National Hospice & Palliative Care Month

pall

Most people have heard of hospice care and have a general idea of what services hospice provides. What they don’t know or what may become confusing is that hospice provides “palliative care,” and that palliative care is both a method of administering “comfort” care and increasingly, an administered system of palliative care offered most prevalently by hospices and hospitals. As an adjunct or supplement to some of the more “traditional” care options, both hospice and palliative care protocols call for patients to receive a combined approach where medications, day-to-day care, equipment, bereavement counseling, and symptom treatment are administered through a single program. Where palliative care programs and hospice care programs differ greatly is in the care location, timing, payment, and eligibility for services. Do you know your options when it comes to Hospice and Community Based Palliative Care? The information in this blog will give you a brief summary of what options are available.

Place:

Hospice
Hospice programs far outnumber palliative care programs. Generally, once enrolled through a referral, a patient’s hospice care program, which is overseen by a team of hospice professionals, is administered in the home. Hospice often relies upon the family caregiver, as well as a visiting hospice interdisciplinary team. While hospice can provide round-the-clock care in a nursing home, a specially equipped hospice facility, or, on occasion, in a hospital, this is not the norm.

Community Based Palliative Care
Palliative care has been enjoying significant growth in the US during the past several years, primarily within hospital settings. This approach has significant value and there is now ample evidence showing positive outcomes for patients receiving hospital-based palliative care. Waiting for a hospitalization to trigger discussions of goals of care, however, may lead to unnecessary suffering. Intervening earlier in the continuum of care for patients with chronic and advanced illnesses can significantly reduce the burden of illness, improve quality of life and prognosis as well as reduce overall healthcare expenditures, while at the same time, aligning expense with meaningful care. Thus community-based models of palliative care are emerging. Generally, once enrolled through a referral, a patient’s community based palliative care program, which is overseen by a team of hospice professionals, is administered in the home. Hospice programs are well versed in providing home-based services to patients with far advanced illness and their families in an interdisciplinary, holistic manner that attends to multiple facets of need; physical, emotional, social and spiritual. Involving the interdisciplinary team earlier in the care of patients with advanced illness presents unique challenges and requires new competencies and systems of care delivery. Community based palliative care programs ensure patients and their families have access to care options that best meet their individual needs while in their home, an assisted living or even a nursing home.

Timing:

Hospice
You must be considered to be terminally ill or have a prognosis of six months or less to be eligible for most hospice programs or to receive hospice benefits from your insurance.

Community Based Palliative Care
There is no time restrictions to receive community based palliative care. The patient must have a life limiting disease to be eligible for Community based palliative care. Community based palliative care can be received by patients at any time, at any stage of illness whether it be terminal or not.

Payment:

Hospice
Before considering hospice, it is important to check on policy limits for payment. While hospice can be considered an all-inclusive treatment in terms of payment (hospice programs cover almost all expenses) insurance coverage for hospice can vary. Some hospice programs offer subsidized care for the economically disadvantaged, or for patients not covered under their own insurance. Many hospice programs are covered under Medicare, Medicaid and most private Insurances.

Community Based Palliative Care
Since this service will generally be administered through a hospice medical provider; it is likely that it is covered by your regular medical insurance. It is important to note, however, that each item will be billed separately, just as they are with regular doctor visits. If you receive outpatient palliative care, prescriptions will be billed separately and are only covered as provided by your regular insurance. For more details, check with your insurance company, doctor, or hospice administration.

Treatment:

Hospice
Most programs concentrate on comfort rather than aggressive disease abatement. By electing to forego extensive life-prolonging treatment, hospice patients can concentrate on getting the most out of the time they have left, without some of the negative side-effects that life prolonging treatments can have. Most hospice patients can achieve a level of comfort that allows them to concentrate on the emotional and practical issues of dying.

Community Based Palliative Care

Since there are no time limits on when you can receive community based palliative care, it acts to fill the gap for patients who want and need comfort at any stage of a life limiting disease, whether terminal or chronic. In a community based palliative care program, there is no expectation that life-prolonging therapies will be avoided.

If you would like more information about Front Range Hospice and Palliative Care please call 303-957-3101 or 970-776-8080 or email us at info@frhospice.com

#hpm #hospicemonth #hospiceawareness

 

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Press Release

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Press Release:

Front Range Hospice, a leading hospice in the Front Range, has changed its name to reflect the addition of Community Based Palliative Care. Front Range Hospice & Palliative Care has developed its program to bring comprehensive palliative care to the home environment. Palliative Care is now common within hospital settings. Yet, waiting for an emergency room visit or a hospitalization to trigger discussions of goals of care can lead to unnecessary suffering.  The Joint Commission, which is considered the Gold Standard in healthcare announced on July 1, 2016 that it was now offering a certification for Community Based Palliative Care. “Front Range Hospice & Palliative Care’s program was developed to meet the Joint Commission standard and we will be applying for that certification”, says Pam Ware, CEO and Founder of Front Range Hospice & Palliative Care.

Martha Twaddle, M.D. stated at a recent National Hospice and Palliative Care conference that “intervening earlier in the continuum of care for patients with chronic and advanced illnesses can significantly reduce the burden of illness, improve quality of life and prognosis as well as reduce overall healthcare expenditures, while at the same time, aligning expense with meaningful care.” After much research, Pam Ware came to the conclusion that a well-designed community based palliative care program was needed if the healthcare community in the Front Range was going to be able to reach the Triple Aim which is the goal of healthcare. The Triple Aim refers to improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.

Under the guidance of a Hospice and Palliative Care certified physician, Dr. Mark Sanazaro, the Community Based Palliative Care program will provide nurse practitioners, clinical social workers, chaplains and volunteers to individuals with life threatening diseases. The goal is through symptom management, education, and counseling, individuals and their families in the program will learn how to Make Best Days Possible while living with a life threatening illness. For further information please call 303-957-3101 or 970-776-8080 or email at info@frhospice.com.

 

3770 Puritan Way, Suite E – Frederick, CO 80516

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What to Ask When Looking For a Hospice

What to Ask When Looking For a Hospice
We Are Not the Same

By Victor Montour

questions

When people are trying to make decisions about which hospice to enroll in, most want to choose a hospice that will deliver the best possible care for whatever time they have left. With the vast number of hospices in the area and the ongoing local press grouping the area hospices as if we are all the same, we thought it was time to revisit this very important topic.

Hospice care is not just hospice care. The care you receive from a hospice agency will vary. WE ARE NOT ALL THE SAME. Each hospice agency has their own staffing model, policies and procedures, response time to a patients needs and so on. As you may know from our Hospice Survey blog, in the past not all hospices measure patient outcomes or quality improvement. Just recently all hospices are required to collect this data and make it public to the consumer. The down side to this is the consumer will not see these results until sometime in 2017 unless they ask. If you haven’t read our blog “Hospice Survey” I encourage you to read it next. Front Range Hospice has been collecting data for years so we can prove that our patients and families receive legendary end of life care. So in an effort to assist you again, here is a list of questions you or your family need to know and ask while looking for a hospice agency to help you.

  • A a consumer you have the right to choose the hospice of your choice. It is unlawful for a healthcare professional to pressure you or make you use a hospice that you have not chosen.
  • You can ask your doctor for advice. Your doctor may be able to tell you the names of the hospices he or she have used in the past and their experience working with them. But also ask your doctor if he or she has a financial relationship with that hospice. Some doctors are employed by hospices, and may have a financial incentive to refer. Patient’s choice trumps doctor’s choice. That is the law.
  • If a referral to hospice needs to be made while you’re in an acute care hospital setting, again you will want to ask if the hospice is affiliated to or owned by the hospital. Some hospital systems strongly encourage their staff to refer to the hospital owned hospice with little regard to the patient’s wishes or choice. Remember you have the right to choice and must be allowed to choose the hospice you want to use.
  • A hospice that is owned or affiliated with a hospital is not the same as a hospital that has a preferred provider relationship with a hospice. These relationships are developed over time and are the result of the hospital’s experience with that hospice. Do not be afraid to ask how that decision came about. A hospital usually makes that decision based on the responsiveness, the feedback they receive from patients and families, the quality data and

As you are doing your due diligence I recommend you call the hospices in your area. Set up a time to interview your choices. During this interview you as a consumer should find out what you can expect from the hospice. Use this scorecard as a guide: Scorecard

  • What services they provide? And when are the services provided? Listen to see if the hospice will work around your needs and preferences or are you put into a model of care that is centered around the hospice and its staff.
  • What is the nurse to patient ratio? The National Hospice and Palliative Care Organization staffing guidelines recommend 10-12patients per registered nurses, 30 patients for social workers and 40 patients for chaplains.
  • Does the hospice provide all four levels of hospice care?” (That’s routine home care, inpatient care, continuous care at home, and respite care). Medicare-certified hospices are required to provide all four, but many don’t. To learn more about the four levels of care in hospice check out our blog Do You Know The Four Levels of Care
  • One of the most important questions to ask: “Is your hospice certified by The Joint Commission (TJC) or the Community Health Accreditation (CHAP)?” This is voluntary participation by the hospice and a commitment to meet the highest standards in the industry. TJC is considered the Gold Standard. Surveyors from these organizations visit and inspect hospices regularly. As a consumer you have the right to see the results from the inspections. You will want to look for any patient care issues. A hospice with a large number of deficiencies, especially in patient care should be avoided as a consumer.
  • Another very important question to ask is “Are your physicians board-certified in hospice and palliative care?” This is a good indication that a hospice takes its medical care very seriously.
  • You will want to ask the hospice “do you allow your patients to utilize their primary care physician (PCP) while receiving hospice services?” If the hospice tells you that you have to use the hospice physician, beware again. As a consumer you have the right to use your PCP as the physician to direct your care on hospice. This being said, you may have to change physicians if you choose to be placed in a skilled nursing facility or are receiving care in a facility that only allows physicians to provide care that are credentialed to provide care in the said facility.
  • Ask “Does the hospice measure and improve the quality of care that they provide to their patients”? If they reply yes your next question needs to be How?” Any hospice that doesn’t have a quick and clear answer for this question probably isn’t serious about patient care. Then ask “can I see the results?” If no, move on. If yes look at the data, ask questions, and make sure that the data comes from an independent 3rd
  • Does the hospice have any special programs or other certifications?
  • You could ask what makes their hospice stand out among the rest.

Finally, one last word of advice. Choosing wisely takes time. So start thinking early about what hospice you’d want when the time comes. How early? People typically enroll in hospice very late. More than half of patients in the U.S. enroll in the last three weeks of life, and about a third enroll in the last week. That’s too late to make careful decisions. So start asking questions now. Think of it as insurance, so when the time comes — as it will, for most of us — you’ll be ready to make a thoughtful choice that is consistent with your preferences.

If you would like more information about Front Range Hospice please call 303-957-3101 or 970-776-8080 or email us at info@frhospice.com

 

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Liver Disease

By Victor Montour

liver disease

The liver plays an important role in many bodily functions from protein production and blood clotting to cholesterol, glucose (sugar), and iron metabolism. A variety of illnesses can have a negative effect on the liver causing liver disease.

The Progression of Liver Disease

There are many different types of liver disease. But no matter what type you have, the damage to your liver is likely to progress in a similar way.

Whether your liver is infected with a virus, injured by chemicals, or under attack from your own immune system, the basic danger is the same – that your liver will become so damaged that it can no longer work to keep you alive.

Anything that keeps your liver from doing its job may put your life in danger.

The Healthy Liver

Your liver helps fight infections and cleans your blood. It also helps digest food and stores energy for when you need it. A healthy liver has the amazing ability to grow back, or regenerate, when it is damaged. Anything that keeps your liver from doing its job – or from growing back after injury – may put your life in danger.

Inflammation

In the early stage of any liver disease, your liver may become inflamed. It may become tender and enlarged. Inflammation shows that your body is trying to fight an infection or heal an injury. But if the inflammation continues over time, it can start to hurt your liver permanently.

When most other parts of your body become inflamed, you can feel it – the area becomes hot and painful. But an inflamed liver may cause you no discomfort at all.

If your liver disease is diagnosed and treated successfully at this stage, the inflammation may go away.

Fibrosis

If left untreated, the inflamed liver will start to scar. As excess scar tissue grows, it replaces healthy liver tissue. This process is called fibrosis. (Scar tissue is a kind of fibrous tissue.)

Scar tissue cannot do the work that healthy liver tissue can. Moreover, scar tissue can keep blood from flowing through your liver. As more scar tissue builds up, your liver may not work as well as it once did. Or, the healthy part of your liver has to work harder to make up for the scarred part.

If your liver disease is diagnosed and treated successfully at this stage, there’s still a chance that your liver can heal itself over time.  But if left untreated, your liver may become so seriously scarred that it can no longer heal itself. This stage – when the damage cannot be reversed – is called cirrhosis.

Cirrhosis can lead to a number of complications, including liver cancer. In some people, the symptoms of cirrhosis may be the first signs of liver disease.

Liver cancer that starts in the liver is called primary liver cancer. Cirrhosis and hepatitis B are leading risk factors for primary liver cancer. But cancer can develop in the liver at any stage in the progression of liver disease.

  • You may bleed or bruise easily.
  • Water may build up in your legs and/or abdomen.
  • Your skin and eyes may take on a yellow color, a condition called jaundice.
  • Your skin may itch intensely.
  • In blood vessels leading to your liver, the blood may back up because of blockage. These blood vessels may burst.
  • You may become more sensitive to medications and their side effects.
  • You may develop insulin resistance and type-2 diabetes.
  • Toxins may build up in your brain, causing problems with concentration, memory, sleeping, or other mental functions.

Once you’ve been diagnosed with cirrhosis, treatment will focus on keeping your condition from getting worse. It may be possible to stop or slow the liver damage. It is important to protect the healthy liver tissue you have left.

Liver failure

Liver failure means that your liver is losing or has lost all of its function. It is a life-threatening condition that demands urgent medical care.

The first symptoms of liver failure are often nausea, loss of appetite, fatigue, and diarrhea. Because these symptoms can have any number of causes, it may be hard to tell that the liver is failing.

Liver failure is a life-threatening condition that demands urgent medical care and symptom management.

But as liver failure progresses, the symptoms become more serious. The patient may become confused and disoriented, and extremely sleepy. There is a risk of coma and death. Immediate treatment is needed. The medical team will try to save whatever part of the liver that still works. If this is not possible, the only option may be a liver transplant.

When liver failure occurs as a result of cirrhosis, it usually means that the liver has been failing gradually for some time, possibly for years. This is called chronic liver failure.

Chronic liver failure can also be caused by malnutrition. More rarely, liver failure can occur suddenly, in as little as 48 hours. This is called acute liver failure and is usually a reaction to poisoning or a medication overdose.

Cirrhosis, liver cancer, and liver failure are serious conditions that can threaten your life. Once you have reached these stages of liver disease, your treatment options may be very limited. If your doctor has told you treatment options are limited or not an option, remember you always have Front Range Hospice as an option. We may not be able to cure your liver disease, but we can manage the symptoms of your illness.

If you would like more information about Front Range Hospice and how we can manage your symptoms from liver disease please call 303-957-3101 or 970-776-8080 or email us at info@frhospice.com

 

 

 

 

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Anticipatory Grief-What is it and Why?

Anticipatory Grief-What is it and Why?
By Nichole Williams, MSW

Grief

“When will the grief go away?” is often a question that we as grievers, and our family and friends, say to ourselves, or one another.  We expect that these feelings will disappear after a certain time frame, sometimes people want us to “get over it.”  Grief doesn’t go away, but in turning inward to work through our grief, we grow emotionally and spiritually. We will heal in some ways, but life will never be the same as it was before.  Often times the grief begins before our loved one passes away, often it begins the day our loved one is diagnosed with their illness.  We call this Anticipatory Grief.  The feelings are much the same, with tightness in our chest, feeling out of control, being emotional, feeling scared, wanting to “wake up from this nightmare”, and questioning the meaning of life.  Anticipatory grief is not just about the future death of our loved one, but also the losses that are already occurring.

I have counseled many patients and their loved ones on what anticipatory grief is, what it feels like, and what to do about it. We grieve because we love this person, and we cannot imagine what life will be like without them.  It is often a confusing time, and often feels stressful.  We are aware of their decline, and we wonder what life will be like without them.  We grieve the loss of their abilities, the loss of future dreams, the loss of their cognition, and the loss of what life once was.  Often times, during this time, our roles change in our relationship. It is hard to go from being wife, husband, daughter, son, father, mother, sister, brother, friend to being caregiver.  We are challenged to provide the best care possible, and be strong for our loved ones.  Our loved one may be changing before our eyes and it is hard to watch.  We may wonder if we are “doing enough.”  We bear witness to their pain and suffering while loving them to the best of our ability.

Our loved ones who are dying also experience anticipatory grief.  I have spent many moments with patients and their family members helping them share their feelings with one another about what is important to them at this time in their lives.  Some people feel that they need time to reconcile or heal their relationship with someone in their life.  Some people want to celebrate their lives, spending time with those who are important to them, and to reflect on their lives.  Saying goodbye to those they love is hard.  Often cognitive impairment due to Alzheimer’s or other related Dementia is especially challenging for the caregiver as they may not know what their loved ones wants or needs are.

An important part of coping with these feelings is first to recognize them, and second, to accept that anticipatory grief is normal.  It is important to find an outlet for sharing these feelings.  Some people find talking to be helpful, others may want to read books or articles, and others may find walking in nature to be a comfort.  In acknowledging our losses, people can process the emotions that they may be feeling.  There is a common myth that if one “holds it all in and be strong” that it will help in “not feeling” the feelings that one is having.  By focusing on the reality of what is happening, and putting words to how one is feeling, it can create opportunities to hold on to one another.  Each person is going to experience and cope with anticipatory grief in different ways, but by keeping the lines of communication open, it can help everyone better understand one another at a really meaningful time.

Another important part of dealing with anticipatory grief is to take care of yourself-which is often challenging while caring for your loved one-but there are resources!  The saying goes “you can’t take care of others if you don’t care of yourself”, and I truly believe this to be true.  Caregiving and anticipatory grief can be a long road, and people need to utilize their support systems to continue providing care to their loved ones.  Asking a friend or family member to stay with your loved one so you can get out of the house or take a nap goes a long way.  Some people find that counseling is helpful to have a place to process complicated emotions without “burdening” someone. This is another way to take some “me time.”  Anticipatory grief is a natural part of losing someone we love.  We grieve because we love.

As the bereavement coordinator at Front Range Hospice, I provide counseling, grief education, and grief resources to patients, family members, and community members.  I see myself as a companion to people who are grieving.  I try to provide an empathetic, warm, caring, compassionate presence and space to hear people’s stories, and assist people in processing their feelings.

If you would like more information about Front Range Hospice and how we can support you through your grief process call 303-957-3101 or 970-776-8080 or email us at info@frhospice.com

Watch out for our next blog: Liver Disease

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Zero Care Deficiencies

By: Victor Montour

frh

Our community partner The Peaks Care Center just completed their annual survey and re-certification process with Zero Care Deficiencies. The team at the Peaks Care Center works very hard to exceed the states minimum standards while remaining patient centered. A Zero Care Deficiency survey is not an easy task to accomplish.

You see, nursing homes participating in Medicare and Medicaid are required by federal law to undergo an annual survey and certification process by its state’s health department. Homes must be in substantial compliance with Medicare and Medicaid requirements, as well as state law in order to re-certify.

Nursing home regulations require each facility to have its latest survey results readily available for review. The survey assesses whether the quality of care, as intended by the law and regulations and as needed by the resident, is being provided in the nursing home.

If a nursing home is found to be violating nursing home regulations, federal law enforcement options include denying payment for new admissions, fining the home, revoking Medicaid and Medicare certifications, transferring residents, and imposing temporary management.

The survey and certification process establishes several expectations of nursing homes, including:

  • Nursing homes participating in Medicare and Medicaid programs must remain in substantial compliance with the Medicaid/Medicare care requirements
  • All deficiencies will be addressed promptly
  • Residents will receive the care and services they need to meet their highest practicable level of functioning

If the annual certification survey finds a nursing home is deficient because it doesn’t meet a requirement of the federal nursing home regulations, the deficiency is recorded in a Survey Report Form. Deficiencies alleged by staff, residents or family members must be confirmed through records, interviews and observations. If staff, resident or family allegations are not confirmed through records, interviews, or observations, the nursing home cannot be cited as deficient. Once a survey team determines that deficiencies exist, it decides the seriousness of the violations. It looks at whether the deficiency status constitutes immediate jeopardy or actual harm, as well as whether the deficiency is isolated, constitutes a pattern or is widespread.

The Medicare website lists the most recent federal survey results, populations of the nursing homes surveyed and facts about nursing homes’ ownership.

All of us at Front Range Hospice congratulate The Peaks Care Center for this awesome accomplishment. If you would like more information about The Peaks Care Center or Front Range Hospice please call 303-957-3101 or 970-776-8080

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Thank you to our Veteran Volunteers

By Nichole Williams, MSW

 

FRH Mem. Day

 

We at Front Range Hospice would like to wish all of those who have served our Country a wonderful Memorial Day!

As part of the We Honor Veterans Level IV program, Front Range Hospice matches veteran volunteers to veteran patients.  This program developed out of the need for special care of veteran patients, due to their unique circumstances at the end of life.  In matching veteran volunteers with veteran patients, it is important to assess veteran volunteers’ military history and experience, to ensure there are no barriers in them serving patients and families.

As the Volunteer Coordinator for Front Range Hospice, I gather information from the veteran volunteers regarding what branch they served in, what their rank was, and if they were a combat veteran or non-combat veteran.  In addition, I inquire about their loss history, assess their level of comfort in being with the dying, and assess their comfort level in being with patients as they share their emotions.  I also discuss any service related trauma that they may have, and how they manage any ongoing mental health needs that they may have.

Veteran volunteers bring their military background and experience to their work in hospice, which allows them to offer life review and healing to patients who are veterans.  Being a veteran volunteer takes special skill and awareness.  Patients who are veterans feel a sense of comradery and connection when being visited by a veteran volunteer as they share common experiences, language, badges of honor, and stories of serving in the military. The services that veteran volunteers provide give patients and their families a sense of connection, a place to have their stories be “heard”, and for them to be themselves.

I want to say thank you for the tremendous service that our veteran volunteers, Jerry Kuntz, and Brian Strong, provide to our veteran patients, and the many other patients that they serve.  Both Jerry and Brian have brought their own experience and life stories, as well as an understanding of what patients who are veterans’ needs are.  They have both honored many patients who are veterans with the We Honor Veteran certificates, assisted in the pinning ceremony, and paid respect to patients by wearing their branch uniform when they visit.  Thank you Jerry and Brian!!!

For more information on how to get involved with the Front Range Hospice Veteran Volunteer Program or Hospice Services please contact us at 303-957-3101 or 970-776-8080.

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