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End-of-life care for cancer patients varies widely at Boston-area hospitals – The

#beth israel hospice


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Study says many patients enter hospice care too late

By Deborah Kotz Globe Staff September 05, 2013

Slightly more patients with terminal cancer are getting hospice care during the end of their lives, but they are still entering hospice care too late within days of death finds a new national analysis of Medicare patients conducted by Dartmouth researchers. And many are still dying in hospitals, often hooked to ventilators in an intensive care unit, despite studies showing that most cancer patients prefer to die at home.

The percentage of end-stage cancer patients who died in the hospital decreased from 29 percent on average to 25 percent from 2003 to 2010, but there are huge variations among hospitals: In Massachusetts in 2010, about 13 percent of terminally ill cancer patients treated at North Shore Medical Center in Salem died there compared with 41 percent of those treated at MetroWest Medical Center in Framingham, according to the analysis released Wednesday from the Dartmouth Atlas Project .

The project researchers receive funding from nonprofit groups to determine how medical resources are distributed and used in the United States. In the analysis, they also found that the percentage of cancer patients receiving hospice care rose nationwide from an average of 55 percent to 61 percent.

These trends can be called encouraging, but most of the hospice care received was within the last three days of life, said Dr. David Goodman, lead author of the report. What s more, the average number of days patients spent in the intensive care unit during the last month of life increased by 21 percent, which Goodman said could be driven by hospitals looking for more generous insurance payments for expensive services.

Massachusetts hospitals also had large differences in their utilization of ICU services during a patient s last month of life: A patient treated at Cape Cod Hospital spent two to three hours on average in the ICU compared with two to three days for someone treated at Lahey Clinic.

Graphic: Hospital outcomes for terminal cancer patients

There is no evidence anywhere that these variations are due to patients at these different hospitals having different preferences for their end-of-life care, said Dr. Lachlan Forrow, director of the ethics and palliative care programs at Beth Israel Deaconess Medical Center.

Even among teaching hospitals differences existed in the approach to caring for terminally ill patients, with fewer than 20 percent of patients dying in hospitals such as Maine Medical Center and Dartmouth-Hitchcock, while more than 30 percent died in Boston Medical Center and Beth Israel Deaconess.

I d like to think we do better than most places, Forrow said of Beth Israel Deaconess, but we don t do remotely as well as we should.

His institution is beginning a program to ask all patients about their end-of-life preferences and to insert that information into their electronic health record so it s easily accessible to any physician treating them.

Dr. Susan Block, chairwoman of psychosocial oncology and palliative care at Dana-Farber Cancer Institute, said it s vital for doctors to have such conversations with patients preferably when initially diagnosed with a terminal illness.

Patient goals should be the biggest determiner of care and these goals should be set early enough in the illness process that patients can have the kind of ending that they want, she said.

Far too often, doctors do not bring up the delicate issue of dying until patients are entering their last week or two of life, Block added, sometimes after they ve been hospitalized repeatedly or given aggressive chemotherapy for incurable cancers.

Dana-Farber had 29 percent of its terminal patients dying in the hospital in 2010, which was above the national average.

Nearly 60 percent of its patients were admitted to the hospital during the last month of life, and 24 percent wound up in the ICU.

About 56 percent of terminal patients at Dana-Farber were enrolled in hospice care, spending an average of nine days there.

To improve those statistics, the cancer center has been testing a communication checklist that oncologists can use to have end-of-life care conversations with patients.

We re trying to measure whether these checklists will have an impact on providing patients with the kind of care they want at the end of their lives, Block said.

Much of the success will probably depend on doctors having more truthful conversations about just how effective or ineffective aggressive treatments are for metastatic cancer.

In a study published last year in the New England Journal of Medicine. Dana-Farber researchers found that 70 percent of patients with end-stage lung cancer in a national sample and 80 percent of those with terminal colorectal cancer did not report understanding that the chemotherapy they were receiving was unlikely to be curative.

We re not doing as good a job as we should be in helping patients make informed choices, Forrow said.

Caring for Terminally ill Patients – The New Indian Express #last #minute

#care of terminally ill patient


Caring for Terminally ill Patients

BENGALURU: When a person is diagnosed with a terminal illness, family members, friends and caregivers should be willing to listen to their concerns, say doctors.

Dr L Srinivasamurthy, medical director, Nightingales Home Care Service, says that in order to take care of patients with cancer and other life-threatening conditions such as liver and kidney failure, AIDS, old age senility and other mental illnesses during their terminally ill condition, a broad, multidisciplinary approach should be followed. In order to give effective palliative care family members should be supportive and make use of available community resources. This care can be successfully implemented even if resources are limited. Palliative care can be provided in tertiary care facilities, in community health centres and even in people’s homes and for this, family members should listen or understand the needs of patients.

Palliative care improves the quality of life of terminally ill patients and their families by providing pain and symptomatic relief as well. It also provides spiritual and psychosocial support from the time of diagnosis to the end of patient’s life, he says.

What to expect from palliative care?

  • Provides relief from pain and other distressing symptoms;
  • Affirms life and regards death as a normal process.
  • Intends neither to hasten nor postpone death.
  • Integrates the psychological and spiritual aspects of patient care.
  • Offers a support system to help patients live as actively as possible until their death.
  • Offers a support system to help the family members cope during the patient’s illness and in their own bereavement.
  • Uses a team approach to address the needs of patients and their families.

In most parts of the world, a majority of cancer patients are in advanced stages of cancer when they first seek medical help. For such patients, the only realistic treatment option is pain relief and palliative care. Effective approaches to palliative care are available to improve the quality of life for cancer patients. The WHO 3-step ladder for cancer pain is a relatively inexpensive yet effective method for relieving cancer pain in about 90 percent of the patients, says Dr Srinivasmurthy.

In the final stages of life-limiting illness, even the best possible care cannot extend life beyond a point, and hence the focus shifts to making the patient as comfortable as possible.

Depending on the nature of the illness and the patient’s circumstances, this final stage period may last from a matter of weeks or months to several years. During this time, palliative care measures can provide the patient with medication and treatments to control pain and other symptoms, such as constipation, nausea, or shortness of breath, says Dr Shoba Naidu, critical care consultant, Sagar Hospital

When to initiate palliative care on your loved ones:

  • The patient wishes to remain at home, rather than spend time in the hospital.
  • He/she stops receiving treatment for the disease.
  • The patient has made multiple trips to the emergency room, the condition has been stabilized, but the illness continues to progress significantly, affecting their quality of life.
  • If a patient has been admitted to the hospital several times within the last year with the same or worsening symptoms.

When caregivers, family members and loved ones are clear about the patient’s preferences for treatment in the final stages of their life, they’re free to devote their energy to care and compassion. To ensure that everyone in the family understands the patient’s wishes, it’s important for anyone diagnosed with a life-limiting illness to discuss their feelings with their near and dear ones before a medical crisis strikes, says Dr Shoba Naidu.

Experts also suggest that it is important to seek financial and legal advice while the terminally ill patient can still participate. Legal documents such as a living will, power of attorney, or advance directives can set forth a patient’s wishes for future healthcare so that the family members are all clear about his or her preferences.

Holistic Nursing Care Plan For Terminally Ill Patient – Essay – 1497

#care of terminally ill patient


Holistic Nursing Care Plan for Terminally Ill Patient

  • Length: 5 pages
  • Sources: 5
  • Subject: Healthcare
  • Type: Essay
  • Paper: # 65372827

Note. Sample below may appear distorted but all corresponding word document files contain proper formatting

Excerpt from Document:

Holistic Nursing Care Plan for Terminally Ill Patient

The objective of this study is to create a holistic nursing care plan for a terminally ill patient. This study will explain how perceptions about quality of life and health promotion might affect care for a dying patient with a lingering illness such as cancer and discuss strategies that could be used in the situation to improve the quality of life for the patient and her husband during this illness.

It is important that the nursing care plan for the terminally ill includes the reassurance that the patient will not be abandoned and that the nurse assist the patient in discussing their care wishes and goals. To assist patients such as the patient in this scenario it is important to understand the concepts and elements of end-of-life care and that the nurse be a skilled practitioner of the nursing arts. The end-of-life care if “patient goal-centered and should be provided for those who have a limited life expectancy.” (Norlander, nd, p.3) The National Hospice and Palliative Care Organization states that Hospice:

” affirms the concept of palliative care as an intensive program that enhances comfort and promotes the quality of life for individuals and their families. When cure is no longer possible, hospice recognizes that a peaceful and comfortable death is an essential goal of health care. Hospice believes that death is an integral part of the life cycle and that intensive palliative care focuses on pain relief, comfort, and enhanced quality of life as appropriate goals for the terminally ill. Hospice also recognizes the potential for growth that often exists within the dying experience for the individual and his/her family and seeks to protect and nurture this potential.” (Norlander, nd, p. 4)

The holistic nursing practice is defined as “all nursing practice that has healing the whole person as its goal.” (Mariano, 2007, p.64) Holistic nursing care is a caring and healing relationship and values the cultural values and beliefs as well as the individuals’ spirituality in the nursing care. Holistic nursing care involves care of the individual’s physical, mental, emotional, and spiritual being with a focus on the individual’s comfort and relief from pain.

Because the patient is terminally ill and is in a great deal of pain one of the first considerations for this patient is relieving her pain so that she is able to function without a great deal of pain. Relieving the patient’s level of depression is also of great importance so that she does not spend the end of her life crying in bed as she is doing presently. The nurse should meet with the family members who are reluctant to visit and explain to them that they have a great role to play in the end-of-life care of this patient. The family members should be brought to the understanding that their role is critical.

Patient Emotional Health

Upon relieving the patient of the pain and depression through use of medication, the hospice-care nursing staff will be of great comfort to the patient through simply talking with the patient about her life and about her wishes for her end-of-life care. The patient should be highly active in determining any life support or alternatively lack of life support that she desires to receive. The patient should be assisted in thinking about her wishes for her funeral, the songs and music that will be used at the funeral and what she chooses to wear at the funeral.

Patient Spiritual Health

The patient’s spiritual affairs should be addressed as well so that the patient is both emotionally and spiritually prepared to deal with the ending of her life due to the progression of the cancer.

Patient Physical Care

Hospice Care is utilized by many patients who are terminally ill. Hospice Care involves nursing staff coming into the patient’s home and assisting them with bathing, dressing, their medication, monitoring the patient’s condition, counseling family members about what they can do to make the patient’s path of dying easier and more comfortable. The hospice philosophy is stated to be a holistic philosophy, is interdisciplinary in nature, and includes physicians, nurses, social workers, clergy, volunteers, and staff assisting with grief of the family. It is reported that hospice care is ” synonymous with supportive care. Pain management and symptom control is state-of-the-art pain. Volunteers are available for respite care and companionship.

Factors Addressed By Hospice

The hospice team assists with the decisions and challenges that the patient and [continue]

Some Sources Used in Document:

Center for hospice care #half #price #hotels

#center for hospice care


Compassion. Integrity. Excellence.

Compassus is dedicated to clinical excellence, compassionate care, and providing comfort and support to patients and their families facing end-of-life issues. Focusing on the quality of life remaining, Compassus provides effective symptom control and care that focuses on the whole individual – addressing physical, psychological, social and spiritual needs.

At Compassus, our mission is to provide hospice care to terminally ill patients and their families with Compassion, Integrity, and Excellence. The Colleagues of Compassus are committed to keeping The Hospice Promise by delivering the highest quality of care, serving the needs of patients and families and spreading the stories of hospice to those whom they come into contact. Our goal is to provide the greatest possible comfort and care for those who experience one of life’s most intimate and challenging moments.

Compassus also provides palliative care to improve quality of life for patients and families who may also be seeking aggressive treatment for their serious illness. Compassus palliative care services can offer relief from symptoms and pain and a care plan based on your values and needs.


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  • Canada OKs Doctor-Assisted Suicide, for Terminally Ill Only #mountain #valley #hospice

    #what is terminally ill


    Canada OKs Doctor-Assisted Suicide, for Terminally Ill Only

    Canada’s Senate on Friday passed a bill that would allow terminally ill people to end their lives with assistance from a doctor.

    The bill passed easily, 44-28, ending a political deadlock between the upper and lower houses. It will become law after royal assent by the governor general, a step that is largely a formality.

    The limitation of doctor-assisted suicide to those who are terminally ill had been a point of contention in lawmakers’ debates. Some senators wanted to broaden the criteria under which people could seek a doctor’s help to die, but the House, led by Prime Minister Justin Trudeau, argued for strict limits.

    The legislation also would allow medically assisted suicide only for those who qualify for government-funded health services in Canada — a measure to prevent people from traveling to Canada to die.

    Canada’s Supreme Court struck down an old prohibition against doctor-assisted suicide in 2015 and gave the government one year to draft legislation regulating the practice.


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    Healing Prayer for Loved One in Hospice #eurodisney #hotels

    #hospice prayers


    The Time for Hospice

    When a loved one is on their last leg you go for a healing prayer of a different sort.

    For a while now we’ve been talking about hospice care for Dad. I love the idea of hospice, the spiritual living in accepting dying as part of the miracle of life. The hospice movement is a caring resource for anyone with ailing loved ones and an answered prayer. But how do you know when?

    I talked to Mom on the phone in the morning. “Daddy’s doing okay,” she said, “but he’s getting awfully confused.” Then I got an email from Will in response to an email from me: “When I was in fifth grade and asked by the yearbook what I wanted to be when I grew up, my response was something like this; I want to be married, have four children, 10 grandchildren and lots of friends. Something in my precocious 11-year-old head sensed that Grampie got the important stuff right.

    “One of Grampie’s trademark phrases was ‘I’m proud of you.’ As he heads down the exit ramp, I couldn’t be prouder of him. As sad as the situation is, the fact that Grampie lived a life to be proud of is the giant, fundamentally important saving grace.”

    Mom called me back in the afternoon to tell me that the head nurse has suggested that we look into hospice. “It’s just what we’ve all been thinking,” I said. Then I read her Will’s email and we both cried a little.

    So much for saving graces.

    Will sent his email from D.C. where he had to be on business. “P.S.” he said at the end, “Glad I can now cross ‘cry on the D.C. Metro’ off my bucket list.”

    Rick’s Blogs

    When Guideposts ‘ executive editor Rick Hamlin volunteers at a soup kitchen, he’s reminded of Jesus’ promise to His disciples.

    At a funeral for a beloved church member, Guideposts Executive Editor Rick Hamlin says a farewell prayer.

    Rick Hamlin shares how Jesus’ promise to remain in us if we remain in Him can change our lives for the better.


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    Hospice of Cincinnati – Locations For Care – Inpatient Care Centers #fitzwilliam

    #hospice of southwest ohio


    Inpatient Care Centers

    Hospice of Cincinnati provides four inpatient care centers throughout Southwest Ohio. Each care center features beautifully decorated private rooms with many of the amenities of home. These care centers provide short-term support for patients and families. Patients receive management of symptoms which can be difficult to manage at home. Family members are relieved of the stress of care-giving for short periods of time. Please call us to arrange a visit or tour of our facilities.
    We would be honored to show you around and answer your family’s questions.

    Hospice of Cincinnati
    at Mercy Health Plaza
    7691 Five Mile Rd
    Cincinnati, OH 45230
    Photo Tour

    Hospice of Cincinnati
    5343 Hamilton Ave
    Cincinnati, OH 45224
    View Map

    A Typical Experience The Dawson Family

    Mia Dawson had been chronically ill for years. She started experiencing increased chest pain and respiratory distress due to heart disease, and the treatments that used to work in the past were no longer working. So Mia was admitted to the hospital. The hospital physician determined that Mia’s heart disease was nearing end-stage and she had less than six months to live.

    Mia spent five days at the hospital and was still experiencing ongoing fatigue and circulatory problems. It became clear that she would need round-the-clock professional care to manage her symptoms and to keep her as comfortable as possible.

    The hospital physician suggested to Mia and her family that hospice care would be the best way to continue keeping Mia as comfortable as possible. A meeting was quickly arranged with a Hospice nurse to discuss Mia s condition, and it was determined that admission to Hospice of Cincinnati s Blue Ash Inpatient Care Center was appropriate. A detailed plan of care was developed for Mia based on the physician s orders and recommendations.

    The Hospice of Cincinnati nurse took care of all the arrangements and assisted with Mia s transfer to our Blue Ash Inpatient Care Center that same day. When Mia arrived at the care center, she was greeted by a member of her care team who helped her settle into her private room and feel welcome in her new surroundings. An admission nurse worked closely with family members to complete consent forms and prepare them for what to expect next.

    Mia immediately began feeling better as her symptoms were managed aggressively by a team of highly-skilled, caring professionals including physicians, RNs and nurses aides. In addition, Hospice social workers, chaplains and volunteers provided additional support to help Mia and her family prepare for the final stages of life.

    Visiting hours were 24 hours a day, seven days a week. Mia was able to spend quality time with her family and assure them that she was ready to go. She also enjoyed additional visits from compassionate Hospice volunteers who shared their time and talents with her. From time to time, Mia s symptoms changed and her care was immediately modified to alleviate any pain or respiratory issues that occurred.

    On her third day at the care center, Mia s illness progressed to the final stages, and her life came to a peaceful end with the loving support of her family all around her. All family members had a chance to speak their hearts and say their goodbyes and were as prepared as one can be for the grievous loss of their loved one. A Hospice nurse confirmed Mia’s death and helped prepare her body for the trip to the funeral home.

    The months that followed were difficult at times for Mia’s family. Occasionally, they received a call from bereavement counselors at Hospice of Cincinnati who offered their support and encouragement through the grieving process. For Mia s family, the calls were a welcome, friendly voice from a team of caring people that would forever hold a dear place in their hearts.

    Hospice Patients Alliance – When It is Inappropriate to Have PRN Medical

    #end stage copd hospice


    Allowing PRN Orders for Morphine
    May Result in Untimely Death
    For COPD Patients

    Morphine is an opioid medication often used to relieve severe pain in cancer and some other diseases. When prescribed by a physician appropriately for relief of pain, it is a blessing to those whose symptoms are relieved, and to the families of those patients who had suffered watching their loved one in agony. When the patient has severe pain, hospices aim at achieving good pain control as one of their top priorities.

    Because morphine is regularly prescribed in hospices for relief of pain and suffering, physicians and nurses come to rely on its power to relieve pain and promote a death without suffering. A death with symptoms well-managed is one important aspect of what is called a “death with dignity.”

    Patients in hospice who have diseases without severe pain may not need morphine for comfort. Some take other analgesics and some take none. But patients who have Chronic Obstructive Pulmonary Disease or “COPD” may especially be sensitive to the adverse effects of morphine. COPD patients have breathing difficulties and anxiety which can sometimes be lessened by very small dosages of a sedative and/or a very small dosage of morphine. However, given in too high a dose, morphine can seriously interfere with a patient’s ability to breathe. In fact, anyone who is given a dosage of morphine which is much higher than they are accustomed to, may stop breathing.

    One of morphine’s main adverse effects is slowing down the respiratory rate, i.e. respiratory depression. If the dosage of morphine is too high for what the patient is accustomed to, the respiratory depression can become severe and actually stop the breathing periodically for a few seconds or many seconds. This pattern of breathing where the patient stops breathing (skipping breaths) and then starts breathing again is termed “apnea.” Apnea commonly occurs as a result of the terminal illness and the dying process, when certain metabolic changes occur in the patient’s body. If the breathing is stopped completely without restarting, the patient dies. Because COPD patients have compromised breathing already. very inefficient breathing, overly high doses of morphine can quickly cause these patients to stop breathing.

    Hospice Patients Alliance has received many, many reports from families about patients with COPD who were given morphine in dosages higher than they were accustomed to receiving. who died shortly after getting those morphine dosages. Most of these patients were given these dosages of morphine by nurses in the hospice setting. In all the cases reported, the physician had ordered that the morphine might be given “as needed” or “PRN” within a certain range and at a certain frequency of time intervals between doses given.

    Giving a medication “as needed” requires a careful assessment of the patient’s vital signs, pain level and need for the medication being considered. When a physician writes a PRN order for morphine, most nurses are very dedicated to assessing the patient’s actual needs and doing everything possible to meet those needs by administering the medication as needed. But in the case of COPD patients, the need for extra vigilance in determining the appropriate dosage is very urgent. Pharmacy and drug references, such as the Physicians Desk Reference and morphine package inserts warn about the dangers of giving too high dosages of morphine to COPD patients. The package inserts and the Physicians Desk Reference even write that morphine is “contraindicated” in general for COPD patients. However, when a patient is truly terminal, some of the rules of prescribing medications are adjusted to meet the needs of the patient. In the terminal COPD patient, morphine is sometimes ordered by the physician to be given in very small dosages.

    If the physician orders the morphine to be given on a PRN or “as needed” basis, when the patient has COPD, and allows a shorter frequency of administration than that needed for the previous dosage to “wear off” or be metabolized, the concentration of morphine actually in the patient’s blood may increase beyond a therapeutic level, causing severe adverse effects, even respiratory shutdown. If you have a loved one with COPD in a hospice care setting and if you are concerned that he may be euthanized before his natural time of passing on, then it is wise to request that the physician NOT write a PRN order for morphine. If the morphine is actually helping your loved one to breathe better, and is comforting, then you may wish to request the physician to consider ordering the morphine on a fixed dosage and schedule, determined by the physician only, not the nurse.

    If you have concerns that your loved one may be medically killed or euthanized in a hospice setting, you should discuss these concerns with the physician and request that PRN orders for morphine not be used. If the physician refuses to do so, you may be able to determine whether the physician is sympathetic to your concerns about euthanasia or not. If you believe the physician is determined to euthanize your loved one, involuntarily, or without your knowledge, then you always have the right to change physicians or to change hospices. Any time that you have concrete evidence that a nurse or physician is acting to euthanize your loved one, the patient, or the patient’s representative may act to change the physician and hospice to a setting that will provide true hospice care.

    Real hospice care is NOT about hastening the death of a patient. It is about providing relief from distressing symptoms, supporting the patient and letting them know that they are valued and loved. Hospice patients necessarily choose not to try to cure the terminal illness, because all efforts to cure the disease are believed to have failed and further efforts are believed to be of no use in curing the disease, i.e. the physician has determined that no efforts would succeed in any case. That does NOT mean that treatment for a urinary or respiratory infection is to be withheld, or that food and water are to be withheld if the patient can absorb them. Withholding food and water is a form of euthanasia for the patient who is not already actively dying! Withholding appropriate treatment for an infection when the patient is not actively dying is also a form of euthanasia!

    Giving overly high dosages of morphine to a COPD patient, or a patient with another terminal illness, is a form of euthanasia. By being alert, discussing your concerns with the physician and hospice staff and acting promptly to prevent overly high dosages of morphine from being administered, you can save your loved one from an untimely death. Removing your loved one from a setting that is bent on euthanizing your loved one may be the only way to save them from being medical killed.

    There are many nurses and physicians who would never even think of doing such a thing, but unfortunately, there are many who would. Surveys and research into the attitudes and practices of physicians and nurses reveals that a significant percentage of nurses and physicians believe that euthanasia is acceptable. If you don’t agree, then you must act to protect your loved one. The best protection is to know what medications are being given, what effect the medications have, what dosages are being given (by being there if possible when they are given) and knowing why the medications are being given. If your instincts tell you that something is not right, act promptly to check with someone you trust who is a nurse, pharmacist or physician who can give you some feedback and further information.

    PRN orders for morphine may be totally inappropriate for COPD patients who do NOT have severe pain!

    Permission is granted to share these articles with others, to print them, or post them on other websites so long as credit
    is given to the author and Hospice Patients Alliance with a link to this original page.

    The National Institute For Jewish Hospice #motel #s

    #jewish hospice


    National Institute For Jewish Hospice

    NIJH was established in 1985 to help alleviate suffering in serious and terminal illness. Its 52,000 members are comprised of business and professional leaders, and a consortium of endowing foundations.

    NIJH serves as a resource and educational center for hospices, hospitals, family service, medical organizations and all health-care agencies, educating them to the issues and challenges of serving the Jewish terminally ill.

    24 hour toll-free number

    A 24-hour toll-free number counsels families, patients and care-givers, and provides locations of hospices, hospitals, health professionals and clergy of all faiths. Toll-Free, 24-Hour Contact 1-800-446-4448.

    NIJH Accredited Hospices

    NIJH has accredited and reaccredited 225 Jewish hospice programs in the United States. We have assisted facilities in planning conferences, training staff and designing appropriate workshops to better serve the Jewish terminally ill.

    The Jewish Hospice Accreditation Conferences

    NIJH provides hospice training and accreditation through the annual national conference, which takes place in November.

    This conference brings together people from hospices across the country in related fields, including administrators, chaplains of all faiths, psychologists, nurses, bereavement counselor and social workers. It is an intensive day of sessions, presenting the best minds in the field to lecture and discuss all aspects of hospice and the Jewish terminally ill. For more information, click here.

    Publications Information

    NIJH produces reliable resources for both the public and professionals. These include books, manuals, CD sets, booklets and other publications. They will be of interest and benefit to hospice professionals, volunteers, patients and family members alike. Click here for more information.

    NIJH also publishes articles and reprints of material that is of interest to the hospice community.

    Business And Consulting Services For Hospice Organizations #cheap #hotels #in #london

    #hospice consultant




    • Pillar #1: Creating a Culture of Growth. Understanding the “Invisible Velvet Glove On The Spigot of Growth” Phenomena.
    • Pillar #2: Referral Inquiry to Admission Conversion Rate.
    • Pillar #3: Maximizing your Medical Director Investment
    • Pillar #4: Sales Team Skill Development: “Happy Feet On The Street”
    • Pillar #5: Executing the 11 Tactics in the “Hospital Tool Kit”
    • Pillar #6: Developing the Physician Office Referral Channel.
    • Pillar #7: Understanding and Executing on the Value Propositions for Senior Living Communities.

    An Expertise In Working With Hospital Based Hospices

    Hospice Advisors has an expertise in working with hospital based hospices to help them both serve more patients within their own health system and the community at large. The founder of Hospice Advisors has 15 years of senior level experience working in health systems which provides a keen understanding to the complexities a health system holds.

    “I met Kurt in Moscow back in 2008. I engaged him to help us with our concept designs for a new hospital that was being built in New Riga (suburb of Moscow). His knowledge of health care with a focus on outpatient services was extremely helpful. Through our business relationship, together we opened a Home Health Care Company called First Home Care. When in Moscow, Kurt also worked closely with several hospices in town to strength their service delivery capabilities. Mr. Kazanowski is both an excellent health care professional and business man.”

    Alexander Goulko, President CEO
    MediCapital One

    “Kurt helped Glacier Hills acquire a personal care home health company. After the acquisition he spent time working with us to develop our Marketing and Business Development Plan which helped us grow our billable hours. Kurt has also worked with me to better understand how to use hospice in our senior community to enhance the quality of care and level of services we could offer to our residences. By blending his experience as a nurse with his business development expertise he offers a unique approach and style”

    “I have worked with Kurt in two different hospice organizations. His passion, innovation and expert knowledge has helped lead these organizations to grow patient census and bring new business development processes and structure into place. Currently, Kurt is assisting me with the development and marketing of a new Palliative Care Consulting service. I would highly recommend any organization looking for assistance, call Kurt”

    Elizabeth Morgan, MD
    Palliative Care Consulting

    “I have worked with Kurt extensively and have consulted with him regularly over the phone on a number of issues over the last two years. Kurt has been very helpful in assisting my organization with our growth strategies in a number of different areas. Kurt has become a good colleague and friend.”

    “Kurt was a perfect match for what we were exploring for our hospital and hospice program. His experience as a hospital executive, coupled with his tenure in hospice and home care, allowed him to quickly position us to have an immediate impact in growing our hospice services. Kurt worked very well with the Executive Director of our home care, hospice and palliative care services and helped her develop and execute growth strategies to allow us to serve more people. Specifically, Kurt has considerable expertise on the use of the General Inpatient Hospice (GIP) level of care and how it can assist hospitals deal better with those higher acuity hospice patients. I would recommend Kurt highly without hesitation!”

    “Kurt has functioned as our Director of Business Development and spends three days a month on site and works remotely with our staff weekly. Through the development and execution of marketing strategies, field coaching with our marketing staff and helping us break into C-Suites; we have been able to grow our census by 53% over a period of year. Kurt has become a part of our organization and we appreciate his commitment to our mission and business objectives”

    About Hospice Advisors

    Hospice Advisors is a specialty, boutique agency that works with hospice, home care and health systems to help them serve more patients, grow market share and develop financial strength. Through developing and executing strategies and actions targeted at serving more patients and growing, we help organizations advance their mission and business related objectives.

    “I met Kurt in Moscow back in 2008. I engaged him to help us with our concept designs for a new hospital that was being built in New Riga (suburb of Moscow). His knowledge of health care with a focus on outpatient services was extremely helpful. Through our business relationship, together we opened a Home Health Care Company called First Home Care. When in Moscow, Kurt also worked closely with several hospices in town to strength their service delivery capabilities. Mr. Kazanowski is both an excellent health care professional and business man.”

    Alexander Goulko, President CEO
    MediCapital One

    “Kurt helped Glacier Hills acquire a personal care home health company. After the acquisition he spent time working with us to develop our Marketing and Business Development Plan which helped us grow our billable hours. Kurt has also worked with me to better understand how to use hospice in our senior community to enhance the quality of care and level of services we could offer to our residences. By blending his experience as a nurse with his business development expertise he offers a unique approach and style”

    “I have worked with Kurt in two different hospice organizations. His passion, innovation and expert knowledge has helped lead these organizations to grow patient census and bring new business development processes and structure into place. Currently, Kurt is assisting me with the development and marketing of a new Palliative Care Consulting service. I would highly recommend any organization looking for assistance, call Kurt”

    Elizabeth Morgan, MD
    Palliative Care Consulting

    “I have worked with Kurt extensively and have consulted with him regularly over the phone on a number of issues over the last two years. Kurt has been very helpful in assisting my organization with our growth strategies in a number of different areas. Kurt has become a good colleague and friend.”

    “Kurt was a perfect match for what we were exploring for our hospital and hospice program. His experience as a hospital executive, coupled with his tenure in hospice and home care, allowed him to quickly position us to have an immediate impact in growing our hospice services. Kurt worked very well with the Executive Director of our home care, hospice and palliative care services and helped her develop and execute growth strategies to allow us to serve more people. Specifically, Kurt has considerable expertise on the use of the General Inpatient Hospice (GIP) level of care and how it can assist hospitals deal better with those higher acuity hospice patients. I would recommend Kurt highly without hesitation!”

    “Kurt has functioned as our Director of Business Development and spends three days a month on site and works remotely with our staff weekly. Through the development and execution of marketing strategies, field coaching with our marketing staff and helping us break into C-Suites; we have been able to grow our census by 53% over a period of year. Kurt has become a part of our organization and we appreciate his commitment to our mission and business objectives”

    Bingo Pet Hospice – Quality of Life for Your Senior Pet #rabbit

    #hospice of greensboro


    Bingo Pet Hospice – Quality of Life for Your Aging Pet and

    We have partnered with Go to sign up and select Bingo Pet Hospice as your cause and start searching the web! With every search one penny is donated to your cause, Bingo Pet Hospice! Watch the pennies add up before your eyes! Check out GoodShop if you are making any purchases online and a matching percentage of your purchase will be donated to Bingo Pet Hospice.

    We are trying to get 50 supporters by November so please help us out!

    Help Bingo Pet Hospice every time you shop online, the iGive Button makes it simple. It’s all free and so easy to be socially-conscious!

    The stores make this possible because they want you to like them and shop at them over and over again. There’s 1449 socially-responsible stores helping to make donations happen.

    I hope you’ll give it a try. Here’s the link:

    Giving Assistant

    Join us for a meeting at!

    Bingo Pet Hospice engages our local veterinarians and community professionals to speak to our group about topics related to our beloved pets. In the past we’ve had the pleasure of having experts talk to us about arthritis, pet trusts, animal chiropractic services, homeopathic remedies and cold laser therapy just to name a few of our topics. Join us for one of our Meetups! Check out the News and Events page for upcoming meetings or visit our meetup site at

    Financial Assistance for Aging Pets

    Caring for an aging pet can be an emotionally and financially difficult situation. Bingo Pet Hospice wants to ensure that the most is being done to create the best quality of life for your pet by providing financial assistance to those who are unable to take on the financial burden. By providing financial assistance, we hope to eliminate any obstacles to maintaining the family unit and keeping the pet comfortable and in the home with the owner they know and love. If you are in need, please fill out an application on our Financial Assistance page. If you are able, please donate to help us support our elderly pet population by sending a check by mail or making a credit card donation on this site.

    Palliative care helps patients not ready for hospice #hospice #of #dayton #jobs

    #hospice tampa


    Palliative care helps patients not ready for hospice

    You’re not from hospice, are you?

    They ask because they aren’t ready for hospice. They may equate it with death. They may not want to stop medical treatments meant to cure or prolong life, even if their suffering is intense.

    Enter the palliative care movement — aimed at providing the comfort of hospice for people who aren’t yet at the end of life.

    The distinction is important both to patients and the physicians seeking to help them. And while it is touted as a less expensive way to provide better care, it also represents a new line of business for health care facilities.

    Farmer is the medical director of Chapters Health Palliative Care. It’s affiliated with LifePath Hospice, the major hospice provider in Hillsborough County.

    Chapters Health Palliative Care started in 2006 for patients who need help managing their pain and other symptoms. Many of them are still getting curative treatment such as chemotherapy and radiation, which hospice patients — defined by Medicare as people with six months or less to live have usually abandoned.

    Hospices around the country see a growing demand for palliative care, especially as b aby boomers age and develop chronic illnesses that require comfort care.

    Hospitals, too, are expanding their palliative care services, often in coordination with hospice institutions, since research findings show that it improves patient outcomes. It is thought that patients who are less stressed by pain are better able to stabilize or even improve their health.

    The palliative care program at the region’s largest hospital, Tampa General, served 1,300 patients last year. The hospital’s foundation is about halfway toward its goal of raising $320,000 to convert some hospital rooms into palliative care suites.

    At Suncoast Hospice, the dominant provider in Pinellas County, new chief executive officer Rafael Sciullo plans to expand the palliative care program, which last year served nearly 1,730 people.

    Suncoast already has a home-based palliative care program and a consult service to two hospitals, Mease Countryside Hospital and Mease Dunedin Hospital, said Sciullo. He wants to expand the consults to more hospitals, and increase marketing for home-based care.

    We do want to dispel any myths that it’s all about dying, said Sciullo. Because it isn’t.

    Pasco-Hernando Hospice has an in-home palliative care program for patients who don’t qualify for hospice. Gulfside Regional Hospice in New Port Richey started a spin-off company, Pasco Palliative Care LLC, which provides services to non-hospice patients at several facilities, including Morton Plant North Bay Hospital in New Port Richey and Medical Center of Trinity, said chief executive officer Linda Ward.

    It’s really going to grow, said Ward. Many hospitals have come on board to recognize that palliative care helps prevent readmissions.

    That’s important at a time when the Medicare program is penalizing hospitals whose patients are readmitted too soon.

    Palliative care could also provide new Medicare income to hospices, who stand to lose money if the federal government clamps down on who qualifies for Medicare’s hospice benefit.

    Why is Medicare eyeing hospice payments? Because most of Medicare spending on hospice in 2011 — $13.8 billion — was for patients who lived longer than six months, the trigger for the hospice benefit. While it’s often not possible to predict when a person will die, that large imbalance, critics say, indicates that some hospices are admitting people who should not qualify for the Medicare hospice benefit.

    As a physician, Farmer says he sees every day how palliative care improves the lives of patients who face not only major illness, but also complicated treatment plans that can be difficult to navigate outside of the hospital. In fact, he said, LifePath’s parent company began its palliative program as a consult service at St. Joseph’s Hospital and Florida Hospital, both in Tampa. Patients were leaving the hospital and going on to live for years at home but without a coordinated plan to address their symptoms, he said.

    Pain is just one issue. An emphysema patient, for instance, might also need low doses of morphine to help him deal with severe shortness of breath. The palliative team helps patients prepare advanced directives explaining what kind of health care they want as they reach the end of their lives.

    What you find is a lot of these doctors know that (their patients) needed this type of care, but they just didn’t have the time, said Farmer.

    Denise Alessandro is the sole caregiver for her 86-year-old mother, who has dementia, advanced arthritis and other ailments.

    We didn’t feel Mom was quite ready at that point for hospice, but we wanted some direction, the Apollo Beach woman said. Farmer helped them with some small changes that made a huge difference, from getting them a hospital bed and wheelchair, to connecting Alessandro with caregiver support groups.

    In recent weeks, Alessandro’s mother began qualifying for hospice care. As is the case in many families, the time in palliative care is making that transition easier to accept.

    I think it’s a wonderful program, Alessandro said of palliative care. I wish more people knew about it.

    Palliative care helps patients not ready for hospice 04/27/13 [Last modified: Saturday, April 27, 2013 9:14pm]
    Photo reprints | Article reprints

    Hospice Peterborough Building for the Future – McColl Turner LLP Chartered Accountant

    #hospice peterborough


    Hospice Peterborough Building for the Future

    The mission of Hospice Peterborough is to enhance the comfort, dignity and quality of life of individuals and families living with or affected by life-threatening illness or grief

    Over 25 Years of Caring for Our Community

    Since 1988, Hospice Peterborough has provided hospice palliative care outreach and support services to those living in Peterborough City and County.
    Hospice Peterborough, along with our community partners at the Peterborough Regional Health Centre (PRHC) Palliative Care Unit, case managers from the Central East Community Care Access Centre (CCAC), palliative care physicians and community nurses, have long recognized the gap in service for people living with life-threatening illnesses. To address these concerns, we have been working diligently towards expanding our community programming and establishing a 10 bed hospice care centre.

    Last year our referrals increased by 22% and it became apparent that we can no longer continue to expand to meet our community’s needs at our current location. At the same time, we know it is time to move ahead with our plans to build a client-centred facility. In response to this unprecedented growth, we purchased a property at 325 London Street at Reid. This location will be transformed into our Hospice Peterborough Care Centre.

    At a symbolic level a hospice is a home, a place of safe refuge; at a functional level it is a home, a care facility, a community meeting space, and a workplace.

    Hospice Peterborough counts on the generous support of our donors to help run our existing programs. Building and operating the hospice care centre will require enthusiastic community support to enable us to continue our current programs while making the dream of a hospice care centre a reality for our community.

    We support the city and county of Peterborough including all its townships of: Asphodel-Norwood, Cavan Monaghan, Douro Dummer, Havelock-Belmont-Methuen, North Kawartha, Otonabee-South Monaghan, Selwyn Lakefield, Trent Lakes.

    No Professional referrals are required for community programs. If you or someone you know might benefit from our services, we are a phone call away and a trained volunteer will refer you to the appropriate staff member.

    Thanks to our funding partners and the generosity of our community we are able to provide our programs at no cost to our clients and their families.
    McColl Turner has been auditors of Hospice Peterborough since 2009 and is a proud sponsor of Hike with Hospice.

    We support the City and County of Peterborough including all its townships of: Asphodel-Norwood, Cavan Monaghan, Douro Dummer, Havelock-Belmont-Methuen, North Kawartha, Otonabee-South Monaghan, Selwyn Lakefield, and Trent Lakes.

    No professional referrals are required for community programs. If you or someone you know might benefit from our services, we are a phone call away and a trained volunteer will refer you to the appropriate staff member.

    Thanks to our funding partners and the generosity of our community, we are able to provide our programs at no cost to our clients and their families.

    Best Practices for Charting – Nursing Link #all #inclusive #hotels

    #hospice charting


    Best Practices for Charting

    Featured Author:

    Kathy Quan, RN, BSN, PHN

    Kathy Quan, RN, BSN. PHN. has over 30 years of experience in home health and hospice care. Teaching patients, caregivers, and other nurses has always been a passion of hers. She also loves to write and has several websites and blogs for nurses, caregivers, and patients. Kathy has also authored four books about nursing, the health care field and caring for aging parents.

    More articles from this author:

    Kathy Quan | NursingLink

    Providing excellent patient care is the most important aspect of nursing. Moreover, taking credit for the care given is also an important responsibility. Most nurses hate the paperwork more than any other aspect of their job, but it’s critical that it be done, and be done well. As with every aspect of quality patient care, charting should be exceptional; it should never be taken lightly.

    The chart is a legal medical record, communicating crucial information to other members of the health care team so that they can make informed decisions. An accurate chart is critical to assessing the patient’s health status, and determining future care and treatment methods.

    State Facts, Not Opinions

    One of the first lessons a nurse learns is that if she doesn’t chart something, it wasn’t done. As a nurse, you can argue to the death that you gave the right meds or checked the heart monitor, but if you neglected to chart it, there s no legal record of it.

    That doesn t mean you should go chart-crazy, and jot down every minute detail. Stick to the facts! For example, don’t get caught in the habit of charting every two hours that a patient was “resting comfortably in bed” until you have actually checked on the patient and noted the exact time. And don t get ahead of yourself: making a comment or checking off a box even two minutes in advance can come back to haunt you. If that patient falls, has a request that someone else responds to, or should code just a minute or two before your recorded entry, your whole level of care could come into question.

    Your patient may be a mean, nasty, curmudgeon, but that’s not for you to say. Neither is it right to say she’s a sweet, adorable old lady. Look for the facts (signs, symptoms, and statements ) as to the basis for the behavior. Is your patient in pain? Is he scared or fearful of a procedure or diagnosis? Is he depressed or anxious? Has he had some issues with family or caregivers? Is the sweet old lady being stoic? Does she understand her illness? Is she in denial? Or perhaps her symptoms have been well-controlled with the current medication regimen?

    Patient A is experiencing 8/10 pain unrelieved by hydrocodone 500mg/5mg q 6 hours. Last dose given 1 hour ago. States he is in constant agony and exhibits angry behavior towards others.

    Patient’s B’s wife confided that her husband is anxious about an upcoming lung biopsy and fears that he has cancer. His father had the same symptoms at his age and died from lung cancer.

    Patient C states her pain is 0/10. States she hasn’t been pain-free in over a year now and is so grateful for her new care and treatment.

    These are perfect examples of outstanding charting. Detailed and straightforward, these statements stick purely to observed behaviors, and medical facts, without any opinion or judgment stuck in.

    Next: Chart as Soon as Possible

    Hospice Patients Alliance – Medicare, Medicaid and Private Insurance for Hospice #ardilaun

    #private hospice



    The major sources of payment for hospice care are Medicare, Medicaid and private insurance, although Medicare certainly provides for the larger segment of the hospice population. Which source of payment covers for your hospice services should have little effect on the type and quality of services you receive.

    Any hospice which receives reimbursement from Medicare or Medicaid must be licensed and certified by the State agency which surveys and inspects health care agencies. If the hospice is part of a national or regional corporation, the location where the hospice actually provides services determines which State performs these inspections. Most private insurers require the hospices to meet the same requirements as do Medicare and Medicaid, and to provide the same set of services included in the standard “Hospice Benefit.”

    There is an additional benefit to having a private insurance company cover your hospice services: you have an insurance company “case manager” who reviews the services needed by the patient and family, and the services being provided by the hospice. Unfortunately, in some instances, some hospices do not provide all the services you are entitled to! In these cases, you need to be assertive and speak with the RN case manager, the hospice’s director or the hospice Medical Director.

    If you still experience any difficulty getting the hospice to provide adequate services, do not hesitate to call your insurance company’s “case manager.” They can “go to bat” for you to get you the services you need. If the hospice still refuses toprovide the services you need, consider switching hospices. Hospices will usually “back down” and provide what you need if you let them know that you will switch. Do not be fooled by “threats” that hospice services will be interrupted or that “it’s not possible” to switch at this time.” Nonsense. You always have the right to choose whichever physician you wish and change at any time; you always have the right to switch hospices to get the services you are entitled to! If you do switch physicians or hospices, the hospice must assure a smooth transition and continuity of services throughout the change.

    Because the Federal and State governments wish to “get their money’s worth” for the funds they pay out to the hospices, it is important to report any hospices who do not provide the full set of services needed to meet the patient’s needs. Since Medicare and Medicaid pay a hospice on a “per-diem” or daily basis for all the services needed, the hospice is receiving payment on the assumption that it will actually provide those services. When a hospice does not provide services needed and which you are entitled to, that hospice may be involved in “health care fraud.” You can help stop the rampant exploitation of the Medicare and Medicaid systems by unscrupulous administrators. report these violations to the Office of the Inspector General. (See “Links to Report Fraud in Hospice” at Section 10 of this text) .

    Permission is granted to share these articles with others, to print them, or post them on other websites so long as credit
    is given to the author and Hospice Patients Alliance with a link to this original page.

    FAQ: What might I expect to happen when someone I – m

    #hospice dying process


    This is a difficult topic for many people to think about, and especially to bring up in a public forum, but people still want and need to know what they might expect as they or someone they care for are declining. It is understandable to fear the unknown, and to fear suffering. I would say that there are a few leading points here:

    1) Most patients don t suffer much as their cancer progresses and as they transition through the dying process.

    2) This process is quite variable from one person to another, but we typically have a good idea of what a patient s leading problems will be weeks to months before a person is experiencing a more rapid decline.

    3) Engaging hospice services/palliative care can help guide expectations and generally manage many of the problems effectively by anticipating them, rather than waiting until very late to accept palliative care.

    While I would never want to romanticize or minimize the challenges of the dying process, I find that the majority of my patients experience a controlled decline in which they really don t suffer. The most common pattern I see is that someone with a progressing cancer will slow down, eat less, begin to lose weight more steadily, and just gradually become less and less active. They no longer go out on walks, then leave the house less often, then spend more time alternating between sleeping and getting up in a chair, then eventually get to a point where they are sleeping most of the time and are pretty much bed-bound. They have less interest in eating, which is sometimes frustrating to the patient but often more so to the family and supporters of the person, who may pressure the patient to force down food that they have little or no appetite for (the danger is that some patients describe distress from the unyielding pressure from well-intentioned but nagging loved ones). Soon, they are sleeping more and more, to the point that they eventually sleep all of the time and are no longer communicative; this is followed by irregular breathing, more prolonged pauses between breaths (called agonal breathing, though it isn t uncomfortable for the person, just a reflex the last phase of the dying process), and then they stop breathing. It s important to remember that this common pathway of progression isn t a lack of will on the part of the person with progressing cancer: they would eat and be more active if they could, but the cancer pours out toxic proteins that mediate this inexorable process.

    It s true that some patients have pain, or a terrible cough, or shortness of breath, agitation, and other problems, but I would say that most of the time, we have signals that these are going to be issues for a long while before the later stages, and it s advisable to deal with them as aggressively as possible before these symptoms become a crisis. Secondly, I most commonly see problems emerge when people (patients and/or their doctors) are very resistant to enlisting hospice support, which typically does a very good job of addressing symptoms proactively, before they become a crisis, and also being able to provide the comfort of helping patients and families/caregivers to understand what to expect in the near future. Just as on a plane, turbulence is much easier to understand if you know to expect it, what it represents, and how you ll get through it.

    About 20 years ago, I spent some time in medical school doing home visits with the very compassionate and thoughtful Medical Director of a Boston hospice. I asked him about his feelings on euthanasia, and he told me that he didn t actually feel that it was a pressing need in almost any cases. Specifically, he noted that it was most common for people to fear two things about dying: being alone in being in pain. Though being a primary caregiver is a very hard job, it is a great blessing to have someone there to help as a caregiver to a terminally ill patient something that even attentive medical care can t substitute for. That care and the ability to ensure that people aren t alone is incredibly helpful. But a medical team today can usually do a good job to minimize the physical suffering of the process to relieve pain and other symptoms. And most of the time, what we see is a patient gradually withdrawing and eventually passing comfortably.

    Related Posts:

    Weldmar Hospicecare Trust is fundraising for Weldmar Hospicecare Trust #hotel #nikko

    #weldmar hospice


    Weldmar s Mont Blanc Trek 2015

    Three countries in three days – our spectacular long weekend trek around Mont Blanc is one of Europe’s most beautiful hikes from 5th to 9th August 2015.

    Our overseas challenges are proving to be very popular and we now have our exciting 2015 adventure planned.

    The spectacular long weekend trek around Mont Blanc is one of Europe’s most beautiful hikes. From the massif of Mont Blanc, seven valleys extend into France, Italy and Switzerland and each retains its own unique culture, architecture and landscape. Each day, hike up ridges and descend into the valleys enjoying views of glaciers, peaks and meadows.

    You will be joining a team of 10-30 other Weldmar supporters and Matt Smith, Events/Challenges Fundraiser for Weldmar

    Learn more at

    Thanks for taking the time to visit our JustGiving page.

    Donating through JustGiving is simple, fast and totally secure. Your details are safe with JustGiving – they’ll never sell them on or send unwanted emails. Once you donate, they’ll send your money directly to the charity. So it’s the most efficient way to donate – saving time and cutting costs for the charity.

    Read full story

    Share this story

    Hearts for Hospice #hotels #london

    #hearts for hospice


    Hearts for Hospice

    Join your heart with ours and give the gift of hospice care today.

    Your gift works through our hands. Together, we can provide physical, emotional and compassionate care to those who are living with a life-limiting illness as well as to those who walk beside them.

    Comfort to those who are suffering.

    Calm to those who are overwhelmed.

    Care along the way.

    “This team was loving, caring, supportive, and professional all wrapped into one. They had heart, what more can I say. I love them all and am so grateful for each of them. Thank you Hill Country Memorial Hospice team.” – A Friend of Hospice

    • Add General Hospice Donation

    Hill Country Memorial Hospital Foundation
    808 Reuben Street
    PO Box 1339
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    Home Health Providers – Centers for Medicare & Medicaid Services #cheap #motels

    #home health care providers


    Home Health Providers

    This page provides basic information about being certified as a Medicare and/or Medicaid home health provider and includes links to applicable laws, regulations, and compliance information.

    A Home Health Agency (HHA) is an agency or organization which:

    • Is primarily engaged in providing skilled nursing services and other therapeutic services; Has policies established by a group of professionals (associated with the agency or organization), including one or more physicians and one or more registered professional nurses, to govern the services which it provides;
    • Provides for supervision of above-mentioned services by a physician or registered professional nurse;
    • Maintains clinical records on all patients;
    • Is licensed pursuant to State or local law, or has approval as meeting the standards established for licensing by the State or locality;
    • Has in effect an overall plan and budget for institutional planning;
    • Meets the federal requirements in the interest of the health and safety of individuals who are furnished services by the HHA; and
    • Meets additional requirements as the Secretary finds necessary for the effective and efficient operation of the program.

    For purposes of Part A home health services under Title XVIII of the Social Security Act, the term home health agency does not include any agency or organization which is primarily for the care and treatment of mental diseases.

    A Home Health Agency may be a public, nonprofit or proprietary agency or a subdivision of such an agency or organization.

    1. Public agency is an agency operated by a State or local government. Examples include State-operated HHAs and county hospitals. For regulatory purposes, public means governmental.
    2. Nonprofit agency is a private (i.e. nongovernmental) agency exempt from Federal income taxation under 501 of the Internal Revenue Code of 1954. These HHAs are often supported, in part, by private contributions or other philanthropic sources, such as foundations. Examples include the nonprofit visiting nurse associations and Easter seal societies, as well as nonprofit hospitals.
    3. Proprietary agency is a private, profit-making agency or profit-making hospital.


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    Hospice care affordable for most Singaporeans: Chee Hong Tat – Channel NewsAsia

    #hospice singapore


    Channel NewsAsia

    Hospice care affordable for most Singaporeans: Chee Hong Tat

    SINGAPORE: The Health Ministry does not require Integrated Shield Plans (IPs) to cover hospice care as an expansion of benefits will result in higher premiums. Minister of State for Health, Chee Hong Tat said this in Parliament on Monday (May 9), adding that IPs, together with MediShield Life, are designed to cover large hospital bills.

    In response to a question from MP for Jurong GRC Dr Tan Wu Meng, Mr Chee said that hospice care is covered under some riders such as Great Eastern’s Total Health Riders and AXA’s Home Care Riders. He added that hospice care is affordable for most Singaporeans, based on his ministry’s data, when combined with government subsidies, Medisave and charity dollars. He highlighted that eight in 10 inpatient hospice bills did not have any out-of-pocket cash payment, while nine in 10 home palliative care patients did not have to fork out cash either.

    Dr Tan asked about patients who fall under the ‘sandwiched class’- who may not qualify for as many government subsidies as patients from low income households, but who still want to take advantage of benefits provided by their IPs, which they purchased while still healthy. He asked whether the MOS would agree that the present system “makes it somewhat unfortunate that these patients can access their Integrated Shield Plan benefits in a restructured hospital, but not should they choose to seek end-of-life care at an inpatient hospice?”

    In response, Mr Chee said government subsidies for hospice care are extended up to the 67 th percentile. Apart from subsidies, he said charity dollars are also an important source of support for patients. He said the government works closely with voluntary welfare organisations and charities in this area. Mr Chee reiterated that there are riders available but importantly, MediShield Life is a new scheme that started in November last year.

    He said, ”It is important for us to focus the scheme on the original intent which it was set out to do, which is to cover large hospital bills. This is something we can review on an ongoing basis, to ensure MediShield Life is able to meet the needs of Singaporeans”.


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    Hospice Admission Criteria for Dementia Patients – Neurology Center: Medical Information on

    #hospice criteria for dementia


    TUESDAY, Nov. 2 (HealthDay News) — Many people with advanced dementia aren’t getting much-needed hospice care because the admission criteria is flawed, researchers say.

    “Dementia is a leading cause of death in the U.S. and hospice care can benefit patients with dementia. The main hindrance to getting palliative [comfort] care is guidelines that try to guide practitioners to wait until an estimated life expectancy of six months,” said Dr. Susan L. Mitchell, a senior scientist at the Institute for Aging Research at Hebrew SeniorLife in Boston, and lead author of a new study.

    Such end-of-life predictions are difficult to make with certainty in dementia cases. Instead of using life expectancy as the requirement for admission, hospice care for dementia patients should be offered based on the patient’s and family’s desire for comfort care, suggest Mitchell and colleagues in the study published in the Nov. 3 issue of the Journal of the American Medical Association .

    Hospice, or palliative, care is most often associated with cancer patients. The goal is to provide comfort and support to patients and their families, instead of life-prolonging treatments.

    For people with cancer, the decision to switch to palliative care is more clear-cut. It generally occurs when someone decides to forgo traditional cancer treatments, such as chemotherapy or radiation, that don’t seem to be working anymore, and instead receive comfort care, which includes better pain management and discussions about important end-of-life care decisions.

    For people with dementia, the decision process is murkier. Most people with advanced dementia are already in nursing homes, receiving around-the-clock care, but palliative care can provide families with additional support and help families make difficult decisions, such as whether or not to treat infections with antibiotics or to use a feeding tube to deliver nutrition. Palliative care may also provide better pain management and symptom relief, said Mitchell.

    To improve the likelihood of dementia patients getting palliative care, Mitchell and her co-authors tried to come up with a better tool to assess their potential life expectancy.

    This new method, dubbed the Advanced Dementia Prognostic Tool (ADEPT), includes 12 items, such as body mass index, ability to perform tasks of daily living like self-feeding, bowel incontinence, shortness of breath and oral food intake.

    The researchers compared their assessment tool with the standard Medicare hospice eligibility guidelines on 606 residents in 21 nursing homes.

    Their tool accurately predicted a life expectancy of fewer than six months 67% of the time, versus 55% for the Medicare guidelines, said Mitchell.

    “While ADEPT was better than the Medicare criteria, its predictive ability isn’t perfect,” said Mitchell. “The delivery of palliative care should be guided by a preference of comfort care rather than by life expectancy,” she added.

    A 2009 study by Mitchell and her colleagues was the first to label dementia a terminal illness like cancer and other incurable diseases.

    Dr. Joseph Shega, an associate professor in the section of geriatrics and palliative medicine at the University of Chicago Medical Center, said he agrees that the issue of comfort care for dementia patients deserves attention.

    “It’s important to recognize that we’re not really good at figuring out how long someone with dementia might live, and I agree with these authors that we should focus more on the goals of care and stop spending resources on trying to figure out how long someone might live,” said Shega.

    “Hospice provides more support for nursing home staff, better support for the family, and can help better educate the family on the natural process of dementia so they know what’s going on,” he explained.

    Hospice also helps manage symptoms, like discomfort or agitation, Shega added, while making sure that care plans and treatment goals agree with the values and wishes of the patients and their families.

    SOURCES: Susan L. Mitchell, M.D. M.P.H. senior scientist, Institute for Aging Research at Hebrew SeniorLife, Boston; Joseph Shega, M.D. associate professor, section of geriatrics and palliative medicine, University of Chicago Medical Center; Nov. 3, 2010, Journal of the American Medical Association

    How to Volunteer for Hospice – Requirements – Duties #hospice #buffalo

    #hospice volunteer duties


    Hospice volunteer duties and requirements.

    The most important requirement for hospice volunteering is a willingness to help. Our volunteer managers can work with you to find the right opportunity to fit your interests or skills. Simply fill out a hospice volunteering application, and we’ll find the perfect fit. Volunteers do not administer medications or perform any nursing duties. The following explains more about volunteer requirements and how to volunteer for Crossroads Hospice.

    What are the requirements for hospice volunteers?

    Crossroads Hospice offers several types of opportunities for volunteering along with the flexibility to donate as much or as little time as you want. Hospice volunteer duties vary for companionship, special projects, office, and bereavement. A volunteer manager can provide you with details.

    What kind of training will I receive?
    Before becoming a Crossroads Hospice Ultimate Giver, you will receive specialized training. We use a team approach for training to create an immediate connection to the program.

    How to volunteer for hospice.

    All hospice volunteers must follow these requirements:

    • Complete the initial application
    • Provide information about your health, physical limitations, etc.
    • You will need to sign consent forms.
    • You will be required to have a Tuberculosis (TB) test performed. This will be done free of charge.
    • It is a requirement that hospice volunteers wait a minimum of one year after the death of an immediate family member or loved one.

    Ready to apply? Fill out a hospice volunteering application today.

    Hospice Care for Cats #list #of #motels

    #cat hospice


    As veterinary care for cats is becoming more and more sophisticated and as more cat guardians understand the importance of a lifetime of preventive care, cats live longer lives. But despite all of that, cats still get sick, and when they do, there are often numerous treatment options. However, some illnesses are considered terminal, and in the past, euthanasia was often the only option pet guardians would consider at that stage. An alternative to premature euthanasia that is garnering more attention in the world of pet care is hospice care.

    Hospice care is about providing good quality of life

    The definition of a terminal illness is an illness for which there is no cure. It is an active, progressive, irreversible illness with a fatal prognosis. Hospice care provides a loving alternative to prolonged suffering and is designed to give supportive care to cats in the final phase of a terminal illness. The goal is to keep the cat comfortable and free of pain, with a focus on quality of life and living each day as fully as possible.

    The decision to stop treatment and begin hospice care can be made at any point in the progression of a terminal illness. Decisions may range from choosing to forego aggressive surgery after receiving a cancer diagnosis because of a poor prognosis, discontinuing chemotherapy or radiation because the cat is either not responding or is dealing with side-effects that are rapidly diminishing his quality of life, or discontinuing medications because medicating the cat is difficult or impossible for the cat owner. Rather than opting for euthanasia, cat owners may choose to provide hospice care for their cat.

    Hospice care is not about giving up

    Hospice care is not a last resort, and is not about giving up, or about dying. It s about finding ways to live with a terminal illness, and it may actually involve providing more care and not less. The decision to provide hospice care should be made in conjunction with your veterinarian, who will become an integral partner in the process.

    What does hospice care involve?

    Hospice care involves the following:

    • Comfort: Provide clean, soft bedding with easy access to food, litter boxes, favorite sleeping spots and interaction with family members. Handle cats gently because many terminal medical conditions create discomfort and pain.
    • Nutrition and Hydration: Provide easy access to food and water. You may need to experiment with special foods to tempt ill cats. In addition to feeding a high quality, grain-free canned or raw (if you cat is immunocompromised, raw food is not recommended) diet, you may need to offer foods such as meat-based baby food (make sure that there is no onion powder in the brand you buy), tuna juice or flakes of tuna spread on top of the cat s regular food, and slightly warming the food to increase palatability. Make sure the cat always has fresh water available.
    • Cleanliness: Sick cats may not be able to groom themselves. Assist your cat with this by gently brushing, and keeping eyes, ears, the area around the mouth and around the rectum and genetalia clean if she can t do it by herself anymore.
    • Pain Management: Cats are good at hiding pain. Watch your cat for signs of pain subtle signs may involve hiding, avoiding contact with family members, or changes in sleeping positions. Rarely will cats vocalize when they re in pain. Work with your veterinarian to develop an appropriate pain control program for your cat.
    • Holistic Therapies: There are many non-invasive, gentle holistic therapies that can provide relief to terminally ill cats. Energy therapies such as Reiki, Healing Touch, Tellington Touch and others are particularly effective.

    A time of peace for cat and human

    Despite the logistic and emotional challenges hospice care presents for cats and their humans, it can also be a time of great peace and increased bonding with your beloved feline companion. It also allows for a gentle preparation for the impending loss for both cat and human. Diagnosis of a terminal illness does not have to be the end it can be the beginning of a deepening, peaceful, final phase of life for both cat and human.

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    Breaking new ground for the Prince and Princess of Wales Hospice (From

    #prince of wales hospice


    Breaking new ground for the Prince and Princess of Wales Hospice

    IN a special appearance in Glasgow, Laura Fraser, the star of hit television series Breaking Bad, encouraged people to put their heart into the Prince Princess of Wales Hospice.

    Loading article content

    The Hollywood actress, who grew up in Glasgow, is the newest patron of the hospice and put the first spade in the ground at the site of the state-of-the-art facility to be built at Bellahouston Park.

    She also helped to launch the Foundation Appeal, the push to raise the remaining £333,000 of the £1 million needed to lay the groundwork.

    “Message hearts have already begun pouring in from all over the city. They will be placed in a large chest and sunk into the foundations under the front door of the new hospice,” she said.

    “These messages are incredibly touching and you can clearly see from the sentiments expressed, just how much the hospice means to the people of Glasgow.”

    Friends, volunteers, dignitaries and supporters of the existing Carlton Place hospice gathered at the south side park where the new building will go up, due to open its doors in 2018.

    Lord Provost Sadie Docherty said more than 36,000 people had been treated at the hospice since it opened 30 years ago.

    “This is an emotional day for many of us,” she added. “We are witnessing the dawn of a new era for the care of the terminally ill.”

    Jamie Hepburn, Minister for Sport, Health Improvement and Mental Health, praised the effort of the fundraising carried out to build the facility. In total it will take £21m to build the hospice on a hilltop site in the park, with £6.5m still to raise.

    “The dedicated hospice staff play such an important role, and I would also to recognise the work of the many volunteers, fundraisers and supporters throughout the hospice movement,” he said.

    “This new facility will bring world-class hospice care to the people of Glasgow, offering privacy and compassionate care to the people who need it.”

    This will be the first hospice in the UK to implement the Sengetun model of care – a Scandinavian model that puts patients and family at the centre of its focus alongside optimal operational efficiency.

    It will also provide hotel style comfort with 16 en-suite bedrooms with private terraces, soft seated areas and domestic style, open plan kitchens. The accommodation will allow patients and families the opportunity to eat together. The aim is to provide more space, independence and privacy to allow greater opportunity for normal family activity.

    The new hospice’s commitment to the palliative care of young people aged 15 and over will also include specialised accommodation to meet their particular needs. This will include family bedrooms, family lounges, social areas, complementary therapy rooms, spa bathrooms, a hydrotherapy pool, sanctuary, sensory room, young people’s lounge and training rooms.

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    Hospice Patients Create Arts – Crafts As Remembrance Gifts for Family #niagra

    #gifts for hospice patients



    Hospice Patients Create Arts Crafts As Remembrance Gifts for Family

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    Hospitalized veteran Joseph Benick works a paint by number kit at the Bay Pines VA Medical Center.

    For hospitalized active duty military and veteran patients, having access to the therapeutic arts crafts provided by national nonprofit Help Hospitalized Veterans (HHV) is something that not only helps pass the time, but contributes to the overall quality of life and rehabilitation.

    Over the years HHV, the largest provider of free arts crafts kits to VA and military medical facilities worldwide, has been told repeatedly about the countless benefits that arts crafts provide-they help veterans suffering traumatic brain injury by improving their concentration skills, or by diverting the attention of a cancer patient during an uncomfortable chemotherapy session. Crafts can also help improve the fine and gross motor skills of a stroke patient. The impact of working on a simple craft kit has had some amazing benefits.

    HHV recently learned about a unique arts crafts program underway at the VA Bay Pines Health Care System where administrators have taken the craft program to its hospice unit. The facility is host to HHV Craft Care Specialist (CCS) Kathy Vanasse, who has helped introduce a brand new perspective on arts crafts.

    Many patients, once facing and coping with impending death, are now becoming more active in the craft clinic, said Vanasse. It s so heartwarming to see these wonderful veterans put a kit together for a family member as a remembrance of them. One veteran completed HHV s Freedom Clock Kit and gave it to his family before he passed away. He asked them to think of him whenever they look at the clock.

    Another item Vanasse reports great success from is the scrapbook kit. The veterans are using the scrapbooks to create something to leave behind so family members can learn their stories. One veteran made his scrapbook entirely about his military service. These projects are giving hospice patients a new sense of purpose and their families are so appreciative when they receive the keepsake.

    Vanasse has been working HHV s craft program at the Bay Pines VA for two years. She says that being around veterans is something she s very comfortable with, as her husband is an Air Force veteran and her son just graduated from Marine Corps boot camp. I love working with the veterans, said Vanasse, they can be quite inspiring. Vanasse is one of 60 CCS s employed by HHV and stationed at a VA or military medical facility.

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    Foyle Hospice call out for Camino de Santiago – Derry Journal #hotel

    #foyle hospice


    Foyle Hospice call out for Camino de Santiago

    The Foyle Hospice has issued a call out to local people seeking the adventure of a lifetime to join its group walk along the Camino de Santiago.

    The local group are due to set off on the French route of the ancient pilgrim’s trail in May 2016.

    The Camino de Santiago team will be departing Dublin and flying with Aer Lingus to the start of the 100km trek.

    A spokesman for the Foyle Hospice said: “This is perfect for those looking to capture the essence of the Camino, a nice walk with good food and discovering local customs, meeting fellow pilgrims and enjoying the unique atmosphere of it all. You won’t forget a single minute of it.

    “This section of the Camino de Santiago starts in Sarria and covers the last 100km of the Camino Francés, the minimum required to apply for your Compostela certificate.

    “The Camino will take you across woodlands, farmland and rustic hamlets, following tracks and paths lined by granite stone walls. The green rolling landscape of Galicia is part of each day’s walk, until you approach your final destination: the mythical city of Santiago de Compostela.”

    Upon arrival, local people will be able to collect their ‘Compostela’ certificate and explore the magic of Santiago’s Old Town, a UNESCO World Heritage Site.

    “We will look after all travel accommodation and will have guides with us at all times on the walk,” the spokesman said.

    Caring for people since 1984 – North London Hospice #what #is #home

    #north west hospice


    See what we’re up to

    Latest News

    Check our news regularly for frequent updates on our recent fundraising events, campaigns and the care we deliver to patients, families and carers.

    Learn more

  • What s On

    Support your local hospice by taking part in an event. From skydives and treks to quiz nights and fetes there is always something new for you to try and you can help raise funds!

    Learn more

  • Education Training

    We offer a range of multi-disciplinary courses to support professionals to develop their knowledge, learn new skills, and improve the care they give to patients and their families.

    Get involved

    in every donated goes direct to care

    of total income from donations fundraising

    is the cost to fund our care

    Leave a gift in your will

  • volunteers support us

    Ever thought of getting a will made? For the month of November we are offering you the amazing opportunity to have your will
    professionally written or amended for free, whilst at the
    same time supporting your local Hospice.
    Instead, you will be invited to make a voluntary donation to North London Hospice, or consider leaving us a gift in your Will, to help us continue our vital services.
    For more information: or call our fundraising team on. See More See Less

    North London Hospice. All rights Reserved. Registered Charity No. 285300

  • Springhill Hospice is lauded for restoring an empty pub into a tea

    #springhill hospice


    Springhill Hospice is lauded for restoring an empty pub into a tea room

    Pamela Gray, team leader (left) and Sarah-Lee Ford, income services manager at Springhill Hospice

    Springhill Hospice has been praised for its ‘inventive’ work to renovate an empty pub.

    The charity received an award from Hospice UK in recognition of its transformation of The Craven Heifer into Springhill Tea Rooms and Gift Shop at the Craven.

    The Broad Lane site had been derelict for two years, but was taken on by the hospice in early 2014 and revamped into the building to sell cuppas, cakes and other items to raise funds for the charity.

    Now, the venture, which was launched last December, has received the Most Inventive Hospice Retail Initiative Award at the recent Hospice UK Retail Conference.

    Julie Halliwell, chief executive at Springhill Hospice said: “I am delighted that we have won this award. Staff and volunteers have worked so hard to renovate the premises and get the tea room and gift shop up and running.

    They very much deserve recognition for the work they have done. It is increasingly difficult to secure the funds we need to operate the Hospice, and we are constantly looking for innovative income generation schemes.

    “The sale of the pub came at just the right time for us, and gave us an opportunity to house our income services team at the same time as developing the tea room and gift shop. We are very grateful to the public for continuing to support us so well.”

    The tea room has space for 60 customers and serves home made treats such as crumpets, sandwiches, cakes, soup and afternoon tea. An outdoor seating area is being set up for the summer months.

    Sarah-Lee Ford, income services manager at Springhill Hospice added: “Opening the tea rooms has been one of our biggest challenges for the income services team.

    However, it’s also been one of the most rewarding seeing people meeting friends and enjoying a cake and a catch up whilst making money for the hospice.”

    Antonia Bunnin, director of Hospice Support and Development at Hospice UK, added: “In recent years there have been lots of headlines about pub closures and empty premises in our communities.

    “The way that Springhill Hospice has brought this old building back to life, back to the community – all while raising vital funds for hospice care – is a wonderfully impressive and creative initiative that deserves to be recognised.”

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    Yolo Hospice Accepted into National Partnership for Hospice Innovation #home #health #care

    #yolo hospice



    Yolo Hospice Accepted into National Partnership for Hospice Innovation

    September 15, 2015

    DAVIS, Calif. Sept. 15, 2015 /PRNewswire/ — Yolo Hospice, headquartered in Davis, has become one of just two California hospices to be accepted into the National Partnership for Hospice Innovation (NPHI).

    NPHI is a nationwide collaborative of not-for-profit, community-integrated hospice and palliative care providers who play a unique role as a crucial safety net for the sickest, most vulnerable patients in their collective communities. According to Craig Dresang, Executive Director of Yolo Hospice, “The partnership’s vision is that every American receives exceptional care during their last stage of life, and that the care is consistent with each individual’s goals, values, and preferences. Members of the partnership invest heavily in bedside care, provide robust bereavement services, offer psychosocial and spiritual support, and consistently achieve the highest standard of care.”

    A priority of NPHI is to stand as leaders in the provision of the highest quality hospice care, to document that leadership through gathering and disseminating data on quality and value, and to set the standard for excellence nationwide. Members, built from the union of the National Hospice Work Group and the Hospice Innovations Group, continue to serve as historic, longstanding leaders in hospice as guardians of the community interest in end-of-life care.

    Dresang says of the partnership, “The key areas of focus include organizational excellence, strategic engagement, data collection and quality initiatives.” Some of the nation’s most highly regarded hospice and palliative care programs are among the group’s membership, including Nathan Adelson Hospice in Nevada, Capital Caring in Washington DC, VNSNY Hospice and Palliative Care in New York, and Midwest CareCenter in Chicago, which is where Dresang was a hospice executive prior to his arrival at Yolo Hospice.

    As the first established hospice in the Sacramento Valley, Yolo Hospice has the longest regional track record as experts in caring for people who have a life-limiting illness. They serve more than 180 communities in the five counties of Yolo, Colusa, Sacramento, Solano and Sutter.

    Pain Medications for Palliative Care #providence #hospice

    #palliative drugs


    Palliative Care Center

    If you or someone you love has been diagnosed with a life-threatening illness, one of the first things you may wonder about is pain. How much pain are you likely to be in? How will you cope with it? What can your doctors do about it?

    The good news is that there is a lot that you and your doctors can do to keep pain at bay. You have multiple options, one of which is medication.

    When it comes to medications for pain management, there are two broad categories: opioids. which dull pain systemically, throughout the body; and adjuvant analgesics, or helper medications that can target specific types of pain. often by fighting inflammation .


    Opioid medications are available only by prescription. There are several opioid drugs that palliative care physicians most commonly prescribe for moderate to severe pain in the context of a serious, life-threatening illness. They are known as opioid analgesics:

    These drugs can be taken in a number of different ways. If the person can swallow, all can be given by mouth. If the person can no longer swallow, some medications can be given intravenously, and some by subcutaneous injection.

    There are other options, as well. “With a compounding pharmacist’s support, we can mix an opioid with a gel to deliver it topically, through the skin ,” says Muir. “There are also formulations of fentanyl, for example, that can be delivered by patch or through a cheek film that crosses the mucous membranes in the mouth .”

    Although opioids are excellent in controlling pain, they do have side effects. Among the most common are:

    • Constipation . This is the one you can’t get around. Most people who take an opioid experience some degree of constipation. and it doesn’t tend to go away as your body gets accustomed to the medication. But as a preventive measure, regularly taking a stool softener and laxative can keep most constipation under control. Also, the drugs lubiprostone (Amitiza ), methylnaltrexone (Relistor) and naloxegol (Movantik) are approved to treat constipation specifically due to opioid use in those with chronic pain not caused by cancer .
    • Nausea . Nausea is a common side effect of opioid medications. About 30% of people get nauseated as a result of taking opioids. Most of the nausea is from the drugs’ slowing effect on the bowels. If you keep the bowels moving, you’re less likely to be nauseated. In many cases, the nausea induced by opioid medications will abate after a few days on a new drug. If not, there are also other medications that palliative care specialists can prescribe to help with nausea.
    • Extreme sedation: Confusion, Sleepiness, and Breathing Problems . Many people worry about becoming mentally foggy or constantly sleepy when on medication for chronic pain. Sedation commonly occurs when first initiating an opioid medication. The sedation usually improves and often resolves in 3 to 4 days unless the dosage of the opioid medication is too high.

    College put on event Simply For Ayrshire Hospice #gold #coast #motel

    #ayrshire hospice


    Ayrshire College

    Courses at Ayrshire College

    College put on event Simply For Ayrshire Hospice

    Ayrshire College students were delighted to once again deliver Ayrshire Hospice’s fantastic ‘Simply For You’ programme at the college’s Ayr campus.

    ‘Simply For You’ is an informal workshop designed to boost confidence and morale for ladies struggling with changes to their appearance.

    Amid lots of fun, laughter and pampering, the Ayrshire Hospice ladies picked up a few style and colour tips from the students while enjoying the friendly support of other women facing similar challenges.

    Students at Ayrshire College have been supporting the programme since 2014.

    This year the Make-Up Artistry and Beauty students provided facials, hand care and make-up sessions, and colour analysis to the hospice women.

    The day was a resounding success, summed up best by one of the ladies who attended. She said “I’ve had a great time! It’s been nice learning some new ideas from the young ones who are training. The Ayrshire Hospice team have been fantastic again.”

    Lisa Flint, Curriculum Manager of Hair, Beauty, Complementary Therapy and Make-up at Ayrshire College, said “We were delighted to hold our first ‘Simply for You’ programme at the Ayr campus. The relationship we have built over the past couple of years with the Ayrshire Hospice provides our learners with invaluable real-life experience whilst supporting our local community.

    “I am extremely proud of the professionalism, knowledge and high standard of treatments the learners provided. They were true ambassadors for Ayrshire College and have gained more insight into the Ayrshire Hospice. The feedback from guests and students proved that this was a huge success and a very enjoyable day for all involved. We are looking forward to holding our next event.”

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    Video of therapy dog caring for hospice patient goes viral #motels #in

    #dog hospice


    Video of therapy dog caring for hospice patient goes viral

    A video of a 4-year-old golden retriever therapy dog caring for a hospice patient in Oregon has gone viral, King 5 News reported.

    JJ, who has been a certified therapy dog since she was 1 year old, is the primary therapy dog at Samaritan Evergreen Hospice House in Albany, Oregon.

    In the video, she is shown with her head on a hospital bed as a patient’s hand touches her face. An unseen man is heard reading the poem, “What then?” by W.B. Yeats, according to JJ’s Facebook page. People have shared the video over 200,000 times.

    “This is a lady who has very few people to visit her. She cannot see and often does not wake up, but she did like having her hand on my fur,” JJ “wrote” in her Facebook post. “We fell asleep later with her hand splayed on my head, but of us snoring (but not proof of that!).”

    I often do bed visits, though never without The Bossy One. This is a lady who has very few people to visit her. She cannot see and often does not wake up, but she did like having her hand on my fur. She was very calm during my visit. We were listening to Yeats, by the way. I was very insistent to have her touch me, more so than usual. We fell asleep later with her hand splayed on my head, both of us snoring (but no proof of that!) I sure can be silly at times, but I also know when to be quiet and present. Her caregivers were very appreciative when they saw this video.

    Posted by JJ, Hospice Therapy Dog on Sunday, February 23, 2014

    According to JJ’s Facebook page, a bed visit can vary but typically involves keeping a patient company, helping them be calm, or distracting a person to decrease agitation while medications take effect. The video was originally posted in February 2014. For the past three years, she has worked 12-hour shifts with her “boss lady,” registered nurse Tracy Calhoun.

    What we do is absolutely touching, but the depth of the response to the video is amazing, as well as heart-warming, Calhoun told King 5 News.

    JJ is a certified therapy dog through Project Canine and works with Hope Animal-Assisted Crisis Response, providing comfort and encouragement to those affected by crises and disaster.

    “Wow! We’re a bit overwhelmed at the response of our reposted video, but happy to be able to share,” JJ “wrote” on her Facebook wall. “Apologies to those who got teary watching the video, it comes with the territory here sometimes.”

    Reviews for Holy Redeemer Hospice in Runnemede, NJ #choice #motel

    #holy redeemer hospice


    Holy Redeemer Hospice

    My mother-in-law was diagnosed with advanced lung cancer that spread to her bones. She was transferred to a nursing home and was supposed to be under hospice care. An aide came out to wash her every d ay, however, my husband and I only saw a nurse twice within the 2 weeks she was there. We received no counseling of any kind to tell us what to expect and what is happening with her. We had to read it online about the dying process and what to expect. She passed away on Friday, January 22 and we still heard nothing from them. They used to be absolutely wonderful. I don’t know what happened. We’re very disappointed.

    by Carmella Formica

    January 23, 2016

    Does this provider give unbiased advice?

    Does this provider offer any coupons, discounts or promotions?

    Not that I have seen

    by Anonymous

    Would you refer this provider to a family or friend?

    Yes, I m going tell everyone about them. I absolutely love this place!

    Does this provider always take that extra step to make you feel special?

    Absolutely, they always make me feel like I m their only patient.

    Did this provider ever take personal phone calls while in the appointment room with you?

    He/she would never do that! Their full attention is always on me.

    Were the restrooms clean at this provider’s office?

    Yes, I could tell they were cleaned regularly

    Did a staff member acknowledge or greet you when you entered?

    Yes, I was greeted when I walked in

    QAPI – What does QAPI stand for? The Free Dictionary #hatta #fort

    #qapi hospice


    References in periodicals archive ?

    The facility was recently awarded with QAPI Accreditation which requires the facility to be successful in three of these four categories: Comprehensive, Continuous, Coverage and Corrective QAPI .

    Clear, complete and accurate nursing documentation communicates important information to others, allows for continuity of quality care, facilitates QAPI initiatives, and bolsters risk management.

    Getting to the root of the problem is an essential part of QAPI .

    The Centers for Medicare Medicaid Services (CMS) is responsible for both promulgating the QAPI regulation and providing technical assistance to NHs.

    At the end of its section on QAPI. CMS states: “We believe these requirements are the single most important provision in this proposed rule to fulfill the congressional mandate for process performance measures based on empirical evidence of organ donor potential and other related factors in OPO service areas.

    We believe that QAPI is regarded by the health care community as the most efficient and effective method for improving quality and performance of health care providers,” CMS stated.

    QAPI at a Glance is the Centers for Medicare Medicaid Services’ implementation guidebook.

    Engage the QAPI or Quality Assurance committee and compliance committee (both committees, being required, should be in place).

    Quality Assessment Performance Improvement – IFMC will complete seven QAPI projects each year.

    This analogy spotlights the fifth step of the 12 Quality Assurance Performance Improvement ( QAPI ) implementation steps–Develop Your QAPI Plan.

    The third of the 12 QAPI implementation steps is “Take your QAPI ‘Pulse’ with a Self-Assessment.

    QAPI is a comprehensive approach to ensuring high-quality, proactive, patient-centered care using evidence-based practices to increase knowledge for planning, implementing and sustaining measurable improvement.

    Palliative Care for Clinicians #palliative #care #at #home

    #criteria for hospice care


    For Clinicians

    Is your patient appropriate for a palliative care referral? A palliative care consultation will assist you in managing complex pain, symptoms, comorbidities, patient/family communication and other issues. Palliative care teams will also save you time.

    The following general referral criteria have been developed to help you assess whether a palliative care consultation would be beneficial to you and your patient. One or more of the following may indicate the need for referral to the palliative care team:

    Presence of a Serious, Chronic Illness

    • Declining ability to complete activities of daily living
    • Weight loss
    • Multiple hospitalizations
    • Difficult to control physical or emotional symptoms related to serious medical illness
    • Patient, family or physician uncertainty regarding prognosis
    • Patient, family or physician uncertainty regarding goals of care
    • Patient or family requests for futile care
    • DNR order conflicts
    • Use of tube feeding or TPN in cognitively impaired or seriously ill patients
    • Limited social support and a serious illness (e.g. homeless, chronic mental illness)
    • Patient, family or physician request for information regarding hospice appropriateness
    • Patient or family psychological or spiritual distress

    Intensive Care Unit Criteria

    • Admission from a nursing home in the setting of one or more chronic life-limiting conditions (e.g. dementia)
    • Two or more ICU admissions within the same hospitalization
    • Prolonged or difficult ventilator withdrawal
    • Multi-organ failure
    • Consideration of ventilator withdrawal with expected death
    • Metastatic cancer
    • Anoxic encephalopathy
    • Consideration of patient transfer to a long-term ventilator facility
    • Family distress impairing surrogate decision making

    Oncology Criteria

    • Metastatic or locally advanced cancer progressing despite systemic treatments with or without weight loss and functional decline;
      • Karnofsky 50 or ECOG 3
      • Progressive brain metastases following radiation
      • New spinal cord compression or neoplastic meningitis
      • Malignant hypercalcemia
      • Progressive pleural/peritoneal or pericardial effusions
      • Failure of first or second-line chemotherapy
      • Multiple painful bone metastases
      • Consideration of interventional pain management procedures
      • Severe prolonged pancytopenia in the setting of an untreatable hematological problem (e.g. relapsed leukemia)

    Emergency Department Criteria

    • Multiple recent prior hospitalizations with same symptoms/problems
    • Long-term-care patient with Do Not Resuscitate (DNR) and/or Comfort Care (CC) orders
    • Patient previously enrolled in a home or residential hospice program
    • Patient/caregiver/physician desires hospice but has not been referred
    • Consideration of ICU admission and or mechanical ventilation in a patient
      • with metastatic cancer and declining function
      • with moderate to severe dementia
      • with one or more chronic diseases and poor functional status at baseline

    Ten Steps for What to Say and Do

    Additional resources on palliative care:

    For information on the development of palliative care teams, visit the Center to Advance Palliative Care at .

    For the National Consensus Project (NCP) Guidelines, go to .

    For the National Quality Forum (NQF), National Framework and Preferred Practices for Palliative and Hospice Care Quality, go to .

    Hospice for children #tombstone #motel

    #hospice for children


    Talking To Children About Death What we say about death to our children, or when we say it, will depend on their ages and experiences.

    Children and Grief: Parents should be aware of normal childhood responses to a death in the family, as well as danger signals.

    When a Parent Dies: All children need to have the facts and their feelings surrounding their loss confirmed often; for this reason it is also important to listen to what they have to say.

    What Do You Tell Children? Children have to be told about death. It will make sorrow and death much easier for a child to deal with if they know something about it beforehand.

    Children’s Understanding of Death This chart is meant to be used as a guideline to children�s understanding of death from newborns through teenagers.

    Helping Teenagers Cope with Grief Bereaved teens give out all kinds of signs that they are struggling with complex feelings, yet are often pressured to act as they are doing better than they really are.

    Helping Younger People Cope with Cancer Deaths and Funerals Understanding the problem; When to get professional help; What you can do to help; Possible obstacles; Carrying out and adjusting your plan.

    Hospice care for cancer patients #hotels #hotels

    #hospice care for cancer patients


    WHO Definition of Palliative Care

    Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:

    • provides relief from pain and other distressing symptoms;
    • affirms life and regards dying as a normal process;
    • intends neither to hasten or postpone death;
    • integrates the psychological and spiritual aspects of patient care;
    • offers a support system to help patients live as actively as possible until death;
    • offers a support system to help the family cope during the patients illness and in their own bereavement;
    • uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
    • will enhance quality of life, and may also positively influence the course of illness;
    • is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

    WHO Definition of Palliative Care for Children

    Palliative care for children represents a special, albeit closely related field to adult palliative care. WHO s definition of palliative care appropriate for children and their families is as follows; the principles apply to other paediatric chronic disorders (WHO; 1998a):

    • Palliative care for children is the active total care of the child’s body, mind and spirit, and also involves giving support to the family.
    • It begins when illness is diagnosed, and continues regardless of whether or not a child receives treatment directed at the disease.
    • Health providers must evaluate and alleviate a child’s physical, psychological, and social distress.
    • Effective palliative care requires a broad multidisciplinary approach that includes the family and makes use of available community resources; it can be successfully implemented even if resources are limited.
    • It can be provided in tertiary care facilities, in community health centres and even in children’s homes.

    Hike For Hospice – Hospice Wellington #motto #farm #motel

    #hike for hospice


    Welcome to Hospice Wellington’s 12th Annual Hike for Hospice!
    Mark Your Calendars for Sunday, June 5, 2016!

    What can you do at Hike for Hospice?

    • Hike! – Participate to celebrate a life – someone fighting a life-limiting disease, a caregiver, the life of a person special to you. Wear their favourite colour, their favourite fashion statement, be creative!
  • Collect donations – from your friends, family, neighbours and co-workers. The top fundraisers will receive a chance to win prizes!
  • Challenge other teams – join the local branches of Scotiabank, Guelph Chamber of Commerce, or the clinical team from Hospice Wellington, or create your own team.
  • Recruit Othersto support Hospice Wellington – Tell people about why you are participating in this exciting event.
  • Encourage donations – If someone is keen to support Hospice Wellington but can’t attend on the day, encourage them to visit our website at where they can donate on-line or phone us at 519-836-3921, or better yet, drop by our offices at 795 Scottsdale Drive, Guelph.
  • HAVE FUN! Hospice is about living life to the end and beyond. This may seem like a hard topic but we love what we do. We know how precious great support can be and how learning to live your whole life, no matter how close the end, is a great accomplishment we can all hope for!

  • Online Degree Programs for Working Adults #online #degree #programs #for #working #adults,


    Online Degree Programs

    To make managing the work-life-study balance more attainable, Warner Pacific College Adult Degree Program (ADP) offers some of its most in-demand programs through online distance learning. You can pursue your degree with us from anywhere you can connect to the Internet and have more control over your online college study schedule. It’s an ideal solution for students whose work schedules are unpredictable or who are raising a family while working full-time.

    Best of all, online education offers you the opportunity to make meaningful connections with classmates and instructors. No matter where your classroom will be today, when you study with Warner Pacific College ADP, you become part of a vibrant, Christ-centered learning community that’s dedicated to your success.

    Current Online Programs

    We currently offer the following online degree programs:

    Curriculum and course progressions are the same whether you study online or at a campus location.

    Flourish with Warner Pacific Online College ADP

    Continue your journey with a Christ-centered college that’s focused on helping you flourish. Contact an enrollment counselor to learn more about Adult Degree Programs at Warner Pacific College today.

    How to Develop Your Social Recruiting Strategy #social #media #for #recruiting


    Thinking about how to recruit using social media? You already know the main benefits of Social Recruiting.


    • Connects you to the largest pool of active and passive job seekers
    • Encourages your employees to refer to their own networks
    • Sends authentic and multimedia messaging to your target audience
    • Lowers the cost of sourcing

    That s all well and good but how do you actually do it? In this guide from our friends at Jobvite you ll find a good outline of a social recruiting strategy.


    This post is written by a guest author. If you are interested our sponsored content options, check out the the Advertising Page – we look forward to hearing from you!

    Weekly recruiting tips direct to your inbox!

    • 10 LinkedIn Headlines that Stand Out from the Crowd
    • 13 Interview Questions You Should Be Asking Finance Candidates
    • What Are the Benefits of Diversity in the Workplace?
    • Do Candidates Need a Premium LinkedIn Account?
    • 13 Recruitment Trends You MUST Know for 2017
    • 7 Most Wanted Work Benefits to Attract Millennials
    • Should We Implant Microchips in Our Employees?
    • 6 Steps to Engaging with Your Workforce
    • How Vodafone Dials Up Global Recruitment Marketing
    • 18 Reasons Every Company Should Use Gmail
    • 7 Most Wanted Work Benefits to Attract Millennials
    • 6 Awesome Recruitment Ads That Are Serious Thumbstoppers
    • Career Management How to navigate your career
    • Employer Hire and retain the best talent
    • Interview Tips How to interview and win the job
    • Job Search How to find your next job
    • Recruiting Tips and tricks from real recruiters
    • Resume & CV Writing How to write the perfect resume
    • Social Media How to use social media for recruiting and job search
    • Technology How to use recruiting technology

    Salvage and accident damaged cars for sale #damaged #cars #for #sale,code #3


    Salvage and Accident Damage Cars for sale

    Salvage4sa is your first choice for buying accident damaged cars and repairable salvage cars.

    Damaged Cars for Sale

    Buying an repairable damaged car can be a great way to make and save money. Not all cars recovered from thefts following an accident or damaged from natural causes are declared a write-off by insurance companies.
    Finding damaged cars can be worth your while. Take your time in researching for these vehicles using Salvage4SA where you might find a damaged car to re-build for re-sale purposes.

    Accident Repairable Cars

    At Salvage4SA, we consider an accident repairable damaged car to be a vehicle that has been labelled as a total loss by the insurance company due to a wreck, theft recovery, disaster or other damage. Partner with Salvage4SA for salvaged vehicles (as opposed to buying a car from a dealer or anonymous person online or through a newspaper) is the fact that we represent the largest salvage companies that have been in the industry for years- providing you with all the information needed to make an informed buying decision. Browse our range of accident damaged and repairable cars for sale now. Our salvage dealers provide a service encompassing the sourcing and managing of stolen and recovered vehicles. They ensure that the correct procedures are followed and that all vehicles are delivered to their premises with the correct documentation. Salvage dealer clients (insurance companies) are updated on the status of all recoveries on a continuous basis by means of progress reports. All vehicles are sold on a tender basis.

    Insurance Write-Offs

    Our Salvage4SA salvage members are professional service providers to the insurance industry, and are constantly provided with repairable vehicles that have been written off by various insurance companies.

    Repair an Insurance Write-off and Save Money

    Whether you plan on re-selling the vehicle or using it yourself, it’s very important to check with one of our salvage companies to know what the requirements are for putting the salvaged car back on the road. Our salvage dealers will give you all the documentation and information you need in order to insure that you make an informed decision when you buy a car. Browse our range of repairable cars for sale now. has on offer code 3 cars for sale as well as stolen and recovered cars for sale. Crashed cars for sale are traditionally only available at a salvage dealership and are hard to find on-line, but we have put together salvage cars from these dealerships and deliver them straight to your desktop. Salvage4sa brings you a large selection of salvage cars for sale in South Africa, in Johannesburg, in Durban and in Cape Town and other cities in-between. By consolidating vehicles from South Africa’s major salvage companies, our SALVAGE CAR FINDER TOOL makes it easy for you to locate the best deals on salvage cars for sale; your choice to buy accident damaged cars and repairable salvage cars.

    At Salvage4sa it’s easy to begin a car buying experience that is traditionally only available to licensed, wholesale auto salvage dealers. Our auto salvage dealer’s directory shows you dealers in your area, what vehicles they have and their details. We bring you great salvage deals at great prices – a great selection of accident damaged vehicles with fresh stock being listed daily. Our site represents some of the largest and most successful salvage dealers in South Africa. Once found, simply complete the ‘Request Form’ and the salvage dealer will contact you directly.

    Department of Transport Vehicle Codes

    Code 1 – New

    New vehicles delivered by a dealer to the first owner.

    Code 2 – Second-Hand

    Used vehicles with one or more previous owners.

    Code 3 – Repairable

    Code 3 vehicles are Code 1 or Code 2 vehicles that have been involved in an accident. Code 3 vehicles have to go through roadworthy to be licensed for road use.

    Is it worth it to buy a Code 3 vehicle?
    ‘Yes’, if the price is very low, and ‘No’ in that the cost of repairs plus the cost of the damaged car might be more than buying an equivalently aged, legal and on-the-road version of the same vehicle.

    Code 4 – Permanently Demolished

    A vehicle falls into this category when the chassis of the motor has been either compacted, compressed, melted, destroyed or damaged to such degree that it cannot be made roadworthy.

    If the damage has been restored or repaired a previously ‘unfit’ car completes a roadworthiness examination, it is then legally allowed to be driven again. Contrary to popular belief, it IS possible to insure a Code 3, but not for more than 60 or 70 percent of normal market value.

    Popular searches

    Get Motorcycle Title Loans Online with Quick Approval #motorcycle #title #loans,motorcycle #title


    Motorcycle Title Loans

    TitleMax® is one of the nation’s largest and most renowned title lending companies. Our customers continue to choose us because we’ve expanded our product line to include motorcycle title loans, and we’ve streamlined the motorcycle title loan process to be as quick and simple as possible. As long as you have a motorcycle that’s paid off with the title in your name, and you have a valid government-issued ID, we could approve you quickly for a motorcycle title loan! In addition to motorcycle title loans online, we offer auto title loans for customers needing extra cash. We also know you’re busy, so we value your time as much as you do. From beginning to end, it typically takes as little as 30 minutes for us to set up a motorcycle title loan and put money in your pocket. That’s right: With a title loan from TitleMax®, you could get the money you need, the very same day you need it! Other lenders can take hours or even days before getting you the money you’re looking for. But at TitleMax®, we strive to provide the best possible title loan experience for our customers, and we know that part of that means getting you cash quick. Get started by filling out our online form for customers interested in motorcycle title loans online.

    How Do I Get a Motorcycle Title Loan with TitleMax?

    Dealing with life’s unexpected curve balls can be stressful. In today’s economy, we can’t always be prepared to deal with such demanding financial emergencies, especially when they come up when you’re least expecting them. And while there are quite a few different avenues you can take to get the money you need (like payday loans, cash advances, pawn outlets, and credit cards), you could find problems associated with each of them that tend to outweigh the benefits. That’s why a motorcycle title loan with TitleMax® could be a better option. With a cash-for-motorcycle-title loan, we could get you the cash you need at a competitive rate, and any credit is accepted. Our customers appreciate the motorcycle loans we offer as an easy way to get cash when they need it. With a TitleMax® title loan, get cash quick using your motorcycle title. So visit your closest store today, bring your motorcycle, its lien-free title, and a valid government-issued ID, and we could have you in and out, set up with one of our title loans on motorcycles with cash in hand, in as little as 30 minutes. So make the smart choice and get a motorcycle title loan or a car title loan with TitleMax® today!

    Title Loan benefits with TitleMax

    Take advantage of your opportunity to set up a motorcycle title loan. TitleMax® customers enjoy numerous benefits when they get a TitleMax® title loan. This is one of the many reasons why TitleMax® has grown to be one of the largest title loan companies in the country. Check out all of the perks to getting a TitleMax® motorcycle title loan below:

    • Quick approval
    • Any credit accepted
    • Quick and easy process
    • Money in as little as 30 minutes
    • Competitive rates
    Title Loans by City
    Get Cash
    Title Loans Pawns by State
    • * Maximum loan amount in Illinois is $4,000. Maximum loan amount in Mississippi is $2,500. Maximum loan amount in Tennessee is $6,500, assuming customer qualifies and accepts both the Pledge and Line of Credit. Maximum loan amount in select Texas stores is $1,340, and in others it is $10,000. Minimum loan amount in California is $2,600.
    • ** Car title loans may require a credit check in California. Motorcycle title loan and pawn approval requires satisfaction of all loan eligibility requirements including a vehicle evaluation and a credit check.
    • *** To be approved for a title loan or pawn, you must be at least 18 years of age (19 in Alabama). Account approval subject to vehicle inspection, appraisal, and, if applicable, a credit check.
    • † Proof of income is required in Illinois, South Carolina, and California. In California you are also required to provide proof of residency, and a valid vehicle registration to obtain a loan.
    • ‡ Signature and personal loans are offered by an affiliate of TitleMax® and are currently only available in Florida. Account approval requires satisfaction of all loan eligibility requirements, including a credit inquiry, and, if applicable, motor vehicle appraisal.
    • § Refinancing of a competitor’s title loan is not available in Mississippi or Virginia. In Illinois, you are required to have reduced your original principal balance by 20% before refinancing. TitleMax®, TitleBucks®, and InstaLoan®, are not considered competitors. Please see a store associate for details.
    • – TitleMax® of Virginia, Inc. d/b/a TitleMax® is licensed by the Virginia State Corporation Commission, license number VTL-11.
    • – In some Texas locations, TitleMax® will act as a Credit Services Organization to assist you in obtaining a loan. Your loan may be made by an unaffiliated third party Lender. Please see store associate for details. Please see Texas Schedule of All Fees .
    • – In GA, TitleMax® offers Title Pawns.
    • – In CA, Loans are made by TitleMax® of California, Inc. California Finance Lenders Law License No. 603K014.

    TitleMax on Facebook TitleMax on Twitter TitleMax on Google+ TitleMax on Instagram TitleMax on Pinterest TitleMax on YouTube

    Home – Semi truck Financing #lease #purchase #truck #jobs, #semi #truck #financing


    Easy Rig Lease


    Semi truck financing bad credit, semi truck financing no money down, semi truck finance florida, lease sale semi trucks guarenteed financing, semi truck financeing

    • At Easy Rig Lease we make it simple and fair. Regardless of your past credit problems we can put you behind the wheel of your OWN semi truck or procure lease or financing for a trailer or any construction equipment. Semi truck financing and leasing is our specialty. Whether you see a semi truck listed for sale on this site, or have your eye on a semi truck for sale elsewhere, we will finance it for you. can pre-approve you for semi truck financing today! Current loan and lease offers available nationwide.
      We specialize in financing people with

      • Bankruptcies
      • Repossessions
      • Tax Liens
      • Slow Pay

        Here is a sample of an application that has a good chance of getting approved

        2. Provide Copy of your last 3 bank statements

        3.Provide a letter of employment or letter of intent to hire. Need a job?

        You can either attach these documents to the bottom of the application
        or Fax them to 631-489-0129

        The main direction of the company is the sales of trailers, Trucks, and heavy duty commercial equipment. Years of experience allows us to bring you competitive rates and sell only quality equipment. We can help with the following:
        Semi truck Financing | Semi Truck Lease | bad credit semi truck finance | used semi truck financing | semi truck financing with bad credit | high risk semi truck financing | guaranteed semi truck financing | financing for semi truck | financing a semi truck | financing companies for semi trucks | semi truck financing | semi truck financing bad credit | semi truck financeing bad credit | bad credit semi truck financing | bad credit financing semi truck | easy semi truck financing

        The year 2009 proved to be another great year for the commercial truck financing industry. How commercial truck financing works is still dominated by modes of transport, Approximately 62% of the commercial truck finance portfolio is movable property. However, since then there has been a cycle of commercial truck sales going up and down. Now we are starting to see gradual increases as the market share of commercial finance truck, machinery and industrial equipment is coming back to life. Over the last year it rose from 30.8% to 32.3% and this increase is undoubtedly the result of a clear recovery in the economy, especially when it comes to financing commercial truck. The total value of commercial financing truck last year of all vehicles exceeded 12 million (about 37% more than last year), including cars and trucks amounted to about 13 million. In this group the highest proportion of truck sales came from financing commercial trucks, about 38.6% were heavy duty trucks. After four quarters of 2006 the value of financing commercial trucks was an estimated two billion and was 45% higher than 2005. The average value of a commercial truck financing loan was over 80 thousand.
        Easy commercial truck financing is currently the fastest growing subgroup of the leasing market of road transport. Last year, over 22% of used commercial truck financing was financed through the form of leasing and the total value of financing for commercial trucks was up by an estimated 58% higher than in the last few years. These are very good results for heavy commercial truck financing. This confirms that the leases are getting better while commercial truck financing rates remain the same. The leasing sector in the market of bad commercial credit financing truck sales and service is continuing to gain popularity among most companies, especially in Tampa fl commercial truck financing is rapidly growing amongst fleet management services.
        The top companies on the leasing market of financing low commercial truck loans remain relatively low because only 10 percent increases of profit were recorded in the commercial truck loans and financing segment. According to members of the Association of leasing companies the development of the industry can use government funds to help with bad commercial credit financing truck. The high demand for owner operators is constantly growing, however it is estimated that 70 percent of owner operators do not have good credit. Owner operators are the force driving the industry that is why there has to be some form of guaranteed commercial truck financing.
        In 2006, banks that specialized in bad credit commercial truck financing lent approximately 8 billion for the purchase of over 298.3 thousand trucks. The financial result is better than that of 2005 by 2.3% and means that fewer banks sold loans (-4.4%). The average value of commercial truck financing bad credit in 2006 was 50,000 and is almost 2.5 times less than the average amount granted for car leasing. There are 2 reasons for this disparity. First, customers of banks much more often choose a mixed option (cash + credit) to finance your vehicle which is greater than leasing on its own. Second, banks have in their portfolio a significant amount of repossessed trucks that qualify for inhouse financing on commercial trucks. They are much cheaper than new ones – for example in the case of the transfer in October by Fortis Bank and fifth in the ranking of 100% share of credit provided was for repossessed trucks.
        On the market for direct financing for commercial trucks most lenders guaranteed financing on commercial trucks and successfully introduced more than 10 different promotions for new vehicles. Some of them are dedicated to selected partners while others are open for everyone.
        According to the very optimistic forecasts of commercial truck financing for bad credit sales of new trailers and trucks, including the value of their loan should be much higher than the prior year. This is mainly because too many loans were given out. A similar dynamics of growth of credit share of funding should demonstrate that bruised credit commercial truck financing is still possible, since there is no clear evidence that repossessions fell sharply and rose. Despite this, 2010 promises to be very interesting because the presidents of the largest banks, non-automotive corporations, announced a fierce competition for the lead in the market for owner operator commercial truck financing. Remember that competition is the best guarantee of high quality low price, namely the cost of credit. So it appears that they will be more accessible and hopefully give owner operators a lower interest. Taking into consideration the total number of all credit type commercial truck financing applicants that apply for loans is steadily rising, by next year there should be more commercial truck leasing financing programs because the average time for commercial financing leasing trailer truck is 36 months.


        Bad credit business loans for your trucking business. Equipment financing Credit repair help for better rates.

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    The Number One HTTP Server On The Internet

    The Apache HTTP Server Project is an effort to develop and maintain an open-source HTTP server for modern operating systems including UNIX and Windows. The goal of this project is to provide a secure, efficient and extensible server that provides HTTP services in sync with the current HTTP standards.

    The Apache HTTP Server (“httpd”) was launched in 1995 and it has been the most popular web server on the Internet since April 1996. It has celebrated its 20th birthday as a project in February 2015.

    Apache httpd 2.4.27 Released 2017-07-11

    The Apache Software Foundation and the Apache HTTP Server Project are pleased to announce the release of version 2.4.27 of the Apache HTTP Server (“httpd”).

    This latest release from the 2.4.x stable branch represents the best available version of Apache HTTP Server.

    Apache httpd 2.2.34 Released End-of-Life 2017-07-11

    The Apache HTTP Server Project announces the release of version 2.2.34, the final release of the Apache httpd 2.2 series. This version will be the last release of the 2.2 legacy branch. (Version number 2.2.33 was not released.)

    The Apache HTTP Server Project has long committed to providing maintenance releases of the 2.2.x flavor through June of 2017, and may continue to publish some security source code patches beyond this date through December of 2017. No further maintenance patches nor releases of 2.2.x are anticipated. Any final security patches will be published to

    Want to try out the Apache HTTP Server?

    Great! We have updated our download page in an effort to better utilize our mirrors. We hope that by making it easier to use our mirrors, we will be able to provide a better download experience.

    Please ensure that you verify your downloads using PGP or MD5 signatures.

    Want to contribute to the Apache HTTP Server?

    Awesome! Have a look at our current ‘Help Wanted’ listings then:

    Copyright 1997-2017 The Apache Software Foundation.
    Apache HTTP Server, Apache, and the Apache feather logo are trademarks of The Apache Software Foundation.

    2017 Silverado 1500: Pickup Truck #s #chevy #pickup #for #sale



    *The Manufacturer’s Suggested Retail Price excludes destination freight charge. tax, title, license, dealer fees and optional equipment. Click here to see all Chevrolet vehicles’ destination freight charges .

    Dependability based on longevity: 1987–July 2016 full-size pickup registrations.

    The Manufacturer’s Suggested Retail Price excludes destination freight charge. tax, title, license, dealer fees and optional equipment. Click here to see all Chevrolet vehicles’ destination freight charges .

    EPA-estimated 16 MPG city/23 highway with available 5.3L V8 engine and 6-speed automatic transmission (2WD) or 18 MPG city/24 highway with 5.3L V8 eAssist (2WD) (limited availability in select markets).

    With available 6.2L V8 engine.

    Requires a compatible mobile device, active OnStar service and data plan. 4G LTE service available in select markets. Visit for coverage map, details and system limitations. Data plans provided by AT T.

    Silverado 1500 LTZ 2WD Double Cab Standard Box or Crew Cab Short Box with the available 6.2L V8 engine and Max Trailering Package. Before you buy a vehicle or use it for trailering, carefully review the Trailering section of the Owner’s Manual. The weight of passengers, cargo and options or accessories may reduce the amount you can tow. Class is half-ton full-size pickups.

    Offer includes discount below MSRP and Cash Allowance. Not available with special finance, lease or other offers. Take delivery by 7/31/17. See participating dealer for details.

    Monthly payment is $16.67 for every $1,000 you finance. Example down payment is 10.3%. Must finance with GM Financial. Some customers will not qualify. Not available with lease and some other offers. Take delivery by 7/31/17. See dealer for details.

    MyLink functionality varies by model. Full functionality requires compatible Bluetooth and smartphone, and USB connectivity for some devices.

    Not compatible with all devices.

    EPA-estimated 18 MPG city/24 highway with 4.3L V6 engine (2WD), 16 MPG city/23 highway with available 5.3L V8 engine and 6-speed automatic transmission (2WD), 16 MPG city/22 highway with available 5.3L V8 engine and 8-speed automatic transmission (2WD), and 15 MPG city/21 highway with available 6.2L V8 engine (2WD).

    Standard on the Silverado High Country and Crew Cab LTZ Z71 models and available on LTZ models with either the 6.2L V8 engine or Max Trailering Package.

    Silverado 1500 Regular Cab Standard Box 4×4. Before you buy a vehicle or use it for trailering, carefully review the Trailering section of the Owner’s Manual. The weight of passengers, cargo and options or accessories may reduce the amount you can tow.

    EPA estimated for Silverado 2WD.

    Silverado 1500 Double Cab Standard Box 2WD with available 5.3L V8 engine and Max Trailering Package. Before you buy a vehicle or use it for trailering, carefully review the Trailering section of the Owner’s Manual. The weight of passengers, cargo and options or accessories may reduce the amount you can tow.

    EPA-estimated 16 MPG city/23 highway with available 5.3L V8 engine and 6-speed automatic transmission (2WD) or 18 MPG city/24 highway with 5.3L V8 e-Assist (2WD) (limited availability in select markets).

    Requires 1500 4-door Double Cab with available 5.3L V8 engine and Max Trailering Package. These maximum payload ratings are intended for comparison purposes only. Before you buy a vehicle or use it to haul people or cargo, carefully review the Vehicle Loading section of the Owner’s Manual and check the carrying capacity of your specific vehicle on the label on the inside of the driver door jamb.

    Silverado 1500 LTZ 2WD Double Cab Standard Box or Crew Cab Short Box with the available 6.2L V8 engine and Max Trailering Package. Before you buy a vehicle or use it for trailering, carefully review the Trailering section of the Owner’s Manual. The weight of passengers, cargo and options or accessories may reduce the amount you can tow. Class is half-ton full-size pickups.

    Limited availability in Alaska, California, Oregon, and Washington.

    Available on LT and LTZ 4×4 models.

    The system wirelessly charges one PMA- or Qi-compatible mobile device. Some devices require an adaptor or back cover. To check for phone or other device compatibility, visit for details.

    Data plan rates apply.

    Visit for vehicle and smartphone compatibility.

    Requires active OnStar service, compatible device, factory-installed remote start and power locks. Data rates apply. Visit for details and system limitations.

    Requires factory installed remote start.

    Requires power locks.

    Requires compatible mobile device and active OnStar subscription. Visit for details and system limitations.

    Not available for City Express, LCF or Colorado Base. Available option for Express Cargo and Cutaway Van, Silverado WT and Custom and Colorado WT.

    Always use safety belts and child restraints. Children are safer when properly secured in a rear seat in the appropriate child restraint. See the Owner’s Manual for more information.

    Visit for vehicle availability, details and system limitations. OnStar acts as a link to existing emergency service providers. Not all vehicles may transmit all crash data.

    The Manufacturer’s Suggested Retail Price excludes destination freight charge. tax, title, license, dealer fees and optional equipment. Click here to see all Chevrolet vehicles’ destination freight charges .

    Math Lesson Plans #online #math #classes #for #teachers


    • Adding and Subtracting Decimals – The student will be able to add and subtract numbers with place values to the hundredths.
    • Adding Integers – Students will use two different types of cereal to practice adding positive and negative integers. This will help them visualize how numbers cancel each other out.
    • Drawing Nets of 3 Dimensional Objects – Students will be able to use concrete materials to help them understand the concept of nets. Being able to take an object and spread it out flat is much easier to see in concrete terms rather than in the abstract.
    1. Estimating – The student will be able to estimate the cost of three new items and the length of time necessary to save the money for those items.
    2. Finding circumference, diameter, and radius – This activity will allow students to measure the circumference, diameter, and radius of a circle in a hands-on way. By being able to manipulate a circle and stretch it out the idea of circumference will be more concrete. Students will use each other, desks, and chairs to create circles that can be measured.
    3. Finding Square Footage – The student will be able to calculate the square footage of a given area.
    4. Graphing – This activity will introduce graphing. The teacher will guide the students as they work together to develop questions, set up a blank graph, interview other students, and fill in the graph with the results. A teacher created worksheet can be completed at the end of the activity to reinforce the concept.
    5. Introducing a standard unit of measure: the foot – This activity will introduce the concept of a standard unit of measure. Students will measure various objects in the classroom using their own feet and a ruler. By comparing their results with their classmates, they will be able to see the value of a standard unit of measure.
    6. Math on a Map – Students will practice finding a variety of information using a satellite picture of their hometown. This would be a great activity to use for review or when there is a substitute.
    7. More or less (or the same) – For this activity, students will work in pairs to play a game. The teacher will introduce the concepts of more, less, and the same. The whole class will play a game with the teacher using dominoes before dividing into pairs to play the game.
    8. Ordering Numbers – Students will work together to practice ordering groups of six and seven numbers. They will use their phone numbers and birth dates written on index cards.
    9. Patterns – This activity will help students see the logic of creating patterns and help them begin to be able to create their own.
    10. Percentages – Students will be able to apply percentages to real life situations by figuring the amount of income tax that will be withheld from a salary.
    11. Plotting points on a graph – The students will use graph paper to plot points on a graph. When the points are connected they will make a familiar shape, number, or letter. They will practice reading co-ordinates to each other, as well as, practice plotting them. The activity is meant to be fun and light, not competitive or stressful.
    12. Polygons – The students will explore and create a poster design using polygons. The posters will be displayed in the classroom and students will be challenged to name as many of them as they can. This activity will allow students a tactile, expressive way to learn about polygons.
    13. Roman Numerals – The student will be able to recognize and name roman numerals up to twenty.
    14. Rounding to the nearest five – Students will enjoy practicing rounding numbers as they try to be the first to cover all their numbers in this game of Bingo. The teacher can set the pace for this game. It can be set at a beginning level with a lot of discussion and helps or it can be played as a speed round where students are racing to find the right numbers.
    15. Symmetry – The student will be able to identify objects that are symmetrical and draw half of an object by looking at the other half.
    16. Using Tangrams to Find Patterns – Students will create patterns using tangram pieces inside a shoebox lid. After they have placed the pieces in the lid, they will count how many shapes there are. So, if they use triangle shapes, they will count how many different triangles there are in the shoebox lid.
    17. Value of Coins – The student will be able to choose the appropriate combination of pennies, nickels, and dimes needed to total the amounts listed on a series of five index cards.

    Ultimate Graphing Pack

    – Self Guided Lessons
    – Great Worksheets

    Word Problems Series

    – Build Skill Sets
    – Challenge Students

    Math Lesson Plans From Other Web Sites

    1. Big Sky Math – 30 lessons.
    2. Introducing Venn Diagrams with Dr. Seuss – The students will be able to compare and contrast Dr. Seuss books.
    3. Leaf Patterns – Given four baggies, each containing a different type of leaf, students will create four different patterns.
    4. Making and Understanding Patterns – The students will be able to identify patterns and create their own original pattern.
    5. – The best site on the Internet for math teachers.
    6. Math Forum Internet Resource Collection, The – Search and browse the library for math ideas and lessons.
    7. Math Forum Teacher’s Place, The – Activities by grade level and interest.
    8. – Offers information about basic math and algebra, includes information about learning styles, study skills tips, tutorial lessons authored by students, math assignments, links to free tutors, math videos, math games, and ways to reduce math anxiety, all in an exciting visual format with animation & music.
    9. – The goal of this web site is to help grade school children improve their math problem-solving and critical thinking skills. It has 4000 math word problems for children to enjoy.
    10. Mega-Mathematics – lesson ideas on interesting subjects such as coloring and graphing games.
    11. METIP Project – The purpose of the project is to produce and test materials that promote digital image processing as a means of motivating K-12 students in mathematics and as a means of teaching mathematical concepts.
    12. Mr. Pitonyak’s Pyramid Puzzle – A lesson that answers What would an Egyptian pyramid cost to build today?
    13. Probability Unit – This curriculum design is for the 8th grade students who are going to learn “Probability” and trying to show the easiest way for them to go into this class. By Christina Cheng.
    14. Smile Program Mathematics – 100 lessons topic-driven lessons.
    15. Storyline For A Unit On Fractions, Decimals, And Percentages For 6th Grade – A complete 33 page unit by Laura Strum.
    16. Suzanne’s Mathematics Lessons – Web and classroom lessons.
    17. Teaching Ideas (Math) – fun and easy ideas for elementary classrooms.
    18. VirtualVacation: The Ultimate Math Lesson Plan – A project-based activity.

    Online MBA Scholarships and Bursaries for International Students in UK Scholarship Positions


    Online MBA Scholarships and Bursaries for International Students in UK, 2017

    Global Business School Oxford (GBS Oxford) offers a number of MBA Scholarships and Bursaries for February 2017 Student Intake. Ten scholarship places are available at £4,500 for the full year-long MBA.

    This unique MBA blended learning programme, which enables students from all over the world to pursue their studies while in employment and is accredited by London Metropolitan University, combines the very best of the Oxford tutorial system with the best of digital learning.

    One of the key objectives of this course is to strengthen students’ management skills to prepare them for promotion in their careers.

    Course Level: Scholarships are available for pursuing full MBA programme at the Global Business School Oxford (GBS Oxford).

    Study Subject: Scholarships are awarded in the field of business administration.

    Scholarship Award: Scholarship places are available at £4,500 for the full MBA programme.

    Number of Scholarships: There are ten scholarships available.

    Scholarship can be taken in the UK

    Eligibility: The MBA course with London Metropolitan University requires

    • A minimum age of 21
    • Bachelor’s degree or 2-3 years work experience at Managerial or Supervisory Level
    • Equivalent overseas qualification recognised by the UK NARIC

    Nationality: Students of all nationalities can apply for Online MBA Scholarships.

    College Admission Requirement

    Entrance Requirement: Applicants must have their bachelor’s degree.

    English Language Requirement: Overseas learners must show proficiency in the English language and have an appropriate qualification equivalent to IELTS 5.5.

    How to Apply: The mode of applying is online.

    Application Deadline: The application deadline is January 25, 2017 .

    Change lives of international students by helping them achieving successful scholarships, financial aid and free education.

    About Us was started in 2007 by Oxford University graduates for helping international students in finding suitable scholarships to study abroad.

    We have helped thousands of students in securing scholarships and financial aid in the world’s top universities.

    Our objective is to help international students in finding matching scholarships – just in time


    Top Retail POS Software – 2017 Reviews, Pricing & Demos #phone #systems


    Retail POS Software

    What Is the FrontRunners Quadrant?

    A Graphic of the Top-Performing Retail POS Products

    FrontRunners quadrants highlight the top software products for North American small businesses. All products in the quadrant are top performers. Small businesses can use FrontRunners to make more informed decisions about what software is right for them.

    To create this quadrant, we evaluated over 100 retail software products. Those with the top scores for their capability and value made the quadrant.

    Scores are based largely on reviews from real software users, along with other product performance details (e.g. what features they offer, how many customers they have).

    Is One Quadrant Better Than the Others?

    Nope, Products in Any Quadrant May Fit Your Needs

    Every product in this quadrant offers a balance of capability (how much the products can do) and value (whether they re worth their price/cost) that makes them stand out in the race for small business software success.

    FrontRunners has four sub-quadrants:

    • Upper Right = Leaders: Leaders are all-around strong products. They offer a wide range of functionality to a wide range of customers. These products are considered highly valuable by customers.
    • Upper Left = Masters: Masters may focus more heavily on certain key features or market segments than Leaders do. If you need a more specialized set of functionality without bells and whistles, then a product in the Masters quadrant might be right for you.
    • Lower Right = Pacesetters: Pacesetters may offer a strong set of features, but are not rated as highly on value. For example, a Pacesetter might offer greater functionality, but cost more.
    • Lower Left = Contenders: Contenders may focus on a more specialized set of capabilities that are priced at a higher point. This makes them ideal for companies willing to pay more for specific features that meet their unique needs.

    Depending on the specific needs of a software buyer, a product in any of these sub-quadrants could be a good fit.

    Why? To even be considered for this FrontRunners, a product had to meet a minimum user rating score of 3.1 for capability and 3.2 for value. This means that all products that qualify as FrontRunners are top-performing products in their market. They appear in the quadrant in relation to how their peers performed.

    For some buyers, a specific FrontRunners sub-quadrant might be best. For example, certain retail software products with an emphasis inventory management fit perfectly at home in the Pacesetters quadrant.

    You can download the full FrontRunners for Retail Management report here. It contains individual scorecards for each product on the Frontrunners quadrant.

    How Are FrontRunners Products Selected?

    Products Are Scored Based on User Reviews and Other Data

    You can find the full FrontRunners methodology here. but the gist is that products are scored in two areas, Capability and Value.

    To be considered at all, products must have at least 10 reviews and meet minimum user rating scores. They also have to offer a core set of functionality for example, all products considered offer point of sale, inventory management and barcode scanning capabilities, as well as at least one of the following: accounting management, customer management and reporting/analytics.

    From there, user reviews and other product performance details, such as the product’s customer base and the features it offers, dictate the Capability and Value scores. Capability is plotted on the x-axis, and Value is plotted on the y-axis.

    Got It. But What if I Have More Questions?

    Check Out Our Additional Resources!

    For more information about FrontRunners, check out the following:

    • Check out the FrontRunners frequently asked questions (FAQ) for more detailed answers and information about how it works.
    • Check out the complete FrontRunners methodology to understand the scoring.

    Have questions about how to choose the right product for you? You re in luck! Every day, our team of advisors provides (free) customized shortlists of products to hundreds of small businesses.

    • Simply take this short questionnaire to help us match you with products that meet your specific needs.
    • Or, talk to one of our experienced software advisors about your needs it s quick, free, and there s no-obligation by calling (844) 687-6771.

    One Last Thing How Do I Reference FrontRunners?

    Just Follow Our External Usage Guidelines

    Check out the FrontRunners External Usage Guidelines when referencing FrontRunners content. Except in digital media with character limitations, the following disclaimer MUST appear with any/all FrontRunners reference(s) and graphic use:

    FrontRunners scores and graphics are derived from individual end-user reviews based on their own experiences, vendor-supplied information and publicly available product information; they do not represent the views of Gartner or its affiliates.

    Runners Up

    Providers listed as Runners Up were eligible for inclusion in the FrontRunners quadrant, including having 10+ product reviews, but their value or capability axis score was not high enough for positioning on the FrontRunners quadrant.

    Buyer’s Guide

    Retail Point of Sale (POS) systems, also known as POS software, have come a long way from being bolt-on applications for cash registers. Today, the cash register as the cornerstone piece of retail technology has been replaced by PCs, tablets and mobile devices.

    Retail software vendors offer integrated software programs and POS systems for “mom-and-pop” stores to large retail chains, and everything in between. Retail software applications handle any combination of checkout, inventory control, customer management, e-commerce sales, merchandising and distribution. These systems help retailers automate the point of sale, improve inventory tracking and enable more effective management of customer data to grow profits and decrease store inefficiencies.

    Continuously falling hardware and equipment costs, the emergence of mobile devices like iPads and new cloud-based POS offerings have led to more choices than ever. This leaves buyers with a daunting challenge as they try to determine the best application for their needs. The goal of this buyer’s guide is to help retailers understand the market as they begin their research. What we’ll cover:

    Common Features of Retail Software

    For buyers that manage a single store, the most important features to look for include:

    • Point of sale management
    • Inventory control
    • Accounting management
    • Customer relationship management

    Retail software products are generally straightforward, helping retailers ring up customers, update inventory levels, present basic reports and keep track of customers.