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

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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.





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

#end stage copd hospice

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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.





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

#hospice tampa

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

#private hospice

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MEDICARE, MEDICAID AND PRIVATE INSURANCE

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.





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

#hospice criteria for dementia

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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





Texas hospice owner ordered nurses to overdose patients, FBI says #orlando #hotels

#hospice news

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Texas hospice owner ordered nurses to overdose patients, FBI says

DALLAS The owner of a Dallas-area hospice ordered nurses to increase drug dosages for patients to speed their deaths and maximize profits, according to an FBI affidavit.

A copy of the affidavit for a search warrant obtained by KXAS-TV in Dallas-Fort Worth alleges Brad Harris ordered higher dosages for at least four patients at Novus Health Services in Frisco. It’s unclear whether any deaths resulted from overdoses of drugs like morphine.

Harris has not been charged. The FBI on Wednesday declined to say whether an investigation is ongoing.

The warrant refers to an FBI raid on the hospice in September. It alleges Harris sent text messages to workers such as, You need to make this patient go bye-bye. On another occasion, Harris told administrators during a lunch meeting that he wanted to find patients who would die within 24 hours.

In at least one instance, an employee refused to follow orders to increase a dosage, the warrant said.

The document explains that federal reimbursements can diminish the longer a patient receives care. A provider eventually can be forced to return federal payments.

A woman who answered the phone Wednesday at Novus declined to comment. Attempts to reach Harris for comment on Wednesday were unsuccessful. A working number for him could not be found; listings for a Brad Harris in the Dallas and Houston areas had either been disconnected or turned out not to be his. The Associated Press also sent a request for comment to two email addresses believed to be his.

Harris, 34, is an accountant who founded Novus in 2012, according to KXAS, citing state records.

Novus’ website says the company offers hospice and home health care services.

The FBI investigation of Novus, which included interviewing several employees, began in 2014 and initially focused on allegations that the company sought federal reimbursements for patients recruited by Novus who didn’t qualify for services, according to KXAS.





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

#gifts for hospice patients

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Media

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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Hospice Patients Alliance – Physicians, nurses and other staff patient advocates? #motels

#advocate hospice

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PHYSICIANS, NURSES AND OTHER STAFF:
ADVOCATES FOR YOUR WELFARE?

When any individual seeks health care, he expects that the physicians, nurses, social workers and other professionals will provide the very best of care in accordance with the most modern standards in the health care industry. Whether it is surgery or medical management of a disease, the expectation never changes. Most people trust their physician and the nurses who care for them. They trust their counselors and therapists. Health care professionals are quite often perceived as quite dedicated individuals who do their very best in caring for their patients.

Hospice is no different from any other aspect of the health care industry in terms of the degree of competence and integrity that is expected by the general public. However, hospice patients and their families are less likely to know when they’re being exploited, because it is less likely that they would know about the standards of care for end-of-life care. Even if they do know the standards, hospice patients and their families are less likely to complain, because of their fatigue, the overwhelming intensity of involvement in caring for their loved one (often around the clock), and their intense grief.

Physicians, nurses, social workers, professional counselors and therapists are licensed in each State to provide health care services. Each State has standards of care for all health care professionals, and each professional organization has published its own Code of Ethics and standards of care. Any licensed health care professional has a duty under the law to maintain professional competence, abide by the Code of Ethics, and actually provide care that meets the standards of care. Most health care professionals take pride in being competent at their work, staying up-to-date, and doing the best for their patient. There is a natural bond between health care professionals and their patients. Many will fight for their patients to protect the patients’ interests. That is what patients expect and what they often receive.

However, with the changes in the health care industry, constantly rising costs of providing services, and stiff competition among health care agencies, hospitals, nursing homes, and hospices, the business of running a health care agency or hospice has taken over in terms of controlling what directives management gives to its staff. No longer can you safely assume that the agency or hospice will necessarily do what’s right or according to the standard of care. Cutting corners has become commonplace in health care. This places terrible strain on the health care staff, who are pulled in mutually exclusive directions by their different obligations under their license and to their employer.

Health care professionals’ first obligation under the law and their license is to the patient: to abide by the Code of Ethics for their profession, maintain professional competence and actually provide the care that meets the standards of care for their line of work. The second obligation health care professionals may feel heavily weighing on their shoulders is to their employer; if the employer directs the health care professional to violate the standards of care (in order to save the employer money), he or she must choose between pleasing the employer (and keeping a job) and doing what’s right for the patient.

Physicians, nurses, social workers and others routinely confront these conflicting obligations and try to find a compromise between the two that is acceptable to both obligations. However, when the policy of the employer is clearly in violation of the standards, the health care professional must choose between right and wrong. There is no middle ground when health care fraud is directed and intentionally committed at the administrative level.

Hospice is fertile ground for health care fraud. There are many ways of exploiting the patients, families and the reimbursement source, whether Medicare, Medicaid, private insurance, or the patients and families own money. Federal investigators have struggled with attempting to stop the flood of health care fraud violations occurring. When the U.S. Office of Inspector General started its Fraud Hotline, they were flooded with thousands of calls about health care fraud. Some career criminals have even been quoted as saying that it was easier to make fortunes defrauding Medicare than through the sales of illegal drugs.

If you are receiving care from health care professionals, you can expect that most of them are very dedicated, and honest individuals. That does not mean that fraud might not occur. Some honest individuals do not have the courage to fight the system and simply decide to choose to ignore violations which are occurring, trying to stay uninvolved and just do their jobs. The financial incentive to the agency/health care institution is to commit fraud in order to bolster their bottom line. The financial incentive to the health care professional to keep quiet arises out of their need to keep their paycheck coming to support their family. Challenging one’s employer’s policies is a sure method of becoming very unpopular at work. Management does not look favorably on employees who expose their white-collar crime! Even co-employees may avoid a health care professional who makes a complaint against the employer. they simply don’t want to have their own jobs threatened.

For the hospice patient and families, you can expect that some of the physicians, nurses, social workers or other staff will definitely speak up on your behalf if they think that improper decisions regarding health care occurring. The best thing you can do to help these health care professionals is to listen closely to what they may say to you. Remember their comments if any problem arises, if you are having difficulty getting proper services. By listening to what some of the hospice staff may tell you, you can glean extremely important clues to what you should be receiving, but may not be receiving. or you may learn of problems which you did not even know existed.

Remember, if you don’t know the standards in hospice, how can you know when you’re being exploited? If you determine that any of the services you are receiving are inadequate or improper, your complaint directly made to the hospice management will be much more powerful than any complaint made by an employee. If you have questions about the care being provided, ask one of the staff who you seem to have a stronger, closer relationship, who you trust. If you’re still unsure, you can contact other hospices, health care professionals you may know or call us at the Hospice Patients Alliance.

While all health care professionals are required to be advocates for the patients under their care, the reality is that some health care professionals choose to look the other way and keep quiet, to save their own job. Health care fraud, under-serving patients and outright violations of standards of care does occur. You can help stop it from continuing by listening closely to the staff you meet, by learning as much as you can about the standards of care (that’s one of the reasons for the Hospice Patients Alliance. to help inform you and protect you), read the contracts and literature provided by the hospice, and be willing to ask probing questions of the hospice staff who work with you. Some hospice staff do not know the full meaning of the standards of care and have been misled by their hospice employers. If you have doubts about what you are told, look up the law for yourself in the Section on Federal Laws Governing Hospice: the Uniform Standards of Care. We will be happy to explain the standards to you if you call.





Hospice care for cancer patients #hotels #hotels

#hospice care for cancer patients

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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.




Cynthia Spencer and Cransley hospice patients will suffer from cuts – BBC

#cynthia spencer hospice

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Cynthia Spencer and Cransley hospice patients ‘will suffer’ from cuts

Image caption Cransley Hospice (top) at St Mary’s Hospital in Kettering and Cynthia Spencer Hospice (bottom) in Northampton both face funding cuts

NHS cuts proposed at two Northamptonshire hospices will lead to patients and families “suffering”, the Labour party has warned.

The service plans to cut funding at Kettering’s Cransley and Northampton’s Cynthia Spencer hospices to save money.

John McGhee, leader of the Labour group at the county council, said cutbacks “will affect the quality of services”.

The NHS said it had to make savings, but had withdrawn its initial figure of £2m which will be discussed further.

A Nene Clinical Commissioning Group (NCCG) spokeswoman said it planned to meet Labour councillors on Thursday to try and answer their concerns.

Mr McGhee said: “It would seem from the clinical commissioning group’s latest statement that once again the hard working people of Northamptonshire are being left to pick up the tab after cutbacks.

“There is no doubt in my mind that these cuts will affect the quality of the services being provided. Ultimately, patients and their families will suffer.”

‘Enhanced service’

An NCCG statement said: “In the original delivery plan a potential reduction in £2m of funding was mentioned.

“Following the ongoing engagement and feedback with hospice trustees, the original figures stated have been withdrawn.

“We continue to discuss what the alternative position should be, but are considering an enhanced service not a reduced one.”

The NCCG said it hoped to fill any cutback in funding with an increase in charitable fundraising and by making changes to its services that reduce demand on its core funds.

It currently contributes 70% (£3.1m) towards the running costs of the hospices, with charitable trusts putting in 30%, which it says is out of proportion with the rest of the country.

Both hospices provide care for people whose illnesses are no longer curable, including many cancer patients.

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Parkinson – s Resource Organization, information and assistance to Parkinson – s

#vitas innovative hospice care

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VITAS Innovative Hospice Care®

Near the end of life, most people hope to remain at home, sustained by familiar faces and routines. Remaining at home though can present many obstacles for the patients and their families including: difficulties with breathing and swallowing, challenges with transferring wheelchair or bed bound loved ones, compromised ability to communicate, and assistance needed with activates of daily living.
VITAS® addresses the physical, emotional and spiritual needs of each of those patients, and our hospice team comes to the patient’s bedside. When necessary, our team works in shifts of continuous home care until symptoms are controlled, avoiding hospitalization. When a patient needs care beyond that which can be provided at home, we provide inpatient hospice care. VITAS® partners with hospitals and nursing homes to offer inpatient are in the comfort of a private suite.

  • Because moments matter, VITAS® admits patients within hours of a request, including evenings, weekends and holidays.
  • Telecare® means patients and families are never alone. VITAS® nurses answer calls 24-7.
  • Tikvah, our accredited Jewish hospice program, assures that end-of-life care is provided to Jewish patients and families in accordance with their traditions.
  • VITAS® meets the unique needs of veterans and can even help apply for benefits the patient orfamily is entitled to.
  • Because end-of-life care is different for every patient, VITAS® offers a variety of personal services: Paw Pals®, friendly visitors, music, art, Memory Bears, life review, massage.
  • VITAS® bilingual staff assures clear communication and culturally appropriate care.
  • VITAS® accepts Medicare, MediCal and private insurance.

VITAS Innovative Hospice Care®
Information: 1.800.723.3233
website: www.VITAS.com

Disclaimer
The inclusion of links on this Website are to Websites that are maintained by third parties over whom Parkinson’s Resource Organization has no control. Such links do not imply endorsement of the material contained therein. Parkinsons Resource Organization makes no claims, representations, or warranties as to the accuracy, completeness, or appropriateness of these Web Sites or the information these websites contain.





Atrial Fibrillation News and Events for Patients from #atrial #fibrillation #patients, #living


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Afib News & Events

Home | Afib News & Events

This page features recent atrial fibrillation news stories, events, audios, and video interviews with some of the world’s top afib doctors. Sign up for our Newsletter on this page to be notified of the latest news stories. Bookmark and visit this page often to keep up with the Atrial Fibrillation News Feed at the bottom of this page.

Video Audio

Here are recent videos and audios. See related News stories for transcripts. See previous videos and audios at more Videos and audios

Video Audio

Here are recent videos and audios. See related News stories for transcripts. See previous videos
and audios at
more Videos
and audios


Managing AF Risks – Drs. Wilber, Redline, & Link


Dr. Kowal on Partnering with Healthcare Providers


Dr. Turakhia on Afib Stroke Prevention


Dr. Turakhia on Afib Medications


Dr. Day on Overview of Afib


Mellanie True Hills – Opening of AF Patient Conference


Dr. Calkins on 2014 AHA/ACC/HRS Atrial Fibrillation Guidelines


Dr. Lakkireddy on Left Atrial Appendage Occlusion & LAALA-AF Registry


Dr. Lakkireddy on Yoga & AF


Q & A Panel — AF Patient Conference


Dr. Prystowsky on AF Rate Control


Dr. Benjamin on AF Family History & Risk


Dr. Marrouche on “Staging” AF Treatment—Pt 2


Dr. Marrouche on “Staging” AF Treatment—Pt 1


Dr. Kowey on AF Treatment


Dr. Russo on Gender Differences in AF Treatment


Dr. Cappato on Afib & Athletes


Dr. Cappato on 2nd WW Survey on AF Ablation


Dr. Reddy at Boston Afib 2010


Prof. Camm at Boston Afib 2010 (low res)


Dr. Natale at Boston Afib 2010 (low res)


Sen. Bill Frist, MD, on AF Stat™


Dr. Argenziano on Atrial Fibrillation Surgery — Part 2


Dr. Argenziano on Atrial Fibrillation Surgery — Part 1


Dr. Cahill on Supplements and Arrhythmia


Dr. Wilber at Heart Rhythm 2009


Dr. Hao on the THERMOCOOL® Catheter Trial


Dr. Damiano on Customized Atrial Fibrillation Treatment


Dr. Edgerton on Atrial Fibrillation Maze Procedure Evolution—13 min


Dr. Prystowsky on Atrial Fibrillation Guidelines for Patients


Dr. Jackman on New Afib and Obstructive Sleep Apnea Findings


Watch Mellanie True Hills’ Atrial Fibrillation Patient Story—20 min


Primary Care Doctor Shortage – How Does the Health Care Law Address


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How to Beat the Doctor Shortage

En español l For years, Marcia Andrews visited the same internist in Washington, D.C. Then she turned 65, got her Medicare card and had to find a new doctor: Her internist was not accepting Medicare patients. Primary care doctors are in such demand now that they can choose not to accept Medicare, whose reimbursements to physicians are lower than private insurance rates.

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More and more people, especially Medicare patients, are having trouble finding a doctor.

The doctor shortage is worse than most people think, says Steven Berk, M.D. dean of the School of Medicine at Texas Tech University. The population is getting older, so there’s a greater need for primary care physicians. At the same time, physicians are getting older, too, and they’re retiring earlier, Berk says. And graying doctors — nearly half the nation’s 830,000 physicians are over age 50 — are seeing fewer patients than they did four years ago, a 2012 Physicians Foundation survey reported.

Soon, this fraying primary care network will face another huge challenge: Under the Affordable Care Act. millions of formerly uninsured men and women will have access to health care.

We need to absorb these 30 million people, and that’s going to be a strain, says Russell Phillips, M.D. director of Harvard Medical School’s new Center for Primary Care.

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A fundamental change

The approach most favored by experts at Harvard and elsewhere is to reshape traditional primary care: from a stream of patients waiting to see one harried doctor to a more efficient team practice in which patients with routine problems are seen by nurse-practitioners and physician assistants — trained specialists with master’s degrees. The team frees the doctor to spend more time with patients with more serious complaints.This change could be as fundamental as the one that took place when most family doctors stopped making Marcus Welby-like house calls.

The Affordable Care Act encourages such a sea change, with provisions that aim to shore up and expand the country’s ailing primary care system while still reducing costs.

The ACA authorizes money to increase the primary care workforce by training more doctors, nurses, nurse-practitioners and physician assistants. It includes more graduate medical education training positions, with priorities for primary care and general surgery, and more money for scholarships and loans for all health professionals. The law expands the number of patients seen at community health centers in areas with too few doctors and increases the number of staffers who work in the centers. It also expands nurse-managed clinics at nursing schools where nurses in training see patients who live in the area.

Another key provision: a 10 percent bonus, through 2015, to primary care doctors who offer services to Medicare patients.

But in these times of shrinking federal budgets, it’s unclear how much ACA primary care money will be available as Congress juggles competing priorities. Congress, for example, already has chopped about $6.25 billion from the ACA’s new $15 billion Prevention and Public Health Fund, which pays for programs to reduce obesity, stop smoking and otherwise promote good health. In addition, federal support for training all types of physicians, including primary care doctors, is targeted for cuts by President Obama and Congress, Republicans and Democrats, says Christiane Mitchell, director of federal affairs for the Association of American Medical Colleges, who calls the proposed cuts catastrophic.

A recent study by the Institute of Medicine and the National Research Council reports that, when compared with citizens of 16 other high-income democracies, including those of Western Europe, Japan and Canada, Americans not only die younger but have poorer overall health. The researchers traced U.S. health disadvantages to a number of causes, including the fact that Americans have more limited access to primary care.

Where have all the doctors gone?

Today, the United States is short about 16,000 primary care doctors — the very doctors (family practitioners, internists and pediatricians) who offer the treatments and preventive screenings that save lives and head off expensive emergency room visits and hospitalizations.

Why the shortage? It starts with huge medical school debts and ends with a doctor who is often overworked and underpaid. While students may enter medical school wanting to practice primary care medicine, they graduate saddled with heavy debt — $250,000 is not unusual — which prompts them to switch to a more lucrative specialty. The starting salary for a primary care physician is $150,000 to $170,000; a radiologist or gastroenterologist can make two to three times that.

Only one in five graduating internal medicine residents plans to go into primary care medicine, the Journal of the American Medical Association reports.

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Looking for a Doctor?

The best place to start is your state medical association. Many provide doctor directories that often include new doctors just setting up practice.

If you’re a Medicare beneficiary, go to medicare.gov . Under Forms, Help and Resources on the home page, select Find doctors, hospitals and facilities. Type in your ZIP code and you’ll get a drop-down menu of medical specialties, including primary care. The tool provides contact information for doctors according to the criteria you enter — geographic location, specialty, etc. Call the office to check whether the doctor is still taking new patients.

Clay Buchanan, a former lawyer, is one of those graduating in May. At 48, the Little Rock, Ark. resident is older than most medical students. He shadowed a family doctor as part of his training — and was hooked. By noon the first day, I loved it, Buchanan says.

New York University and several other colleges are planning to experiment with a three-year program.

Health clinics offer primary care

Community health centers offer another form of primary care. Nationwide, the centers serve 20 million patients a year using a team approach, and are open to all on a sliding fee scale. Under the ACA, they are expected to double their capacity to 40 million patients by 2015. To entice doctors to work at these centers, the National Health Service Corps repays up to $120,000 in loans for each doctor in return for four years’ service.

Technology, including telemedicine — which could reduce patient trips to the doctor’s office — also should help expand health care.

Another way to increase health services is to give physician extenders — nurses and other medical professionals — more autonomy. Patricia Grady, director of the National Institute of Nursing Research at the National Institutes of Health, supports increasing the role of trained nurses, allowing them to set up independent practices where they could do physical exams and advise patients on exercise and diet.

But that position has met with some resistance. The American Academy of Family Physicians and the American Medical Association (AMA) favor training more physicians and nurses but want to keep nurses in teams led by doctors.

Nurses and foreign doctors

Permitting more foreign doctors to practice here also would increase the pool of primary care providers. Last fall, President Obama signed a three-year extension of a visa waiver program that allows states to place 30 foreign medical school graduates a year in medically underserved areas for three years. Most remain in the communities after they satisfy their commitment. Still, the shortage is so acute, even the AMA is lobbying Congress to increase to 50 the number of foreign-educated doctors each state is allowed.

In the meantime, more Americans are anxiously searching for a primary care doctor — or waiting months to see one. Marcia Andrews, whose Washington doctor refused to take Medicare, finally found a new doctor who does. The search took her 18 months.

Marsha Mercer is a freelance journalist who lives in the Washington, D.C. area.

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Palliative care helps patients not ready for hospice #santa #monica #motels

#hospice tampa

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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]
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Parathyroid Hormone (PTH) Test #high #calcium #levels #in #cancer #patients


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Parathyroid Hormone (PTH) Test

What Is a Parathyroid Hormone (PTH) Test?

The four-sectioned parathyroid glands are located in your neck, at the edge of the thyroid gland. They’re responsible for regulating calcium, vitamin D, and phosphorus levels in the blood and bones.

The parathyroid glands release a hormone called parathyroid hormone (PTH), also known as parathormone. PTH helps regulate calcium levels in the blood.

Calcium imbalances in the blood may be a sign of parathyroid gland or PTH issues. Calcium levels in the blood signal the parathyroid glands to release PTH. When calcium levels are low, the parathyroid glands increase PTH production. When calcium levels are high, the glands slow down the secretion of PTH.

Some symptoms and medical conditions may cause your doctor to measure how much PTH is in your blood. Because of the relationship between calcium and PTH in the blood, both are often tested at the same time.

Why Do I Need a Parathyroid Hormone Test?

Healthy calcium levels are essential for your body to function properly. Your doctor may need to measure PTH if:

  • you’re having symptoms of too much calcium in the blood (fatigue, nausea, thirst, abdominal pain)
  • you’re having symptoms of too little calcium in the blood (abdominal pain, muscle cramps, tingling fingers)
  • your blood calcium test comes back abnormal
  • they need to figure out the cause of too much or too little calcium in the blood

Too much calcium could be a sign of hyperparathyroidism. This is a condition caused by overactive parathyroid glands that produce too much PTH. Excess calcium in the blood can lead to kidney stones, irregular heartbeats, and brain abnormalities.

Too little calcium could be a sign of hypoparathyroidism. This is a condition caused by underactive parathyroid glands that aren’t producing enough PTH. Not enough calcium in the blood could lead to:

  • osteomalacia (weakened bones)
  • muscle spasms
  • heart rhythm disturbances
  • tetany (overstimulated nerves)

Your doctor may also order this test to:

  • check parathyroid functioning
  • distinguish between parathyroid-related and nonparathyroid-related disorders
  • monitor the effectiveness of treatment in parathyroid-related issues
  • determine the cause of low phosphorus levels in the blood
  • determine why severe osteoporosis isn’t responding to treatment
  • monitor chronic conditions, such as kidney disease

What Is the Procedure for a Parathyroid Hormone Test?

You’ll need to get your blood drawn for a PTH test. Your doctor will recommend a PTH test:

  • if you have signs of too much or too little calcium in your blood
  • before having hyperparathyroidism surgery
  • to assess the functioning of your parathyroid gland.

Before the Test

You may need to refrain from eating or drinking for a specific period of time before the blood test. Ask your doctor about specific pretest requirements. Before having this test, tell your doctor if you have hemophilia, a history of fainting, or any other condition.

The Test

The process of taking a blood sample for testing is called venipuncture. They usually draw blood from a vein from the inner elbow or back of the hand.

Your doctor or a lab technician will sterilize the area with an antiseptic. Then they’ll wrap a plastic band around your arm to apply pressure and to help your veins swell with blood. After the veins swell, they’ll insert a sterile needle directly into the vein. The blood will collect in an attached vial. When there’s enough blood for the sample, they’ll untie the plastic band and remove the needle from the vein. They’ll clean and bandage the site of the needle insertion if necessary.

Some people experience only slight pain from the needle prick, while others may feel moderate pain, especially if the vein is difficult to locate. It’s common for the spot to throb after the procedure. Some bleeding is also common, as the needle will break the skin. For most people, bleeding is slight and won’t cause any issues.

Infants and Young Children

The testing process may be different for infants and young children. The doctor or lab technician may make a small cut to allow blood to come to the surface. They’ll then use a test strip or slide to collect a small sample of blood. They’ll clean and bandage the area if necessary.

What Do the Test Results Mean?

Your doctor will evaluate your PTH and calcium test results together to assess whether your levels are within normal ranges. If PTH and calcium are in balance, your parathyroid glands are very likely functioning properly.

If PTH levels are low, you may have a condition causing low calcium levels. Or, you may have an issue with your parathyroid glands that’s causing hypoparathyroidism.

If PTH levels are high, you could have hyperparathyroidism. Hyperparathyroidism is commonly due to a benign parathyroid tumor. If PTH levels are normal and calcium levels are low or high, the issue may not be your parathyroid glands.

High PTH levels could indicate:

  • conditions that cause increased phosphorus levels, like chronic kidney disease
  • the body isn’t responding to PTH (pseudohypoparathyroidism)
  • swelling or tumors in the parathyroid glands
  • pregnancy or breastfeeding in a woman (uncommon)

High PTH levels could also indicate a lack of calcium. This could mean you’re not getting enough calcium in your diet. It can also mean that your body isn’t absorbing calcium, or you’re losing calcium through urination.

High PTH levels also point to vitamin D disorders. Maybe you’re not getting enough sunlight, or your body has trouble breaking down, absorbing, or using this vitamin. Vitamin D deficiency can lead to muscle and bone weakness.

Low PTH levels could indicate:

  • an autoimmune disorder
  • cancer originating from another part of the body has spread to the bones
  • you’ve ingested excess calcium over a long period of time (from milk or certain antacids)
  • hypoparathyroidism
  • low levels of magnesium in the blood
  • radiation exposure to the parathyroid glands
  • vitamin D intoxication
  • sarcoidosis (a disease causing inflammation to tissues)

If either PTH or calcium levels are too high or too low, your doctor may want to do additional testing to more clearly identify the problem.


New lockers for Peace Hospice patients #what #is #end #of #life #care

#peace hospice watford

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New lockers for Peace Hospice patients

Peace Hospice Care has been awarded 2,000 from Watford Borough Councils small grants fun to purchase bedside lockers for their Inpatient Unit in Watford.

Published: Wednesday, 20th January 2016

They replaced the original lockers, bought 15 years ago, which were old and no longer fit for purpose. Patients have been delighted with the new lockers which safely store their personal items, help to keep them as independent as possible and keep the rooms tidy and welcoming.

Around 250 patients stay in the unit every year, spending their final days being cared for by a specialist team.

Liz Kennedy, Matron of Peace Hospice Care s Inpatient Unit said: We are so grateful to Watford Borough Council for their contribution towards the purchase of our new bedside lockers in the Inpatient Unit. The new lockers have a larger storage space and easier access with patients being able to use the side openings from bed or chair. The lockers are able to be locked if desired and also support infection control. In addition to all this they look great! Thank you.

Not for profit groups in Watford have the opportunity to apply to the council for a grant of up to 2,000 to help fund a project, equipment or community initiative. The grant is available for local groups who work with the community for the benefit of residents.

Applications can be made up to Friday 5 February 2016 so there are only 3 weeks left to take up this opportunity. Applications for the following financial year will open on 1 April.

Elected Mayor Dorothy Thornhill said: This is a great resource for local groups looking to make a real difference to the community. Please do get in touch with our friendly funding team to find out more.

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Palliative and Supportive Care for Cancer Patients #comfort #care #hospice

#palliative care for cancer patients

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Palliative and Supportive Care

UPMC CancerCenter utilizes the UPMC Palliative and Supportive Institute to extend its array of cancer care services. The program includes a multidisciplinary team of health care professionals dedicated to providing comprehensive and coordinated care to people with life-limiting illnesses and to their families. The palliative care team works with a person’s primary medical team to provide symptom management, family support, psychosocial care, and spiritual care, as well as to assist with discharge planning and integrate inpatient services with outpatient and home-based programs.

Individuals and their families are given consultations regarding prognosis, care goals, and options and education on psychosocial, spiritual, and financial concerns. These consultations are shared with the person’s referring physician, as well as with the nursing staff and other health care providers.

The team cares for people while in the hospital and works with many programs, such as home care, hospice, and nursing homes, to support people after they leave the hospital. Support and comfort are given to the person’s family while they are caring for the patient and during their bereavement.

In addition to the inpatient consultation service, the UPMC Palliative and Supportive Institute provides care for those who are not yet hospitalized for their illness and for recently hospitalized patients. The team’s goal is to maintain the highest quality of life for the longest possible time by developing a treatment plan that may include:

  • Dealing with symptoms such as pain, nausea, and anxiety.
  • Planning for home care and hospice.
  • Coping with psychological and spiritual concerns.

Patients may also be interested in the Outpatient Pain Program at UPMC CancerCenter.





Palliative Care for Cancer Patients in NY #home #health #care

#palliative care for cancer patients

#

What is it?
Cancer is a broad term that encompasses a variety of disease processes that can involve any organ in the body including the blood system. Cancer is caused by abnormal cells that start to grow out of control and destroy normal functioning cells in the process.

What can I expect if I am diagnosed with cancer?
Once you are diagnosed with cancer, you will likely talk to a physician who specializes in treating your type of cancer like an oncologist, hematologist and/or surgeon. They are going to use information about you and your illness such as your age, stage and type of cancer in order to come up with a prognosis and a treatment plan for you.

What questions should I ask and what should I think about?
It is important to make sure that you understand your diagnosis. You should not be afraid to ask your doctor questions. I recommend that you go to your appointments with a friend or loved one so that they can help you to remember what the doctor tells you. It does not hurt to take notes or even to record your visit with the Doctor. You might want to ask your medical provider the following questions:

  1. How did you confirm that this is the correct diagnosis? Is there any chance that the diagnosis is uncertain?
  2. What are my risk factors for getting this problem?
  3. What are my treatment options and how soon do we need to begin?
  4. What are the pros and cons of each treatment option? What happens if I decide to do nothing? How long do I have to decide what I want to do next?
  5. Where can I find more information about this?
  6. What can I expect from this illness?
  7. What are possible side-effects from the treatment?
  8. How will my symptoms be addressed?
  9. Where can I find help with locating counseling and support groups for myself? What about counseling and support for my family and caregivers?
  10. Will I be able to talk with a patient advocate, patient navigator or social worker? (You may want to talk with one of these professionals if you have questions about the financial implications of your diagnosis/treatment, your insurance coverage, taking leave from work, finding help with other social issues such as transportation, housing, etc.)

How can ePalliativeCare.com help?
Use this site to explore links in order to find additional information and resources in your area. If you are a resident of the state of New York and you would like to talk with a palliative care specialist, click on the “Schedule an Appointment” button.





Hospice Help Foundation – Supporting hospice patients – families #north #shore #hospice

#help the hospice

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Since 2008, Hospice Help Foundation has been providing assistance to hospice patients and their families with dire financial need in an effort to ease the burdens that can accompany a terminal diagnosis.

The Foundation grants last wishes to patients and supports the wishes of families for loved ones. We provide assistance for services not covered by Medicare, Medicaid, or private insurance.

Our support can make all the difference in the world to someone. Many struggling patients and families empty their bank accounts to fight a terminal illness, and are left with no financial resources in their final days. The financial and emotional strain at end of life is enormous for people in this situation.

Hospice Help Foundation steps in where insurance and other support falls short, to help patients and families by providing funds for critical items that bring comfort and dignity at end of life.

Examples of how we help include:

  • Providing rent, utilities, and food, enabling hospice patients to remain at home for their final days
  • Paying veterinary bills to keep patients and their pets together
  • Funding ramps, wheelchairs, and scooters, so that people can remain mobile for as long as possible
  • Paying travel fees to bring family members together at the end of life
  • Making last wishes become a reality
  • Funding household purchases and repairs that raise the quality of life for a hospice patient
  • Covering after death expenses for people with the most extreme need who would otherwise not have a dignified burial or cremation

Your donation truly makes a difference for patients in need. Thank you for ensuring that we continue to provide the critical assistance that is not otherwise available to those in need at the end of their lives. Together, we are making our communities a better place to live and a more caring and compassionate place to die.

Learn more about our important work in this interview with our Executive Director, Janet Prescott, on the WTPL FM Pulse radio show Dying to Talk. hosted by the Cremation Society Foundation s Buddy Phaneuf.

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Texas hospice owner ordered nurses to overdose patients, FBI says #motels #florida

#hospice news

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Texas hospice owner ordered nurses to overdose patients, FBI says

DALLAS The owner of a Dallas-area hospice ordered nurses to increase drug dosages for patients to speed their deaths and maximize profits, according to an FBI affidavit.

A copy of the affidavit for a search warrant obtained by KXAS-TV in Dallas-Fort Worth alleges Brad Harris ordered higher dosages for at least four patients at Novus Health Services in Frisco. It’s unclear whether any deaths resulted from overdoses of drugs like morphine.

Harris has not been charged. The FBI on Wednesday declined to say whether an investigation is ongoing.

The warrant refers to an FBI raid on the hospice in September. It alleges Harris sent text messages to workers such as, You need to make this patient go bye-bye. On another occasion, Harris told administrators during a lunch meeting that he wanted to find patients who would die within 24 hours.

In at least one instance, an employee refused to follow orders to increase a dosage, the warrant said.

The document explains that federal reimbursements can diminish the longer a patient receives care. A provider eventually can be forced to return federal payments.

A woman who answered the phone Wednesday at Novus declined to comment. Attempts to reach Harris for comment on Wednesday were unsuccessful. A working number for him could not be found; listings for a Brad Harris in the Dallas and Houston areas had either been disconnected or turned out not to be his. The Associated Press also sent a request for comment to two email addresses believed to be his.

Harris, 34, is an accountant who founded Novus in 2012, according to KXAS, citing state records.

Novus’ website says the company offers hospice and home health care services.

The FBI investigation of Novus, which included interviewing several employees, began in 2014 and initially focused on allegations that the company sought federal reimbursements for patients recruited by Novus who didn’t qualify for services, according to KXAS.





3 Thoughtful Gift Ideas for Hospice Patients – Family – Caregivers Blog

#gifts for hospice patients

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Posted on Sunday November 29, 2015 in Caregiving Tips

When a loved one is on hospice, the greatest gift you can give them is your time. Sit with them as you play their favorite music, read to them or share memories. No gift you give is more valuable than this time together.

For many, though, gift giving is an additional way to show your love around the holidays and special times like birthdays and Mother’s Day. When someone’s on hospice care, traditional gifts like gift cards and new clothing aren’t usually helpful. The transition to celebrating the holidays with a loved one on hospice can be difficult to adapt to, so here are three ideas for practical and thoughtful gifts for someone receiving hospice care. Also be sure to check out our previous article featuring 5 gifts for the terminally ill .

Gift Ideas for Hospice Patients

1. Hot Water Bottle Cover

Hot water bottles are wonderful for giving a hospice patient extra warmth. But, let’s face it: They’re not very attractive. Change that for your loved one with the gift a handmade hot water bottle cover. Etsy has handmade covers in a variety of styles, from cozy crochet to sincere messages and cute animals. Find one that suits your loved one’s personal style and it will give them a smile this winter.

2. Digital Frame

Surround your loved one with beautiful memories of the people they loved by collecting the images on a digital frame. Photos of grandchildren, treasured vacation memories and special moments can be gathered together and added to the digital frame using an SD Card or flash drive. Even when a hospice patient is too tired to read, they can still enjoy the gift of seeing the faces of the people who love them. Digital frames are available in a variety of sizes and prices to suit any budget or space.

3. Messages of Love

Take the idea of memories a step further by setting up an account with Life On Record. Here’s how it works: Relatives and friends call a special toll-free number and share memories and well wishes, letting your loved one know how much they are appreciated and how many lives they have affected. The callers can speak for up to 30 minutes and all the messages can be transferred to a CD or self-playing speaker. The CD will not only be a beautiful gift for your loved one; it will also become a treasured family keepsake for years to come.

Looking for more suggestions? See more gift ideas for the terminally ill on our Pinterest Board.

If you found this information helpful, please share it with your network and community.

Copyright © 2015 Crossroads Hospice. All rights reserved.

Please enable JavaScript to view the comments powered by Disqus.





Deutsche Bank – Goodie bags for terminally ill patients at Dover Park

#dover park hospice

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Goodie bags for terminally ill patients at Dover Park Hospice

June 2014 │ Singapore

15 Global Transaction Banking (GTB) Singapore staff visited Dover Park Hospice on June 6, 2014, to deliver sweet snacks and drinks to terminally ill patients and their families after their lunchtime meals.

Through the generosity of GTB staff, the volunteers raised donations which enabled them to assemble goodie bags with filled with bowls of ‘tau huay’ (soya beancurd) dessert, drinks, snacks and wet wipes for nearly 100 patients. The home-care patients were not forgotten either, with separate bags kept for staff to take on their next patient visits.

It was a touching visit for the volunteers, who felt that they could make a small difference for the patients they met, while gaining a tiny insight into the suffering and difficult times the patients were going through. That afternoon, the volunteers went away feeling that they might have been able to contribute at least a little to the hospice’s aim to “make every moment matter” for the patients.

Joey Han said, “It was comforting to see that patients at Dover Park Hospice are able to live the last days of their life in comfort and with dignity. The quality of care during this transition is made possible by the professional staff and volunteers at Dover Park Hospice.”

Manish Thakur. another volunteer, summed up the experience: “Corporate Responsibility activities where we give back to society and community are always rewarding and blissful experiences. Dover Park Hospice is providing a noble service for the patients during the twilight of their life journey. As they say – There is a lot of difference between human being and being human. A few understand it.

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Hospice Buffalo – End of Life Dreams and Visions: The Patient’s #hospice

#hospice buffalo

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End of Life Dreams and Visions: The Patient s Perspective

By: Sarah Kuszczak, Clinical Research Coordinator

People have been recording accounts of dreams and visions experienced toward the end of life for centuries. Family members and staff here at the Center for Hospice and Palliative Care (CHPC) have long noted that these dreams and visions are often deeply comforting and profoundly meaningful for patients and their families alike. The CHPC research team is conducting a project to examine hospice homecare patients dreams and visions from their perspective and most importantly, to further explore their social and spiritual impact. This project could not be carried out without the Dream Team , a group of nurses, social workers, chaplains, and expressive therapists who ask the patients about their dreams and visions each week during their routine visits. Here are some of their reflections about why they have joined the Dream Team and how it has helped them to improve patient care:

I am passionate about research that will further bolster what we as clinicians do here at Hospice Buffalo. This research study has not only given me an excellent opportunity to advance the field of hospice and palliative care, but also to better get to know the use of sleep and dream assessment in my daily patient care. Kevin McKenzie, Nursing Home team social worker

My favorite aspect of being on the Dream Team is learning about how important dreams are to patient s health. Dreams are an integral part of their approach to sickness and suffering. Ken Keenan, Team 7 11 Nursing Home team chaplain

It is my intention to deepen my understanding of the dying process, while providing support, comfort, and awareness of the process itself. I hope to be able to convey to patients just how normal and natural their dying process is. Annie Allen, expressive therapies

It s another way of connecting with and serving our patients and families Jessica Gallman, Team 9 social worker

I joined the Dream Team to obtain a greater understanding of end of life dreams/visions and their impact on the patient This helps me to educate and assist patients to process their dreams and visions. Amy Whelan, Team 9 nurse

The CHPC research team would like to thank Philip Hubbell, whose generous donation has made this study possible. This study is a follow-up to one that was conducted in the Hospice Inpatient Unit, which you can read about here:
HospiceBuffalo.com/Journeys

About

The official blog for Hospice Buffalo. Stay up-to-date with research findings, Life Transitions Center grief & wellness posts, Hospice Foundation event updates, family and volunteer stories and daily happenings at Hospice Buffalo.

Looking for posts from our Research team? Search key word: RESEARCH.

Want posts on the Foundation? Search key words: EVENTS and FOUNDATION.

Looking for Life Transitions Center? Search key words: LTC, GRIEF, WELLNESS, CAREGIVING or SUPPORT.

Looking for more?
Check out www.hospicebuffalo.com

Me, Elsewhere





Hospice Patients Alliance: Patient Advocates #when #to #call #in #hospice

#hospice patients

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“Serving hospice patients and their families is one of the greatest privileges and trusts a health care professional could ever be granted. Only those staff with great love, sensitivity, and compassion understand the real mission of hospice. Really, it is a “calling.”

“The Constitution of our nation is firmly based upon respect for the sanctity of life, the liberty to live in freedom until a natural death occurs in its own timing.”

– Ron Panzer, Founder, Hospice Patients Alliance

Read what could be the most important book you ever read:

Stealth Euthanasia: Health Care Tyranny in America
(Hospice, Palliative Care and Health Care Reform)

Explains what is happening in our health care system now, even without “death panels.” This web-book is available online at no charge so that everyone can get this vital information. Share this book with others you know!

Click “Buy Now button” above for hard copy printed version .

“Ron Panzer’s knowledge of the health care industry — and its dark side — is exceptional.
Equally exceptional is his dedication to authentically pro-life hospice care.”

“Every person who works in health care, and particularly those who deal with
end-of-life issues, would do well to read Ron’s new e-book,
Stealth Euthanasia: Health Care Tyranny in America .

“Dare I say that many of them are in for a wake-up call!” — Matt Abbott. pro-life journalist

Imposed Death: Stealth Euthanasia Conference
DVDs Now Available!

Did you miss the Imposed Death 2012 Conference on Stealth Euthanasia?
DVDs of the entire conference are available now for only $20.
You can purchase the DVDs online or send a check (made out to Human Life Alliance) to:
Human Life Alliance, 1614 93rd Lane NE, Minneapolis, MN 55449. For more info. call 651.484.1040

Speakers include: Ron Panzer, Pres. of Hospice Patients Alliance, Alex Schadenberg of Euthanasia Prevention Coalition, Julie Grimstad of Life Is Worth Living, Cristen Krebs, RN, DNP of Catholic Hospice of Pittsburgh and Mary Kellett, of Prenatal Partners for Life!

What others have to say: “Thanks again for your advice – it was invaluable.
Knowing there are people like you and your organization is a God send!”

Other books available for immediate download:

Order the Most Complete Guide to Hospice Care available
The Hospice Patients Alliance Family Guide to Hospice Care

Get the answers you need now!
(PDF)

Restoring the Culture of Life
(The Ethics of Life In Healthcare and Society)
(PDF)





Going the Extra Mile for the Hospice and Palliative Patients #dog #rock

#hca hospice care

#

About Campaign

ends 30 Sep 2016, 12 AM

Mr Lim Nghee Huat, a seasoned ultramarathoner, is one of Singapore’s SG50 runners who has been through some of the planet’s toughest foot races. Having completed the 2,500 km for the SG50 celebrations together with another ultramarathoner, he will be taking part in the Ultra Great Britain 320 km on 20 August 2016 to raise funds for HCA Hospice Care. HCA Hospice Care (HCA) is Singapore’s largest home hospice provider which has benefitted more than 60,000 patients since its inception in 1989. Hospice care is most appropriate when a patient no longer benefits from curative treatment and life expectancy is at less than 12 months. Generally focused on pain and symptom control, hospice care enables patients to spend their last days with dignity and have a good quality of life. HCA serves anyone who requires palliative care, regardless of age, religion, ethnicity, nationality and financial status.

About NPO

We understand the medical and psychological needs of patients, caregivers and their families. By managing our patients pain and other symptoms with specialised care and support, we enable them to spend their last days at home, in comfort and dignity, with their families and loved ones. Additionally, we care for the caregivers by providing them with psychosocial support, practical training, and advice at all hours with our 247 hotline. As our home hospice service for adults is provided free-of-charge to all patients under our care, we rely on donations to support what we believe is a basic right: to die with dignity. With your contribution and commitment to helping us, we are confident of achieving our goal to adding life to the days of patients with life-limiting illnesses.

Who’s Fundraising For Us

Be the first to fundraise for us!





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 #motels #in

#care of terminally ill patient

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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.





Palliative Care for Cancer Patients in NY #box #hill #motel

#palliative care for cancer patients

#

What is it?
Cancer is a broad term that encompasses a variety of disease processes that can involve any organ in the body including the blood system. Cancer is caused by abnormal cells that start to grow out of control and destroy normal functioning cells in the process.

What can I expect if I am diagnosed with cancer?
Once you are diagnosed with cancer, you will likely talk to a physician who specializes in treating your type of cancer like an oncologist, hematologist and/or surgeon. They are going to use information about you and your illness such as your age, stage and type of cancer in order to come up with a prognosis and a treatment plan for you.

What questions should I ask and what should I think about?
It is important to make sure that you understand your diagnosis. You should not be afraid to ask your doctor questions. I recommend that you go to your appointments with a friend or loved one so that they can help you to remember what the doctor tells you. It does not hurt to take notes or even to record your visit with the Doctor. You might want to ask your medical provider the following questions:

  1. How did you confirm that this is the correct diagnosis? Is there any chance that the diagnosis is uncertain?
  2. What are my risk factors for getting this problem?
  3. What are my treatment options and how soon do we need to begin?
  4. What are the pros and cons of each treatment option? What happens if I decide to do nothing? How long do I have to decide what I want to do next?
  5. Where can I find more information about this?
  6. What can I expect from this illness?
  7. What are possible side-effects from the treatment?
  8. How will my symptoms be addressed?
  9. Where can I find help with locating counseling and support groups for myself? What about counseling and support for my family and caregivers?
  10. Will I be able to talk with a patient advocate, patient navigator or social worker? (You may want to talk with one of these professionals if you have questions about the financial implications of your diagnosis/treatment, your insurance coverage, taking leave from work, finding help with other social issues such as transportation, housing, etc.)

How can ePalliativeCare.com help?
Use this site to explore links in order to find additional information and resources in your area. If you are a resident of the state of New York and you would like to talk with a palliative care specialist, click on the “Schedule an Appointment” button.





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





Gift Giving Ideas for Home Care Patients #hospice #of #the #north #shore

#gifts for hospice patients

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Gift Giving Ideas for Home Care Patients

Finding the perfect gift for a home care patient can be especially challenging, particularly at the holidays. Family caregivers and other friends can have a difficult time determining what is the best gift to give for a home care recipient, but in these challenging economic times. they are most appreciated.

Liberty HomeCare Hospice Services serves thousands of patients each year in North Carolina, South Carolina and Virginia. Those patients all have different needs and levels of care, but research has indicated that certain gift ideas are often appropriate for most home care patients. Those ideas include:

1. Your time – The best gifts can be free. Those receiving home care can face several hours of quiet time in their homes. A simple afternoon talking to them and checking up on them can make a huge difference. Another valuable gift is taking care of some of a home care patient’s necessities, including their shopping needs and their chores around their home.

2. Your memories – Loved ones receiving home care appreciate things that can remind them of happy times. Homemade cards and gifts from young children are often welcome, and so are photo albums filled with memories. Some caregivers of home care patients create photo albums filled with highlights of the previous year to help a home care patient feel like a bigger part of the family.

3. A warming touch – Many home care patients, particularly seniors, have specific needs in the winter. Some need winter clothes, including sweaters and jackets, and others can also use blankets and slippers. Look for clothes that are easier for seniors, including ones with no buttons, snaps or zippers.

4. Your thoughtfulness – Many home care patients enjoy music, and would appreciate playlists for iPods or other devices. Books also make good gifts, as well as DVDs. Keep in mind that some seniors may need assistance in setting up electronics, so ensure that they understand how to work them when they are by themselves.

For other suggestions, check with your local home care provider or visit http://www.caregifting.com/.





Gift Basket Ideas for Hospice Patients #karaka #tree #motel

#gifts for hospice patients

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Gift Basket Ideas for Hospice Patients

Related Articles

When a patient is placed in hospice care, her life and the lives of friends and family become a waiting game. If the patient is conscious and cognizant, she needs distractions from focusing on the future — and so do her caregivers. Many gifts double as presents for the patient and items to help caregivers deal with the daily care of the patient.

Personal Care

Many terminally ill patients have dry, sensitive skin and appreciate personal-care items. Lotion should be fragrance-free, non-greasy, good for sensitive skin and formulated for hands, face and feet, which get particularly dry. If necessary, purchase separate lotions. Lip balm should be basic, with no peppermint extract or additives that might increase skin dryness or cause a burning or tingling sensation. Add a pair of soft socks already washed in dye-free, perfume-free detergent. If treatment has caused hair loss, purchase a couple of decorative head scarves designed for cancer patients. Hospital and institutional beds usually have standard-issue white sheets, and the pajamas are bland and look like everyone else’s. If the patient is conscious and the facility allows it, pack colorful pajamas and a set of bright sheets to brighten his surroundings. If the person is on hospice at home, a small aromatherapy basket may help mask the scents that often come with illness.

Entertaining Distractions

Both the patient and the caregivers need a break from thinking, so give the individual a basket of entertainment. Include DVDs or Blu-ray discs as well as an assortment of music CDs or a device loaded with playlists. Some hospice patients may have failing eyesight or be too weak to pick up a book, so include audio books in the basket. A deck of cards with decorative backings, dominoes or small board games also serve to pass the time.

For Children

Sitting or lying in a bed can be boring for any child, and many children in hospice care spend most of their time in one room and can’t run around outside. For a child, make a gift basket that includes a soft stuffed animal, books caregivers can read aloud, video games if the patient has the energy to utilize them, CDs or a device with loaded playlists and activity options such as maze books and crayons. For a younger child, purchase books that have plenty of color illustrations. If the patient is too tired to look at books, give poetry books such as those by Shel Silverstein, which can be read to her. Tailor the music to the patient’s preference: Soothing lullabies or classical music might help young children relax, while teens might prefer something a bit more lively.

Comforting Food

If the hospice patient has no dietary restrictions and has the strength and tolerance to eat anything, go all out and fill a basket with his favorite food or desserts. If nausea is a concern, stick to unsalted or low-sodium saltines, cans of low-sodium, all-natural soup and ginger tea. According to American Cancer Society, ginger may affect blood clotting, so if the patient has cancer, have the caregivers check with the doctor to see if ginger-based food is appropriate.





Deutsche Bank – Goodie bags for terminally ill patients at Dover Park

#dover park hospice

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Goodie bags for terminally ill patients at Dover Park Hospice

June 2014 │ Singapore

15 Global Transaction Banking (GTB) Singapore staff visited Dover Park Hospice on June 6, 2014, to deliver sweet snacks and drinks to terminally ill patients and their families after their lunchtime meals.

Through the generosity of GTB staff, the volunteers raised donations which enabled them to assemble goodie bags with filled with bowls of ‘tau huay’ (soya beancurd) dessert, drinks, snacks and wet wipes for nearly 100 patients. The home-care patients were not forgotten either, with separate bags kept for staff to take on their next patient visits.

It was a touching visit for the volunteers, who felt that they could make a small difference for the patients they met, while gaining a tiny insight into the suffering and difficult times the patients were going through. That afternoon, the volunteers went away feeling that they might have been able to contribute at least a little to the hospice’s aim to “make every moment matter” for the patients.

Joey Han said, “It was comforting to see that patients at Dover Park Hospice are able to live the last days of their life in comfort and with dignity. The quality of care during this transition is made possible by the professional staff and volunteers at Dover Park Hospice.”

Manish Thakur. another volunteer, summed up the experience: “Corporate Responsibility activities where we give back to society and community are always rewarding and blissful experiences. Dover Park Hospice is providing a noble service for the patients during the twilight of their life journey. As they say – There is a lot of difference between human being and being human. A few understand it.

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Patients and Families: Good Samaritan Hospice #the #standard #hotel

#good samaritan hospice

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Patients and Families

The best time to talk about hospice care is before there is an immediate need. But regardless of when you begin the process, our team will work with you to understand the unique needs and desires of the patient and their loved ones.

As a non-profit organization, we look at what we do as a calling, not a business. Throughout the Roanoke and New River valleys, our focus is solely on helping patients and their families experience as much joy and love and happiness as possible throughout this journey.

We begin by talking about not just what a patient needs, but what they want. We want to know how we can help make every moment, both big and small, better. We look after the physical, emotional, and spiritual needs of the patient, as well as those around them. And beyond medical and palliative care, we work to help patients and families have positive experiences throughout the journey, moment to moment, day to day, for as long as possible.

To begin a referral, or to set up a chat, call 540.776.0198 (Roanoke) or 540.381.3171 (NRV), or contact our admissions director Kathy Bell .

Good Samaritan Hospice

Good Sam is a member of the National Hospice and Palliative Care Organization, Virginia Association for Hospices the Palliative Care Partnership of the Roanoke Valley

2016 Copyright Good Samaritan Hospice | All rights reserved | Privacy Practices





Going the Extra Mile for the Hospice and Palliative Patients #sarcee #hospice

#hca hospice care

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About Campaign

ends 30 Sep 2016, 12 AM

Mr Lim Nghee Huat, a seasoned ultramarathoner, is one of Singapore’s SG50 runners who has been through some of the planet’s toughest foot races. Having completed the 2,500 km for the SG50 celebrations together with another ultramarathoner, he will be taking part in the Ultra Great Britain 320 km on 20 August 2016 to raise funds for HCA Hospice Care. HCA Hospice Care (HCA) is Singapore’s largest home hospice provider which has benefitted more than 60,000 patients since its inception in 1989. Hospice care is most appropriate when a patient no longer benefits from curative treatment and life expectancy is at less than 12 months. Generally focused on pain and symptom control, hospice care enables patients to spend their last days with dignity and have a good quality of life. HCA serves anyone who requires palliative care, regardless of age, religion, ethnicity, nationality and financial status.

About NPO

We understand the medical and psychological needs of patients, caregivers and their families. By managing our patients pain and other symptoms with specialised care and support, we enable them to spend their last days at home, in comfort and dignity, with their families and loved ones. Additionally, we care for the caregivers by providing them with psychosocial support, practical training, and advice at all hours with our 247 hotline. As our home hospice service for adults is provided free-of-charge to all patients under our care, we rely on donations to support what we believe is a basic right: to die with dignity. With your contribution and commitment to helping us, we are confident of achieving our goal to adding life to the days of patients with life-limiting illnesses.

Who’s Fundraising For Us

Be the first to fundraise for us!





Hospice Patients Alliance – Signs of Approaching Death #home #healthcare

#hospice stages of dying

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SIGNS AND SYMPTOMS OF APPROACHING DEATH

When confronted with approaching death, many of us wonder when exactly will death occur. Many of us ask the question, How much time is left? This can often be a difficult question to answer. The dying do not always cooperate with the predictions of the doctors, nurses or others who tell family members or patients how much time is left.

Hospice staff have frequently observed that even the predictions by physicians about the length of time from the original diagnosis till death is often inaccurate. Many families report that the doctor told us he [the patient] only had so much time left, and he’s lived much longer than that. . or a similar story. Statistical averages do not tell us exactly how long a particular patient has to live; they can only serve as a general guideline or point of reference.

Although statistical averages do not help much in an individual case, there are specific signs of approaching death which may be observed, and which do indicate that death is approaching nearer. Each individual patient is different. Not all individuals will show all of these signs, nor are all of the signs of approaching death always present in every case.

Depending on the type of terminal illness and the metabolic condition of the patient, different signs and symptoms arise. An experienced physician or hospice nurse can often explain these signs and symptoms to you. If you have questions about changes in your loved one’s condition, ask your hospice nurse for an explanation, that is one of the reasons she is serving you.

There are two phases which arise prior to the actual time of death: the pre-active phase of dying, and the active phase of dying. On average, the preactive phase of dying may last approximately two weeks, while on average, the active phase of dying lasts about three days.

We say on average because there are often exceptions to the rule. Some patients have exhibited signs of the preactive phase of dying for a month or longer, while some patients exhibit signs of the active phase of dying for two weeks. Many hospice staff have been fooled into thinking that death was about to occur, when the patient had unusually low blood pressure or longer periods of pausing in the breathing rhythym. However, some patients with these symptoms can suddenly recover and live a week, a month or even longer. Low blood pressure alone or long periods of pausing in the breathing (apnea) are not reliable indicators of imminent death in all cases. God alone knows for sure when death will occur.

Signs of the preactive phase of dying:

increased restlessness, confusion, agitation, inability to stay content in one position and insisting on changing positions frequently (exhausting family and caregivers)

withdrawal from active participation in social activities

increased periods of sleep, lethargy

decreased intake of food and liquids

beginning to show periods of pausing in the breathing (apnea) whether awake or sleeping

patient reports seeing persons who had already died

patient states that he or she is dying

patient requests family visit to settle unfinished business and tie up loose ends

inability to heal or recover from wounds or infections

increased swelling (edema) of either the extremities or the entire body

Signs of the Active Phase of Dying

inability to arouse patient at all (coma) or, ability to only arouse patient with great effort but patient quickly returns to severely unresponsive state (semi-coma)

severe agitation in patient, hallucinations, acting crazy and not in patient’s normal manner or personality

much longer periods of pausing in the breathing (apnea)

dramatic changes in the breathing pattern including apnea, but also including very rapid breathing or cyclic changes in the patterns of breathing (such as slow progressing to very fast and then slow again, or shallow progressing to very deep breathing while also changing rate of breathing to very fast and then slow)

other very abnormal breathing patterns

severely increased respiratory congestion or fluid buildup in lungs

inability to swallow any fluids at all (not taking any food by mouth voluntarily as well)

patient states that he or she is going to die

patient breathing through wide open mouth continuously and no longer can speak even if awake

urinary or bowel incontinence in a patient who was not incontinent before

marked decrease in urine output and darkening color of urine or very abnormal colors (such as red or brown)

blood pressure dropping dramatically from patient’s normal blood pressure range (more than a 20 or 30 point drop)

systolic blood pressure below 70, diastolic blood pressure below 50

patient’s extremities (such as hands, arms, feet and legs) feel very cold to touch

patient complains that his or her legs/feet are numb and cannot be felt at all

cyanosis, or a bluish or purple coloring to the patients arms and legs, especially the feet, knees, and hands)

patient’s body is held in rigid unchanging position

jaw drop; the patient’s jaw is no longer held straight and may drop to the side their head is lying towards

Although all patients do not show all of these signs, many of these signs will be seen in some patients. The reason for the tradition of keeping a vigil when someone is dying is that we really don’t know exactly when death will occur until it is obviously happening. If you wish to be there with your loved one when death occurs, keeping a vigil at the bedside is part of the process.

Always remember that your loved one can often hear you even up till the very end, even though he or she cannot respond by speaking. Your loving presence at the bedside can be a great expression of your love for your loved one and help him to feel calmer and more at peace at the time of death.

If you have questions about any of the changing signs or symptoms appearing in your loved one, ask your hospice nurse to explain them to you.





Caring for Terminally ill Patients – The New Indian Express #online #hotels

#care of terminally ill patient

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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.





Nurses play vital role in care of terminally ill patients – UQ

#care of terminally ill patient

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Nurses play vital role in care of terminally ill patients

Nurses play a crucial role in decisions surrounding treatment of terminally ill patients.

10 November 2014

A University of Queensland study has found nurses play a crucial role in decisions surrounding treatment of terminally ill patients.

UQ School of Social Science Associate Professor Alex Broom said dying patients who were told further treatment would be futile often turned to nurses for emotional support.

The transition to end-of-life care has traditionally been the doctor s decision, Dr Broom said.

The study shows how important nurses are in decisions about when life-prolonging treatments should end and in supporting patients and families in the process of accepting that they are dying.

Nurses often bear the brunt of patient and family grief as the end of life nears.

Nurses spend so much time with patients that they are often in a better position than doctors to know how patients are really coping with often highly toxic, technically life-prolonging treatments.

The study found that patients would often put on a brave face when their doctor was present and then ask the nurse to tell the doctor they d had enough.

This can put the nurse in a difficult position professionally, placing them as mediator between doctor, patient and often-panicked family members.

Nurses in the study said communicating with patients and families was much easier when doctors had already spoken openly and honestly with patients about the fact that it was time to stop active treatment.

A major problem for nurses is that some doctors avoid difficult conversations; even continuing patients on active treatment, while others were rushed or blunt, leaving the nurse to explain the situation and provide emotional support to patients and their families, Dr Broom said.

The study involved 20 Australian nurses from Brisbane hospitals, mostly consisting of cancer nurses.

The study explored their experiences of caring in the context of medical futility.

Nurses in the study emphasised the emotional toll of caring for patients and families at the end of life, the need to balance caring with protecting themselves from burnout, and the fact that there was very limited debriefing or counselling provided.

It s not uncommon for a nurse to have to walk out of a room where a patient they have known for months or years has just died, straight into a finance meeting or to treat another patient, without five minutes to themselves to reflect on the previous patient s death, Dr Broom said.

While the nurses discussed the rewards of being involved in the transition to end-of-life care, they emphasised the mounting pressures on the nursing profession to engage in technical, task-orientated work and how this could compromise their capacity to support patients nearing the end of life.

The results of the study show that nurses play a much greater role than previously thought in decisions about medical futility, and that their role as a crucial mediator and support provider in this context is increasingly challenged by the growing unrealistic expectations placed on nurses working in Australian hospitals, Dr Broom said.

Results of this study were published in the journal Qualitative Health Research in October.





Hospice El Paso, Texas – Care for Terminally Ill Patients #motels #in

#hospice of el paso

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Careers

At Hospice El Paso, we improve the quality of life for patients facing terminal illnesses and provide support for their loved ones.

If one of your goals is to make a difference with your work and you think hospice work is for you, come and join our team of caregivers, registered nurses, physicians, home healthcare aides, social workers, chaplains, bereavement counselors and trained volunteers.

For more information on job openings please click on the Application for Employment link.

Hospice El Paso is proud to be an Equal Opportunity Employer.


Please fill out this form as completely and accurately as possible. We will receive and follow the Employment Application submitted online.

Depending on your connection speed, this form will take approximately 1 min. to load.

You will need Adobe Reader in order
to open this file. Please visit http://get.adobe.com/reader/
to download Adobe Reader for Free.

You may also drop or mail applications to the following address:

Hospice El Paso
1440 Miracle Way
El Paso, Texas 79925

Fax to:
Human Resources
915-532-7822





Cancer Patients #macmillan #hospices

#hospice for cancer patients

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Cancer Patients

Hospice Care for Cancer Patients

Tidewell Hospice partners with you to assist in the management of care for patients with cancer. Tidewell’s hospice program assists physicians, patients and family with managing the symptoms of cancer at home.

The goals of hospice care for oncology patients are to:

  • Closely monitor and manage symptoms to reduce episodes of crisis.
  • Reduce hospital days and emergency department visits.
  • Increase the ability of patients to cope with the illness.
  • Increase family caregiver confidence and coping.
  • Improve quality of life and help patients accomplish important goals
  • Tidewell Hospice helps patients meet these goals through:
  • Regularly scheduled visits by staff with specialized training in symptom man­agement including care for symptoms specific to cancer.
  • Specialized protocols and treatment path­ways designed for end-stage disease.

When is Hospice Appropriate for Cancer Patients?

Any patient with advanced cancer may be ap­propriate for referral to hospice care. It may be appropriate to initiate a hospice assessment if a patient has experienced any of the following:

  • Disease with metastasis.
  • Multiple symptoms or other disease involvement.
  • Uncontrolled pain.
  • Symptoms that impede adequate nutrition such as dry mouth or dysphagia.
  • Rapid decline in functional status in combi­nation with other symptoms.
  • Documented clinical decline over the past six months.
  • Frequent hospitalizations, office or ER visits.
  • Serum albumin 2.5 gm/dl.

Note: These factors are general medical guidelines and are not intended to be strict crite­ria. The decision to admit a patient to hospice is based on the clinical guidelines and each patient’s unique needs. Please call a Tidewell Hospice phy­sician at (941) 894-1777 or (866) 833-3753 to discuss your patient’s specific need

Benefits of Early Referral for Cancer Patients

Studies show that most Americans prefer to receive end-of-life care at home. The earlier they are referred to hospice care the bet­ter their chances at remaining at home with their family. The families of hospice patients often indicate that they wish their loved one had been referred to hospice sooner. Hospice ensures patients and their families optimal quality of life.

An earlier referral to hospice:

  • Allows specialized pain and symptom management to begin sooner.
  • Prevents emergency room visits and readmission to the hospital.
  • Provides patients and families time to deal with practical issues such as wills and advanced care plans.
  • Encourages meaningful conversations and a chance to say “goodbye.”
  • Provides family support and education that helps relieve the stress and exhaus­tion often experienced by caregivers.

Contact Tidewell Hospice Admissions at (941) 894-1777 to refer patients for hospice care or for assistance in receiving reimbursement for care you provide for your patients receiving hospice care.

How Tidewell Supports Oncologists

The valuable physician-patient relationship doesn’t have to change when a cardiac patient is admitted to hospice. Physicians can stay involved, but with added resources provided by Tidewell.

  • You can still see the patient in your office and bill Medicare and other insurers for the services you provide.
  • Tidewell can help your office with billing concerns related to hospice care.
  • Continuous and customized commu­nication from the Tidewell care team regarding your patient’s care plan and status.
  • You can consult with any member of Tidewell’s interdisciplinary team about your patient’s care.
  • Intensive pain and symptom manage­ment can reduce emergency room visits, repeat hospitalizations and calls to your office.
  • Tidewell doctors are available to follow your patient and relieve the burden of writing prescriptions and other paper­work.
  • All medications, supplies and durable medical equipment are provided and managed by Tidewell.
  • Tidewell provides 24/7 support to your patient, decreasing the demand on you and your staff

Contact Tidewell Hospice Admissions at (941) 894-1777 to refer patients for hospice care or for assistance in receiving reimbursement for care you provide for your patients receiving hospice care.

Excellence In Service

Tidewell reinforced its reputation as one of the premier hospices in the nation when the prestigious Community Health Accreditation Program (CHAP) once again issued Tidewell accreditation with deemed status, signifying a gold standard of excellence among hospice care providers. Created in 1965 as a joint venture between the American Public Health Association and the National League of Nursing, CHAP was the first accrediting body for community-based health care organizations in the U.S.

Tidewell Event Calendar

  • September 5, 2016 3:00 pm Newly Bereaved Group: RSVP 941-894-1794
  • September 15, 2016 2:30 pm Grief Loss Support Group – Ellenton
  • September 19, 2016 6:00 pm Survivors of Suicide: family and friends of victims – Sarasota
  • September 20, 2016 2:00 pm Spousal Loss Support Group – Sarasota

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Cynthia Spencer and Cransley hospice patients will suffer from cuts – BBC

#cynthia spencer hospice

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Cynthia Spencer and Cransley hospice patients ‘will suffer’ from cuts

Image caption Cransley Hospice (top) at St Mary’s Hospital in Kettering and Cynthia Spencer Hospice (bottom) in Northampton both face funding cuts

NHS cuts proposed at two Northamptonshire hospices will lead to patients and families “suffering”, the Labour party has warned.

The service plans to cut funding at Kettering’s Cransley and Northampton’s Cynthia Spencer hospices to save money.

John McGhee, leader of the Labour group at the county council, said cutbacks “will affect the quality of services”.

The NHS said it had to make savings, but had withdrawn its initial figure of £2m which will be discussed further.

A Nene Clinical Commissioning Group (NCCG) spokeswoman said it planned to meet Labour councillors on Thursday to try and answer their concerns.

Mr McGhee said: “It would seem from the clinical commissioning group’s latest statement that once again the hard working people of Northamptonshire are being left to pick up the tab after cutbacks.

“There is no doubt in my mind that these cuts will affect the quality of the services being provided. Ultimately, patients and their families will suffer.”

‘Enhanced service’

An NCCG statement said: “In the original delivery plan a potential reduction in £2m of funding was mentioned.

“Following the ongoing engagement and feedback with hospice trustees, the original figures stated have been withdrawn.

“We continue to discuss what the alternative position should be, but are considering an enhanced service not a reduced one.”

The NCCG said it hoped to fill any cutback in funding with an increase in charitable fundraising and by making changes to its services that reduce demand on its core funds.

It currently contributes 70% (£3.1m) towards the running costs of the hospices, with charitable trusts putting in 30%, which it says is out of proportion with the rest of the country.

Both hospices provide care for people whose illnesses are no longer curable, including many cancer patients.

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