Friday, December 31, 2010

Persuasion Tactics of Effective Salespeople

subject: Tips on talking about hospice from a salespersons rules

http://blogs.hbr.org/cs/2010/10/persuasion_tactics_of_effectiv.html

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Health Matters: Palliative Care and Hospice Services

Being diagnosed with a life-limiting or terminal illness is devastating for both the patient and their loved ones. Navigating the many options for care can be a frustrating and confusing task. Expert Gary Buckholz, MD, with San Diego Hospice and The Institute for Palliative Medicine, joins our host, David Granet, MD, to discuss both palliative care and hospice and how these services help people by addressing their physical, emotional and spiritual needs. Series: Health Matters [6/2010] [Health and Medicine] [Show ID: 17814]

 

Become a hospice volunteer. Learn about hospice and the special philosophy of care that allows you to face death by really living.

Volunteer Training Online

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I just saw this on Vancouver Sun

Tuesday, December 28, 2010

Medicare to Cover End-of-Life Planning Talks

Medical News: Medicare to Cover End-of-Life Planning Talks - in Public Health & Policy, Medicare from MedPage Today http://t.co/zzojzYP Finally, the talks can continue with reimbursement for the conversation.

Family members of patients in the advance planning intervention reported significantly less emotional trauma afterward, Karen M. Detering, MBBS MHlth Ethics, of Austin Health in Heidelberg, Victoria, Australia, and colleagues reported online in the BMJ.

The discussion about end of life care options are not just about the patient - it's also about the family.

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Wednesday, December 22, 2010

What's the Distinction Between Hospice and Palliative Care?

What's the Distinction Between Hospice and Palliative Care?

Author: Daniel Butler

Yankee hospice service started with the Connecticut Hospice in March 1974. Today, there are over 2,884 Medicare-certified hospices, and an extra 200 volunteer hospices within the U.S., with as several as 1.5 million Americans seeking hospice treatment in recent years. As a program designed to facilitate palliative take care of terminally sick patients and their families, several people marvel, what then is that the difference between hospice and palliative care, or are they one in the identical? Whereas palliative care addresses patients with life-threatening illnesses, anyone, regardless of life expectancy, will receive this kind of care. Hospice, meanwhile, provides for patients who will not profit 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 religious wants and expectations of a patient with a life-threatening illness, at any time during that illness, whether or not life expectancy extends to years. Palliative care will 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 staff and clergy in their home or a hospital, however also in nursing or assisted living facilities. Hospitals, hospices, skilled nursing facilities and health care clinics offer these services, that may include a monthly visit to a doctor, or weekly home visits from a social employee or nurse to help manage pain and symptoms. The goal of hospice care is to keep pain and suffering of an individual 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 alternative long-term care facilities, hospice relies on the assumption 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 employees and trained volunteers who manage the patient\'s pain and symptoms; assist with the emotional and spiritual aspects of dying, offer needed medications and provides, coach the family on how to worry for the patient, and, offer bereavement counseling to surviving loved ones. Whereas Medicare, Medicaid, most non-public insurance plans, HMOs, and different managed care organizations provide hospice coverage, Medicare or Medicaid does not currently cover palliative care. Some non-public insurance companies cover the costs of care, but it is vital for you to ask the palliative care supplier how or if the services can be covered and what, if any, prices you\'ll be asked to pay. The goal of hospice care is to keep pain and suffering of someone 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 different long-term care facilities, hospice relies on the assumption that every person has the right to die pain-free and with dignity, and with family and friends nearby.

Article Source: http://www.articlesbase.com/health-articles/whats-the-distinction-between-hospice-and-palliative-care-3886155.html

About the Author

Jeff Patterson has been writing articles online for nearly 2 years now. Not only does this author specialize in Pain Management, you can also check out his latest website about Honeywell Heaters Which reviews and lists the best honeywell gas heaters

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Tuesday, December 21, 2010

The Role of Advance Directives when dealing with palliative care, end-of-life care and hospice care | Eye Opener: The Nash & Associates Blog | %post_tags

In a previous blog, I raised the issue of “Advanced Directives” and how, according to a Medscape physician survey, physicians do not always honor these legal documents.  One of the “excuses” cited the definition of futility in treating a terminal medical condition, arguing for palliative care as opposed to withdrawal of care.  Obviously, confusion exists amongst these providers as to what constitutes comfort care versus unnecessary prolongation of life and/or exposure to unnecessary procedures in a patient with a terminal condition.

Palliative, End-of-Life and Hospice Care

Palliative care is essentially comfort care.  To “palliate” means to “ease” or “make less severe” – therefore, medical care that is designed to palliate symptoms of a particular disease is care designed to ease or lessen the severity of symptoms associated with that disease.  It can be in an acute condition, a chronic condition or even a terminal condition depending on the stage of the illness.  Some of the symptoms often palliated are nausea and vomiting (chemotherapy, cirrhosis), anorexia (cancers, AIDS), pain (rheumatoid arthritis, cancers), shortness of breath (COPD/emphysema, interstitial lung disease), dizziness (Meniere’s disease, multiple sclerosis), incontinence (spinal cord injuries, stroke), constipation (inflammatory bowel disease, chronic pain syndromes), and many others.  There are various treatments available for the treatment and/or management of these symptoms, but they are not necessarily curative of the underlying condition.  Some chronic conditions, like Rheumatoid Arthritis, are manageable but not necessarily curable, so the treatment rendered is to palliate/lessen the symptoms and hopefully put the auto-immune disorder into remission for a period of time.  Rheumatoid Arthritis, however, is NOT a terminal condition; patients usually die of complications or other co-morbidities.  Palliative care can also incorporate a variety of specialties with overall coordination of care that involves communication with the family, spirituality and emotional support.  Palliative care is a critical component of end-of-life and Hospice care.

End-of-Life care is a well-coordinated approach to end-of-life issues when a condition is deemed terminal, such as incurable metastatic cancer, end-stage multiple sclerosis or even liver cirrhosis when organ transplant is not an option.  Life expectancy can vary widely, with physician guestimates being greater than 6 months (as much as one year or more).  End-of-life care typically incorporates palliative care to ease the symptoms of the disease process as well as counseling services, emotional support and even spiritual support.

Hospice care is end-of-life care, incorporating palliative care, reserved for the last 6 months of life or less.  Care is shifted from curative therapies to pain management and ease of other symptoms of illness.  There are many Hospice programs that offer services in a variety of locations, all of which is dependent on the patient’s and the patients’ family’s wishes. They can be rendered at home, in a nursing home, in the hospital or in a dedicated Hospice facility.  Services provided by these organizations can even include basic housekeeping, personal hygiene care, grocery shopping, and even companionship in addition to the palliative medical therapies.

Where do advanced directives come into play?

Advanced directives can affect every one of these aspects of care.  They reflect the patient’s or the patient’s medical power of attorney’s wishes regarding palliative care modalities, end-of-life care and Hospice care.

About.com’s website on palliative care offers a great example of palliative care that transitions to end-of-life and at-home Hospice care for “Aunt Tilly”.

A patriarch of the family has essentially been healthy his entire life, shoveling  snow and cutting grass into his 85th year of life.  Things shift during the 86th year, and he develops congestive heart failure which has triggered multiple falls and syncopal episodes, presumably from hypoxemia.  There are several hospitalizations to evaluate his condition with institution of multiple medical therapies/drugs to stabilize his condition.  Unfortunately, his heart is weak, and ultimately his kidneys begin to fail.  No advanced directives had ever been discussed, as with many people of his generation; fortunately, he remained of sound mind.  At first, everything was a whirlwind……medication infusions to prevent irregular heart rhythms, blood transfusions to address his anemia since the kidneys were no longer working properly to stimulate the bone marrow to make more red blood cells, and finally, dialysis???  Well, if the kidneys are not working very well, not filtering the blood to produce urine and not stimulating the bone marrow to produce RBCs, we have to fix this, right?  What was not mentioned was that blood transfusions have to be given with intravenous fluids, which then worsen the fluid overload and congestive heart failure making it even more difficult for the poor man to breathe.  Higher and higher amounts of oxygen are needed to keep him comfortable, while his body is swelling up with fluids.  So, STOP THE MADNESS!  This family patriarch, after being informed of the complicated nature of his essentially end-stage condition, opted to forego hemodialysis; he did not want to be hooked-up to a machine for 3 hours a day, 3 days a week, just to filter his blood in an attempt to garner perhaps 6 more months of life; that kind of life had no quality to it in his mind.  In addition, since the blood transfusions would only worsen his breathing, he refused any more blood.  He wanted to be kept comfortable with pain medications and oxygen which was done in the hospital; he did not want to be shocked (defibrillated) or resuscitated in any way.  Comfort measures were provided in the hospital where he was given a large, private room, and he passed away peacefully within 3 days; there were no restrictions on family visitation, and he was surrounded by those dearest to him.  A chaplain was available within minutes of his death to comfort the family and offer prayer to ease everyone else’s suffering and loss; this patriarch was already at peace and without pain.

In this particular example, it was beneficial that my family member was of sound mind to make his own decisions at the end of life with regard to blood transfusions and hemodialysis.  It would have otherwise been very difficult for the family to come to some kind of consensus.  It was also better, in this case, that he remain in the hospital since his wife was still living and would have to return to their home alone following his death; having her live in the house in which her husband of 67 years had died would have been too much for her to bear.  This emphasizes the importance decision-making while one is of sound mind.  Cancers can spread to the brain; toxic metabolites that accumulate when vital organs fail can render a patient confused or even comatose; acute strokes can also affect one’s cognitive capabilities, not to mention other organ systems (breathing, toileting, swallowing, etc.).

Advanced directives can be as precise or as vague as one desires.  It seems to me that the more detailed the directive, the less chance one encounters of a physician or care provider ignoring the directive or “interpreting” the directive in a way that confuses loved ones, exposing the patient to unnecessary procedures and/or life-extending treatments.

Have you ever had to deal with any of these issues – advanced directives, palliative care, end-of-life care or hospice care? What has your experience been? Do you have any suggestions that might be helpful to others, who may be faced with similar issues?

More on this topic soon: What constitutes a terminal condition?

Related Posts:

Advanced Directives: The Right to Die With Dignity. Does the Medical Profession Honor Them?

Making Your Wishes Known at the End of Life (NY Times article by Dr. Pauline W. Chen )

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This entry was posted on Tuesday, December 21st, 2010 at 7:34 am and is filed under Advanced Directive, Chronic Pain, End-of-Life Care, Health Care Agent, Hospice Care, Medical Ethics, Medical Procedures, Palliative Care. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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Hospice volunteers provide comfort to families in trying times

Montgomery Advertiser http://www.montgomeryadvertiser.com/article/20101221/LIFESTYLE/12210310/Hospi... Providing comfort and care near the end of life for a terminally ill person is at the heart of hospice care -- a way to bring peace and dignity to both the patient and the family.

An important part of that care comes from volunteers, those who feel a special calling to share compassion and kindness when a family needs it most.

Hospice is not a place. It's a concept that focuses on caring, not curing, for people facing a life-limiting illness or injury. Hospice involves a team-oriented approach to medical care, pain management, and emotional and spiritual support tailored to the patient's needs and wishes, according to the National Hospice and Palliative Care Organization.

Among the members of such a team are physicians, nurses, home health aides, social workers and clergymembers. One of the vital components of the support staff is the volunteer -- someone to fill in the gaps and help a patient, and his or her family, through the precious final weeks, days and minutes of life.

In fact, for most hospices, volunteers are not just a luxury -- they're a requirement. Federal regulations require that for hospices that participate in Medicare, 5 percent of all patient care hours must be provided by trained volunteers.

"That's because the philosophy of hospice, when it began in the 1970s, was all volunteer," said Clara Jehle, volunteer coordinator for Hospice of Montgomery. "Medicare wanted to retain that volunteer image, so they put in (that standard.)"

The volunteer provides companionship and socialization for a patient who is homebound or in a nursing home or assisted living facility, and helps the family meet its emotional needs, said Marti Galloway, manager of volunteer services for VistaCare Hospice.

"When you become sick with a terminal illness, your world just becomes increasingly smaller as you become sicker," Galloway said. And if the patient and the primary caregiver don't have adequate support, everyone's quality of life suffers.

That's where the most visible hospice volunteer steps in -- to provide respite care to a caregiver and family. It is not always easy, but it is emotionally rewarding.

-->(2 of 4)


"It's such a blessing to be invited into someone's home," said Mona McDermott, bereavement, social work and volunteer coordinator for Baptist Hospice. "It's a very special time in their lives. It can be sad, but it can also be healing, and a time to make wrongs right.

"To be allowed into someone's life and home at that time is incredible."

The volunteer is often relieving a caregiver, to give that person some time to himself or herself for a few hours.

In that time, the patient may want company or comfort, or nothing at all.

"If they want to talk, we talk, but if they want to sleep, we let them," said Gary Jones, a volunteer with Hospice of Montgomery for about three years.

The intimacy required at such a time means that the volunteer and family have to be a good fit for each other, and that's one of Jehle's tasks as volunteer coordinator for HOM.

"I look at the characteristics and personalities of the patient and the family, and see what fits best," Jehle said.

Giving back

Most who volunteer for a hospice have a personal connection. They had a close friend or family member who received hospice services, so they want to give something back.

"They realize how important it is to have someone to talk to, to have the things they needed," said Paul Cowley, chaplain of Wiregrass Hospice.

But it's crucial that such a volunteer be well along in the grieving process, something a coordinator can determine in the interview.

"If I think they're still grieving, I'll steer them to other ways to volunteer, maybe administratively in the office," said Galloway of VistaCare Hospice, which is owned by the Gentiva company.

In fact, many don't realize that there are several avenues for volunteering with hospice -- not just interacting directly with end-of-life patients.

"Whatever special skill they have, we see if we can find a way to use it," Galloway said.

For example, some ladies' church groups crochet or knit hats and lap blankets for patients; one group makes shawls that are prayed over as they're being made, Galloway said.

-->(3 of 4)


One of McDermott's volunteers made Christmas stockings for patients this year. Local church groups gave personal grooming items to fill the stockings. After that, a group of young people at the Mount Meigs youth facility put the stockings together.

"We have one group, one of the local churches, and they take up money to buy cases of Ensure, which are very expensive," McDermott said.

The ones who provide clerical help are just as important as those who sit with patients.

"There's a lot of paperwork we have to keep up with," said Cowley, the chaplain at Wiregrass Hospice, which, like VistaCare, is a for-profit hospice owned by Gentiva.

Galloway agrees.

"Hospice is a very paper-intensive world," she said. Any help with filing and organizing helps the medical records person to operate more efficiently.

Such help is even more important to the nonprofit hospices.

"We can never pay enough for staff," Jehle said.

There are even ways for the homebound to help.

"If you want to do bereavement or Christmas card mailings, we can bring the materials to you, and you can prepare it and we can pick it up," McDermott said.

Retiree Charlie Brown has volunteered with Hospice of Montgomery for five or six years, and his role is very straightforward: He runs plans of care between doctors' offices and the HOM office, twice a week.

His satisfaction comes in knowing he's helping the staff of HOM, and helping them in their mission.

"You'll certainly get some personal satisfaction out of helping," Brown said. "For me, it's ideal to spend some hours outside the home."

Linda Gates has volunteered with Baptist Hospice for almost two years. She works at a grief camp for bereaved children, which is an annual event each spring at Camp Chandler.

"It's to help them get through their grief, because children grieve differently than adults," Gates said. "Coming to the camp gives them a chance to talk about (their grief), and they're with other kids. I think that helps them open up."

She also sends notes each month to bereaved families. "I try to write something to give them some peace, something to let them know that we love them and that we care."

-->(4 of 4)


Some volunteers help with fundraising. While hospices receive Medicare, Medicaid and private insurance reimbursements, raising money is an essential component for both Baptist Hospice and Hospice of Montgomery, which are nonprofits.

Hospice of Montgomery has its annual Monte Carlo benefit; the Baptist Health Care Foundation raises money for Baptist Hospice through its annual Montgomery Family Christmas concert, which this year featured singer John Tesh.

Volunteers help with the behind-the-scenes work at those events as well.

All kinds of volunteers

While many hospice volunteers are retired, people of all ages find ways to help.

"We have some who have been volunteers for more than 25 years," McDermott said. "Some are almost 90 years old, and they're still very active."

Teens can help, too. Min-ji Kim is a senior at St. James School and is in her third year of volunteering. She helps Galloway with administrative functions at VistaCare.

Kim wants to be a doctor, and thought hospice would be a good way to expose herself to the medical field.

"If I have an opportunity, I'll continue (volunteering) at college," she said.

No matter the age, all hospice volunteers have a special gift.

"It takes a giver, a selfless, servant-oriented person. A person who gets pleasure in sharing themselves with another person, a helper, a nurturer," Galloway said.

The work can be challenging, but is very rewarding.

"Without exception, volunteers tell me they're the ones who were blessed by the experience," Galloway said.

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Monday, December 20, 2010

The Best Pictures You will Take This Year

I am not a professional photographer but my work in hospice teaches me the value of living and photos of loved ones is part of that valuing process.

This weekend I took a few shots of my family celebrating an early Christmas dinner together. 

My mother usually loves to have her picture taken and then 99% of the time complains that it was not a good picture.

This year I asked her to do something different from the traditional, "look at the camera and smile" routine.

"Mama, look at someone in this room and remember a wonderful thought about them or a wish you have for them".  She looked at my niece and smiled that wonderful smile that can only come from the heart of someone that loves another.  The picture was perfect.  I was almost surprised when she looked at the shot and said, "That's......that's actually a good picture of me!".

So began a new tradition.  Each person in the room chose another person on which to focus and think kind or loving thoughts. Picture after picture came out great.  The best part is that when these pictures are reviewed, each of us will remember the person for whom we wished love for shared treasured life moments.

Hospice has taught me how to take great pictures; take them with love.

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Bangor, ME | St. Joe's Healthcare employees bringing Christmas cheer to Homecare and Hospice patients

BANGOR, Maine (NEWS CENTER) -- St. Joseph Healthcare employees have donated hundreds of items over the past several weeks to give to the hospital's Homecare and Hospice patients.

Employees spent Monday morning packing gift bags filled with everything from pasta, soup, and other condiments to tissue boxes and other paper products. Hospital officials say they packed more than 60 bags to distribute to patients. St. Joseph employees say the gift bags are a surprise to the patients who are getting them, and they can go a long way especially during the holidays.

"These folks are going through a lot in their homes, and are going to be very appreciative of the things that were gathered from folks here at the hospital and homecare," said Homecare and Hospice Clinical Leader Janice Hatch.

Hatch says the gift bags will be distributed to patients all week leading up to Christmas. She says it's the first year St. Joe's has done the program for its Homecare and Hospice patients.

NEWS CENTER

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Sunday, December 19, 2010

Hospice and Patient Centered Care - The Facility Experience

"amenities are a critical part of the patient experience and possibly even a valuable component of patient-centered care" How Does Your Hospital Room Make You Feel? By PAULINE W. CHEN, M.D Published: December 16, 2010 While most of us, doctor and patient, would agree that having at least a few amenities would be nice, they don’t come cheap. Improving a hospital’s nonclinical services has been shown to be more costly than similar adjustments in clinical care; and it’s unclear whether the benefits are worth the cost. Third party payers like Medicare currently underwrite a large portion of these services when they pay a fixed amount for each patient discharged with a certain diagnosis. But under the Patient Protection and Affordable Care Act, these expenditures could come under more scrutiny. Hospitals will be reimbursed according to a value-based payment system; and those “values,” which have yet to be determined, may not include the nonclinical aspects of a patient’s experience. That is unless all of us, doctors and patients, can finally acknowledge that all aspects of a patient’s hospital experience count. “Whether Medicare dollars should be used for these services is an important question,” Dr. Romley said. “But the happiness and joy that these amenities provide for patients over the course of what is otherwise a difficult experience is something we should respect.” Added Dr. Goldman: “It’s not just about patient survival anymore; it’s also about the patient experience.”

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Wednesday, December 8, 2010

Survey finds gap in doctor-patient communication

Dr. Megan Wills Kullnat, a fourth-generation physician, communicates with a new patient at her pediatric practice.

Enlarge image

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By Michael Lloyd, AP
Dr. Megan Wills Kullnat, a fourth-generation physician, communicates with a new patient at her pediatric practice.

But a national survey of doctors and hospitalized patients finds that, in reality, effective communication often is sorely lacking.

Only 48% of patients said they were always involved in decisions about their treatment, and 29% of patients didn't know who was in charge of their case while they were in the hospital.

"That's terrible," says Beth Lown, medical director of the Schwartz Center for Compassionate Healthcare at Massachusetts General Hospital, which commissioned the survey by Marttila Strategies in Boston. These patients "are orphans" in the hospital, she says.

Eighty-one percent of patients and 71% of doctors agreed communication made a difference in "whether a patient lives or dies," according to the survey of 500 doctors and 800 patients.

"So there's a disconnect between what people say they want and what's happening," says Gregory Makoul, chairman of the American Academy on Communication in Healthcare.

Emphasis on better communication has increased in recent years as the medical community has become more aware of its effect on patient healing. Since 1995, U.S. medical students have been required to get training in communication skills. And in 2005, the United States Medical Licensing Exam began to include testing on interpersonal and communication skills.

Communication skills and high patient-satisfaction scores can give hospitals a competitive edge as well as reduce malpractice claims, says Debra Roter, a professor at Johns Hopkins University in Baltimore.

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I learned something new - the US Medical Licensing Exam began including testing on interpersonal and communication skills in 2005. 5 Years later, I think it's time to review the impact of these skills.

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Tuesday, December 7, 2010

Light a Caring Candle for Elizabeth Edwards

Caring Candle for
Elizabeth Anania Edwards
Breast Cancer
Caring.com: Senior Care

Sponsored by Hospice Volunteer Training Online

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Saturday, December 4, 2010

Diminished Clarity of Goals

The 92 year old woman had a skin cancer that was biopsied.  Following the results, a surgey took place to remove the cancer which was now reportedly an aggressive cancer. It had spread behind her eye and into her skull.  The family was not studying steps to take next but depending on health care professionals to guide them in their decision making.  Surgery would be the treatment option that would be decided on by the family.

A couple of month earlier, this 92 year old woman was still taking daily walks and enjoying her kids, grandkids, and great grandkids.  She would sometimes get my mail by mistake in her mailbox.  "You have a letter here" she would call and say.  "Better come get a cup of coffee with me and see if it's anything important".  The letter would almost always be a piece of junk mail but the kind senior would hold it ransom until me or my husband would come to her house, get the letter and proceed to visit.

I placed a courteous call to my neighbor, the daughter of the 92 year old woman, to inquire about her mother's status. 

"She's on a ventillator.  If she makes it through this, then we are going to discuss chemo and radioation.  Can hospice help her?".

"Really?", I thought.  I knew better than to voice my opinion.  I can't imagine putting someone through that who is 92 and has aggressive cancer so I asked the neighbor to ask the doctor one question.  "Will this treatment be for curing or for just making Mama comfortable?"  Then, I told her the truth.  "If the doctor says this treatment is not for cure, then you know that he or she believes there is a good chance that your mother will not live longer than 6 months".  It may have seemed cruel but I couldn't lead her to believe that hospice is a great service to provide a lot of extra attention but a specialty program for the person who may not live through their disease.  By the way, this did not remove hope but evoked words of gratitude from the daughter,  "That's what I wanted to hear - the truth".

I didn't want to interject too much of my opinion here with fear of making the daughter feel guilty about any decisions she and her family were making at this time. I wanted the doctor to have an opening to begin discussing possible outcomes and hopefully this question would be the prompt.

I took the scenario personally as I do any situation that seems to cause more harm than good.  Mentioning the situation to a hospital discharge planner, I was taken aback at her response.  "Whose to say that this woman won't live until she's 102 and that is what she wants?"  Good point.  Who was I to say that all this was not going to work and offer this woman a long satisfying quality of life?

This is where I began another awakening.  I still have a few of them as I get older.

The goals of care begin to distort because none of us ever know what the real outcome will be.  How can the layperson ever know that the decisions made during a crisis are going to be the best for those we love?  I believe completely in advanced directives like the 5 Wishes form that I present to community groups. However, in moments like this one the advanced directives only tell us that our loved did not want to be eternally hooked up to a machine.  Rarely do we discuss what we want done in the earlier stages of bad news discussions.  In survival mode at the beginning of the roller coaster ride of disease, all decisions are optimistic.  We will try anything and everything and when that doesn't work we will choose not to be kept alive by life support systems.  Somehow we must learn to clarify our goals earlier - or maybe just continue the way we do things now.

Last night, the 92 year old's life ended, 2 days after surgery.

 

 

Robin Watts is the founder of Hospice Volunteer Training Online

 

 

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Wednesday, December 1, 2010

The Hospice Volunteer Daily

The Hospice Volunteer Daily is a great resource for hospice agencies.  I use one of the articles daily in educating the community and referral sources about the benefit of hospice services.

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Thursday, November 25, 2010

Hospice Opportunities/Events

Blue Ridge Hospice: Help is needed sorting donated merchandise. 540-536-5210, www.blueridgehospice.org.

Optimal Hospice Foundation needs volunteers to assist in organizing fundraising events such as the upcoming "Light Up A Life Celebration" that will be held in December in the Bakersfield, Taft, Tehachapi and Lake Isabella communities. If you would like to honor a loved one at the "Light Up A Life Celebration" or you would like more information on volunteering for this cause, contact Foundation Director Ann Smart at 716-8000.

Optimal Hospice Care is looking for community support for the annual Optimal Hospice Care Food Drive that helps provide holiday meals for some of the families in its care. Non-perishable food items and grocery gift certificates from local stores are welcome. If you are interested in donating, contact the volunteer office at 716-4000, or simply drop the items in the Food Drive Donation boxes between 8 a.m. and 5 p.m., Monday through Friday, at Optimal Hospice Care, 4700 Stockdale Highway, Suite, 120.

 

 

http://volunteertrainingonline.com/courses

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Wednesday, November 24, 2010

Financial Wealth Management and Hospice

The microphone clumsily danced before me as I sat in as a guest on a radio show this morning to discuss National Hospice Month, holiday grief, and advanced directives.  After previewing the Facing Death PBS special, my thoughts were not collectively focused on the normal promotion of hospice services. 

Why was hospice only mentioned once in a show about death and dying?  More to the point, why was it mentioned in the context of "we can send you home with hospice....(pause)....or not".  The solution in my mind is obvious and quite helpful to referring physicians.  Look at the patient and family, begin with the usual "we can send you home with hospice" and remove the pause and the "or not". When hospice is mentioned say, "I would like for you to talk to someone from hospice so you can better understand what is available for you and your family and then you can make a more informed decision".  My supposition is that the palliative care teams would have loved to have at least received an honorable mention.  We haven't come quite as far as I thought in the hospice and palliative care field.

Perhaps the local listening audience of the financial wealth management show wondered why hospice would be on a financial show. Ironically, I can make hospice fit into any show because of the holistic services provided by the hospice benefit.  I once spoke immediately following an entertainment segment and very easily related it to hospice.  During that particular show I spoke about making dreams come true for those who are in their last days of life, taking flowers to patients, and serenity that spills over the family when hospice becomes a word of comfort rather than a word to be feared.

The wealth management show went well as we discussed leaving a legacy of peace.  The most important gifts we can leave our family and friends is making decisions about our finances, health care directives, and discussions that reveal our values and memories.  Once we give of these actions, we create peace for those we leave behind. Most of the younger patients tend to ask first about financial concerns (unless they are in severe pain).  "Can someone help me find out about my life insurance?" or "Will you help me with my disability application?" are common inquiries prior to asking anything health related.  Financial questions require the resources that hospice social workers can address and contribute to the course of counseling and support necessary to bring comfort to the patient.

The north georgia mountains a.m. morning show does not reach the magnitude of people that PBS does, but maybe today the show was just as valuable.

 

 

 

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Wednesday, November 17, 2010

HIPAA Course

The online training for hospice volunteers now includes another course for those interested in their annual competency exam for HIPAA requirements.  The information is freely available on the government websites.  The course is a reiteration of the guidelines from HHS and OCR and the information is divided into manageable sections for easier comprehension.  The exam is 25 questions and requires a passing score of 75% to obtain a certificate of completion.

Both course are available at

http://www.volunteertrainingonline.com/courses

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Sunday, October 31, 2010

Hospice and Nursing Homes Blog: Hospice Volunteers With No Patients (Video 1:34

The emotional state of doctors can affect patient care

by Jeffrey Knuppel, MD

Great doctors listen to their patients.

They start out by asking open-ended questions, and unless patients get too far off-track, they don’t typically interrupt them. Despite having limited time for appointments, they have an unhurried manner. They make eye contact with their patients and do not bury their heads in charts and computer screens. Their patients leave their appointments feeling respected and heard.

Of course no doctor is likely to be able to do all of these things all of the time, but some come closer to this ideal more consistently than others.

But great doctors additionally have a “sixth sense.” They can “read between the lines.”

It’s vital that physicians listen to their patients, but human beings are complicated and sometimes do not say what they mean or mean what they say. Or, they may not even know for sure how they feel. Therefore, listening to a patient’s words alone is not enough.

Exceptional physicians have honed the skill of reading non-verbal cues as well as easily-missed subtleties of spoken language that help them to interpret their patients’ histories with greater accuracy. Ultimately, since they are able to connect with and truly understand their patients better, they have the potential to provide superior care.

But, wait. There’s an invaluable clinical pearl that physicians can borrow from the world of psychotherapy to help them to better hone this “sixth sense.”

I’ll explain.

Have you ever been around a negative, depressed person for too long? Or too many negative, depressed people in a short period of time?

How did you feel?

Let me guess–you probably felt depressed or “blah” yourself.

What about someone who was in a very happy and joking mood?

Did you want to smile and maybe laugh?

And that’s the “secret”–it’s actually quite simple: The feelings that others elicit in you are often reflections of their own internal mood states. So, how you feel in the presence of someone very well might be similar to what they are feeling.

I’ve seen this occur from being around people experiencing other emotional states as well.

An anxious, obsessive, fearful person often creates a sense of anxiety, tension, and unease in those around him.

An untrusting or even paranoid person often causes others to feel suspicious.

The list of possibilities goes on and on.

And while this “window” into a patient’s emotional state is not always reliable, it often is. It’s potentially important “information” that shouldn’t be ignored, regardless of a doctor’s specialty.

In addition to providing a clue about the patient’s own feelings, there is another reason that I believe it’s helpful for doctors to be tuned into our own emotions. Our emotional state can impact patient care.

As physician blogger, Rob Lamberts, points out, the doctor-patient interaction involves two humans. He states:

Patients forget that doctors have bad days, get depressed, are sometimes sick, and can be as irrational as patients. We are forgetful at times, don’t always think of things that may be obvious, and even get distracted at times. Sometimes our kids annoy us, sometimes our marriages are bad, some of us have our own past trauma, and sometimes the patient immediately before your appointment was very difficult.

With regard to being “irrational,” that’s exactly what can happen when we have strong emotional reactions to our patients: We doctors can easily lose our objectivity. Making diagnostic and treatment decisions when in an overly emotional state can jeopardize good patient care.

So, what can physicians do?

We can try to pay more attention to how we feel when we’re with our patients. If we notice ourselves having strong emotional reactions, whatever they may be, we should remind ourselves that they may mirror our patients’ mood states. By simply getting ourselves in the habit of being more mindful of our emotions, I believe we’re less likely to allow them to inappropriately sway our clinical judgment.

Jeffrey Knuppel is a psychiatrist who blogs at Lockup Doc, where this post originally appeared.

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Very interesting article - the doctor's mirror of emotions can impact patient care.

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Grieving online - LancasterOnline.com Lifestyle

 

In a day when everything is virtual, it is no surprise that people are utilizing the Internet to help them grieve.

Online tributes to those who have passed are inundating the Web with memories of loved ones being posted on Facebook, MySpace, Internet memorial sites and funeral home pages.

Word of someone's death now spreads quickly and a network of support can appear within minutes online.

"I call it e-mourning," said Patti Anewalt, director of Hospice of Lancaster County's PATHways Center for Grief & Loss. "The bottom line to this is that the Internet provides a way for people to connect with each other and they can grieve anytime, day or night."

Websites are modern versions of traditional grieving techniques including talk therapy and writing in a journal, according to an article at www.cnnhealth.com. By sharing grief over the Internet, people feel as if they're being listened to and feel that they're not alone.

Social networking pages of those who have died are sometimes established by those who remain. Memories, messages and pictures are posted as a way to grieve and allow the friends and family to "connect" with their loved one, Anewalt said.

"We used to think that you get over a loss," Anewalt said. "You don't forget, you continue to remember that person and many people post things as a way to remember them and celebrate them."

The Internet allows people to connect and grieve together, even if they live far apart. In cases where family members may live across the country, social networking pages allow them to continue to work through their grief after the funeral, or allows them to share in the mourning process if they can't make it to services because of distance.

"It allows people to know they are not alone," Anewalt said. "It provides a safe place to mourn."

Wendy Rebman Lefever's 24-year-old son Zach died in an October 2009 accident, and she has found comfort in using a Facebook page as a way to help her mourn.

"I have learned so much about him and what he meant to people," Lefever said. "It's so comforting to be able to be close to him at the click of a mouse and leave thoughts about him on his page. I have shared a lot and so have others."

Although Zach's personal Facebook page is private and only allows those who are "friends" with him to post messages, Lefever created the "In Memory of Zach Lefever" page on Facebook as a daily journal, of sorts, to memorialize her son. The page is filled with messages not only from his mother, but other relatives and friends who post sentimental, and sometimes funny, thoughts to whomever wishes to read the posts.

"It gives me a piece of him that is still here and that I can connect to," Lefever said. "I journal on there for myself, but do not expect any kind of response. The response is amazing, though.

"His friends are a testament to him. They have not forgotten him and the posts they leave touch my heart," Lefever said.

"I am sure I am further along in the grieving process because I was able to write and share my son and thoughts," Lefever added.

Terry Christopher, 27, of Lancaster, has found an online outlet has enabled him to deal with the grief of losing his brother, Kevin, who died unexpectedly last November at age 24. Family and friends use Facebook to memorialize Kevin.

"I have learned a lot about my brother," Christopher said. "When you get that many different perspectives coming together on one page, it allows me to see him the way others saw him and see the memories they have of him."

"It helps me to stay close to him," he said.

However, there may be a downside to online grieving.

"The con is that I might be sitting down at night and reading the posts on Facebook and crying," Christopher said. "The posts may affect me that way.

"I might have been crying that night anyway," he added.

Grieving, which was once a very intimate and private process, is now more public with online grieving.

"Each person grieves differently," Christopher said. "Looking at an online site might be hard for some because it forces you to deal with your grief and think about the person

"I am constantly thinking about him," Christopher said.

Even when a person dies, his or her social networking site can remain active for a long time, unless someone knows the person's password and wishes to delete the person's site.

MySpace handles each incident on a case-by-case basis, according to spokesperson Corrina Pieloch.

"When notified, MySpace will work with families to respect their wishes," Pieloch said in an e-mail. "We often hear from families that a user's profile is a way for friends to celebrate the person's life, giving friends a positive outlet to connect with one another and find comfort during the grieving process."

However, the social networking site does not allow anyone to assume control of a deceased user's profile nor does MySpace delete profiles for inactivity. MySpace will delete a profile at the request of a family member, according to Pieloch.

In light of the growing number of memorial postings, Facebook has made adjustments to its policies, according the the company's site. According to a blog written by Max Kelly, Facebook's director of security, sensitive information such as contact information and status updates are removed after an account is memorialized following the person's passing. Privacy is also set so that only confirmed friends can see the profile. The changes allow family and friends to leave posts on the profile but prevent others from logging on to the page.

Facebook has developed an application called Mournwatch, www.mournwatch.com, an online site designed specifically for posting memories of loved ones, according to www.facebook.com/media. Mournwatch currently has more than 9,500 memorials posted.

Although many people post memorials without thinking and may be deep in their mourning process, there are precautions that should be taken before grieving online.

"People are very lonely and vulnerable while grieving," Anewalt said. "People put themselves out there and are very emotional. It depends on what you are posting and where — it's hard to take back.

"And unfortunately, in the world of technology, there are people out there who will prey on the vulnerable," she added.

Anewalts suggests thinking twice before posting online, checking to make sure it is a credible site, reading the other posts before posting your own and not answering messages from anyone you do not know after you post.

"Do not use the online sites as a substitute, though, for face-to-face support," she added.

Cesbenshade@Lnpnews.com

 

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Saturday, October 30, 2010

Hospice Massage: Ethical Considerations

Forward Printer Friendly --> PDF Version

Massage Today
November, 2010, Vol. 10, Issue 11

Hospice Massage: Ethical Considerations

By Ann Catlin, LMT, NCTMB, OTR

http://www.massagetoday.com/pdf_out/MassageToday.com-Hospice-Massage-Ethical-...

As a massage therapist, like other health care professionals, you are expected to adopt and uphold standards of practice that serve as "guiding principles" in scope of practice, client relationships, clinical decisions, and business practices.
If you choose to work in hospice you enter a complex field of service that exposes you to ethical issues and dilemmas unique to end-of-life care.

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Saturday, October 16, 2010

"Everette Payne's Second Wind Dream - Part 3"

"Everette Payne's Second Wind Dream - Part 4"

I love being a part of the Second Wind Dreams program. I must say that the board members and contributors to the dream really were left out of the interview but were such a tremendous part of the dream. But, that's what good board members do; they stay behind the scenes making sure that everything turns out perfectly. If any board member is reading this, let me just say from the bottom of my heart "Thank You!"

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"Everette Payne - Part 2 of his Second Wind Dream"

"Everette Payne's Second Wind Dream - Part 1"



:

Second Wind Dreams video
Part 1 - SWD: Everette Payne

© 2010 YouTube, LLC
901 Cherry Ave, San Bruno, CA 94066

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Friday, October 8, 2010

Nurses duck end of life care discussions | News | Nursing Times

Nurses duck end of life care discussions

5 October 2010 | By Steve Ford

It is nurses, not patients, who are reluctant to broach discussions about end of life care, a conference was told last week.

Speaking at Nursing Times’ Primary Care Live conference, Liz Clements, community matron for supportive and palliative care in Oxfordshire, said: “Sometimes it is us; we don’t want always to address it with patients.

“Sometimes they do, but we’re not ready to. We don’t want to have that conversation.”

The national end of life care strategy says patients should be enabled to make a decision about their favoured place of death.

But Ms Clements said patients often could not do that because they were not being made aware of the options.

She noted this was sometimes about nurses not having the right communication skills but in other cases it boiled down to their reluctance to broach the issue.

“We need to turn that round and think about if patients have the choice to discuss [where they would like to die] they’re more likely to achieve it,” she said.

A report published two weeks ago by the NHS end of life care programme said most nurses involved in end of life care were not trained in communication beyond a basic level.

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Wednesday, September 29, 2010

Print Article: New end-of-life program inspires STC nursing students

New end-of-life program inspires STC nursing students

2010-09-23 23:46:28
stc-house-students-john

WESLACO — Six South Texas College nursing students pondered how they would prepare for the possibility of their own imminent deaths, sitting just doors away from four patients facing that very situation.

It was no surprise the exercise drew tears in the quiet room, said Naila Rodriguez, one of the students in a new end-of-life care program at STC.

The nursing group spent their entire Tuesday at Aurora House, a Weslaco-based specialty care center for patients with a handful of months left to live.

"Imagine saying goodbye to your kids — your everything," Rodriguez said. "What goes through your head as death comes in a few months? What do you tell your family? This gives us patience when a patient is impossible and we don’t know why."

Partnered with Aurora House, STC recently adopted a new pilot program this semester to teach soon-to-be nurses a four-pronged palliative care approach to hospice and end-of-life treatment. The program is the first of its kind in the Rio Grande Valley.

"Physicians can’t move on and just fix the physical pain," said program director Dr. Raphael Rodriguez. "There’s still spiritual, psychological and social pains that can make a patient’s experience worse."

After drafting the program, Dr. Rodriguez persuaded the college to send six fourth-semester students to the care center each week.

There, a chaplain, social worker and doctor teach them how to help dying patients overcome mental, spiritual and emotional distress.

Palliative care has grown in popularity around the country as nurses more frequently act as intermediaries between overworked doctors and worried patients and families.

The American Association of Colleges of Nursing emphasized the need for better end-of-life care in 1997, and Chelan Williams, a nursing instructor at STC, said the Valley is finally catching up.

"The philosophy is not to prolong suffering or hasten death," Williams said. "The Valley is still years behind in the entire medical field.

Dr. Rodriguez hopes to instill that individual-based approach in the students rotating through Aurora House. The facility sees six new students each week but exhaustively explains the overwhelming list of non-physical symptoms that often tax patients’ well-being.

On Tuesday, the students listened intently to a Knapp Medical Center chaplain as he discussed the communication barriers nurses can dissolve by staying aware of the patient’s belief in prayer, differences in relatives’ religions or worry of the afterlife.

Afterward, Naila Rodriguez and her peers began evaluations on a younger male patient.

Though the students asked if he would like to be moved or made more comfortable, he admitted he would not mind passing away soon.

"Every patient — not just those that know they’re dying — can hurt more than pain," Naila Rodriguez said. "We can use these lessons for any type of patient. Hospitals or long-term care do not have to be so sad or scary."

Neal Morton covers education and general assignments for The Monitor. He can be reached at (956)683-4472.

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