The Apple Farmer and the Hospice Marketer

As a young girl, Daddy would often have conversations with me about good customer service.

He spoke to me as though I had already chosen the career of marketing before I had even reached the age of 10.

Daddy believed in leading by example and often

displayed the courtesies of removing his hat as

he entered a room, opening doors for others, and

always responding with "Yes sir" or "Yes Ma'am"

as he spoke to youth and elders alike. 

"Try this apple" he would say to the customer. 

When the purchase was complete, I watched the

customer leave the premises of the apple house

with an overflowing bag.  If a dozen apples were

purchased you could bet at least 13 apples were in the bag.

My parents encouraged me with words of "you can be anything",

"you are no better than anyone else and no else is better than you",

and "I love you".

Daddy would often let me play with balancing the checkbook.  I

would fret as I saw a near 0 balance and feel relief as deposits

were figured into the scenario. 

Looking back, I can only surmise now that this early childhood

education has played a significant role in who I am now.

I love great customer service, I take great pride in good financial

stewardship (I am truly debt free and no one really believes that

except my husband), and I wonder sometimes if my purpose in

life is to be of service through understanding and encouragement.

In case you are in health care, I strongly suggest you find an

apple farmer to mentor you in your career.

They truly know how to plant the seeds, nourish growth and

celebrate with gratitude the yielded crop.

 

 

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Change of Address: 10 Great Sites for Hospice Care and Why

When someone you care for is approaching the last days of their life, you will want those remaining days to be as comfortable as possible. That is what hospice care is all about. Whether you are in that position now or simply want to be informed ahead of time, the following sites can provide plenty of information and answers to your questions.

1. Hospicenet.org – This site is filled with information. It allows you to search for hospice providers. It has information for patients and caregivers. It also has information regarding hospice for children and dealing with bereavement. An excellent non-profit site.
2. Hospicefoundation.org – This is the official site of the Hospice Foundation of America. In addition to providing resources for patients and caregivers, this site has resources, classes and training materials for hospice providers and clergy. You’ll find links to all things hospice on this site.
3. Cancer.org – This is the site for the American Cancer Society. Since cancer is one of most common reasons for the use of hospice care, the American Cancer Society provides plenty of helpful information regarding hospice. Information like how to choose a hospice provider, who pays for the cost of hospice and much more.
4. Thehomecaredirectory.com – This site allows you to search for home care services by location, first by state and then by city. Once you receive the list of providers in your city, you are able to request information online from the providers. The site provides a very thorough request form that allows you to customize your information request to meet your specific situation.
5. Mayoclinic.com – The well known Mayo Clinic in Rochester, Minnesota provides some great information on hospice care. The site has a very thorough listing of criteria you should be looking for in a hospice provider. The Clinic also provides information for those wishing to serve local hospice providers in a volunteer capacity.
6. Webmd.com – Webmd is a great site for any medical information and hospice is no exception. The sites starts with an overview that explains exactly what hospice is, who it is for and the general services to expect from hospice providers. That is just the beginning to the information to be found on this site. The hospice section continues with more detailed information under additional subtitles.
7. caringinfo.org – This is another non-profit site that provides resources for all different stages of life and care.  It has information for those simply wanting to prepare for the future, individuals in end of life situations, caregivers and even information for employer’s regarding ways they can be supportive of employees dealing with their own or a loved one’s final days of life.
8. nhpco.org – This is the site for the National Hospice and Palliative Care Organization. There is plenty of information for everyone on this site but it appears to have some of the best resources for hospice providers. It includes links to education and conferences and current news regarding hospice care.
9. nahc.org – This is the official site of the National Association of Home Care and Hospice. This site is mainly focused on providing resources to hospice providers. It includes information regarding current legal issues, pending legislation and educational opportunities for hospice providers. It does also include information for consumers and media as well.
10. Eldercare.gov – This site is sponsored by the U.S. Department of Health and Human Services. It provides assistance in finding services regarding care of the elderly in specific locations. These service listings include hospice care but also include several other services related to caring for the elderly that may be helpful in a hospice situation as well.

End of life situations are difficult for any family to deal with. Becoming informed about the resources available to you and your loved one can certainly ease some of the stress involved.

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Can Good Care Produce Bad Health?

http://www.jhartfound.org/blog/?p=2765 Can Good Care Produce Bad Health? Amy Berman Tuesday, January 11, 2011 15:19 For those of you who haven’t yet heard, I have recently been diagnosed with Stage IV inflammatory breast cancer. This rare form of breast cancer is known for its rapid spread. True to form, it has metastasized to my spine. This means my time is limited. As a nurse, I knew it from the moment I saw a reddened spot on my breast and recognized it for what it was. My recent journey through the health care system has been eye-opening. In only a few months, I have witnessed the remarkable capabilities and the stunning shortcomings of our health care system firsthand. I am writing here because in the time I have left, I hope my story and my journey can help illustrate why some of the reforms that my colleagues and I at the John A. Hartford Foundation, as well as many others, have championed are so important. © iStockphoto.com/belterz At the cancer’s earliest appearance, I consulted with a well-regarded oncologist in New York. After the tests were done she regretfully informed me that my disease was not curable. Because my cancer is hormone-receptor-positive, she recommended an evidence-based course of medications aimed at slowing the progression of the disease. Before I committed to this course of care, I wanted to get a second opinion. I secured an appointment with the pre-eminent researcher/clinician in the field of inflammatory breast cancer, at a top medical institution in Philadelphia. The building was beautiful, the staff attentive. They even assigned a nurse, whom they assured would follow me throughout my course of care. I had no doubt that the care would be top-notch. Everything changed when my mother and I sat down with the physician. He never asked about my goals for care. He recommended an aggressive approach of chemotherapy, radiation, mastectomy, and more aggressive chemotherapy. My doctor back in New York had said this was the standard, evidence-based protocol for patients in Stage IIIB, whose cancer had only spread locally. But since I am in Stage IV she said I wouldn’t get the benefit of this aggressive, curative approach. “All of my patients use this protocol,” he said. I was shocked. “Does this mean I could get better?” I asked. “No, this is not a cure.” he answered. “But if you respond to the treatment, you might live longer, although there are no guarantees.” My goals are to maximize my quality of life so I can live, work, and enjoy my family with the least pain and the most function. Would I undergo a year or more of grueling, debilitating treatment only to live with spinal fractures if the cancer progressed? Would the treatment strip me of the quality of life I enjoy now? I wouldn’t be cured by the treatment. Would I get the possibility of quantity and no quality? I pressed him. “Why do the mastectomy?” I asked, puzzled. “The cancer has already spread to my spine. You can’t remove it.” His brow furrowed. “Well, you don’t want to look at the cancer, do you?” He made it sound like cosmetic surgery. Considering that a total mastectomy includes months of pain and rehabilitation, I thought that worrying about the view was secondary. Right now, I feel fine. I can work. I am pain free. Did I want to trade that for a slim chance of a little extra time (no guarantees, of course)? Would they be years of living, or years of suffering? “But what about the side effects of radiation?” I asked. “I’ve heard they are terrible.” He frowned and seemed annoyed by my questions. “My patients don’t complain to me about it,” he replied. Inwardly, I shook my head. Of course his patients never complained to him. Most of them were probably unaware that other, less aggressive treatments were viable options for patients with this stage of disease. To me, there were real drawbacks. Undergo aggressive therapy that might buy me a longer life…at what cost? I might never recover my health for the limited period of time I might have following the aggressive treatment. This doctor, top in his field, was reflecting the bias of our medical system towards focusing only on survival. He was focused only on quantity and forgot about quality. The patient’s goals and desires, hopes and fears, were not part of the equation. He was practicing one-size-fits-all medicine that was not going to be right for me, even though scientific studies showed it was statistically more likely to lengthen life. His lack of concern for my focus on quality versus quantity of life reminded me of how so many older Americans are treated at the end of life, shuttled in and out of hospitals and hooked up to countless machines to keep them alive when all they want is to manage pain and symptoms and to spend their final days at home, with their loved ones. Based on a perverse set of metrics, the Philadelphia oncologist was offering technically the “best” care America had to offer. Yet this good care was not best for me. It wouldn’t give me health. Instead, it might take away what health I had. It doesn’t matter if care is cutting-edge and technologically advanced; if it doesn’t take the patient’s goals into account, it may not be worth doing. I returned to my original oncologist. I was determined not only to choose treatment that would maximize the healthy time I had remaining, but also to use that time to call on our health care institutions and professionals to make a real commitment to listening to their patients. In the health policy field, we call this patient-centered care. As a nurse and a senior program officer at a health care foundation, I understood my disease and my health care options well enough to make an informed decision about my treatment. What about the millions of older Americans facing a terminal illness or chronic disease? How can they possibly stand up to the juggernaut of our health system and say, “No. I want care that focuses on my goals, care that is centered on me.” We need to make it easier for everyone to obtain care that fits their health care goals. How can we change the system and the measurement of quality to place the patient at the center? I call on everyone involved in health care practice and reform efforts to give serious thought about how we can reorient our health care system toward patient-centered care.

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Ethics: When the Patient and Family Members Disagree | Pallium India

credit: mynameisharsha

An article by Dr Robert L Fine from Dallas, Texas, USA in the Journal of Pain and Symptom Management (Vol 40, No.4, October 2010) highlights the importance of patient-centered care.

He asks, what would you do when the patient who has gone through dialysis for many years, at the end of his life expresses a wish not to be resuscitated and then becomes too weak to argue, and the family insists on resuscitation for “religious reasons”?

The obvious answer would be to go by the patient’s wishes, but it is not an easy thing for the team to do, when faced with the angry family. (In India, often, the family would simply take the patient away to a high-tech hospital in the face of such confrontation).

Dr Fine suggests that often physicians “acquiesce to the most insistent voice in the room”. The patient is weak and is less liable to be heard any longer!

He says, ‘among the rationalizations… for such avoidance behaviors are, “I’m getting paid to do the wrong thing, but that’s the system we live in and it’s not my problem to fix”, or the more cynical, “The patient should have chosen a better family”. Another common excuse….is “Dead patients don’t sue, but angry relatives do”.

The author goes on to explain the importance of keeping the focus on the patient. Taking decision-making away from individuals to “ethical committees” can help resolve the problem. Indeed!

Keeping the Patient at the Center of Patient- and Family-Centered Care

Abstract – The practice of palliative care typically refers to the focus of treatment as the patient and family. Tending to the needs of both patients and their families is usually good, but what should clinicians do when they perceive the best interests, needs, or treatment preferences of the patient are in conflict with those of the family or other surrogate?

Physicians may be able to suppress the inevitable moral cognitive dissonance of such circumstances, write orders, and walk away, but other health care professionals, especially nurses, may not have it so easy. This article suggests practical steps to obviate conflict in such circumstances before offering an ethical analysis focusing on notions of autonomy, beneficence, and true caring for patients, especially those near the end of life.

The limitations of surrogate decision makers are considered and legal liability concerns are briefly explored, ultimately leading to the conclusion that keeping the patient at the center is sine qua non of patient- and family-centered care.

via palliumindia.org

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Advanced Directives Workshop at Mountain Lakes Medical Center

Regency Hospice will present "5 Wishes" an advanced directives workshop at Mountain Lakes Medical Center on Thursday, January 20th from 2:30 -3:30 p.m. in the conference room adjacent to the main dining room.  For more information, call 706-490-2824 or the Regency Hospice office at 1-800-577-8791.  Free admission and take home materials.

 

 

Hospice = Love by rwatts44
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Time Off For Good Behavior

I can't say I am disappointed about having a "snow day". 

Just like school, I was pretty excited to see the snow on the ground this morning.  But then again, I am blessed to have shelter, food and family.  This turned out to be a day of gratitude rather than worry over what work is left undone. 

I wonder if school  - I mean work is on for tomorrow.

 

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Paying Your Employees to Volunteer Can Reap Big Rewards : Lifestyle :: American Express OPEN Forum

Paying Your Employees to Volunteer Can Reap Big Rewards

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Nov 18, 2010 -

During the best of times, people searching for employment used to ask themselves, “What can this company do for me?” with regard to securing a corner office, an expense account, or numerous other perks. But young employees currently entering the work force – the ‘Millennial generation‘ or ‘Generation Y’ – are asking questions more geared toward social issues: “What will this company enable me to do to improve the world at large, while pursuing philanthropic interests?”

 

Today, businesses are no longer fundamentally attractive to this new breed of potential employees for writing checks to charities or for sponsoring tables at benefits. Now, companies must not only talk the talk, but they must let their employees walk the walk as well – paying staff their normal wages to volunteer during working hours. But as the age old saying goes: “you reap what you sow,” and the benefits come full circle so everyone wins.

As evidenced in a survey referenced in The Wall Street Journal, “For many young job hunters, a prominent employee-volunteerism program is a strong selling point. A 2006 survey of 1,800 13-to-25-year-olds found that 79 percent want to work for a company that cares about how it affects or contributes to society. Sixty-four percent said their employer’s social and environmental activities inspire loyalty.”

One company that goes above and beyond when it comes to affording their employees the ability to volunteer while footing the bill is Patagonia. According to their website, “employees can leave their jobs to work for the environmental group of their choice. Patagonia continues to pay their salaries and benefits while they’re gone, and environmental groups worldwide get them for free. To date, more than 750 employees have taken part in the program.” Last July, in response to the disastrous oil spill in the Gulf, Patagonia sent up to 10 employees per week to Louisiana, paying them their regular salaries in addition to all of their expenses while in the Gulf region, to assist their environmental partner, the Louisiana Bucket Brigade in creating an Oil Spill Crisis Map to detect where the need for help was most imminent.

What goes around comes around. Patagonia reckons that, “volunteers return with a powerful sense of purpose and accomplishment that inspires their colleagues and encourages other employees to work on behalf of the natural world.”

At first glance, it may seem counter-intuitive to some employers to send their staff out to work for other people while on the clock, but evidence that doing so comes full circle in a highly beneficial light may sway even the most traditional thinkers. According to a study done at The University of Florida, “employees who volunteered felt more connected to their companies and were more likely to work harder on tasks… They spoke positively about their employer in public and were less likely to daydream, cyber loaf or take extra time off work… Employees felt a stronger bond with their company because they believed it shared their ideals in caring about the community, and they were more likely to be better employees because of it.”

Additionally, sending workers outside the office broadens not only their perspective, but also their skill set. ‘On the job’ training takes place on a much greater canvas, with the world as a backdrop. Evan Hochberg, National Director of Community Involvement, Deloitte Services LP offers, “Volunteering with non-profits is important for the community, but it also greatly benefits the volunteer… Skills-based volunteering, in particular, can give younger employees a chance to develop their management, teamwork, communication and leadership skills, as well as their technical skills.”

Companies are cluing in to this trend, and recognizing how it will be a boon to business. “A Boston College Center for Corporate Citizenship 2009 study found 83 percent of large corporations think it is important to have employees volunteer. In that same study, 62 percent of employees said they’d rather work for a company that allows volunteer opportunities.”

While some small businesses may not have the financial means to pay employees to volunteer outside the office, the benefits don’t necessarily come packaged in an ‘all or nothing’ scenario. Employers can organize company wide events, encouraging employees from all levels within to participate on common ground, volunteering in support of a charitable cause. Working toward a common goal with group effort will help foster the same outcome of increased camaraderie, enhanced company loyalty, and broadened perspective. As Winston Churchill said, “You make a living by what you get. You make a life by what you give.” To attract today’s best employees, the work/life balance must be understood, supported and lauded. 

Tags: wall street journal, beth shea, volunteering, patagonia, inhabitat, employees, innovation, evan hochberg

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