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Hospice and How It Can Help the COPD Patient AND Caregiver –

#end stage copd hospice

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Hospice and How It Can Help the COPD Patient AND Caregiver

Hospice can be an invaluable resource for people with end-stage COPD and their overworked, overwhelmed caregivers. But before I get into that, let me apologize. I’m writing 3 posts today, and they’re all a bit on the depressing side, because they deal with death.

I don’t mean to remove all hope for people fairly new to COPD as they read these posts. There are many opportunities for hope and a certain quality of life, even after a diagnosis of COPD. But it’s also a fact that COPD is a chronic, progressive illness for which there is no cure. Eventually, death does become a reality. It can take years, but it will happen at some point. So, while it’s important to live life to the fullest as long as you can, it’s also important for both patient and caregiver to prepare for what is coming in the future.

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So, this post is about how hospice can help, and the sooner it is initiated once the end is approaching, the better. Unfortunately, many people do not get referred to hospice (or are not ready to accept it) until far too late. And at that point, there may not be time for hospice staff to do what they are so good at. easing the way to a dignified, peaceful death.

My mom was referred to hospice during a recent hospitalization. and it turned out to be far too late. Although I have said that she was “dying for the last 2 years” more than once, in the end, she deteriorated so rapidly that we weren’t even thinking hospice before she went into the hospital. And then it was too late for her (or us) to reap the benefits, for the most part.

Hospice is a concept of care that provides comfort and support (on several levels) to patients and caregivers when traditional medical care can no longer prevent death from coming on, usually within a few weeks or a few months.

Hospice is a team-oriented approach that neither prolongs life nor hastens death. According to the Hospice Foundation of America, “the goal of hospice care is to improve the quality of a patient’s last days by offering comfort and dignity.”

Hospice care is not just about providing physical care, though that is certainly included. It’s also about the emotional, social, and spiritual impact of the disease and of the dying process.

Hospice does not usually refer to a place. 80 percent of hospice care is provided in the patient’s home. The emphasis is on enhancing comfort and reducing any pain or distress.

When the doctor says that nothing more can be done to improve or even maintain respiratory function, and that death is likely within the next one to six months, then hospice should certainly be considered. Hospice doesn’t mean giving up. it means making a conscious choice to focus on the quality of your life in your last days and then to go out on your own terms!

When you accept hospice, though, you are accepting that you will no longer be accepting life-sustaining or invasive treatments, except in the case of an emergency. It also entails acknowledging “Do Not Resuscitate” (DNR) status. In other words, if your heart or lungs stop working, you do NOT want emergency personnel to initiate treatment that would get things going again.

However, if you were to fall and hit your head or if you broke a bone, then emergency treatment for those would be acceptable, even if you are on hospice.

Once you go on hospice, you are not a prisoner. You CAN change your mind and go off of it. But you can only do that once or twice. So do not take the decision about hospice lightly. Make sure you are ready.

What Does Hospice Offer?

As I’ve already stated, hospice can be beneficial both to the patient and to the caregiver. I have been a COPD caregiver for more than 4 years, and it takes a toll. So, even if patients are willing to “go it alone”, keep in mind how helpful hospice can be to your caregivers.

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Most people who have hospice have Medicare health insurance, but both Medicaid and private insurance also often will cover hospice care in qualified people. Here are the hospice services typically covered by Medicare:

  • Nursing care and case management
  • Physician oversight sometimes home visits
  • Home health aide bath services
  • Medical appliances, medication, and supplies
  • Spiritual, dietary, and other counseling
  • Trained volunteers for patient companionship caregiver respite
  • Social work services
  • 24/7 on-call availability

Most people think of hospice in relation to cancer patients, but it can also be helpful to a respiratory patient. As death approaches in someone with COPD, breathing gets harder and harder and air hunger, fear and stress can develop.

Hospice nurses can help tweak oxygen levels and delivery methods, along with morphine and other medicines to control this air hunger and emotional stress. How much will that contribute to a more peaceful, gentler COPD death?

How to Learn More About Hospice

The Hospice Foundation of America website has lots of information about hospice, such as their Myths and Facts About Hospice page and their Hospice Stories section.

You can also talk with your doctor about hospice, and/or talk with the staff at one of the local hospices in your area. You should be able to find them listed on the Web or in the yellow pages of a phone book. Local hospitals may have their own hospices or be able to refer you to one as well.

My Personal Hospice Experience

My mom was diagnosed with COPD back in December 2005. Although she went on oxygen, for a couple of years, she still seemed pretty healthy. Then, in February of 2007, she developed pneumonia and was hospitalized. At that time, her doctor suddenly referred her to hospice, telling us it was not just for dying patients (which is not really true).

At that point in time, neither mom or I was prepared to think of her as imminently terminal, but we accepted hospice and they initiated services that seemed more like traditional homecare than anything else. Unfortunately, about 6 weeks later, mom’s femur broke and hospice was cancelled so she could have the leg surgically repaired.

2007 was a rough year, with 5 hospitalizations in total. On the 4th one, we thought we were going to lose Mom, but by 2008, she was on the mend and over the next year got better and better, often not really even needing her oxygen. Hospice was a distant memory.

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Towards the end of 2009, Mom’s breathing started to gradually worsen and I started wondering how much longer she could go on. But she soldiered on, adapting to every little change. Her current doctor talked about hospice when Mom started to ask questions about what the end would be like, but it still didn’t seem like time.

Then, in early November of 2011, Mom just suddenly decompensated, breathing-wise, and had to be hospitalized. Within a week, the doctors decided her lung deterioration was so far advanced, there was nothing more to be done, and started to prepare her to come home to die, which is what Mom wanted so badly.

A hospice referral was initiated, and they helped us with the whirlwind of preparation to bring Mom home on 12 LPM of oxygen (2 concentrators!), a CPAP machine, and kinds of other equipment and medication. It felt like we were setting up an at-home hospital room.

Mom came home on her birthday, and it was a joyful day for her, though also exhausting and with a few scary moments for both her and me. The hospice nurse spent 4 hours with us, getting us situated and setting up support services for the future. I was grabbing that lifeline, as the thought of being chained to my home 24/7 (Mom couldn’t be left alone) was pretty overwhelming and terrifying.

We thought we had at least 3 months to prepare and deal with the dying process. But Mom had other ideas. She passed away early the next morning. In the end, all that the hospice team was able to do for us was set things up and then to come out and pronounce her so that we didn’t have to call the police or coroner. Those things were great, but there is so much more hospice could have done for us, had there been more time.

So, our experience was that first we got hospice way too early and then in the end, way too late.

If you are starting to sense that your life is coming to a close, at least start thinking about hospice and what it can do for you and yours. Don’t wait until the end is right there before you take action!

Published On: December 08, 2011





Dr John Smith: Cransley Hospice staff can hold their heads up high

#cransley hospice

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Dr John Smith: Cransley Hospice staff can hold their heads up high

Our heads go down and we mutter something like “it was nothing, anyone could have done it”.

That may be the case, but it generally isn’t, for we have made the choice to care about someone, when others might have walked away.

So it’s heads up and a big thank you for saying that.

This week it happened to me. I hadn’t seen the lady for 16 years when she said “hello”. To be honest I could not recognise her and said so. No worries because it was a long time ago when her mum was a patient in the hospice. Sixteen years on and she wanted to thank me for the care that was given.

She hadn’t forgotten and did not want to forget. What was a difficult time became a good time, and out of that time came even more good because some time later she began to work in the hospice too. It made sense of the tragedy and the memories that she has are good ones. There are no regrets.

The word hospice literally means a resting place on a journey. In the sense that we use it today the journey is coming to an end.

To rest we need support and good symptom control, to rest we need to know that our family and friends are being cared for, to rest we need people to listen to us, to hear our fears, to hear us say thank you for the life that we have been given and, yes, to be able to express our regrets for what we have struggled with, for the wrongs we may have done, to seek forgiveness and to be forgiven.

Hospice is often the place where we begin to make sense of our lives, a sort of summing up of what we have been, what we are and what we mean to others.

It is when this happens that people express their thanks. And it is not a transitory thank you either, it is almost lifelong. Yes, I can hold my head up high and Cransley Hospice and its staff should too.





Great Moments Can Be Small Moments – A Hospice Volunteer – s

#hospice stories

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We worked everything out as she wanted; her doctor cooperated with us. A living will was drawn up, but at the time, a living will was not recognized in the state. She died at home with no tubes to keep her alive; her doctor or a nurse came in regularly to administer drugs for pain. My sister died with dignity.

The above is all provided with hospice care. But, my sister died in 1978, and there was no hospice as yet. Elizabeth Kubler Ross was talking about a different way of dying but it was not yet accepted.

I never forgot the experience of watching a loved one die.

Thirty years later, after I retired from work, I found I was tired of playing Bunco and cards. I wanted something more in my life. I contacted Casa de la Luz Hospice and became a volunteer. Now, I don’t think I have done anything more important in my life. I had been conditioned to think that my life revolved around the special moments—marriage, raising children, children graduating, more marriages, and then grandchildren. These things are all important and worth remembering. But, by becoming a hospice volunteer, I have learned that great moments can be what may be a small moment. I am thinking of being in the Casa de la Luz Inpatient Unit, sitting vigil. The harpist came in and began to play; I was near the patient. The patient opened her eyes and asked me, “Am I in Heaven now?” I replied, “No. Not yet.” That was a moment, small to others, but big to me that I will not forget.

It doesn’t take me long to become involved with a patient. It’s important to me to learn about the patient’s past, family, likes, dislikes, and what makes the patient smile. The patient learns that I am there to help, to listen, and to be quiet—whatever the patient needs. We share experiences, have new experiences, and all is confidential. I’m surprised, sometimes, at what I hear.

Each patient is different and has different needs. For example, if I am told a patient isn’t eating enough, then I arrange my visits around the lunch hour so that I can encourage the patient to eat. You’d be surprised how many patients now eat dessert first and then their lunch. On holidays I try to dress the season—maybe a Halloween shirt, a Santa hat, or red, white and blue for the 4 th of July. Little things mean a lot to a terminally ill individual who is alone and has outlived his/her family and friends.

I am also a knitter. I love to knit prayer shawls and afghans for our hospice patients. I have a memory afghan that I knitted a couple of years ago. It is made up of 20 individual squares, each knitted with a different pattern and then sewn together. Each of the squares was knitted while I visited my patients. I treasure it.

I carry a hospice bag with me at all times. In it I have a book to read, crossword puzzles, snacks and water, and of course, my knitting. As a vigil volunteer, I never know how long my visit will be. I like to be available day or night to keep vigil with a dying patient. If I’m going for a companion visit with a patient, I try to keep it to one or two hours. I watch to see how the patient is holding up; is he/she looking tired? I will drive anywhere to see a patient. Distance is not a problem to me.

I cannot explain the reward I receive by comforting someone who is in need. I just know that the reward is huge, and I think my patients can “feel” my energy.

Being a hospice volunteer is not for everyone. But, to me and the other volunteers, our rewards are well worth it.

Often, I am asked, “How can you watch someone die?” My reply is, “I don’t watch a patient die; I believe that I’m there to help them pass on to the next stage of life.”

By Diane Gilbert, volunteer of two years

Learn more about the various volunteer opportunities with Casa de la Luz Hospice on the Volunteers page of our website.





Where Can I Find Free Online Christian Counseling Courses? #christian #counseling #degree


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Where Can I Find Free Online Christian Counseling Courses?

Free online Christian counseling courses can be found at the Master’s International School of Divinity. Students will be able to access course materials at their own convenience. Schools offering Christian Counseling degrees can also be found in these popular choices.

What You Need to Know

Free online Christian counseling courses teach you counseling techniques, using the Bible’s teachings as a guide to the human mind and mental health. You’ll learn how to provide counseling for common issues, such as marriage, money and anger issues. You may be presented with test questions after reading each chapter to help you assess your understanding of the content.

Master’s International School of Divinity

With these three courses, the Master’s International School of Divinity presents the Bible as a basis for providing psychological counseling. The first course is a 5-step, scripture-based counseling course where methodology is covered. In the Bible as the inerrant guide for mankind course, you’ll delve into this topic during this class, which also attempts to answer the question of the Bible’s authenticity. A third course, on the Biblical foundation for mental health, is a 6-part course (including an introduction), where students will explore the concept of sanctification as a foundation for Christian counseling. This course doesn’t address the treatment of serious mental disorders – and it is no substitute for the professional training needed to become a licensed healthcare provider – but it may help you give better advice to a fellow churchgoer.

Biblical Directionism Counseling

What Will I Learn?

You’ll compare Christian counseling and Biblical counseling methods, and you’ll learn how various counseling models are developed. You’ll also learn how to gather data from a counselee and apply the five-step counseling model.

What Materials Are Included?

You need to have a Bible on hand during the course. Otherwise, study materials are easily accessed on the Master’s International School of Divinity website. Materials consist of audio highlights – which can be downloaded and played via Windows Media Player – and seven chapters of online instruction in the Biblical Directionism counseling model.

What Assignments Will I Complete?

This course features self-correcting exams at the end of each chapter. You should take these multi-question tests if you are taking this class to earn the Certificate of Completion.

The Bible As The Inerrant Guide for Mankind

What Will I Learn?

This course discusses the validity of the Bible, the reality of God and the scholarly and scientific debate surrounding these subjects. Opinions of theologians, professors and other preeminent thinkers are presented.

What Materials Are Provided?

The course is presented in the form of a downloadable textbook in Microsoft Word format. The only other required text is a copy of the Bible. Written exercises based on the course chapters allow you to further explore and understand key messages.

The Biblical Foundation for Mental Health

What Will I Learn?

You’ll cover topics like sin, grace and sanctification. You’ll learn how a cooperative effort between God and an individual can facilitate the counseling process. Scriptural examples are used throughout to reinforce Christian concepts. End of chapter questions help you assess your understanding of the material.

What Materials Are Provided?

You can access all of the necessary materials for this course through the school’s website. The school also provides a web link to helpful Bible study tools which can aid your learning.

To continue researching, browse degree options below for course curriculum, prerequisites and financial aid information. Or, learn more about the subject by reading the related articles below:


How much you can borrow with a Mortgage in the UK #can


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How Much Can I Borrow?

1) How Much You Earn

The amount you can borrow will vary between lenders but the rule of thumb is three and a half times your annual earnings.

You may get up to four times your earnings, particularly if you have a good mortgage broker.

For a couple buying together typical variations would include:

Couple 1. two and a half times both annual incomes.

Couple 2. three to three and a half times the greater income plus one year of the second income.

You can check out our couple s mortgage calculator. to see how much you can borrow.

Here s a secret

Assuming you have a regular income and clean credit history you re likely to get a loan fairly easily.

Despite the impression you may be given that you ve got to jump through the hoops, there is strong competition between lenders to get your business.

Some lenders now use more sophisticated credit rating methods, where they examine your income and your outgoings.

The idea is that every borrower has unique circumstances. Someone with teenage children and high outgoings can t afford to borrow as much as a singleton earning the same salary.

2) Depending on How Much The Property is Worth.

Most lenders will loan up to 75% of the property s value. (This is known as the loan to value ratio).

Some lenders might lend more a mortgage broker would know who but you would probably have to pay over the odds eg a higher interest rate.

Depending on the area you want to buy in, the lender may refuse a loan. for example if they feel the property isn t expensive enough for the area.

More often, it s the opposite case where a property is seen as too expensive.

Some mortgage lenders will put a limit on the amount they ll allow on certain types of property. For example, thatch-roofed, timber framed . and houseboats? Well that s a whole different deal.

3) Depending On How Much The Mortgage Lender Thinks You Can Afford

You may be able to get a mortgage which stretches your budget to the limit but leaves you in trouble when you have to pay the other costs involved in buying your home and its future running costs

Some lenders will want to estimate this by checking your average outgoings eg your household bills, any debts etc. Some will get you to fill in a detailed questionnaire either by hand or on the phone or online etc.

Note that how much you can borrow is not necessarily what you can afford

If you re a first time buyer it will always help if you can show you ve been paying regular rent for a similar amount to what your intended mortgage payments will be.

Read On / Mortgage Basics

Now that you’ve read this are you interested in talking to a mortgage adviser? Fill out the quick form below and you’ll be contacted soon by an independent. regulated mortgage specialist for a free no obligation quote.

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and £15,000 on your Mortgage

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Mortgage Sorter provides you with jargon free, consumer friendly information on UK Mortgages and other personal finance areas. We have been online since 1999 and are are completely independent. Please note that this website provides information and not financial advice. Always get independent advice and try to get at least three quotes when buying any financial product or service in the UK

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How Long Can Cord Blood Stem Cells Be Stored? #how #long #can


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What Happens To Cord Blood Stem Cells After 20 Years of Storage

Companies have only started to store cord blood for the last 20 to 25 years or so, and for cord tissue a bit less than this. Given this limited time frame of those working in the field, there is no data on how well blood or tissue stores beyond 20 years. Studies have found, however, that cord blood may be able to be stored indefinitely at liquid nitrogen temperatures (-196 degrees Celsius), and there is no evidence that it degrades over time. Research conducted by one of the foremost experts on cord blood stem cells shows that after 23.5 years of storage, there was no degradation in the cord blood samples. In terms of payments, after 20 years of storage you can prepay $1999 for another 20 years of storage. It’s common to think of the payment process like life insurance. If you pay for the initial storage and cancel after 20 years, it’s like canceling life insurance early just because you’re still living.

Studies have found, however, that cord blood may be able to be stored indefinitely at liquid nitrogen temperatures (-196 degrees Celsius), and there is no evidence that it degrades over time.

Our Quality Promise

Americord is of the highest quality in cord blood and cord tissue storage. We believe in and follow all of the best practices for cord blood and cord tissue collection and storage. These include the following:

  • FDA
  • AABB standards
  • State guidelines
  • Federal guidelines and applicable licenses

Not only are our practices safe, but we also use the only commercially available FDA-approved sterile exterior cord blood bag that is on the market and the fastest medical courier. Using these quality methods and materials, we have been able to collect up to twice as much as other cord blood banks and industry standards. A larg er amount of stem cells opens up the possibility to treat larger patients or expand treatment options for smaller patients.

Learn more about the differences and benefits of cord blood banking and cord tissue banking to know what’s best for your family plan.

Ready to enroll? Just call 866-503-6005 or sign up online .

Have Cord Blood Questions?

Explore your birth plan options.


How Can I Become a Data Modeler? #learn #data #modeling, #how #can


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How Can I Become a Data Modeler?

Research what it takes to become a data modeler. Learn about job duties, education requirements, job outlook and salary to find out if this is the career for you. Schools offering Cloud Computing degrees can also be found in these popular choices.

What is Data Modeler?

Data modelers design computer databases that help bankers, scientists and other professionals organize data in computer systems. They then use these databases to run statistical analysis and extract meaning full information. This information is written up in reports that are presented to business executives, lead researchers or other employers. Learn more about this job, including career preparation, outlook and earning potential, in the table below.

Education Field of Study

Management information systems or other computer-related field

Source: *U.S. Bureau of Labor Statistics, **PayScale.com

What Do Data Modelers Do?

Data modelers organize data in a way that makes databases easier to access. To accomplish this, data modelers often work with data architects to create the best applicable database design or structure for a system. They analyze and identify the key facts and dimensions to support the system requirements. Additional duties include restructuring physical databases, managing data, reorganizing database designs, and maintaining data integrity by reducing redundancy in a system.

What Skills Do I Need?

To work as a data modeler, you need to be familiar with the different types of data models. These models explore the domain, concepts of the domain, and the internal make-up of databases involving tables and charts.

Since you must alter various database designs and domains, you need to be familiar with basic modeling tools such as ERWIN or Embarcadero. You also need to have knowledge of database computer language, SQL, and have some experience implementing Oracle or Terandata database systems.

How Can I Prepare?

While there are no specific degree requirements for this position, employers prefer candidates who have technical aptitude rather than a specific degree. In order to gain a deeper knowledge of database structures, algorithms and programming languages, students should focus on a degree that offers coursework in information technology, computer science or programming.

How Much Will I Make?

According to the U.S. Bureau of Labor Statistics, all types of computer occupations – including data modelers – should see 12% job growth from 2014-2024 (www.bls.gov ). PayScale.com reported that the median salary for data modelers was $82,385 per year in 2017.

What Are Some Related Alternative Careers?

Actuaries use statistics, finance theories and financial data to analyze the financial risks of business decisions and help come up with solutions to reduce those risks. Professionals in this profession often hold a bachelor’s degree in statistics, mathematics or actuary science. Computer systems analysts examine a companies computer system, with the objective of finding solutions to problems or ways to make systems more efficient. They typically have a bachelor’s degree in a computer-related field.

To continue researching, browse degree options below for course curriculum, prerequisites and financial aid information. Or, learn more about the subject by reading the related articles below:

Popular Schools

An admission advisor from each school can provide more info about:

  • Programs Curriculum
  • Tuition Financial Aid
  • Admissions Starting Dates

The results below may include sponsored content but are popular choices among our learners.


Hospice Marketing – Are You Tapping The Target Who Can Dramatically Grow

#hospice marketing

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Hospice Marketing Are You Tapping The Target Who Can Dramatically Grow Your Census?

When it comes to hospice marketing. Most hospices focus almost exclusively on marketing to medical providers. Makes sense right? After all they have the power to refer. But doing so ignores a powerful demographic. One that has the need, the ability, the drive and the opportunity to refer to your hospice. She is the in home gatekeeper and she should be a key focus for your hospice.

We know the struggles with consumers thinking all hospices are the same; we know the struggles of ‘the list’ given to patients by case managers. But I can tell you from 20 years of ROI studies of our hospice gatekeeper direct strategies consumers have power and they will motivate their physician to refer and they will demand the hospice partner of their choice. To the point of dramatic census growth, averaging 60 percent with our partners.

We have several case studie s but here is one that is a great example of the power of targeting the in home gatekeeper. We partnered with a hospice that had only three provider liaisons working out of three locations at the time. They decided to expand their service area throughout the entire state. Expansion came without the power of acquisition, meaning no relationships, no existing patients. And no additional provider liaisons. Since relationships with physicians and other medical providers take a while to build, we took our story directly to the in home gatekeeper. We created an intense gatekeeper direct strategy involving social media, web, traditional marketing, advertising and recreating conversations we knew would resonate deeply with her. We used specific strategies to lower her psychological purchase price of hospice care and to build a connect between her and our hospice partner. Their census grew 300% taking them from three locations to 35 and positioning them as the largest hospice provider in their state.

We continue to see significantly more individuals benefiting from hospice when a sound gatekeeper direct focus works in tandem with building supportive and educational relationships with providers. So for most hospices what seems to be missing in their efforts to connect to this powerful referral source?

Though many hospices’ messaging begins to speak to the gatekeeper (Web, Facebook, brochures, advertising), they often are focused more on listing services, explaining what she doesn’t know about hospice, debunking hospice myths, or talking about their hospice and sharing testimonials. Rather than connecting to this powerful decision maker in real and profound ways that resonate with her. This takes understanding this gatekeeper better than they understand themselves. We’ve spent two decades gathering intensive data on what will drive her action to choose a certain hospice. If your hospice wants to care for more individuals and be able to provide the full benefit of hospice sooner, then look to the in home gatekeeper; she can be your hospice’s best friend.

Consider re-inventing your conversations with her. Truly examine how you are communicating with her. Then build strategies and messages based on intensive research that tell your hospice’s story like it has never been told before, in a way she will find hard to ignore. Then give these messages the power to be heard.

Anoroc hospice marketing is the leading expert on the in home hospice gatekeeper. Anoroc can review your hospice marketing communications strategies to help ensure your messaging is on target.





What really happens to your body when you stop drinking alcohol, what


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What really happens to your body when you stop drinking alcohol?

There are plenty of reasons to quit drinking alcohol. Perhaps you can’t party as hard as you once did, and the hangovers are getting worse. Maybe you’ve developed a beer belly. Possibly, there’s a deeper issue at play and you don’t want your drinking to get out of hand before it’s a problem—unless it already is and you just don’t realize it. Whatever your circumstances are, you’re here, and you’re ready to kick the sauce. Let’s breakdown what happens to your body once you quit drinking.

The first 48 hours after you stop drinking may be the biggest detox hurdle. Depending how much you were drinking, this may feel like a hangover or it may be more than that. Withdrawal symptoms can include sweating, a rise in blood pressure, shakiness or tremors, and insomnia as well as the usual hangover symptoms like headache and nausea.

You probably saw that one coming. If you’ve been drinking alcohol regularly, your body is going to take note when it’s gone. According to the National Institute on Alcohol Abuse and Alcoholism, cravings are to be expected when your drinking behavior changes. The equilibrium your body created to adjust to alcohol in your system will no longer exist. That first day you go without a drink, especially if you’ve been drinking every day, is likely going to be filled with cravings for alcohol. For some, cravings can last weeks, months, or years depending on the amount and regularity of alcohol use prior to quitting.

If you are a heavy drinker, you may not be out of the woods after 48 hours. Between 48-72 hours is generally when the onset of ‘delirium tremens’ occurs for some. Delirium tremens is sudden confusion that may be paired with hallucinations, shaking, irregular heart rate, and an increase in body temperature so high that it can sometimes lead to seizures. If you are a heavy drinker, it is important to detox from alcohol under the supervision of a medical professional as the withdrawal from quitting cold turkey can lead to death.

While hangover and withdrawal symptoms can be uncomfortable, and at times dangerous, the good news is that after peaking at around 72 hours after the last drink, the last of these symptoms will generally start to subside. At this stage your body begins to create a new equilibrium that does not include alcohol and its effects.

While your body will have adjusted after a week of not drinking, there may be psychological effects of detox that last longer. Some people report feelings of anger and aggression, general anxiety and depression, nightmares and difficulty sleeping, and even decreased libido. This is in part because alcohol use affects neurotransmitters that are implicated in mood, such as serotonin. There may also be underlying issues for which alcohol has been used to self-medicate. Often the experiences and emotions that were being ignored during alcohol use rise to the surface after you stop drinking. During this time it can be helpful to seek out counseling, either individual or in a group, to handle these emotions and experiences.

It may take a week or two, but after you quit drinking you’ll ultimately sleep better. According to research, drinking increases brain wave patterns that usually happen when you’re awake. In normal deep sleep, the brain activity is in delta waves. Consuming alcohol causes brain activity during sleep to happen in alpha waves. Alpha waves are generally only seen in brain activity when we’re awake, but resting. We all know that resting on the couch isn’t the same thing as getting a good night’s sleep, so it’s no wonder that people who drink regularly often feel tired and fatigued during the day.

You may be thinking, “But I always fall asleep faster when I drink!” That may be true, but it’s only for a little while. A review of several studies found that even if alcohol helps you fall asleep more quickly and deeply at first, the quality of your sleep suffers overall, leaving you feeling tired the next day. So while you may have a hard time falling asleep at first when you stop drinking, you’ll be more refreshed the next day.

You’ll lose weight

If you stop drinking and change nothing else about your diet or level of activity, you’re likely to lose weight. It’s partially the simple concept of calorie counting—alcohol, especially beer, contains a lot of calories. A single IPA may have as many as 200 calories; and a margarita could have roughly 300. If you suddenly drop hundreds of calories a day, the pounds will drop off over time. Plus, you’ll overeat less. Research shows a link between alcohol consumption and heightened senses. Being intoxicated sends the hypothalamus in the brain into high gear, which makes the body more sensitive to food smells. That, combined with alcohol’s famous ability to remove inhibitions, leads to extra eating.

Your skin will look better

Alcohol is a diuretic, meaning it causes water to exit the body. Not so much “cause” as “force.” In short, it’s severely dehydrating. It decreases the production of a hormone that helps the body absorb and hold water. This is why water is needed during a hangover. Over time, less water in the body leads to noticeable effects, such as parched and dry-looking skin, rosy red cheeks, dandruff, and eczema. After kicking the sauce, you should see a vast improvement in the quality of your skin.

Blood sugar levels return to normal

When the body is processing alcohol, it stops efficiently maintaining proper blood sugar levels. Not only does it get in the way of your body accessing glucose stores but it decreases the effectiveness of insulin, the hormone that regulates blood glucose levels. That leads to wildly out of control blood sugar levels, which over time can lead to type II diabetes. Blood sugar levels often normalize when alcohol is no longer a factor—in studies, they’ve been shown to drop by as much as 16 percent.

Your chances of developing several forms of cancer decrease

The National Cancer Institute has linked heavy drinking with an increased risk of several cancers, among them: mouth, liver, breast, colon, and rectal cancer. Without alcohol in the body, that’s one less carcinogen to worry about.

Liver fat will decrease

In a small study conducted by New Scientist and the Institute for Liver and Digestive Health at University College London Medical School, abstaining from alcohol for a month led to an average of 15 percent decrease in liver fat (with some individuals seeing a 20 percent decrease). This is important because fat accumulation in the liver can lead to liver damage and eventually liver disease.

Your immune system will work better

Excessive drinking has been linked to many immune-related health effects. These include higher susceptibility to pneumonia and other respiratory disorders, greater likelihood of sepsis and certain cancers, a higher instance of postoperative complications, and poor wound healing, among many others.

Research suggests this is because alcohol overexerts the immune system. In fact, some studies have found that a single episode of binge alcohol intoxication leads to exertion on the immune system and inflammation. The good news is that it can be reversed. After you stop drinking, your immune system’s response will be strengthened over time.

You have a better chance of conceiving

If you’re trying to have kids, your chances will be better once you stop drinking because alcohol reduces fertility. In one study, healthy women who drank 10 or more drinks a week decreased their odds of conceiving to 34%. While you may be thinking that you’ll be fine because you don’t drink that much, even moderate drinking affects fertility. In the same study, women who drank between one and five drinks per week (less than one drink per day) decreased their odds of conception to 61%.

Brain damage could be reversed

Extended alcohol use and abuse can negatively impact your brain. According to research, alcohol’s most significant impact is on the areas of the brain critical to learning and impulse control. While some of these changes may be permanent, especially for those who abuse alcohol for an extended period of time, there is some hope.

According to the National Institutes of Health, abstaining from alcohol over several months to a year may lead to a partial correction of some structural brain changes that were caused by alcohol and may also reverse negative effects on problem-solving, memory, and attention.

It may be hard

If you are a moderate drinker, you may be able to quit on your own without too much trouble. If you’re a regular or heavy drinker, however, you may find it much more difficult. Both internal and external triggers may lead you to want to start drinking again. No matter your current level of drinking, there are many resources available if you want to stop, including a state by state resource guide. Whether you utilize an online support group, attend meetings, or seek individual counseling, quitting drinking is possible for everyone.


Online Course: Excel 2016 – Certificate and CEUs #editing #certificate #online, #excel


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Online Class: Excel 2016

Course Description

Microsoft Excel is a spreadsheet program that comes packaged with the Microsoft Office family of software products. Just like the other programs by Microsoft, Excel can be used for a wide variety of purposes such as creating an address book, grocery lists, tracking expenses, creating invoices and bills, accounting, balance checkbooks and other financial accounts, as well as any other purpose that requires a spreadsheet or table.

This course will cover the many features of Excel 2016 and will teach you how to use them, starting with the simple and working to the most complicated. The good news is that Excel 2016 makes everything easy. By learning how to navigate the program and where to find each feature, operating Excel can become a breeze.

This course will teach you how to:

Create a spreadsheet

Format cells, rows, columns, and entire worksheets so they fit and match your data

Enter data into a spreadsheet

Use formulas and functions for math, accounting, and totaling.

Create formulas and functions

Calculate data

Create charts and diagrams for your data

Create data lists and forms

Create and use pivot tables and pivot charts.

Work with Excel templates

Share and protect your worksheets and workbooks

Use What-If Analysis to determine possible outcomes. For example, sales goals

And much more

This course was designed to teach you skills you’ll need to successfully use Excel 2016. Each lesson contains instructions and illustrations to show you how to use the features, then walks you through step-by-step so you can see how everything is done. You don’t need previous experience with Excel to be able to complete this course. This course will start with basic skills, then move forward to more advanced features and techniques. Although you do not need access to Excel 2016 for this course; it is highly recommended. A free trial of Excel 2016 is available on the Microsoft website.

7/3/2017 11:39:52 AM

Lesson 1: Introduction to MS Excel 2016

Excel can be used for a wide variety of purposes such as creating an address book, grocery lists, tracking expenses, creating invoices and bills, accounting, balance checkbooks and other financial accounts, as well as any other purpose that requires a spreadsheet or table.

  • Lesson 2: Navigating Excel 2016

    In this lesson, we’re going to focus on the major elements of Excel 2016 and take a few minutes to become familiar with their purpose.

  • Lesson 3: Worksheets and Workbooks

    Worksheets are stored in workbooks, and workbooks are the files that you actually save.

  • Lesson 4: Entering Information into MS Excel 2016

    Starting to enter information is as simple as clicking on a cell in the spreadsheet and typing, but there are some things that are helpful to know – and that you can do – before you ever type that first letter or number.

  • Lesson 5: Introduction to Working with Cells, Rows, and Columns

    If you want to move data from its original location and relocate it somewhere else, you must cut the data, then paste it somewhere else. You can cut or copy cells, rows, columns, or entire worksheets.

  • Lesson 6: Formatting Data and Cells

    Taking the time to format a worksheet can take it from the black and white page of data and gridlines to something that looks professional and attractive.

  • Lesson 7: Formatting Rows and Columns

    In Excel 2016, the width of a column is determined by how many characters that can be displayed within a cell.

  • Lesson 8: Editing Cells, Rows, Columns, and Worksheets

    Excel 2016 makes creating – and editing – spreadsheets a lot easier because correcting errors is easy mess free.

  • Lesson 9: Introduction to Formulas and Calculations

    If you use spreadsheets to do accounting for a business, track totals, invoice customers, or anything that requires mathematics, Excel’s ability to calculate formulas is going to save you errors and headaches.

  • Lesson 10: Working with Formulas and Functions

    In Excel, a function is a predesigned formula that does a certain calculation. This can make it easier because you don’t have to construct every formula yourself.

  • Lesson 11: Maintaining Worksheets

    It’s important to learn how to maintain your worksheets to help you keep on top of all the information.

  • Lesson 12: The What-If Analysis

    A what-if analysis lets you explore possibilities by entering possible values into the same equation so you can see the possible outcomes in the cells of your spreadsheet.

  • Lesson 13: Adding Images and Graphics

    You’ve already learned how to format a worksheet and enter information into Excel. Now we’re going to show you how to add elements such as graphics and images.

  • Lesson 14: Charts and Diagrams

    Charts and diagrams are tools you can use to visually represent the data in a worksheet.

  • Lesson 15: Creating Data Lists

    A data list or a database table are types of worksheets that aren’t used to calculate values, but to store information, such as names and addresses of clients or perhaps a library of books.

  • Lesson 16: Managing Data

    A form is simply a dialog box that lets you display or enter information one record (or row) at a time. It can also make the information more visually appealing and easier to understand.

  • Lesson 17: Pivot Tables and Pivot Charts

    A pivot table sounds more difficult and confusing than it really is. Most people say they don’t like pivot tables, or they don’t understand them. In truth, they’re not that difficult at all.

  • Lesson 18: Printing Worksheets and Workbooks

    Headers appear at the top of a worksheet. Footers appear at the bottom. Both can contain page numbers, and headers often contain the title of the worksheet and perhaps the date.

  • Lesson 19: Templates

    Templates are worksheets that are already designed for you.

  • Lesson 20: Protecting, Saving, and Sharing Workbooks

    Add protection to worksheets so that they can’t be edited by other people. You can lock cells or an entire worksheet.

  • Additional Course Information

    • Document Your Lifelong Learning Achievements
    • Earn an Official Certificate Documenting Course Hours and CEUs
    • Verify Your Certificate with a Unique Serial Number Online
    • View and Share Your Certificate Online or Download/Print as PDF
    • Display Your Certificate on Your Resume and Promote Your Achievements Using Social Media

    Course Title: Excel 2016

    Course Number: 8900368

    Languages: English – United States, Canada and other English speaking countries

    Course Type: Computer Skill

    CE Accreditation: Universal Class, Inc. has been accredited as an Authorized Provider by the International Association for Continuing Education and Training (IACET).

    Grading Policy: Earn a final grade of 70% or higher to receive an online/downloadable CEU Certification documenting CEUs earned.

    Assessment Method: Lesson assignments and review exams

    Instructor: UniversalClass Staff Instructor

    Duration: Continuous: Enroll anytime!


    How to Clean a Microfiber Couch #can #you #steam #clean #a #microfiber


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    How to Clean a Microfiber Couch

    Microfiber is a stain-resistant material with a smooth, velvety texture. Thus, microfiber furniture is trendy, aesthetic, and yet easy to maintain. They are super absorbent and easy to clean because of the microscopic fibers.

    However, if you do not clean your microfiber couch regularly then it can become dreadfully dirty. Most microfiber couches, feature a mix of pure microfiber and polyester-based material.

    They cannot be cleaned with water alone as it is likely to leave behind water stains or marks. Nevertheless, you can use water safely if your microfiber furniture’s tag is marked with a ‘W’ which refers to water.

    How to Clean a Microfiber Sofa

    Step for Cleaning

    1. Remove the cushions from the couch.
    2. Vacuum the couch or sofa thoroughly to get rid of dust and debris.
    3. Clean the couch with a slightly damp microfiber cloth to get rid of surface dirt. Prefer to use a white rather than a colored cleaning cloth as while scrubbing it can leave behind its own color on the couch.
    4. Remove tough stains by spraying rubbing alcohol (isopropyl alcohol) or clear alcohol (gin, vodka) on the affected area and scrubbing it with a soft, absorbent, cotton cloth, scrub sponge, or a soft scrub brush.

      Unlike water or any water-based solution, alcohol evaporates quickly and hence, it is less likely to saturate the fabric. If the tag on your sofa or couch reads S-W then you can use water-based cleaning solutions like a gentle soap, carpet cleaner, upholstery shampoo, etc.
    5. Let the fabric dry. To speed up the drying process, you may use a blow dryer on the wet spots.
    6. Finally, scrub the surface of the fabric with a soft, clean scrub brush in circular motion. It helps fluff up the microfiber and soften the stiff fibers.

    How Remove Stains and Other Problems

    • Apart from rubbing alcohol and clear alcohol, distilled water and baby wipes are considered useful for clearing stains, even ink stains and water rings from a microsuede couch. You can try a dry cleaning solvent, too.
    • For removing nail polish or other tough stains, consider using an aerosol hairspray or simply a nail polish remover on the stained spot.
    • To remove pet hair from the couch, use a sticky lint roller. Besides, you may pick up the pet hair with rubber gloves.
    • When dealing with vomit stains, use a mixture of white vinegar and water, both mixed in equal parts. Spray the solution on the stain and scrub it with a soft cloth or scrub sponge. As for the vomit smell, you may sprinkle baking soda on the affected area and leave it overnight. In the morning, vacuum it away. You can use this trick to get rid of urine stains and smells, too.
    • In case there is chewing gum stuck on the fabric, rub an ice cube on it. Ice helps harden the chewing gum so that it can be peeled off easily.
    • Using a steam cleaner with fabric attachment (set to delicate mode) is also considered good for cleaning microfiber sofa, cushion, loveseat, and so on.

    Additional Tips

    • Before cleaning the entire sofa or couch, make sure you test your cleaning solution on a small portion of the sofa. Cleaning microfiber furniture with soaps and detergents is usually discouraged as it tends to ruin the material’s ability to repel stains and damage its texture.
    • It is recommended to avoid saturating the fabric of your couch with water or any cleaning solvent as it may leave behind stains.
    • Though microfiber furniture is stain-resistant, it is not completely immune to stains. So, deal with fresh spills and stains immediately. Spills in particular, should be blotted with a paper towel as soon as possible so that the fluid does not seep in the padding present underneath.
    • You should clean the couch at least one a month. Plus, vacuum clean the dust and dirt once or twice a week, especially if you have pets.

    How Big a Mortgage Can You Afford? #can #you #assume #a #mortgage,


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    5 Questions to Ask Before You Trust Someone with Your Money

  • 9 Small Financial Steps That Will Pay Off Big in the Future

  • 10 Stylists’ Secrets to Make Your Home Look Great

  • Who Am I Meant to Be?

  • How to Find Your Budgeting Personality

  • 5 Things People with Hefty Savings Don’t Do

  • 6 Things Not to Do in a Job Interview

  • The Best Time of Year to Buy Anything

  • 5 Things to Say in Awkward Situations Instead of “I’m Sorry”

  • Suze Orman: “What Money Has Taught Me About Personal Power”

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  • How to Make Any Bathroom Look Bigger (and We Mean Any)

  • 12 Questions to Ask Yourself Before Quitting Your Job

  • Becoming the Person You Were Meant to Be: Where to Start

  • 4 Brilliant Ways to Make an Extra $500 a Month

  • Money-Saving Myths You Can Ignore

  • Tony Robbins On How To Trick Yourself Into Growing Your Savings

  • 5 Things Wealthy People Don’t Do

  • Suze Orman Answers All Your Financial Aid Questions

  • Find $1,230 in Your Dining Room

  • Suze Orman: The Best Financial Moves for Your 20s, 30s, 40s, 50s, 60s and Beyond

    How Big a Mortgage Can I Afford?

    When you’re buying a home or refinancing a mortgage—as record number of us are doing these days—one of your most important considerations is what size mortgage you can realistically afford. To figure out that number, just follow the steps below.

    This formula does not account for the tax savings conferred by home ownership. You will want to figure that savings into your calculations before you shop for a home. A tax advisor can help.


  • DFW Bankruptcy Attorney – Vida Law Firm #yes, #you #can #still #file


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    Bedford – Main Office
    3000 Central Drive | Bedford, TX 76021
    Local: 817-358-9977 | Metro: 817-355-0707
    Fax: 817-358-9988

    YES. you can still file a Chapter 7, a Chapter 13 or a Chapter 11 bankruptcy case under the new Bankruptcy Code of 2005.

    Behrooz P. Vida and Carla R. Vida are bankruptcy attorneys for Fort Worth and surrounding areas. All of our energies and resources are devoted to developing winning solutions that can help set you free from the endless cycle of paying your debts, and yet not getting ahead because of high interest and penalty fees. We represent consumers and small businesses in need of financial relief. Bankruptcy can help with credit card debts, repossessions, foreclosures and some tax issues.

    MAIN OFFICE LOCATION
    3000 Central Drive, Bedford, Texas 76021
    Phone: 817-358-9977 Fax: 817-358-9988
    Office Hours: 8:30 a.m. to 5:00 p.m.
    Closed for lunch from 12:00 p.m. to 1:00 p.m.

    We are a debt relief agency.
    We help people file for bankruptcy relief under the Bankruptcy Code of 2005.

    Filing Chapter 7 serves you in two ways. First, as soon as the case is filed, all of your creditors are stopped

    Chapter 11 is a reorganization bankruptcy for corporations and people who don’t qualify for chapter 13.
    Has dollar limitations on

    Chapter 13 is a reorganization type of bankruptcy. The law firm forms a plan to pay certain.

    To learn more about our practice, please visit our multimedia showcase


    Finish Your Bachelor s Degree #can #i #finish #my #degree #online


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    Finish Your Bachelor s Degree

    For alumni who already possess an associates degree, Thomas Edison State University is ready for you to come back to school to finish your bachelor s degree .

    Most associate degree programs at the University fit seamlessly into one of our bachelor degree programs. This means most associate degree graduates will only have to earn an additional 60 credits, depending on your academic evaluation.

    All bachelor s degree programs at Thomas Edison State University are designed around the unique needs of adults, like you.

    In addition to online courses, independent study and credit-by-exam programs, students can earn credit for college-level knowledge acquired outside the classroom, through prior learning assessment and through professional and military training.

    As a Thomas Edison State University graduate, the $75 application fee is waived for you.

    If you are interested in a master s degree, you can take advantage of our Bachelor s to Master s Program. where you can earn 9 credits toward a master s degree while you finish your bachelor s degree.

    Ready to take the next step? Apply today .

    Finishing Your Bachelor’s Degree Contact Form

    Thanks for your interest in finishing your bachelor’s degree at Thomas Edison State University. Our admissions counselors are ready to answer any questions you may have about how your associates degree will apply toward a bachelor’s degree and what the next steps are to earning your degree.

    Leslie Beck, BSN
    I chose the University because it afforded me that wonderful flexibility. The University made it a realistic goal.
    Watch Leslie


    Hospice care can increase life expectancy #help #the #hospices #jobs

    #hospice life expectancy

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    Hospice care can increase life expectancy

    by Emily Nelson
    Apr 18, 2013

    More than 44 percent of Americans with less than six months to live choose hospice care, and 97 percent of those people choose home hospice care, according to a recent study conducted by the National Hospice and Palliative Care Organization.

    Hospice care is designed to focus on comfort and quality of life, rather than a cure, for dying patients. The proportion of dying patients who used hospice care rose from 21.6 percent in 2000 to 42.2 percent in 2009.

    While most of us prefer to avoid the topic, how we choose to spend our final days could quite literally be a matter of life and death. Planning ahead can be crucial to making hospice care available as soon as someone needs it.

    “There are studies to the effect that show if you are in hospice care your life expectancy is longer than if you are not in hospice care,” Chicago hospice nurse Steve Wren said.

    The New England Journal of Medicine published a 2010 study on terminally ill lung cancer patients that showed those receiving palliative care had a better quality of life and lived an average of three months longer than those who did not seek palliative care.

    Palliative care focuses on relieving a patient’s suffering in all disease stages, and it often goes hand in hand with hospice care. It includes a team of medical professionals addressing physical, emotional, spiritual, and social concerns for patients suffering from a serious illness.

    Terminal illness sometimes gives people the freedom to go off medications and remove some of the symptoms and side effects.

    Wren said that, in many cases when patients are taken off medications they are on for conditions such as high cholesterol to osteoporosis, the patient improves. “You have a 90 year old who is taking a mass amount of medications, you go through that list and you say, do we really need to be worrying about osteoporosis with someone who has terminal colon cancer? Probably not.” Wren said.

    Journey Care Hospice in Barrington is a nonprofit hospice care that provides inpatient 24-hour care. Communications Specialist Lisa Encarnacion said the decision for a patient to elect inpatient hospice care is “basically based on the doctor recommendation and around the clock care is required.”

    Hospice is covered by insurance. The national hospice organization reports that the percentage of hospice patients covered by Medicare’s hospice benefit versus other payment sources was 84.1 percent in 2011.

    The Medicare Payment Advisory Commission reported that Medicare spending for hospice has increased from $2.9 billion in 2000 to $13 billion in 2010. Medicare costs associated with home care are significantly lower than inpatient hospice. The Center for Medicare and Medicaid services published 2013 daily hospice payment rates of $153.65 for home care and $682.59 for inpatient care.

    An independent study conducted by Duke University revealed that home hospice saves Medicare over $2,300 per patient on average.

    A 2009 study by the Health Services Research and Development Service reported that the final 30 days of life accounted for 78 percent of a person’s lifetime healthcare costs. Those who had end-of-life discussions, including the decision to seek hospice care, consumed costs 35 percent lower than those who did not.

    The Journal of the American Medical Association published the study that also concluded that 80 percent of those terminally ill would prefer to die at home. However, it is unclear whether home care has an impact on a patient’s longevity over inpatient hospice, according to the study.

    A European study conducted by Rand comparing home hospice to inpatient hospice concluded that prognosis is not affected by place of care. However, Wren disagrees. “In my experience they do tend to live a little bit longer and a little bit more comfortably inpatient,” Wren said.

    Whether or not those in the end stages of life choose to die at home or an inpatient setting, having the discussion can provide peace of mind to family members, Wren said. “I think you are going to see more people making good end of life choices and that they talk about what they want those choices to be,” he added.

    ©2001 – 2014 Medill Reports – Chicago, Northwestern University. A publication of the Medill School .





    Dr John Smith: Cransley Hospice staff can hold their heads up high

    #cransley hospice

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    Dr John Smith: Cransley Hospice staff can hold their heads up high

    Our heads go down and we mutter something like “it was nothing, anyone could have done it”.

    That may be the case, but it generally isn’t, for we have made the choice to care about someone, when others might have walked away.

    So it’s heads up and a big thank you for saying that.

    This week it happened to me. I hadn’t seen the lady for 16 years when she said “hello”. To be honest I could not recognise her and said so. No worries because it was a long time ago when her mum was a patient in the hospice. Sixteen years on and she wanted to thank me for the care that was given.

    She hadn’t forgotten and did not want to forget. What was a difficult time became a good time, and out of that time came even more good because some time later she began to work in the hospice too. It made sense of the tragedy and the memories that she has are good ones. There are no regrets.

    The word hospice literally means a resting place on a journey. In the sense that we use it today the journey is coming to an end.

    To rest we need support and good symptom control, to rest we need to know that our family and friends are being cared for, to rest we need people to listen to us, to hear our fears, to hear us say thank you for the life that we have been given and, yes, to be able to express our regrets for what we have struggled with, for the wrongs we may have done, to seek forgiveness and to be forgiven.

    Hospice is often the place where we begin to make sense of our lives, a sort of summing up of what we have been, what we are and what we mean to others.

    It is when this happens that people express their thanks. And it is not a transitory thank you either, it is almost lifelong. Yes, I can hold my head up high and Cransley Hospice and its staff should too.





    Great Moments Can Be Small Moments – A Hospice Volunteer – s

    #hospice stories

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    We worked everything out as she wanted; her doctor cooperated with us. A living will was drawn up, but at the time, a living will was not recognized in the state. She died at home with no tubes to keep her alive; her doctor or a nurse came in regularly to administer drugs for pain. My sister died with dignity.

    The above is all provided with hospice care. But, my sister died in 1978, and there was no hospice as yet. Elizabeth Kubler Ross was talking about a different way of dying but it was not yet accepted.

    I never forgot the experience of watching a loved one die.

    Thirty years later, after I retired from work, I found I was tired of playing Bunco and cards. I wanted something more in my life. I contacted Casa de la Luz Hospice and became a volunteer. Now, I don’t think I have done anything more important in my life. I had been conditioned to think that my life revolved around the special moments—marriage, raising children, children graduating, more marriages, and then grandchildren. These things are all important and worth remembering. But, by becoming a hospice volunteer, I have learned that great moments can be what may be a small moment. I am thinking of being in the Casa de la Luz Inpatient Unit, sitting vigil. The harpist came in and began to play; I was near the patient. The patient opened her eyes and asked me, “Am I in Heaven now?” I replied, “No. Not yet.” That was a moment, small to others, but big to me that I will not forget.

    It doesn’t take me long to become involved with a patient. It’s important to me to learn about the patient’s past, family, likes, dislikes, and what makes the patient smile. The patient learns that I am there to help, to listen, and to be quiet—whatever the patient needs. We share experiences, have new experiences, and all is confidential. I’m surprised, sometimes, at what I hear.

    Each patient is different and has different needs. For example, if I am told a patient isn’t eating enough, then I arrange my visits around the lunch hour so that I can encourage the patient to eat. You’d be surprised how many patients now eat dessert first and then their lunch. On holidays I try to dress the season—maybe a Halloween shirt, a Santa hat, or red, white and blue for the 4 th of July. Little things mean a lot to a terminally ill individual who is alone and has outlived his/her family and friends.

    I am also a knitter. I love to knit prayer shawls and afghans for our hospice patients. I have a memory afghan that I knitted a couple of years ago. It is made up of 20 individual squares, each knitted with a different pattern and then sewn together. Each of the squares was knitted while I visited my patients. I treasure it.

    I carry a hospice bag with me at all times. In it I have a book to read, crossword puzzles, snacks and water, and of course, my knitting. As a vigil volunteer, I never know how long my visit will be. I like to be available day or night to keep vigil with a dying patient. If I’m going for a companion visit with a patient, I try to keep it to one or two hours. I watch to see how the patient is holding up; is he/she looking tired? I will drive anywhere to see a patient. Distance is not a problem to me.

    I cannot explain the reward I receive by comforting someone who is in need. I just know that the reward is huge, and I think my patients can “feel” my energy.

    Being a hospice volunteer is not for everyone. But, to me and the other volunteers, our rewards are well worth it.

    Often, I am asked, “How can you watch someone die?” My reply is, “I don’t watch a patient die; I believe that I’m there to help them pass on to the next stage of life.”

    By Diane Gilbert, volunteer of two years

    Learn more about the various volunteer opportunities with Casa de la Luz Hospice on the Volunteers page of our website.





    Residential Electrician, Electrician #are #you #in #the #dark, #are #you #in #the


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    Welcome to Our Site


    We are strictly residential electricians. This means we know how to take care of your home in every way. We specialize in accent lighting, ceiling fans. kitchen remodels. bathroom lighting. can lighting, energy efficient lighting. attic fans. house wiring. and much more.

    Our company cleans up like no other contractor you ve seen. We vacuum up any mess with our own vacuum! All our employees are cordial and trustworthy. We are a family company and we consider our customers to be our extended family. Your satisfaction with our service is our utmost priority. Our customers generally come to us through word of mouth and our phone rings constantly. Thank you for recommending us through the years and trusting us with your home.

    We Provide Services to the Following Cities and Towns in CA:

    • Orange County, CA
    • Mission Viejo, CA
    • Irvine, CA
    • Woodbridge, CA
    • Turtle Rock, CA
    • Newport, CA
    • Newport Beach, CA
    • Big Canyon, CA
    • Balboa, CA
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    • Newport Coast, CA
    • Shady Canyon, CA
    • Laguna, CA
    • Laguna Beach, CA
    • Corona Del Mar, CA
    • Huntington Beach, CA
    • Seal Beach, CA
    • Long Beach, CA
    • Sunset Beach, CA
    • Los Alamitos, CA
    • Rossmoor, CA
    • Fountain Valley, CA
    • Costa Mesa, CA
    • Yorba Linda, CA
    • Orange, CA
    • Anaheim, CA
    • Anaheim Hills, CA
    • Tustin, CA
    • Tustin Ranch, CA
    • North Tustin, CA
    • Santa Ana, CA
    • Villa Park, CA
    • Rancho Santa Margarita, CA
    • Lake Forest, CA
    • Irvine Spectrum, CA
    • Foothill Ranch, CA
    • Coto De Caza, CA
    • Coto, CA
    • Dove Canyon, CA
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    • San Juan, CA
    • San Juan Capistrano, CA
    • Laguna Niguel, CA
    • Laguna Hills, CA
    • Trabuco Canyon, CA
    • Dana Point, CA
    • San Clemente, CA
    • Saddleback, CA
    • South Orange County, CA

    Excellant work and very courteous. Thank you!

    The team was very efficient and did a clean, professional job of installing our two ceiling fans. The did a great job of explaining the controls after installation. Great job!

    Outstanding and professional service. will always recommend Armes Electric for any electrical work.

    Jason and Juan did an absolutely flawless job installing can lights. They left no holes in the walls or marks on the ceiling – just two lights exactly where we asked that they be installed. Your workers always do an outstanding job.

    Armes Electric provides you with these services, and More..

    Kitchen/Bath Remodels
    Recessed Can Lighting
    Picture Lighting
    Accent Lighting
    Under cabinet Lighting
    240 Spa Runs
    Convenience/Holiday Outlets
    Troubleshooting

    We look forward to serving all of your electrical needs.

    We are strictly residential electricians. This means we know how to take care of your home in every way. We specialize in accent lighting, ceiling fans, kitchen remodels, can lighting, attic fans, and much more. Our company cleans up like no other contractor you ve seen. We vacuum up any mess with our own vacuum! All our employees are cordial and trustworthy. We are a family company and we consider our customers to be our extended family. Your satisfaction with our service is our utmost priority. Our customers generally come to us through word of mouth and our phone rings constantly.


    7 Ways to Get Healthcare Administration Experience #what #can #i #do #with


    #

    7 Ways to Get Healthcare Administration Experience

    Earn your MHA online from the George Washington University. Experienced health care professionals looking to advance into executive roles can now earn their MHA online from the world-renowned Milken Institute School of Public Health at the George Washington University. Study with top faculty, gain invaluable skills and network with health leaders. Learn more.

    The online Master of Public Health (MPH) program from the Milken Institute School of Public Health at the George Washington University helps students succeed in advancing the health of population locally and globally. Request Information.

    Any healthcare student knows that experience is hard to get, but it is necessary in developing a successful career. During the course of his education, a budding healthcare professional will take on internships and work at as many jobs as possible just to get the experience he needs to move ahead in his career. It is more than just having something to put on his resume. It is also the need to learn the business with practical, hands-on experience that can allow him to expand his skill set.

    When you make the decision to take on a career in the healthcare industry, the next step is to lay the educational foundation and gain the experience you will need to succeed. But the big question is how do you get that experience at the earliest points in your career? You need to be prepared to work for free and you also need to be creative. As you pursue your dream of a job in the field of healthcare administration, you need to find ways to get healthcare experience that can be valuable later on in your career.

    #1 Become Familiar With Your Chosen Healthcare Discipline

    When you say that you want to get into the field of healthcare administration, you still have a significant amount of narrowing down to do. There are many different ways you can go and many different kinds of curriculums you can choose to study in your pursuit of a healthcare career. The best place to start is to research the top healthcare schools online and study their curriculums to see what kind of education appeals to you. Some of the best educational facilities to look into include:

    • University of North Carolina School of Public Health
    • Tufts University
    • Harvard School of Public Health
    • Johns Hopkins Bloomberg School of Public Health

    All of these universities have comprehensive curriculums that you can investigate online and used to make your decision. You will also find that many of these schools offer 101 level classes in healthcare free online. Take a couple of these courses to see if the coursework is for you.

    #2 See What Kinds Of Jobs Are Available

    The fields of healthcare administration and healthcare management are full of a variety of positions. A sampling of the types of organizations that hire healthcare administrators includes:

    • Health Networks
    • Long-Term Care Facilities
    • Public Health Advocate Groups
    • Hospitals
    • Research Facilities

    An Internet search of the various online job hunting websites will give you a good idea as to what kinds of jobs are available and what kind of experience that you need. The more comprehensive online employment websites will outline the exact kind of educational background and experience you will need to be considered for certain positions. You can use that information as your guide to developing your career.

    #3 Get As Many Internships As You Can

    When you are studying in the healthcare field, you will qualify for a variety of internships that will become invaluable to developing your career. Some of the more prominent national internships are offered by organizations such as:

    • U.S. Department of Health and Human Services
    • Mayo Clinic
    • World Health Organization
    • Children’s Hospital Network

    If you cannot get an internship, the contact your local healthcare organization and offer to work for free during the summer or any time you have off from classes. The more time that you spend gaining exposure to actual job activities within your profession, the better it looks on your resume. As was mentioned, you will have to put in a lot of time working for free when you are establishing your career. But the end result will be a series of valuable pieces of work experience that you can add to your resume.

    #4 Investigate Free Online Courses And Seminars

    There is a long list of free online healthcare courses and seminars available that will help you to gain a detailed understanding of what the healthcare industry is and what will be expected of you. The major universities offer many online free courses as well as the websites that specialize in online training. You will also find that there are plenty of online free course and seminar offerings from groups such as the World Health Organization and the American Medical Association.

    In most cases, these online courses and seminars will consist of class notes, slides and recorded lectures. Many of these courses also offer self-assessment tests that you can use to gauge your understanding after reviewing the material. These free courses and seminars are great ways to get a better understanding of the healthcare industry and get a head start on your education.

    #5 Ask For Experience

    Some of the largest healthcare organizations in the world are non-profit organizations who are always looking for ways to groom the next generation of healthcare professionals. You can contact these organizations and ask them if they offer any way of gaining experience in the healthcare industry. Some may suggest that you visit a local office and talk to some of the professionals who work there, while others may point you towards their website and suggest that you look at their news section or other parts of the website.

    The most prominent international health organizations to contact include:

    • The World Health Organization
    • American Red Cross
    • PATH
    • Doctors Without Borders
    • Peace Corps
    • U.S. Department of Health and Human Services

    #6 Try As Many Fields As You Can

    As was mentioned, the healthcare industry is filled with a variety of organizations. When you start choosing the places that you would like to volunteer for or take an internship with, try to investigate as many options as you can. For example, you may find that you are not as attracted to the idea of getting involved in international health policy as you are with helping doctors to cure diseases. That means that you would be more interested in an internship with a place like the Mayo Clinic, which does a significant amount of medical research, as opposed to an organization such as PATH, which gets involved in global health policies.

    Getting involved in an advocate group is much different than getting involved with a heath network. The best way to discover the field that appeals to you is to try and discuss options with as many different kinds of organizations as possible and then choose your calling carefully.

    #7 Build Your Way Up

    If your goal is to become a registered nurse, then you should first try to gain a nursing assistant’s certificate before trying for the RN designation. The same goes for people who want to get into a healthcare administration or management position. There are stepping stones you can take which will help you to achieve your goals and build on your experience. Rather than trying to make the leap from the beginner level to a level of relatively significant experience, you should take the time to work your way up through the ranks first.

    The benefit to working your way up is that you will significantly improve your educational and experience foundation. You will also have a lot more to put on your resume and that can help you as you reach for your true healthcare career goals.


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    Death and denial on the cancer ward: Refusing to accept reality can

    #care of terminally ill patient

    #

    Death and denial on the cancer ward: Refusing to accept reality can be shattering to family, study finds

    Tom Blackwell
    Friday, Sept. 14, 2012

    Naomi Kogan, a social worker at Montreal’s Jewish General Hospital, speaks with a patient undergoing chemotherapy at the hospital. Terminally ill patients who refuse to acknowledge their prognosis can cause their loved ones anxiety, depression and even rage, Kogan and two co-authors found in a newly published study. Christinne Muschi for National Post

    The single parent had been in hospital for months, suffering from terminal cancer but refusing to accept that death was near.

    Even the person’s two young children were unaware of the dire prognosis, recalls Naomi Kogan, a social worker at Montreal’s Jewish General Hospital who cared for the patient. Finally, last month, a teenage daughter arrived at the hospital to learn that her only parent would not be coming home — minutes before the person died.

    “The impact has been devastating, to have only an hour to say goodbye,” said the social worker. “The child is having major difficulties.”

    Related

    Yet such entrenched denial of terminal disease is a surprisingly common occurrence on the cancer ward, said Ms. Kogan, and a new study she and colleagues have just published suggests it can have a shattering impact on the family members who care for those patients.

    Relatives struggling to play along with the alternate reality sometimes have to turn a blind eye as the patient pretends to ignore dangerous symptoms, and are unable to share their own emotional turmoil over the illness, the researchers found. Sometimes, children are left completely in the dark.

    Ms. Kogan suggests that health-care workers dealing with those people face similar angst.

    It’s been such a difficult element in my work for all these years, so challenging and causing so much frustration

    “These [patients in denial] are people who until the end are carrying this protective mechanism like a tortoise shell,” she said in an interview. “It’s been such a difficult element in my work for all these years, so challenging and causing so much frustration.”

    The patients at the heart of her study, co-authored by Robin Cohen, a McGill University oncology professor, and Michelle Dumas, an Ottawa General Hospital nurse, acknowledge that they have cancer, but tend to minimize the seriousness of the condition that appears destined to kill them.

    Despite what would seem like unequivocal evidence to the contrary, one woman in the study remained convinced she would recover, and married her common-law partner — inside the palliative-care ward.

    Christinne Muschi for National Post Entrenched denial of terminal disease is a surprisingly common occurrence on the cancer ward, says social worker Naomi Kogan, seen talking with a chemotherapy patient at Montreal s Jewish General Hospital.

    When Ms. Kogan started her career 24 years ago, the psychiatry department would be summoned in an effort to help such patients face reality, but health-care workers no longer try to disavow them of their beliefs, now considered a coping mechanism that is useful to the patient, at least.

    A Montreal woman, who asked not to be named, said she and her family have been dealing with such a situation for several weeks. A close relative has stage-four cancer and likely has less than a year to live, yet until recently has cheerfully avoided the grim truth of her prognosis. She even talked from her hospital bed about running a half-marathon next year.

    She would act as though everything was just fine. It was impossible to even acknowledge she was sick. It was very frustrating and isolating

    “She would act as though everything was just fine,” said the relative. “It was impossible to even acknowledge she was sick. It was very frustrating and isolating.”

    For the study published in the journal Palliative and Supportive Care. Ms. Kogan’s team identified dying patients at the Segal Cancer Centre who were in denial, and arranged interviews with family caregivers of 16 of them.

    All said they felt it necessary to maintain their loved ones’ sense of denial, but that keeping up the pretence of normalcy took a toll in terms of anxiety, depression and even “feeling enraged.” Some said they were forbidden to dig up more information about the disease or ask probing questions of medical staff, or felt they could not make arrangements for funerals or future finances.

    More than half the patients went so far as to not get the care they needed, masking symptoms that might have prevented them from receiving more of the chemotherapy they considered life-saving, or that would drive home the dire state of their health, the study said.

    One patient refused to disclose such problems as severe diarrhea that should have prevented him from getting chemotherapy, went ahead with the treatment and almost died, prematurely, as a result. Another actually hid weights in his clothes so he would reach the minimum requirement to continue chemo, as patients who are too emaciated are not eligible, said Ms. Kogan.

    He’s been crying for the past three days. He’s got pain in the neck, pain in the back, and he doesn’t want me to talk about it

    Others would not acknowledge escalating pain, or refused to step up their medication levels in response. “He’s been crying for the past three days. He’s got pain in the neck, pain in the back, and he doesn’t want me to talk about it,” one caregiver told the researchers.

    Ms. Kogan said there is not a lot that health-care and social workers can do in the face of such denial, though sometimes they can counsel the family members about their own anguish over the situation, and try to help make practical arrangements.

    She said she was able to convince the single-parent patient, after much prodding, to prepare a will, without actually saying the person was dying. The will was a crucial tool for the family as the children started a new life with relatives.

    Elizabeth Beddard-Huber, an advance-practice nurse specializing in pain management at the B.C. Cancer Agency, said she also encounters patients in denial, an experience that can be stressful and “hard to watch,” especially when young children are involved. In one case, two teenagers were so troubled by their inability to talk frankly to their fatally ill mother, they began acting out at school, she said.

    Like the Montreal researchers, Ms. Beddard-Huber noted that such patients will hang on desperately to the hope of chemotherapy, decline pain medication and other palliative care, and occasionally look elsewhere when conventional medical treatment reaches a dead end.

    “Sometimes it gets to a point where they have to spend quite a bit of money to seek extra treatment and go to Mexico or to China or to the States for special treatment,” said Ms. Beddard-Huber. “They’re looking for that miracle.”





    Hospice care can increase life expectancy #portarlington #beach #motel

    #hospice life expectancy

    #

    Hospice care can increase life expectancy

    by Emily Nelson
    Apr 18, 2013

    More than 44 percent of Americans with less than six months to live choose hospice care, and 97 percent of those people choose home hospice care, according to a recent study conducted by the National Hospice and Palliative Care Organization.

    Hospice care is designed to focus on comfort and quality of life, rather than a cure, for dying patients. The proportion of dying patients who used hospice care rose from 21.6 percent in 2000 to 42.2 percent in 2009.

    While most of us prefer to avoid the topic, how we choose to spend our final days could quite literally be a matter of life and death. Planning ahead can be crucial to making hospice care available as soon as someone needs it.

    “There are studies to the effect that show if you are in hospice care your life expectancy is longer than if you are not in hospice care,” Chicago hospice nurse Steve Wren said.

    The New England Journal of Medicine published a 2010 study on terminally ill lung cancer patients that showed those receiving palliative care had a better quality of life and lived an average of three months longer than those who did not seek palliative care.

    Palliative care focuses on relieving a patient’s suffering in all disease stages, and it often goes hand in hand with hospice care. It includes a team of medical professionals addressing physical, emotional, spiritual, and social concerns for patients suffering from a serious illness.

    Terminal illness sometimes gives people the freedom to go off medications and remove some of the symptoms and side effects.

    Wren said that, in many cases when patients are taken off medications they are on for conditions such as high cholesterol to osteoporosis, the patient improves. “You have a 90 year old who is taking a mass amount of medications, you go through that list and you say, do we really need to be worrying about osteoporosis with someone who has terminal colon cancer? Probably not.” Wren said.

    Journey Care Hospice in Barrington is a nonprofit hospice care that provides inpatient 24-hour care. Communications Specialist Lisa Encarnacion said the decision for a patient to elect inpatient hospice care is “basically based on the doctor recommendation and around the clock care is required.”

    Hospice is covered by insurance. The national hospice organization reports that the percentage of hospice patients covered by Medicare’s hospice benefit versus other payment sources was 84.1 percent in 2011.

    The Medicare Payment Advisory Commission reported that Medicare spending for hospice has increased from $2.9 billion in 2000 to $13 billion in 2010. Medicare costs associated with home care are significantly lower than inpatient hospice. The Center for Medicare and Medicaid services published 2013 daily hospice payment rates of $153.65 for home care and $682.59 for inpatient care.

    An independent study conducted by Duke University revealed that home hospice saves Medicare over $2,300 per patient on average.

    A 2009 study by the Health Services Research and Development Service reported that the final 30 days of life accounted for 78 percent of a person’s lifetime healthcare costs. Those who had end-of-life discussions, including the decision to seek hospice care, consumed costs 35 percent lower than those who did not.

    The Journal of the American Medical Association published the study that also concluded that 80 percent of those terminally ill would prefer to die at home. However, it is unclear whether home care has an impact on a patient’s longevity over inpatient hospice, according to the study.

    A European study conducted by Rand comparing home hospice to inpatient hospice concluded that prognosis is not affected by place of care. However, Wren disagrees. “In my experience they do tend to live a little bit longer and a little bit more comfortably inpatient,” Wren said.

    Whether or not those in the end stages of life choose to die at home or an inpatient setting, having the discussion can provide peace of mind to family members, Wren said. “I think you are going to see more people making good end of life choices and that they talk about what they want those choices to be,” he added.

    ©2001 – 2014 Medill Reports – Chicago, Northwestern University. A publication of the Medill School .





    Marriott Travel Deals: Now You Can Afford To Follow Your Heart #cheap

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    Best Available Rate Guarantee assures you receive the best rates when you book directly with us. If you find a lower publicly available rate within 24 hours of booking, we will match that rate plus give you 25% off the lower rate, subject to guarantee terms and exclusions. Guarantee does not apply to Delta Hotels, Protea Hotels®, Ritz-Carlton Montreal, The Ritz London, and Ritz-Carlton Residences®. Marriott Rewards® and The Ritz-Carlton Rewards® members (“Rewards Members”) who book rooms through a Marriott® Direct Booking Channel, authorized travel agents or select corporate travel partners (“Eligible Channels”) at hotels that participate in Marriott Rewards® and The Ritz-Carlton Rewards loyalty programs will receive an exclusive, preferred rate (“Marriott Rewards Member Rate”). Member Rates are available globally at all hotels that participate in Marriott Rewards, excluding hotels in Mainland China, Macau, Hong Kong and Taiwan. Exclusions apply. See our Terms Conditions for additional details related to our Best Available Rate Guarantee and Marriott Rewards Member Rate. Hotels shown on Marriott.com may be operated under a license from Marriott International, Inc. or one of its affiliates

    © 1996 – 2016 Marriott International, Inc. All rights reserved. Marriott proprietary information





    Death and denial on the cancer ward: Refusing to accept reality can

    #care of terminally ill patient

    #

    Death and denial on the cancer ward: Refusing to accept reality can be shattering to family, study finds

    Tom Blackwell
    Friday, Sept. 14, 2012

    Naomi Kogan, a social worker at Montreal’s Jewish General Hospital, speaks with a patient undergoing chemotherapy at the hospital. Terminally ill patients who refuse to acknowledge their prognosis can cause their loved ones anxiety, depression and even rage, Kogan and two co-authors found in a newly published study. Christinne Muschi for National Post

    The single parent had been in hospital for months, suffering from terminal cancer but refusing to accept that death was near.

    Even the person’s two young children were unaware of the dire prognosis, recalls Naomi Kogan, a social worker at Montreal’s Jewish General Hospital who cared for the patient. Finally, last month, a teenage daughter arrived at the hospital to learn that her only parent would not be coming home — minutes before the person died.

    “The impact has been devastating, to have only an hour to say goodbye,” said the social worker. “The child is having major difficulties.”

    Related

    Yet such entrenched denial of terminal disease is a surprisingly common occurrence on the cancer ward, said Ms. Kogan, and a new study she and colleagues have just published suggests it can have a shattering impact on the family members who care for those patients.

    Relatives struggling to play along with the alternate reality sometimes have to turn a blind eye as the patient pretends to ignore dangerous symptoms, and are unable to share their own emotional turmoil over the illness, the researchers found. Sometimes, children are left completely in the dark.

    Ms. Kogan suggests that health-care workers dealing with those people face similar angst.

    It’s been such a difficult element in my work for all these years, so challenging and causing so much frustration

    “These [patients in denial] are people who until the end are carrying this protective mechanism like a tortoise shell,” she said in an interview. “It’s been such a difficult element in my work for all these years, so challenging and causing so much frustration.”

    The patients at the heart of her study, co-authored by Robin Cohen, a McGill University oncology professor, and Michelle Dumas, an Ottawa General Hospital nurse, acknowledge that they have cancer, but tend to minimize the seriousness of the condition that appears destined to kill them.

    Despite what would seem like unequivocal evidence to the contrary, one woman in the study remained convinced she would recover, and married her common-law partner — inside the palliative-care ward.

    Christinne Muschi for National Post Entrenched denial of terminal disease is a surprisingly common occurrence on the cancer ward, says social worker Naomi Kogan, seen talking with a chemotherapy patient at Montreal s Jewish General Hospital.

    When Ms. Kogan started her career 24 years ago, the psychiatry department would be summoned in an effort to help such patients face reality, but health-care workers no longer try to disavow them of their beliefs, now considered a coping mechanism that is useful to the patient, at least.

    A Montreal woman, who asked not to be named, said she and her family have been dealing with such a situation for several weeks. A close relative has stage-four cancer and likely has less than a year to live, yet until recently has cheerfully avoided the grim truth of her prognosis. She even talked from her hospital bed about running a half-marathon next year.

    She would act as though everything was just fine. It was impossible to even acknowledge she was sick. It was very frustrating and isolating

    “She would act as though everything was just fine,” said the relative. “It was impossible to even acknowledge she was sick. It was very frustrating and isolating.”

    For the study published in the journal Palliative and Supportive Care. Ms. Kogan’s team identified dying patients at the Segal Cancer Centre who were in denial, and arranged interviews with family caregivers of 16 of them.

    All said they felt it necessary to maintain their loved ones’ sense of denial, but that keeping up the pretence of normalcy took a toll in terms of anxiety, depression and even “feeling enraged.” Some said they were forbidden to dig up more information about the disease or ask probing questions of medical staff, or felt they could not make arrangements for funerals or future finances.

    More than half the patients went so far as to not get the care they needed, masking symptoms that might have prevented them from receiving more of the chemotherapy they considered life-saving, or that would drive home the dire state of their health, the study said.

    One patient refused to disclose such problems as severe diarrhea that should have prevented him from getting chemotherapy, went ahead with the treatment and almost died, prematurely, as a result. Another actually hid weights in his clothes so he would reach the minimum requirement to continue chemo, as patients who are too emaciated are not eligible, said Ms. Kogan.

    He’s been crying for the past three days. He’s got pain in the neck, pain in the back, and he doesn’t want me to talk about it

    Others would not acknowledge escalating pain, or refused to step up their medication levels in response. “He’s been crying for the past three days. He’s got pain in the neck, pain in the back, and he doesn’t want me to talk about it,” one caregiver told the researchers.

    Ms. Kogan said there is not a lot that health-care and social workers can do in the face of such denial, though sometimes they can counsel the family members about their own anguish over the situation, and try to help make practical arrangements.

    She said she was able to convince the single-parent patient, after much prodding, to prepare a will, without actually saying the person was dying. The will was a crucial tool for the family as the children started a new life with relatives.

    Elizabeth Beddard-Huber, an advance-practice nurse specializing in pain management at the B.C. Cancer Agency, said she also encounters patients in denial, an experience that can be stressful and “hard to watch,” especially when young children are involved. In one case, two teenagers were so troubled by their inability to talk frankly to their fatally ill mother, they began acting out at school, she said.

    Like the Montreal researchers, Ms. Beddard-Huber noted that such patients will hang on desperately to the hope of chemotherapy, decline pain medication and other palliative care, and occasionally look elsewhere when conventional medical treatment reaches a dead end.

    “Sometimes it gets to a point where they have to spend quite a bit of money to seek extra treatment and go to Mexico or to China or to the States for special treatment,” said Ms. Beddard-Huber. “They’re looking for that miracle.”





    Hospice care can increase life expectancy #legian #beach #hotel

    #hospice life expectancy

    #

    Hospice care can increase life expectancy

    by Emily Nelson
    Apr 18, 2013

    More than 44 percent of Americans with less than six months to live choose hospice care, and 97 percent of those people choose home hospice care, according to a recent study conducted by the National Hospice and Palliative Care Organization.

    Hospice care is designed to focus on comfort and quality of life, rather than a cure, for dying patients. The proportion of dying patients who used hospice care rose from 21.6 percent in 2000 to 42.2 percent in 2009.

    While most of us prefer to avoid the topic, how we choose to spend our final days could quite literally be a matter of life and death. Planning ahead can be crucial to making hospice care available as soon as someone needs it.

    “There are studies to the effect that show if you are in hospice care your life expectancy is longer than if you are not in hospice care,” Chicago hospice nurse Steve Wren said.

    The New England Journal of Medicine published a 2010 study on terminally ill lung cancer patients that showed those receiving palliative care had a better quality of life and lived an average of three months longer than those who did not seek palliative care.

    Palliative care focuses on relieving a patient’s suffering in all disease stages, and it often goes hand in hand with hospice care. It includes a team of medical professionals addressing physical, emotional, spiritual, and social concerns for patients suffering from a serious illness.

    Terminal illness sometimes gives people the freedom to go off medications and remove some of the symptoms and side effects.

    Wren said that, in many cases when patients are taken off medications they are on for conditions such as high cholesterol to osteoporosis, the patient improves. “You have a 90 year old who is taking a mass amount of medications, you go through that list and you say, do we really need to be worrying about osteoporosis with someone who has terminal colon cancer? Probably not.” Wren said.

    Journey Care Hospice in Barrington is a nonprofit hospice care that provides inpatient 24-hour care. Communications Specialist Lisa Encarnacion said the decision for a patient to elect inpatient hospice care is “basically based on the doctor recommendation and around the clock care is required.”

    Hospice is covered by insurance. The national hospice organization reports that the percentage of hospice patients covered by Medicare’s hospice benefit versus other payment sources was 84.1 percent in 2011.

    The Medicare Payment Advisory Commission reported that Medicare spending for hospice has increased from $2.9 billion in 2000 to $13 billion in 2010. Medicare costs associated with home care are significantly lower than inpatient hospice. The Center for Medicare and Medicaid services published 2013 daily hospice payment rates of $153.65 for home care and $682.59 for inpatient care.

    An independent study conducted by Duke University revealed that home hospice saves Medicare over $2,300 per patient on average.

    A 2009 study by the Health Services Research and Development Service reported that the final 30 days of life accounted for 78 percent of a person’s lifetime healthcare costs. Those who had end-of-life discussions, including the decision to seek hospice care, consumed costs 35 percent lower than those who did not.

    The Journal of the American Medical Association published the study that also concluded that 80 percent of those terminally ill would prefer to die at home. However, it is unclear whether home care has an impact on a patient’s longevity over inpatient hospice, according to the study.

    A European study conducted by Rand comparing home hospice to inpatient hospice concluded that prognosis is not affected by place of care. However, Wren disagrees. “In my experience they do tend to live a little bit longer and a little bit more comfortably inpatient,” Wren said.

    Whether or not those in the end stages of life choose to die at home or an inpatient setting, having the discussion can provide peace of mind to family members, Wren said. “I think you are going to see more people making good end of life choices and that they talk about what they want those choices to be,” he added.

    ©2001 – 2014 Medill Reports – Chicago, Northwestern University. A publication of the Medill School .