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Common Hospice Myths

Mon, 27 Jul 2009 16:30:00 GMT

Hospice is often misunderstood. Sometimes it’s even misunderstood by experts. It is obvious that if even the medical community does not fully understand some facts about hospice, then the public certainly might not know the facts.

Several points come to mind. Perhaps we could call these “hospice myths.” You know, a myth is some mythical story or belief that may not be true. Well, some hospice myths really need to be put to rest.

Myth: Hospice is a place. Most patients and families believe when they hear about hospice care they think they have to go somewhere to receive that care. In fact, not myth, some hospice organizations do have a hospice house. A place or a unit where patients with incurable disease can go to receive care. But that’s not the norm. The norm is that hospice is a service, not a place, and hospice will come to the patient, their home, their nursing home, their assisted living. We even have a patient who is homeless and lets us know where to meet him to provide the care he requires.

Myth: The hospice myth that patients will die immediately when hospice care begins. This is commonly held as a fact but indeed it is a myth, not based on truth at all. Medicare provides the guidance here. Patients who doctors believe can live up to six months have the opportunity to enroll in hospice and take advantage of hospice care for many weeks, even many months. Now it is true that some patients come to hospice very, very late in their disease and they may live only a short time. Often we hear from these patients and their families “if only we had known about hospice earlier we would have signed up”.

Myth: Hospice patients have to give up their own doctor. This is absolutely a myth. Hospice invites family doctors, personal doctors, to continue care of their patients when that patient is enrolled in hospice. Some of the better hospice organizations do have doctors that can make patient visits. But they never interfere with the private doctor and patient relationship.

Myth: Hospice is only for cancer patients. Well, this is not exactly a myth. In the very beginning of hospice most patients were cancer patients. But, over time patients with other diseases—diabetes, heart disease, stroke, Parkinson’s, Alzheimer’s realized that there was a great benefit from hospice care. Now days there are more non-cancer patients enrolled in hospice than there are cancer patients.

Myth: Hospice is too expensive for most families. This is a myth. Hospice is a Medicare benefit. That means that Congress has passed laws that say that people who are on Social Security or are receiving Medicare can have hospice care. It is a 100% benefit; anything related to the terminal diagnosis is paid for by Medicare. Many private insurances also have a hospice benefit and for folks younger than Medicare age they may want to check their health insurance plan to see if there is a hospice benefit.

Myth: All hospice organizations are the same. Although all hospice programs are governed by the same Medicare rules and regulations, hospices are anything but the same. Covenant Hospice is considered one the largest and most comprehensive hospices in the nation.

Jul 27, 2009 11:30 AM

IDG: A Team Approach to Care

Mon, 27 Jul 2009 16:15:00 GMT

A team approach. The most recognized “team” in healthcare is probably the doctor and the nurse. We have all seen them working together to diagnose, treat, and cure. They each have their own specific job. The doctor is the intellectual diagnostician and the nurse is the compassionate caregiver that provides comfort. For hundreds of years this team has worked very well to provide patient care.

For the best in end of life care, provided by Covenant Hospice, this team approach is taken to a whole new level. The Interdisciplinary Group or IDG is commonly used in the hospice environment. This team approach still includes a doctor, the medical director, and a nurse—often called the clinical manager.

However, beyond the doctor and nurse, several other individuals are involved in the IDT. Each member of this team has the focus of providing the best quality of life for the remaining days of that patient.

Those other team members include licensed social workers, chaplains, volunteers, bereavement (or grief counselors), and sometimes even family members who all work together to understand that particular patient and their needs. These needs often include medical, social and spiritual.

This team approach is so important that the entire team meets every two weeks to talk about each patient which the team is caring for and supporting, and not only the patient, but their family as well.

Each member of the team is given the opportunity for input so that the whole team can provide the care that best benefits the patient and their family. Nearing the end of life is sad and stressful, but knowing that there is an entire team there to support and add life to days when days can no longer be added to life is hopeful and comforting.

Jul 27, 2009 11:15 AM

Hospice Physician: Not a Replacement

Mon, 27 Jul 2009 16:00:00 GMT

Whenever there is a discussion of hospice, it can sometimes be a very difficult time. Hospice care means end of life care, and that means the realization that the patient has a life-limiting illness. “Life-limiting” — that’s very profound. Most of us, sometime in our life, have an illness or a medical condition and we don’t expect it to be life-limiting. We go to the doctor, the emergency room, or the hospital. We expect it to be diagnosed, treated, and cured. If it can’t be cured then at least we want that disease or medical condition to be controlled.

There are many medical conditions that you could name right now that can’t be cured. Conditions like Diabetes, high blood pressure, chronic lung disease, and many cancers. Medical science is looking, always doing research in hopes of curing these diseases, but at least in this day and age most of these diseases can be controlled. With proper therapies and medications, life can go on and in most cases be enjoyed. But occasionally the disease cannot be cured and cannot be treated effectively.

Eventually, as we grow very old these conditions become life-limiting. Even though knowing that you or someone you love has life limiting illness, it’s hard to swallow. Thank goodness hospice care is available. Hospice is a specialty of doctors, nurses, social workers, chaplains, volunteers, and others that as a team cares for patients who are at the end of their life. That hospice team attempts to bring comfort and quality of life to the remaining days of that patient.

The goal of hospice is comfort and symptom control. That means comfort in every area. Spiritual comfort, social comfort and the relief of pain and anxiety. The whole hospice team is there for the patient and their family evaluating the needs and reporting them back to the hospice physician so that care and medications can be in place to comfort that patient.

Most patients and families are often nervous or even afraid to start hospice care because it means accepting the fact that the end of life is near. However, after the patient and the family experience the symptom control, pain relief, the compassion, and the dedication that the hospice team gives to that patient they are grateful, relieved, and often report it is the best medical care they have ever received.

Most national surveys show great patient and family satisfaction with hospice care. The team makes a difference. However, the team does not stand alone. The patient’s primary doctor, the attending physician, the family practitioner that they have been with for years is invited by hospice to continue their involvement. Often, it is the patient’s private doctor that knows them the best, understands their response to medications and treatments and that knows their personality and their spirit.

The hospice team embraces the knowledge that the primary doctor can contribute. The hospice team wants the primary doctor to be involved, to guide therapies, and to actually become part of the hospice team. It’s important to know that taking on hospice doesn’t mean that a patient has to “give up” the family doctor.

Jul 27, 2009 11:00 AM

Hospice or Home Health

Mon, 27 Jul 2009 16:00:00 GMT

Home is where the heart is. Home sweet home. There’s no place like home. We do love our homes and for almost all of us, there is no place we would rather be. Our homes are an extension of ourselves. We find comfort there and hopefully we find love and peace in our homes. When we are away from our homes some of us even develop an illness. It happens to people in the military, in college students, in business people who are often away from their homes. We call this illness “homesick”. It doesn’t really matter where we are, if we aren’t home, we miss it and long to be there.

When, however, we really get sick with an accident or a serious medical condition the hospital is where we receive our medical care. In the hospital we have specialists, technicians, nurses and therapists that can help us through the surgery, illness or the serious medical condition. We all appreciate the high level of quality health care that is provided in a hospital. However, when we start to recover or even get just a little bit better most of us want to go home.

At home, to continue our recovery after a hospitalization there are three options of care. One option is friends and family. If the illness or injury wasn’t too serious, if our hospitalization wasn’t complicated, and if our health is improving our friends and family may give us the support with daily activities, errands, and simple tasks that we need to improve our health.

The second option is home health agencies. Home health agencies provide skilled nurses and aides, social workers, and support for a longer recovery period that may include rehabilitation and perhaps other special care like post surgical dressing changes or special nutrition support. Home health agencies exist in every community whether a large city or a small farm community.

In the last several years Medicare has changed home health from a nearly pure care giving situation to a combination of care giving and education. Now days to qualify as a home health patient there must be identified a healthy, able, caregiver in the home. A husband, a wife, a son, a daughter, or even a good friend who can commit themselves to the education that the home health agency gives them so that they, not just the nurses, the aides, or the other home health staff can provide care but that private individual will be responsible for the majority of the care for the patient. For those patients who are receiving Social Security Medicare usually covers the cost of the home health agency care.

The third option is hospice care. Immediately hospice care sounds like the end of life care, and it is, but it isn’t about the very end of life. It’s not about the last hours or days of life. Hospice care is a Medicare benefit and for those patients who may have a life limiting illness, not limited to days but perhaps weeks, even months, even several months at that, hospice care provides all of the benefits of friends and family care, all of the benefits of home health agency care, plus volunteers, chaplains, social workers, grief counselors and specialized doctors as well as the nurses and hospice aides that provide such wonderful, compassionate care.

It is very hard to think about hospice care because that does mean end of life care. Even if it’s the last five or six months of life, most people don’t want to think about letting go or “giving up.” However, hospice care can absolutely be the most appropriate care. If someone, a patient, needs to go to the hospital for an illness or a surgery and they can completely recover they don’t need hospice care or probably don’t even need home health care.

If there goal is after a hospitalization or a serious illness to rehabilitate and recover then home health agency care would be the best option. But sometimes, and eventually, for all of us we will have a medical condition or an illness from which we cannot recover (we are not immortal on this earth). For patients who have tried their best to recover from illness, those who have used all of the strength possible to rehabilitate back to a healthy state, who have given everything they’ve got to get well but do not and it is finally realized by the patient and their family that they have come to a place in their life where more hospitalizations, more physical therapy, more medications will not improve their life then at home (home sweet home) hospice care may be the best option of all.

Jul 27, 2009 11:00 AM

Hospice Inpatient Facilities

Mon, 27 Jul 2009 16:00:00 GMT

It seems that our whole life is about planning. We plan for a new baby to come into the family. We plan for high school graduations, for new jobs, for a move to a new home. We plan for our retirement and many families even plan for the burial of a loved one by buying plots far ahead of time. Those plans seem productive, even ordinary. But planning for death—it just seems like something we don’t want to think about. By giving it thought and planning we can bring comfort and some sense of peace to that person’s passing.

One of the ways to plan is to think in your own life how you would want to die. Ask your loved ones, even when they are well before the sign of any progressive medical condition or disease process, what they would want at the end of their life. Covenant Hospice has done exactly that. They’ve asked the questions—what do you want at the end of your life, how do you want to die. The answers come in two major forms. If the person being asked is very healthy, bright, alert, and capable they often respond by saying “I want to be very, very old when I die, I want to have lived a full life, and I want to die peacefully”. On the other hand, when a person who is terminally ill or realizing that their death may come within weeks or months their answer is a bit different “I want to be comfortable and pain free. I want to have my family and friends come together in joy and happiness around me. I want to be at home and not in the hospital hooked to tubes and machines.” Would your answers be similar?

A long and full life. Well, no one can guarantee that. But a pain free and comfortable life surrounded by family and friends at home are just the kind of wishes that hospice organizations help to fulfill. The doctors, nurses, and other hospice caregivers are experts in pain and symptom management. So, peace, comfort, and a pain free life is what they can help with. Covenant Hospice social workers, chaplains, and volunteers do their very best to bring family and friends together to celebrate life and joy.

Most end of life patients want to die at home and hospice provides that support by making house calls, home visits and practically the whole hospice team can bring the medications, medical supplies, evaluations, examinations, and support right to the person’s bedside in the comfort of their own home. Sometimes, however, the needs of the patient cannot be met at home. Perhaps, a hospital bed, oxygen tanks, a bedside commode just won’t fit in the house. Other times the patient’s symptoms may be so extraordinary that in order to guarantee comfort that person needs to be with nurses and caregivers around the clock. Or maybe the stresses are just too much for the patient and family and they just can’t handle all of the care that needs to be delivered at home. In those cases many hospice organizations provide a home like environment in inpatient units. These are actually facilities standing alone or attached to a hospital where hospice patients can move to receive the care and support that they and their families require.

The key word here is move not transfer. Transfer sounds so sterile and medical—like transferring from one medical unit to another. No, indeed, this is a move where the patient and the family can move the patient, their favorite pictures, the family Bible, perhaps a rocking chair to the facility to be comfortable. Because most patients want to have their last days at home these facilities provide a home like environment, they become the patient’s home where families are welcomed around the clock without limited visiting hours. Where homemade food can be brought in, enjoyed and even shared. The Covenant Hospice inpatient units are a home to the patient and their family where the medical care, medications, treatments can all be provided by the staff and the love and attention can be provided by the friends and family.

Jul 27, 2009 11:00 AM

Hospice: Not Just for Cancer

Mon, 27 Jul 2009 16:00:00 GMT

When you are feeling bad or have a new health problem you go to the doctor for tests and a diagnosis. While you are waiting for that diagnosis it is human nature to worry…to worry about what might be wrong with you…what is the problem, what is the disease, what is the diagnosis. One of the reasons for worry is the scariest diagnosis of all—cancer.

For any of us cancer just seems to be that terrible medical word that is associated with death. So much so that when someone has a diagnosis of cancer and they fight the good fight, take all of the treatments and survive we celebrate them. Who hasn’t seen the ladies in pink shirts who are breast cancer survivors? All of us have heard stories of friends or family members who have had colon cancer and survived, men who have had prostate cancer and survived. We celebrate survivors of cancer.

With new and modern technology hopefully we will celebrate more of those survivors because today cancer isn’t a death sentence. In fact, more people with cancer survive than succumb. Still, it is a devastating diagnosis and usually the first reaction is shock and disbelief that it could happen to us or someone we love. The second reaction is what can we do about it? What treatments are available, what are our chances for a cure? Those are absolutely the right questions and the right emotions.

What becomes apparent over days, weeks, even months is that there is hope for patients with cancer. Truly, there is no end to that hope. Initially, we hope and work for a cure, but if that is impossible then we hope and strive for control, at least, we might live longer with this disease.

Finally, if the cancer increases or spreads and starts to consume our energy patients and their families learn that there is still hope and that’s the hope of having the final days of their lives enriched and comforted by hospice care. Hospice care is end of life care that is aimed at pain control, comfort, and care at home with family if that is at all possible.

Hospice makes wishes come true. Maybe not the wise to have the cancer go away but the wish to die with dignity, with self respect, without pain, at home, with family. Hospice had its beginnings and foundation built on the respectful, comforting care of cancer patients. But times are changing. People are living longer and often living and finally dying of chronic disease. Like strokes, heart attacks, Alzheimer’s, Parkinson’s, heart disease, lung disease, and fewer patients with a cancer diagnosis are dying because of the cancer.

Now days, hospice isn’t just for cancer patients anymore. Anyone who has a diagnosis, cancer or otherwise, who is facing the last weeks or months of their life can have hospice provide them with the comforting care that makes everyday special even when more days cannot be added to life.

So if you or someone you love has an illness or a medical condition that’s not cancer you still will want to check into the benefits of hospice. It’s not easy facing the end of life, but it is easier with hospice care.

Jul 27, 2009 11:00 AM

Hope

Mon, 27 Jul 2009 16:00:00 GMT

When it comes to our health “hope” is a very strong and even intense word. For minor illnesses, we hope we get over them soon. For chronic, long term medical conditions, like high blood pressure, diabetes, and arthritis we hope to control them. We hope the patient can follow the doctor’s orders and have a good quality of life. For life threatening diseases like cancer, strokes, serious heart attacks we hope the patient can fight the disease and beat it.

Generally we hope that the patient can have a cure and not die. That kind of hope, along with support and perhaps mixed with prayer, can make a world of difference in a patient’s life. They know that they are important. They know that they are being cared for and being cared about. That kind of hope often gives the patient the emotional support to be brave and courageous in the face of serious disease or difficult treatment.

Hope, when realized along with good medical treatment and lots of support may mean that the disease is cured. Or medical conditions are controlled and the patient, the person we are hoping for, can live a long life that is also filled with quality. Sometimes our hopes are not answered and disease shortens life. Even when our hopes are answered life is not endless.

Now theologians and spiritual leaders may say that life is endless and that we can experience immortality. Well I’ll leave that to your own personal faith. However, we can all agree that in our present body we will come to the end of our life. For ninety percent of us, those of us who don’t die very suddenly, we may have an opportunity actually to see before us into the future the last days, weeks, or months of our lives.

When our days, weeks or our months are numbered, and whether we are very old and a cure was effective or whether we are still young and the cure was not effective, how can we anticipate the end of our life, understand it, plan for it, and still nurture the most quality for whatever time we have left? For decades now, hospice has focused on exactly this issue.

When life is limited the quality of life does not automatically have to be limited. Covenant Hospice provides care and compassion when curing a disease is no longer possible. Covenant Hospice is not a place to give up… it’s a place to live up. Live up to our maximum potential for as long as we possibly can. With symptoms controlled, individuality respected, and family supported, hospice focuses on life. In Covenant Hospice when a cure is no longer possible, care is always possible.

Jul 27, 2009 11:00 AM

Can My Doctor Provide Hospice Care?

Mon, 27 Jul 2009 16:00:00 GMT

The short answer is yes, of course but now days no answer could be quite that simple. Family doctors, internists, geriatricians, even pediatricians, specialists like surgeons and cancer specialists can all provide hospice care.

Doctors who know their patients very well may know hospice care only to a limited degree. Oh, doctors, any doctors, understand that hospice care is comfort care and symptom control near the end of life. Most doctors, whether they know much about hospice or not, seem to understand that comfort and compassion are the foundation principles of hospice care. Therefore, doctors certainly can provide comfort. Most doctors understand how to relieve pain, calm anxiety, improve depression, and provide compassion to their patients.

Doctors are confident professionals and frequently I am told that doctors don’t need a hospice organization to provide hospice care. They explain to me that hospice is not only an organization of doctors and nurses but rather hospice is a philosophy of care. A philosophy that embraces acceptance of a life limiting illness or disease, a philosophy that focuses on comfort and compassion, and therefore any doctor can embrace the hospice philosophy. And, I have to agree with them.

Hospice is absolutely a philosophy of care. It’s a philosophy of embracing the patient and family. Not the test. Not the x-ray results. Not a new medication. But focuses absolutely and completely on the patient and family needs. The patient’s need to cope with their illness and disease. The family’s need to support someone they love. The patient’s need for symptoms control, pain management, and attention to depression and loss. But what the hospice organization has that the philosophy alone does not are people.

We’ve got people. We’ve got people with the philosophy, we embrace and endorse that philosophy that family doctors and cancer doctors speak of. But with that philosophy we’ve added people. We’ve added doctors and nurses and hospice aides to give a gentle bath. We’ve added chaplains, not to preach, but to listen and support the patient and their family with whatever their personal needs and their spiritual needs might be.

We’ve got social workers who want to understand the patient as a person, where are they in their life because after all it’s life that’s important not just the dying. Social workers focus on supporting and family with whatever their needs might be. Grief counselors and bereavement specialists are there because any terminal illness comes with a sense of loss—often despair, anxiety, stress, fear, and depression.

For the patient’s while they are still living who may be grieving about their disease or their terminal illness bereavement specialists are there for them and for the families long after the patient is gone. Our grief counselors are supporters. We have nurses in hospice who understand the symptoms, the common symptoms, the severe symptoms that they are specially trained to understand and doctors, hospice physicians, who are specialists in their field but compassionate and caring as well. Hospice physicians are not remote, sterile specialists. They are hands on, heart on doctors who care about the patients and families they serve.

So doctors who know the hospice philosophy but don’t understand the hospice organization fully can provide connected care, compassionate care, and comfort care but only as one physician. When they use that wonderful hospice philosophy and join it to a hospice organization now that family doctor, that internist, that geriatrician or cancer specialist can connect their own personal philosophy to the hospice people that can join with the family and loved ones to provide the care and support that any patient with life limiting illness deserves.

Jul 27, 2009 11:00 AM

Alzheimer's Disease and Your Family

Mon, 27 Jul 2009 16:00:00 GMT

Alzheimer’s. It’s all in the family. If you had to name one disease or medical condition that affected the family more than the patient it would likely be Alzheimer’s disease.

In the very early stages of Alzheimer’s disease, the patient often realizes that something has gone wrong. There is memory loss and often impaired judgment and decision making. During this early phase the patient may realize that things just aren’t right. However, the patient with Alzheimer’s, because of the memory and judgment impairment, cannot evaluate the situation correctly.

So if the patient has an awareness of the disease, it is often demonstrated by an increased level of anxiety. That is, the patient knows something is wrong but they don’t know what it is that is wrong and because their thinking and memory isn’t clear they become anxious about the changes. As the disease progresses the patient often loses all concept of the memory loss or change in judgment.

The patient may still be anxious because of change or depressed because of a sense of loss, but for many patients with advancing Alzheimer’s they actually become oblivious to the disease itself. This is certainly not true of the family. Alzheimer’s is a disease that affects the entire family. First, there is the dismay with the initial diagnosis. No one wants their grandfather, mother or spouse to be diagnosed with Alzheimer’s.

Most of us know enough about Alzheimer’s. It is a memory loss disease, a disease of declining function and ultimately patients with Alzheimer’s will come to the end of their life. Even if the patient doesn’t know all of this, the family does. They watch their loved one with Alzheimer’s forget, then decline, then diminish both in a mental and physical sense.

Loved ones become care givers as the disease progresses. Then, care givers in some instances may actually have to place the Alzheimer’s patient in a special unit or nursing home.

Alzheimer’s has been called a “cruel thief” and it should be. The disease certainly takes away memory and judgment from the patient, but it also takes away dreams, hopes, and future plans for the patient’s loved ones. Instead of dreams of travel, gardening or lazy afternoons on the porch, the family is now planning how to take care of the Alzheimer’s patient. That is the disease stealing away hopes, dreams, and plans.

In other diseases the family certainly surrounds the patient as they fight for their health, as they fight against the disease such as cancer or heart disease. The difference with Alzheimer’s is that the patient doesn’t know to fight, doesn’t know how to fight or what to do. The chore of caring, medicating, and nursing usually falls squarely to the family.

Fortunately, more and more is learned about Alzheimer’s every day. Support groups and associations are there to help with explanations and planning and even though Alzheimer’s is a cruel thief, there are opportunities to give the patient and their loving family quality time. Maybe even time measured in years.

Jul 27, 2009 11:00 AM

AIDS Update: Chronic or Terminal Disease

Mon, 27 Jul 2009 16:00:00 GMT

In the early 1980’s an epidemic struck America, one that is still with us today. That is the epidemic of HIV/AIDS. Many doctors practicing during this time remember seeing young men in their 20’s and 30’s coming to the hospital and just wasting away to their death. In 1983 this disorder was called Acquired Immunodeficiency Syndrome.

This meant that the immune system of these young men, and a few women, failed to protect them from ordinary and even unusual infections. About that same time the virus that caused this disease, the human immunodeficiency virus, HIV, was detected and identified.

HIV/AIDS was deadly. It was certainly a terminal disease. It seemed clear very early on that it occurred frequently in homosexual men. It also occurred in intravenous drug users—those people using drugs who shared needles. When children, women, and heterosexual men came down with HIV/AIDS it was identified that blood transfusions, blood products, and in one famous case, dirty dental instruments could transfer the disease.

For the first several years treating HIV/AIDS really meant treating the infections like eye infections, lung infections, skin infections, and blood infections, but not directly treating the HIV virus itself. Therefore, the complications of HIV/AIDS could be treated and somewhat managed but the disease was ultimately still terminal.

We turned the corner in the 90’s after Ryan White became a famous child victim of HIV/AIDS. His national notoriety led to a government commitment to understand and treat the disease. One of the first effective medications was AZT. It actually seemed to slow the progress of the disease itself. But it wasn’t a cure.

The focus wasn’t just the treatment of HIV/AIDS but the prevention. Gay men were educated, needle sharing drug abusers had programs and education, and blood transfusions and other blood products were tested completely so that they no longer represent a risk of HIV/AIDS transmission. Those preventative measures are ongoing today and they have made a difference. It is estimated that thousands of at risk people do not have HIV/AIDS today because they paid attention to the safety warnings.

Yet, when someone contracted the disease it was still considered terminal. End of life and hospice organizations were established to care for the dying HIV/AIDS patients. Then, surprisingly and rather suddenly, a whole new class of drugs was identified. The anti-retroviral drugs and proteace inhibitors used in combination actually seemed to reduce the infective HIV virus.

Then, famous celebrities with HIV, like the basketball player Magic Johnson, didn’t die. In fact, they seemed to live normal lives. Medicine and research had a victory over this disease. Although many experts in the area are cautious when they speak, HIV/AIDS isn’t the terminal disease it once was. The infection may persist but it is controlled. HIV/AIDS patients don’t automatically die. They are living and with continuous medication and treatment, they are even thriving.

Today HIV/AIDS is still a terrible disease. There is the social stigma related to it and it requires continuous, everyday treatment. But it has changed from a terminal disease to a chronic, controllable disease.

Jul 27, 2009 11:00 AM

Adult Failure to Thrive

Mon, 27 Jul 2009 16:00:00 GMT

What’s the old saying? Something like, “it’s hard to get old but it beats the alternative.” Well, getting old sure does beat the alternative of dying young and luckily, as a nation, we are living longer.

The average life span is about 80 years old. As we age most of think about planning for our old age. We want to have a place to live, some money, retirement, and if we can, we would sure like to have good health and financial ability to enjoy our old age. But, two things are inevitable—death and taxes.

We’ll have to see what happens to taxes, but we know as we get closer to death most people become very weak and frail. Doctors often call this syndrome the adult failure to thrive. Other names include the dwindles or the spiraling decline, and we may just call it feeble or weak.

With this decline, this failure to thrive we see four major elements. One is mental or cognitive decline. That is forgetfulness or the inability to do normal mental tasks like paying the bills or making a favorite recipe.

There is physical decline, or the inability to spring out of a chair like we used to. It now takes both arms and maybe even a helper to stand upright or to walk a long distance. These folks may need a handicapped sticker so that they can park close to their destination. Or perhaps the decline has progressed, and riding in a car is no longer even possible.

Then there is depression. As any of us start to lose our functional ability, when we can’t do what we used to do it’s very easy for us to get depressed. As people get older they often get very thin and skinny. They just don’t have an appetite. Go to a nursing home or retirement center and look at the oldest people. Very few of them are overweight, most are skin and bones. That loss of appetite and loss of weight is a natural phenomenon as we get very old.

Although getting old and having adult failure to thrive is a natural phenomenon with old age, it is often associated with many diseases such as Alzheimer’s, arthritis, heart disease, high blood pressure and other disorders. However, there is no specific treatment for adult failure to thrive. We can’t cure it. We can’t make it go away.

We can certainly recognize that it is a real process and put a care plan in place so that our older loved ones with memory loss and frailty, who don’t have the strength they used to have, those with depression and sadness and those without much of an appetite can be cared for.

A care plan in the family or with home health, in a nursing home or assisted living center may be just the care that older people with adult failure to thrive need to enjoy life and the love of those around them who care.

Jul 27, 2009 11:00 AM

Cultural Differences at the End of Life

Mon, 27 Jul 2009 16:00:00 GMT

Most of us during our lives are concerned about our health, well being and about preventing our death. It is widely held and deep seeded that most of us would choose to live a long life and try to prevent death. However, very few of us have thoughts or conversations about the inevitable-- and that is our death.

Ten percent of deaths in this country are sudden and unexpected. They could be heart attacks, strokes, automobile accidents, workplace disasters, and the like. However, 90% percent of the deaths in this country are not sudden, and they can even be anticipated like death from old age, heart disease, cancer or an on-going chronic illness. These are all diseases and health disorders that give us some kind of warning about our death. They actually give us time to plan for comfort at the end of our lives.

When questioned, people who see the end of their life coming have three common wishes or desires. They want to be comfortable. They want to avoid or control pain. They want to be at home or in a comfortable environment with their family and loved ones around them. For most of us, it just seems natural that we would want to be without pain. We would want to be at home and surrounded by love. However, that is not always the case.

Beliefs about death vary within a family and certainly within different cultures. Caucasians are more likely to choose hospice as a means to meet their wishes at the end of their life, while African Americans and Latinos are less likely to choose hospice. Some cultures actually believe that being alone is more appropriate at the end of life. Remember that picture of an old Eskimo man floating away on an iceberg removing himself from his village and his family to be alone at the end of his life?

Some cultures believe that pain at the end of life is the pathway toward death. They actually resist or refuse pain medications. Cultures that accept, even embrace death as a natural, accepted occurrence experience anxiety, fear, pain and discomfort. But they hold tightly to their cultural, religious, and family beliefs.

Hospices, healthcare organizations that comfort and tend to people at the end of their life, understand these cultural and personal choices that individuals make.

Culture is to be respected and supported by hospice organizations. Covenant Hospice never makes someone change their beliefs, or accept care that they would be uncomfortable with. If you or someone you love has a limited life expectancy, you owe it to yourself to check into Covenant Hospice to see if there could be comfort and support during this challenging part of life.

Jul 27, 2009 11:00 AM

Creating an Advance Directive

Mon, 27 Jul 2009 16:00:00 GMT

An advance directive is a document that outlines what type of medical treatment you want, or don’t want, in the case that you become unable to make healthcare decisions for yourself. These documents are sometimes referred to as living wills and address what life-sustaining measures, if any, you want for yourself. For many people this depends on the severity of the illness and the likelihood of recovery with good quality of life.

According to Aging with Dignity, only one in five Americans has filled out an advance directive. Many people avoid it because they think doing so is a difficult and lengthy procedure or because they are young and in good health, and don’t feel the need to have one.

Making your wishes known about how you want to be treated should you become seriously ill, however, is important no matter your age. Likewise, knowing the wishes of your family members means that you can help make decisions about their care knowing that you are doing what your loved one wants.

Aging with Dignity is an organization dedicated to providing a simple, straightforward approach to creating an advance directive through their “Five Wishes” booklet. Written with assistance from The American Bar Association’s Commission on the Legal Problems of the Elderly, “Five Wishes” lets you dictate exactly how you wish to be treated if you get seriously ill. It addresses your personal, emotional, spiritual and medical wishes, including:

The person you want to make healthcare decisions for you when you can’t
The kind of medical treatment you want or don’t want
How comfortable you want to be
How you want people to treat you
What you want your loved ones to know

“Five Wishes” outlines detailed end-of-life issues like what life support treatment you want, who you want with you, what type of personal care you want provided and whether you want prayer and scripture readings by members of your family and faith community.

Featured on CNN and NBC’s Today Show, as well as in the pages of Time and Money magazines, “Five Wishes” has been called the first “living will with a heart.” You can get your free copy of “Five Wishes” at any Covenant Hospice branch office.

Jul 27, 2009 11:00 AM

Coping with Grief During the Holidays

Mon, 27 Jul 2009 16:00:00 GMT

If you have ever lost anything you immediately conjure up those feelings of loss. You regret the loss. You miss whatever it is that you lost. The worst loss of all, one of the most intense emotions that any person can ever feel, is the loss of a loved one. Not only do we have great regrets at losing someone we love, we miss them desperately. The emotions boil with great intensity. We may become lonely or depressed. We may wish for the good times to return again. We may long for the apology or reconciliation that never happened. It may be that with loss of a loved one we just sit down with an aching heart and cry our eyes out.

Immediately after the loss of a loved one the emotions seem overwhelming. But, as time goes by, the pain seems to ease a bit and our feelings soften a bit. Just when we think we’re coping well and moving on some little event or reminder takes us immediately back to the intense feelings of loss and grief.

It is during the holiday season, a time we think of families being together, laughter, food, church services, presents, and most of all togetherness, that these triggers of sadness and grief occur the most often. The smallest thing may trigger the return of enormous emotional sadness, grief, and loss. During the holidays, the flicker of a candle, the scent of a Christmas tree, the sight of a stocking that was hung by the chimney with care, the words of a friend, or a sermon by the preacher can instantly set off sadness and loneliest.

There are a few tips to help lift a saddened heart during this time of year.

· Recognize that grief and sadness is a real and expected emotion. Don’t put it away or try to ignore it. The loss of a loved one is important and it should be recognized. Remember the person. Say a prayer for them. Light a candle for them. Hang a Christmas ornament for them. Talk about their special place in your life with friends and family. Make time to deal with the memories and then move on to other friends, family, and celebrations of the holiday.

· Find things that comfort you. Perhaps, a Christmas tree, old Christmas cards, family photos, music that is soothing.

· Plan ahead. Look forward to being involved, not lonely during the Christmas season. Visit with friends. Go to church services. Cook with family. Give your time as a volunteer. As you keep your loved one in your heart make room there for other people, for happiness, for comfort and for yourself.

The holiday season is for celebration, for memories, for friends, for family, for prayer and Thanksgiving. The loss of a loved one brings sadness and grief. But, let the holiday season and the joy it represents lift that grief and your heart so that the season can also be filled with smiles.

Jul 27, 2009 11:00 AM

Controlling Symptoms

Mon, 27 Jul 2009 16:00:00 GMT

The number of reasons doctors say they refer patients to hospice is the expertise in high quality of symptom management.

Doctors, most doctors, are all about preventing disease, curing disease, healing, recovery, and rehabilitation. If you pick any specialty other than hospice it is all about preserving health and function, preventing disease, or recovering a patient to their previous status. They are about making patients better.

Hospice is the specialty of caring for patients and their families near the end of life. They, too, are all about making patients better. Not better in terms of curing diseases that can’t be cured, but better in terms of adding quality of life to every day that a patient has yet to live. They, the hospice doctor and team, help add quality to the patient’s life and make the patient better in terms of comfort by controlling the patient’s symptoms.

As medical conditions and diseases progress, if they cannot be cured or controlled will eventually result in the patient’s decline. There are common symptoms that are associated with advanced disease processes. The disease can be cancer or non-cancer diagnosis like heart disease, lung disease, stroke, Alzheimer’s and the like. The diseases can be different but the symptoms are often the same. The four major symptoms are pain, shortness of breath, digestive disturbance, and anxiety.

Pain we usually think of as physical pain. Like the pain that comes from cancer pain or liver pain, perhaps, bone and joint pain. But the pain can be more than physical pain. The pain can be emotional with a sense of loss, sadness, or grief. It is important for the hospice team to control the pain, diminish it as much as possible. We have many tools including potent medications, therapies, and other interventions.

Shortness of breath sometimes referred to as air hunger is often described by patients as a sense of suffocation. This symptom is very common in patients with heart disease, lung disease, anemia, low blood count, and some cancers. The hospice nurses often employ oxygen, respiratory therapy treatments, calming medications, and other modalities to reduce the symptom of suffocation or shortness of breath.

GI disturbance is very common in many advanced disease states--nausea, vomiting, constipation, diarrhea or just the symptom of not being hungry. If you have ever been even a little bit sick you might recall that even the smell of food would upset your stomach and certainly this is the case in patients with advanced disease processes.

Hospice dieticians and staff know not to force feed patients when they are having serious upset stomachs. Even though we all feel that a good, hearty meal could help anyone feel better, filling up the stomach of a sick person only makes them feel worse. Sure, if they are hungry and they want to eat we recommend a good hearty diet but hospice rarely, if ever, recommends artificial nutrition. Such as feeding tubes or intravenous feedings because we understand that this often makes the symptoms even worse. Diarrhea and constipation can be treated and improved with several different therapies.

Anxiety sometimes described as fear, sadness, depression or just stress can be an overwhelming symptom. Hospice has many methods to help reduce this anxiety. Medications, counseling, companionship, chaplain services, volunteer services, support groups and the heartfelt compassion that hospice provides to patients and families can help greatly in diminishing anxiety, fear, and depression.

The major four are important and dealt with on a daily basis. But there are many other minor symptoms that don’t seem minor when it affects the quality of life of a person. Symptoms like insomnia, sleeplessness, dry itchy skin, dry eyes, stuffy nose, skin rashes and lesions are all important when they occur in any of our patients. Covenant Hospice has experts and therapies to deal with all the symptoms that a patient might experience during this difficult time of life.

Jul 27, 2009 11:00 AM

Pain vs. Total Pain

Mon, 27 Jul 2009 16:00:00 GMT

Pain hurts. No pain…no gain. Pain is an unpleasant, sensory experience with possible tissue damage. But we don’t need a definition of pain, we’ve all felt it and we know what pain is. Will Rogers said that pain is such an unpleasant experience that it dampens all of life’s pleasures. Pain is often associated with illness, disease, medical conditions and is one of the most common symptoms for hospice patients who are receiving end of life care.

Pain, physical pain, comes in several different forms. Somatic pain is the pain of muscles, joints, cartilage, ligaments, and structural tissue that is transmitted along normal nerves to the brain and interpreted as mild to severe physical pain. It’s the kind of pain we usually associate with muscle cramps, terrible arthritis, or even severe trauma. Crushing trauma, broken bones, or even a sliced finger in the kitchen.

Visceral pain is the pain generated in organs. Like the liver, kidneys, spleen, gallbladder. Often a diseased organ initiates a deep, intense internal pain that is transmitted along normal nerves to the brain and interpreted there as a colicky, cramping, continuous pain. This visceral pain is often found with internal cancers, liver disease, gallbladder disease, ulcers and other internal disease processes.

Neuropathic pain is different in that abnormal nerves, sick nerves, may transmit false impressions of pain that are interpreted as intensely real by the brain. This kind of pain is often shooting or radiating, transmitted pain from one place to another. It may be found in diabetics with nerve damage or patients who suffer with sciatica and have an intense pain down their low back into their legs. It’s occasionally seen in some vitamin deficiencies when nerves don’t develop properly or have nerve fiber damage because of a disease process.

Covenant Hospice doctors and nurses are well aware of these types of pain and they are experts at evaluating, treating, and controlling somatic, visceral, and neuropathic pain. Almost any kind of physical pain you could describe would fall into one of these categories.

Yet physical pain is not the only pain that patients suffer. Suffer may be the key word. Pain, physical pain, is different than suffering. People may suffer because they are sad, depressed, lonely, lost. They may suffer or have psychological or spiritual pain because they can’t be united with their family. Or they haven’t connected with all of their religious beliefs. Patients may be pained with the knowledge that they are a burden to their family or no longer a useful employee at work.

Total pain is more difficult to scientifically describe and measure than physical pain. Total pain is all of the emotional, psychological, spiritual and physical pain that any patient may suffer. It is this total pain that gets the attention of hospice caregivers. Knowing the patient as a whole person and not just for their physical pain is important to hospice. Treating the physical pain is important and treating emotional pain is also important. Comforting the person, bringing quality to their life is the goal of understanding and treating total pain.

Jul 27, 2009 11:00 AM

Mortality Compression

Mon, 27 Jul 2009 16:00:00 GMT

“Mortality Compression.” That’s a new term that is starting to enter medical meetings and lectures. Mortality, well that certainly refers to the fact that we are all mortal on this earth—meaning that we will come to the end of our life. Mortality is the medical term that often refers to death. But compression, how would we compress our mortality? How would we push it all together in a small space or time?

Mortality compression may be a new use of words but it’s certainly not a new concept. If any of us think about our own mortality, the end of our life, we’ve probably either not wanted to think about it at all or we have thought about how we would want to die. Although it’s not usually thought of as a happy topic, stop right now for just a moment and think about how you would want to die.

Well, most of us probably have the same thoughts. We would like to live a long life. Very long if we could! We would like to come to a very peaceful death. In fact, most of us would like to be active in our last days of life and then die quickly and peacefully. Perhaps, even in our sleep.

Surveys have asked this question and most respondents say that they would wish to die peacefully, comfortably, without pain. The majority state that they would like to die at home in their own bed surrounded by happy people who love them, their family. Living a very long life with vitality and vigor coming to a rather quick and peaceful end is mortality compression.

Living a long, healthful life and experiencing a short, peaceful death seems better than the alternatives. However, we don’t always have the choice about how we come to the end of our life. If all of us could choose to have a mortality compression, kind of life and death, then hospitals, nursing homes, and hospice organizations might not be required.

Doctors know that only some diseases can be cured. Most, like high blood pressure, diabetes, arthritis, Alzheimer’s, heart disease, lung disease, liver disease, and others can be treated and somewhat controlled. But eventually time and health problems will become overwhelming and healthcare organizations to provide care, support, and comfort will be required.

Covenant Hospice provides care for those who are facing the end of their life. However, not all of the patients that hospices care for have lived a very long life. Some actually are suffering terminal illness in their middle ages, others as young adults. Covenant Hospice even takes care of infants and children who require comfort, medical care, and compassion in the final months of their life.

Because all of us won’t experience a mortality compression end to our life, Covenant Hospice is there to provide the kind of care most of us would wish for.

Jul 27, 2009 11:00 AM

Living with Hospice

Mon, 27 Jul 2009 16:00:00 GMT

Well, right off the bat “living with hospice” sounds like an oxymoron. That’s a phrase that has words or meanings that sound exactly opposite. Hospice is all about a terminal disease and dying, isn’t it? So what could living with hospice mean?

Hospice does indeed admit and accept and care for patients who are nearing the end of their life. Hospice engages a whole team of specialists for pain management, social support, spiritual support and every day care. As a patient nears the end of their life hospice also engages and supports the family and loved ones of the patient who is terminal. However, terminal doesn’t mean terminal today or tomorrow or even next week.

It doesn’t have to mean terminal even next month. Research has shown that when two patients with a similar disease are studied, one in hospice and the other with regular medical care, the outcome is often surprising. The hospice patient in these studies lives an average of twenty nine days longer than the regular care patient. The big question then would be why? Why would a patient who is terminal in hospice live longer than a terminal patient who is not in hospice?

One of the theories, the most commonly accepted one, is that of the stress factor. The patient who has a terminal disease receiving regular medical care is often still fighting their own emotions with hope that they will live longer. They’re fighting, often with their doctor, to beat death. They are in a continuous physical and emotional struggle that consumes their energy. We know that their stress hormones like adrenalin and cortisol levels are elevated as they fight on.

While the hospice patient with the same terminal disease has come to some emotional and spiritual acceptance they now realize that their life is limited and their choice is to have a comfortable, pain controlled, loving life—whatever life they have left. So with their pain controlled and with their emotional and physical struggle diminished they can then enjoy a quality of life instead of a fight with disease.

Many times we are told by hospice patients and families “I should have come to hospice sooner”. Or, “my father may be dying but his quality of life has improved with hospice care.” Now hospice can’t guarantee any one will have a longer life, but they can guarantee compassionate, high quality care that allows the patient to have their pain and symptoms reduced and managed. To have the kind of care that focuses on the person and their wishes and their family and their individuality instead of more medical tests, therapies, surgeries, and procedures.

When patients and families can be comforted they can then reflect on the quality of their day. They can look forward to catching another fish, reading another book, solving the puzzle first on Wheel of Fortune instead of fighting a disease that is draining the life out of them. Hospice is about life, and living everyday to the fullest.

Jul 27, 2009 11:00 AM

Letting Go

Mon, 27 Jul 2009 16:00:00 GMT

As physicians, We’ve always been a bit conflicted by the term “letting go.” It seems on the one hand that letting go means letting go of hope, letting go of opportunity for cure and improvement. On the other hand letting go may indicate that the patient has come to a realization with their disease that they need to let go of false hope for a cure or improvement. Letting go for patients and families may mean a peaceful “letting go” of earthly bonds. Letting go of this life and embracing the next. Letting go could mean letting go of the fight, giving up. Letting go could me letting go of pain and anguish and moving toward peace and contentment.

A famous medical writer, Dr. Elizabeth Kubler Ross, described the stages of feeling and emotions that patients and families go through when they are faced with the worst medical news ever that there is a terminal prognosis. She described initially shock and disbelief, the sense that it just couldn’t be happening to me, the doctors must be wrong. Then the stage of anger. The “why me” stage. “What did I ever do to deserve this?” Angry that life has changed, that bad news faces them, that it just isn’t fair.

Then a very difficult stage called bargaining. Staying prayers like “God, get me through this and I’ll dedicate my life to you” or “Doctor, I’ll take the experimental therapy if you can just save my life”. Bargaining with doctors, nurses, ministers, priests, even family members. This is the stage where patients and families often seek cures that aren’t proven, experimental therapies that don’t work, and endless tests and treatment that lead to futility and not a cure.

Then as the disease or medical condition worsens there comes an overwhelming sense of sadness and gloom. This stage is often referred to as depression.

The reality of the situation sinks in and depression can, in some cases, overwhelm the patient and their family. Finally, with support, faith, and sometimes courage, there comes the stage of acceptance. This really is happening and everything that I have done cannot change it.

We would like to think that hospice helps to bring that sense of acceptance. That the hospice staff and caregivers with compassion and medical science can bring to the patient and their family the peace that comes with acceptance. So often patients and families tell the hospice nurse “If I’d only known about you earlier I would have worried and suffered so much less.”

We believe that for patients and families who are cared for by hospice “letting go” means letting go of pain and accepting comfort. Letting go of fear and accepting confidence, and security. We think that it could mean with hospice letting go of anger and even letting go of some depression knowing that loving staff in hospice with the best tools they can use bring comfort and quality of life to hospice patients and their families.

Jul 27, 2009 11:00 AM

Insurance Coverage for Hospice

Mon, 27 Jul 2009 16:00:00 GMT

It seems that all of the current national headlines are about healthcare reform. Even if you are not interested in this topic, you probably know that some 46 million people in this country are without health insurance. Health insurance comes in many forms. The major insurer in this country is Medicare. For people who have worked and received Social Security they also, if disabled or retired, qualify for Medicare.

Most of us who are still working have health care provided in full or part by our employer. Those in the military and their dependents have full coverage and those with past military service may have Veterans Administration healthcare benefits. Health insurance comes in many forms and the coverage may be minimal or complete.

Some of the political and economic debate about healthcare reform is based on the expense of Medicare, the concept of employee benefit through the workplace, or individually owned health insurance policies, and the concept of universal healthcare (which generally means we all, every person, has the same government sponsored insurance and we all get the same healthcare benefit).

How does all of this affect who pays for hospice? Hospice care has been a Medicare benefit since 1983, and since most patients in hospice are over 65-years-old or have been on Social Security disability, Medicare pays most of the hospice bills across the country. Private health insurance usually focuses on cure, recovery, and rehabilitation. Some insurance companies are now starting to understand the importance of hospice, and that hospice can be a benefit of many private healthcare policies. Tricare and VA help those with present and past military service. Medicaid, on the state level, may assist those who qualify.

Probably the most important concept for hospice is the concept of compassionate care at the end of life. This care is not only meant to be sensitive and supportive to the patient and family in terms of medical care, it is meant to identify burdens and stresses in the patient’s life and help diminish them. One major stress may be the worry a patient or their family has about paying for hospice services.

Medicare, private insurance, Medicaid, Tricare and veterans benefits may pay for hospice services. Most hospices practice compassion in accepting all patients who need their services, not just the ones who can pay for it. So, in the final analysis, insurance coverage is not required by most hospices.

Our recommendation would be, if you or someone you care about might need hospice services, ask right up front about insurance and pay requirements or restrictions. The patient and their family are the customer and as the customer they can pick and choose that hospice that represents the highest quality and can provide them service based on their need, not their ability to pay.

Jul 27, 2009 11:00 AM