciation week. Pathways would like to formerly applaud all of our volunteers who help our patient’s tell their stories. Thank you for giving your time and attention to other human beings when they need it the most.

Jeannine, an 89 year-old French lady, knew her days were numbered. More than anything, she wished to put her memories down on paper. I visited her three times before she suddenly passed away. During those special hours as I typed, her accented voice whisked us back into history… 

Like the children in C.S. Lewis’ The Chronicles of Narnia, I found myself in a world of adventure and war, love and loss. Pausing occasionally to clarify the spelling of a French name, Jeannine spoke for hours about her ancestors and their lives in France. She told stories of war, including her time as a resistance fighter in World War II, and of her father, a pilot, crossing over enemy territory on dangerous missions. She told stories of tragedy; stillborn babies, deaths from tuberculosis and pneumonia, and widows and orphans left behind by war. She remembered how elderly folks were forced to sleep on hard wooden floors in the wintertime while invading soldiers occupied their homes.

She also told stories of the human spirit, recalling how her uncle, a chef, made piping hot French fries for hordes of hungry children who waited on the streets for their parents to return home from working late. She described independent wives who rejected their alcoholic, skirt-chasing husbands in favor of raising their children alone and successfully running their own businesses. 

 Humor was frequently woven into her stories, such as the young woman who duped her boyfriend into marrying her, and a village that fooled the occupying enemy soldiers by playing a trick involving a sacrificed pig.

Interspersed throughout her monologues were heartfelt remarks about today’s world. She spoke with ease and fluidity about changing gender roles, the difficulty of learning a foreign language, intolerance towards homosexuals, and the importance of understanding cultural differences. She lambasted the government with characteristic poise and clarity in one breath, while bemoaning the loss of children’s innocence in the next. She remarked on the lack of opportunities for “kids to just be kids.” 

When she spoke about the physical, social, and psychological devastation of ongoing wars, her wise eyes would become rimmed with sadness. “We have not learned the lessons of the past,” she would say, slowly shaking her head.

Unfortunately, Jeannine and I did not get to finish her memoirs. I often remember something she told me at our first visit. With calm conviction, and a touch of regret, she looked me in the eye and declared that everyone has a story to tell. She felt that such a significant task as preserving that knowledge should never be delayed until it is too late.

For the privilege of sharing in her memories, for the insight she dispensed with such wit and character, and for all the reminders of what is truly important in life, I would like to thank Jeannine. Merci Beaucoup.

 

http://bit.ly/1hBYhG2

A Hospice Volunteer Breaks Barriers with Bubbles

by Sherry Rayner, Pathways Hospice Volunteer

The most heart wrenching yet fulfilling cases I’ve had as a Hospice volunteer has been with Pathways KIDS. During this time, I have learned that flexibility is the key and there is always a way to communicate.

My last case was with a Vietnamese family in East San Jose. Their youngest son, Jefferson Vu, was a 4-month-old patient who had a rare genetic disease. My job was to entertain his energetic 3-year-old brother, Truman, so their mother, Tam Vu, could get some much-needed rest and tend to her baby without interruption.

My initial contact by telephone was with the father, Ho Vu, who spoke English fluently. I knew he would be away when I visited each week. My concern was how I would communicate with the patient’s mother and brother, as I knew their English was limited.

As my first visit approached, I felt both anxious and excited. I carried a huge canvas tote bag filled with lots of toys, books and videos. Upon knocking on the front door of their condo, I was greeted by a sweet, smiling young woman and her active and excited 3-year-old son, Truman. Leaving my shoes at the door with families, I was graciously welcomed in.

I was then introduced to their precious baby boy, Jefferson. He was lying very still on a pink satin pillowcase in the middle of their big bed. In direct contrast to the rambunctious Truman, Jefferson was very still, tiny and fragile. He sounded like a wounded baby kitten when he cried. When he opened his eyes you saw big brown eyes looking back at you. His face would light up with the most radiant smile when spoken to softly.

Meanwhile, Truman anxiously eyed my canvas bag to see what I’d brought. Not being able to contain his curiosity any longer, we opened the bag. Out came a small nerf ball and a suction – cupped basketball hoop to put on their closet door. Truman was soon animation in action as he jumped and leaped trying to make a basket. When he made a basket, his Mom and I would clap with joy. During this time, Jefferson, the baby, slept soundly. There were two completely different worlds going on in one small bedroom.

Each week Truman would discover a new item in the canvas bag. Soon, he was helping me carry the bag up the stairs. The biggest hit of all was the “Bubble Machine.” Truman and I would go outside to the porch and play with a battery-operated bubble machine. At the flick of a switch, hundreds of tiny iridescent bubbles filled the air. Soon an excited little boy, ran, jumped, and squealed with joy. The smile on his face was only outdone by the sound of his giggles. He’d race around trying to catch every bubble, breaking it or holding it, letting them crash into him with glee. Needless to say he was hooked on the bubble machine and caught me by surprise when in English he’d ask for bubbles every visit.

One particular week, we were lying looking through his English/Vietnamese Kids Picture Dictionary when he focused on the medical page. He quickly pulled up his pant leg and showed me his scratch. I then showed him a scar I had on my leg. Much to my surprise he leaned over and kissed my “boo boo.” Tears welled up in my eyes as I held him and said, “Thank you, it’s all better now.” I was no longer worried about how we would communicate.

We played together for six months and in January 2007 Jefferson peacefully passed on, at home, in his mother’s loving arms with his brother and Daddy close by. What a cherished journey, never to be forgotten. I’ve learned there are always ways to reach out, but never imagined a bubble machine would be one of them.

About Sherry Rayner

Sherry Rayner has volunteered with Pathways Hospice for over 20 years. With her art teacher education and professional graphic design experience, Sherry is known for the creativity that she brings to her volunteer work. She began volunteering with Pathways after raising a family, care giving for several family members and volunteering with several other organizations. Known for brightening the days of patients of all ages, Sherry has recently specialized in the unique concerns of Pathways KIDS and their families.

Grief & The Holidays: A Time of Challenge & Hope

REMEMBERING

Soon it will be holiday time again and reminders of their loss are everywhere for those who are grieving. Traditionally this is a time of joy, sharing of memories, warmth, peace, and coming together in love.

For those who are grieving, the holidays are also a vivid reminder of those that are so dearly missed. Add to this the common expectation that all should be as it was and many grieving families find the holiday season to be the most difficult time of the year. 

The period after the death of a loved one is a journey through grief. We cannot forget and we cannot bury the pain. It is not easy. Our hearts, minds and bodies are grieving and not functioning in their full capacities, as though part of us is missing. 

Yet, we don’t have to hide from our experience of grief. These are natural feelings–they are all a part of the process–we can share them, we can accept them, we can feel them.

WAYS OF COPING

As the holidays approach, start with a blank slate. Accept that you may not have the energy or inclination to accomplish all the things that you or others have come to expect during the holidays. 

Rather than do things automatically, discuss and think about what you really want to do, what you don’t want to do, and what will be difficult but you want to try. We encourage people not to be afraid to make changes in traditions or start new ones.

Equally important is to acknowledge how you feel. It will be a sad time. Many recently bereaved worry they will spoil the holidays for others. According to families Pathways has counseled, the most painful thing is when they try to keep their feelings inside.

If friends or family members take the initiative to talk about the person who has died, it relieves the tension and creates an opportunity for sharing.

MANAGING YOUR GRIEF 

While there are no universal methods for healing and coping, there are some concrete things you can do that may make the holidays easier and provide an opportunity to honor those you love who have died.

  
Acknowledge your grief; accept yourself in whatever mood you find yourself.

• Remember you are not alone. Attend a remembrance event or grief support group.
• Make some personal choices based on your level and what is right for you.
• Give yourself permission to let go of certain traditions–it’s okay to make changes.
• Share your plans with others; let them know how they can help you.
• Reserve time to honor your loved quietly, alone or with others: light a candle, place a photograph on the table, share memories, make a memorial donation.

And finally, as you navigate through your grief this holiday season keep your loved one in your heart and remember to care for yourself.

Hospice Impacts Spouses' Survival: Live Longer

Using hospice not only benefits patients, there is some evidence that it may help surviving widows and widowers live longer.

Some time ago researchers at Harvard Medical School and the University of Pennsylvania Department of Medicine examined death rates of surviving spouses of 195,553 elderly American couples.  The premise was that the 30,838 people who used hospice had “good deaths” that were less stressful for their spouses and would result in living longer.

The results of the matched retrospective cohort study suggest that the supportive end-of-life care provided by hospice has a beneficial impact on spouses.  “Hospice may attenuate the ordinarily increased mortality associated with becoming widowed,” concluded authors Nicholas Christakis and Theodore Iwashyna.  The results were statistically significant in both men and women.

After adjusting for variables, 5.4% of bereaved women died by 18 months after the death of their husbands when hospice was not used compared with 4.9% when hospice had been used.  Of the surviving husbands, 13.7% died within 18 months when their wives had not had hospice care compared with 13.2% when their wives died with hospice.

The support of hospice care appears to not only improve quality of life for patients, but reduces the stress on survivors to the extent that they live longer.   

For more information see Social Science & Medicine, 2003, vol. 57, issue 3, pages 465-475.

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 25.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Morphine Labeling

New Look

For many years now the most common concentration of oral morphine solution used in hospice has been 20 mg per mL.   Although the concentration is exactly the same, you may begin seeing different labeling.  It may now read 100 mg per 5 mL.

The Food and Drug Administration worked with Roxane, the largest manufacturer of oral morphine solution to change the labeling and the look of the product to reduce the possibility of errors.  The intent of this labeling is to help differentiate this product from another product with a concentration of 20 mg per 5 mL.

The volume of liquid is unchanged:

• 5 mg = 0.25 mL
• 10 mg = 0.5 mL
• 20 mg = 1 mL

Although the label prominently says 100 mg per 5 mL, you will also see (in smaller letters) 20 mg per mL. 

The new labeling may mean a little change in our mathematics, but remember that the concentration has not changed. 

If you have any questions about the concentration or labeling, call Pathways (1.888.755.7855) and we will be glad to double check your calculations with you. 

This article was originally published in Pathways & Partners Newsletter - Issue 25.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

ALS: Amyotrophic Lateral Sclerosis

What is ALS?

Often called “Lou Gehrig’s Disease,” ALS is a degenerative disease of the nerve cells in the spine and brain.  As the neurons that connect the brain to muscles begin to die, the brain can no longer control muscle movement.  In later stages the patient may be totally paralyzed; for most, their minds are not affected.   

• About 5,600 cases are diagnosed annually; 60% are men, 93% are Caucasian
• Most people are between 40 and 70 years old

Early Symptoms

ALS may start with simple muscle stiffness and can differ a lot from one person to the next.  But 60% begin with muscle weakness.  A person may trip over carpet edges, have trouble lifting, or have slurred speech. They may drop things, have abnormally tired arms and legs, or even uncontrollable crying or laughing.

Later Symptoms

The rate of progression can vary, with an average survival time of 3 to 5 years, but many live 5, 10 or more years.  In a small number of people, ALS stops.  Later symptoms are:

• Muscle weakness in hands, arms, legs or muscles for speech
• Twitching and muscle cramping, especially in hands and feet
• “Thick” speech and difficulty speaking loudly
• Difficulty breathing and swallowing

End Stage ALS

Changes that may mean the death is nearing include a sense of breathlessness or the onset of a lower level of consciousness.   As respirations fail, the resident becomes less and less aware, then unconscious.   Nearly 60% of people with ALS have a sudden rapid decline and die within 24 hours.  Death also seems to happen most often at night when breathing naturally becomes slower and more shallow. 

Pain in ALS

Pain is common in later stages, probably from stiff joints, muscle cramps, or pressure on the skin and joints from immobility.  A combination of anti-inflammatory, anti-spastic and non-narcotic pain relievers may work until later stages when morphine often achieves the best pain relief.

Treating the Whole Person

Since the awareness and thinking usually remain intact, every effort should be made to continue communicating with the resident, even when he or she is too weak to speak.  This may mean using a communication board.

Knowing that death is near can lead an individual to seek resolution of “unfinished business.”  Hospice chaplains can provide spiritual support for the resident and reassure him that his family will have ongoing bereavement support.  Volunteers may supplement visits from family members.   Together we can support all the resident’s needs through the rest of his life.  Families will remember the end-of-life care you give for the rest of their lives.

This article was originally published in Pathways & Partners Newsletter - Issue 25.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Benefits of Dogs

Healthier Living

Most people know that people who own dogs live longer, have lower blood pressure, less anxiety and better immune systems.  They also have more social interactions, Alzheimer’s patients with dogs in the home have fewer outbursts and men with dogs have lower triglycerides and cholesterol.  These are the scientific conclusions of research about family pets that can be easily found. 

But there are even more benefits and some of them are pretty astounding.  Dogs are being trained to assist in the medical field.  For instance, dogs can be trained to sniff out low blood sugar in diabetics, picking up odors beyond human capacity.  Dogs can also be taught to prod the diabetic with a cold nose, fetch a blood glucose testing equipment or press a phone button that calls 911.

It could be scent or it could be a subtle change in behavior, but some dogs are able to sense a seizure coming on as much as 30 minutes before it occurs.  This means the dog may be able to alert the person, go for help, move objects out of the way and lay down next the person during the seizure.

More and more people with post traumatic stress disorders, such as soldiers returning from war zones, are benefiting from dogs as companions because they can they can ease anxiety in a number of ways.

Dogs also have the remarkable ability to detect certain kinds of cancers.  One example is being able to reveal the presence of bladder or prostate cancer cells in urine.  Some researchers have shown that dogs can recognize lung and breast cancers by smelling the patient’s breath, and they can spot melanoma by licking a person’s skin.

A dog’s brain may be only one tenth the size of a human’s, but his nose more than makes up for it: dogs have 40 times as many scent receptors as humans.  It is truer than ever that dogs really are man’s best friend. 

References: My Health News Daily; Web MD.

This article was originally published in Pathways Residential Care Journal - Issue 4.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

One from the Heart Awards Breakfast #OFTH

If you only attend one event this fall,
it should definitely be One from the Heart!

Be a part of Pathways’ compassionate and caring mission. This inspirational breakfast has become a “must attend” for nearly 650 friends and supporters of Pathways, corporate and community leaders, and medical professionals. One from the Heart annually honors individuals and organizations that have made an enduring contribution to Pathways and end-of-life care.

Over the past twenty-one years, the One from the Heart Awards Breakfasts have raised over $4 million for Pathways to ensure extraordinary hospice and home health care for the Bay Area.

One from the Heart Awards Breakfast

Friday, October 5, 2012, 7:30 to 9:30 am

Crowne Plaza Cabana Hotel, Palo Alto

Tables and individual seats available.

For more information about the One from the Heart Awards Breakfast or other events, contact Holly Smith, Event & Sponsorship Manager, 408.730.1200 or events@pathwayshealth.org or visit www.pathwayshealth.org.

Join the conversation:
on Twitter using #OFTH
on our Facebook event page
on our Linked event page

Learn more about our featured speaker, Jon Katz:
http://www.bedlamfarm.com/
http://hospice.bedlamfarm.com/

Documenting and Billing for Care Plan Oversight

Home Health & Hospice

There is one service that is not face-to-face that physicians can be reimbursed for by Medicare—care plan oversight (CPO) of patients receiving home health or hospice.  Because the rules are complicated, many physicians simply don’t bill for this service.  Here we’ll try to break it down.  
To bill, CPO services must take at least 30 minutes in a calendar month. The services do not need to be provided on the same day, but the total services over the course of a month must add up to at least half an hour.  Medicare uses two HCPCS codes to pay for CPO:  G0181 is for home health, and G0182 is for hospice. 

YOU CAN BILL FOR TIME SPENT:

• Reviewing charts, reports and treatment plans
• Reviewing diagnostic studies that weren’t associated with a face-to-face encounter
• Phone calls with other health care professionals involved in the patient’s care who are not employees of the practice
• Conducting team conferences
• Discussing drug treatment and interactions (not routine prescription renewals) with a pharmacist
• Coordinating care if physician or non-physician practitioner time is required
• Making and implementing changes to the treatment plan

YOU MAY NOT BILL FOR THE TIME YOU SPEND:

• Renewing prescriptions
• Talking with fellow employees at the practice
• Travel time
• Preparing or submitting claims
• Talking to the patient’s family, even if discussing treatment plan changes
• Holding informal consults with physicians who are not treating the patient
• Working on discharge services
• Interpreting test results at an E/M visit

GOOD HABITS

• Keep a log of the patients you provide CPO to; use this as a reminder to pull those charts at the end of the month. 
• Keep a simple CPO log in each of these charts and document the date, total time and a brief description of the services as you provide.  Sign this documentation.
• At month end gather the logs, total the time and bill for those for whom you provided at least 30 minutes of CPO.  Put the beginning and end dates of the month as the dates of service and be sure to put the provider number of the home health agency or hospice on the claim form.

For more information or questions, or to receive written materials about billing for care plan oversight, call Kaye Holbrook at 408.773.4359 or email your request to kholbrook@pathwayshealth.org.

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 24.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Heart Failure & Hospice

Patients with congestive heart failure who elect hospice live longer than those who don’t.  These were the findings of a defining 2007 study published in the Journal of Pain and Symptom Management.  Other diagnoses also experience longer prognosis with hospice, but none longer than the 81 day extension of life in heart failure.

Many factors probably contribute to the increased longevity.  Hospice care increases monitoring in the home and gives psychological, emotional and spiritual support from friendly visitors.  This holistic attention may increase the desire to live and reduce the sense of being a burden to one’s family.

Skipping the ER

Heart failure is the diagnosis most commonly associated with hospitalization.  By some estimates, patients with heart failure are readmitted at a rate of nearly 50% within six months.  For some patients, knowing that they have 24-hour access to nursing advice and visits for management of symptoms gives them a welcome alternative to the emergency room. 

Who is Appropriate?

Medicare guidelines include:

• Patient is optimally treated with vasodilators or unable to tolerate them.
• Patients with conditions usually treated with surgery are either ineligible or decline it.
• Patient is Class IV on the New York Heart Association scale: unable to do any physical activity without discomfort and symptoms may be present at rest.
• If ejection fraction is available, 20% or less is appropriate for hospice.
• Co-morbidities play a large role in estimating prognosis.  The following co-morbidities support a prognosis of 6 months or less in conjunction with the conditions listed above:
• Symptomatic arrhythmias resistant to treatment
• History of cardiac arrest, resuscitation or unexplained syncope
• Brain embolism of cardiac origin
• Concomitant HIV disease

The extra time that hospice can give patients may be especially important to patients and families trying to find resolution and peace at the end of life.  

Questions to Ask Patients

• Do you have discomfort when physically active? or Does physical activity give you more discomfort?
• Do you get short of breath when you are lying down?
• Do you ever wake up at night feeling short of breath?
• When you are resting in a chair do you ever feel short of breath, perspire or have chest pain?
• Do you have any swelling?
• Do you need help with activities like dressing, bathing, walking or eating?

Supporting Documentation

• Cyanosis
• Rales
• Dusky nail beds
• Tachycardia or bradycardia
• Hyper- or hypotension
• Jugular venous distension
• Liver enlargement
• Cachexia
• Orthopnea
• Paroxysmal nocturnal dyspnea
• Decreased ejection fraction
• Weight gain due to fluid retention

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 24.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Managing Agitation in People with Dementia

Agitation in dementia has many possible causes.  It can be a result of degeneration of the nervous system which may lessen a person’s ability to cope.  Another huge factor is that the resident is unable to communicate a need.

Six Triggers
Researchers have identified six main causes of agitation in dementia.  As caregivers, it is our job to do the detective work to find out what the cause might be.  We need to imagine ourselves in his or her shoes to help figure out the trigger.  If at first you don’t succeed…be persistent, keep digging!  And always consider a combination of factors.

Fatigue: Most of us tend to be more irritable when tired and people with dementia are no exception.  Did the resident get enough sleep last night?  Has he had more activity than usual today?  You can ask, “Would you like to rest now?” 

Change: People with dementia usually like routine—everything done the same way, at the same time, every day.  What’s different today?  Think of anything new: maybe a new caregiver, clothes, holiday decorations or a change in lunch time or bath time.

Perception of loss: If the resident is reliving a loss such as the death of a loved one, empathy followed by distraction may work to divert the person’s attention.  If the loss is the perception that something has been taken, help the resident to look for it.  If the loss centers around money, it may help the resident if the family will bring in some loose change to keep in the resident’s pocket so he can be reassured that he has his money or his wallet.

Stimulus levels: Consider the environment.  What is going on around the resident?  Some people react negatively when there is too much noise, too many people or too much activity.  Others may tolerate this normally, but react badly when they are more tired.  This might be a time to walk the resident to a quiet area or his or her room where they have a chance to feel calmer.

Is it possible the resident is under-stimulated?  Could he be bored or restless?   Perhaps he or she needs physical activity such as a walk outside.  Could she be lonely?  You can ask family members to make a video of themselves doing routine activities for the resident to watch when she misses them.

Excessive demands: With dementia comes the loss of the ability to process multiple thoughts at one time.  People with dementia can’t multi-task or multi-think.  So we need to be careful in our communications that we only make one brief request of them at a time.  Saying “Brush your teeth, then you can get into your pajamas and ready for bed” may simply be too many concepts.  You may be more successful breaking it into bite-sized chunks: “Now it’s time to brush your teeth.”  When that is accomplished: “Now it’s time to put on your pajamas.”

Physical stressors: Rule out pain: it could be a headache, a pebble in the shoe, a stomach ache, a urinary tract infection or clothes that are too tight.  Look for signs of injury: red spots or bruises, limping, a bump on the head or holding a body part.  Look for signs of infections such as a rash, redness, runny nose or strong smelling urine.  Could the resident feel cold or hot and unable to tell you?  Is he or she uncomfortable due to wet briefs?

Communication

One of the greatest frustrations of having dementia is not being able to clearly communicate your wants and needs.  But we can do a lot to facilitate better communication.  First we need to make sure the resident is ready to communicate: are his glasses clean?  Is her hearing aide in, turned on and does it have a good battery?

Now the resident may be ready to communicate, but are YOU?  You should identify yourself every day, sometimes more than once a day.  Don’t assume the resident will remember you just because he knew you last week. 

Key Principles

It is essential that you know what the person’s limitations are.  If he or she has had a stroke it is important to know what parts of speech and thinking were affected.  Sometimes a stroke leaves the person unable to understand speech, other times he understands but cannot get the right words out.

Remember that agitation is a symptom that means something else is wrong.  It is the job of caregivers to figure out what the real cause is.  So when the resident is agitated, put on your detective hat and see if you can’t solve the mystery at the bottom of the behavior.

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 23.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Most Cancer Docs Reach Out to Bereaved

Seventy percent of cancer physicians contact bereaved family members and caregivers of their patients who die.  But of the 162 physicians surveyed, more than two thirds do not feel adequately trained to do this sort of reaching out.  These were the results of a study presented at the 53rd Annual Meeting of the American Society for Radiation Oncology (ASTRO).

Most of those surveyed sent condolence letters, and some called or attended funeral services.  One perceived barrier to bereavement follow-up is lack of time.  Another factor was uncertainty about which family member was the most appropriate person to contract.

“This study highlights the need to more clearly define the physicians’ role in bereavement activities and address bereavement activities in providers’ postgraduate training as we work to improve the multidisciplinary treatment of cancer patients and their families,” said lead author Aaron S. Kusano, MD, a radiation oncology resident at the University of Washington School of Medicine in Seattle. 

Source:  www.medicexchange.com/ASTRO-2011/most-cancer-physicians-reach-out-to-bereaved-family-caregivers-astro-2011.html.

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 23.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Hospice Facts & Figures: 2010 Snapshot

The National Hospice and Palliative Care Organization (NHPCO) has released facts and figures for 2010. Key statistics in the report, which mainly compares data from 2009 to 2010, include:

• 1.58 million hospice patients served
• Average length of service was 67.4 days
• Median length of service 19.7 days
• 66.7 % patients died at home
• 21.9% died in hospice inpatient facilities
• 11.4% died in acute care hospitals
• 87.2% of hospice patients were 65 or older: 38% were 85 or older
• 35.6% deaths with diagnosis cancer; 13% deaths with diagnosis dementia

The percentage of non-white Caucasian patients increased in every category: 11% multiracial or other race in 2010, compared to 8.7% in 2009; 8.9% v. 8.7% Black/African American; 2.5% v. 1.9% Asian, Hawaiian, other Pacific Islander; and 0.3% v. 0.2% American Indian or Alaskan native. 
 

Source: www.nhpco.org/files/public/Statistics_research/2011_Facts_Figures.pdf

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 23.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.

Hospice Care Guide - Questions & Answers - Part Three

Pathways will be sharing the answers to some of the most commonly asked questions regarding hospice care beginning this week. 

Can we go to the hospital?     

Yes.  You can always go to the hospital.  Hospice asks that you call them first.  They may be able to manage your crisis at home.  If not, they can arrange transportation to the hospital.  There are times that the hospice may ask you to go to the hospital for a short stay if there is a problem that can be managed better there.

My loved one lives in a nursing home.  What can hospice do that they can’t?    

Nursing homes are experts in long-term care.  Hospice nurses are experts in symptom management and end-of-life care.  Hospice nurses are best equipped to deal quickly with health problems that arise.  Other benefits of hospice include more frequent personal care, volunteer visitors, paid medications and supplies, and bereavement follow-up for family members.

When should we think about getting hospice help?     

You can let your doctor know that you would like hospice care if it becomes appropriate.  You are entitled to at least six months of care, but some doctors hesitate to talk about hospice for fear you will think they are “giving up.”  Hospice is not giving up.  Just like you, we hope you do well.  Hospice is a way to be sure of the best care, no matter how things turn out. 

Is hospice linked to a religion?     

No.  Hospice care is only related to health insurance.  Because of the special nature of hospice care, we do make spiritual care counselors available to patients and families.  They can also help to link you to someone in your own faith community.

Who decides whether we get hospice?     

You do.  Your doctor authorizes care, but you decide if you want this care or not.  Sometimes the doctor calls hospice and asks us to contact you about hospice.  Some families call hospice and have us contact the doctor to ask for authorization.  Pathways will send someone, free of charge, to make an information visit if you need this.

Who makes our health care decisions when we are on hospice?      

You and your doctor are always in control of your care.  Hospice will make suggestions about your care, but you will always be in control.

What happens if my loved one is still alive at the end of six months?      

Hospice must periodically recertify that the patient has a prognosis of six months or less.  If at each of these dates it appears that the patient has six months or less to live, then the patient can stay on hospice.  If the course of the disease is slow, some people may be on longer than six months. 

Can we stop hospice care?

Yes.  Any patient can go off hospice at any time.  You can also come back on hospice if circumstances change.

What if the patient’s health improves? 

Sometimes with the extra care from hospice a patient’s health improves.  They may start eating more and be more active.  If they improve to the point that it looks like they will live more than six months, we will discontinue hospice care.  The patient can return to hospice in the future when needed.

What does hospice do for us after my loved one dies?  

A large part of hospice care is bereavement support for families and friends.  Pathways provides phone calls, newsletters, counseling, support groups, and remembrance events for families after a death.


Download a complete set of the questions and answers that we covered in this blog series by clicking here.

Hospice Care Guide - Questions & Answers - Part Two

Pathways will be sharing the answers to some of the most commonly asked questions regarding hospice care beginning with our last post on April 18th.   

Can we visit our own doctor?

Yes.  Your primary care doctor remains your doctor under hospice care.  Your doctor gives us direction about your care.

Will someone come to stay with us?

No.  Hospice does not provide shift care or 24-hour care.  Team members make visits. But a nurse is available by telephone 24-hours a day and can come at any time if a visit is necessary.

Do I have to give up my medications?  

No.  Hospice will pay for your medications that are related to the terminal diagnosis.  If there are medications that hospice does not cover, you can continue to get them and take them as you always have.

How will hospice manage pain if it occurs?  

Hospice usually treats pain aggressively.  We know that pain interferes with eating, sleeping, visiting and general quality of life. Uncontrolled pain can also shorten life.

The patient and family are always in control of their care and can decide how they want to treat pain.

Will my loved one be asleep all the time?   

Not usually.  Some diseases cause the patient to be less alert.  If pain is severe, pain medicine may make a patient sleepier than usual for two or three days, then they will be as alert as the disease lets them be.

Does hospice do anything that will make my life shorter or longer?    

No.  Hospice tries to improve life in the final months or weeks, but does not try to shorten or lengthen life.  Research shows that with the extra care from hospice people who go on hospice usually live longer than those who do not.

What about help with practical things like grocery shopping?   

You can have a volunteer if you like.  Volunteers can help you with practical matters such as shopping, or they can stay with your loved one while you go out.

What if caring for my loved one at home becomes too much for me to do?    

If you feel you cannot continue caring for the patient at home, the hospice social worker can assist you to find a skilled nursing facility or residential care facility.

Be sure to check back in with us next week for the next part of our blog series on commonly asked hospice questions and answers.  

At the end of the blog series we will post a downloadable PDF with all of the questions and answers covered in this blog.