We Honor Veterans Program Awarded for Excellence

We Honor Veterans Program Awarded for Excellence

National Hospice and Palliative Care Organization program We Honor Veterans receives ASAE Power of a Award.

Front Range Hospice has chosen to be a leader in hospice care and to push ourselves to go above and beyond the highest standards in our industry.  As we continue to provide legendary care to every individual in need of end of life care. We are always looking for ways to reach those that are underserved or misinformed about end of life care. This constant search to reach out to our communities has brought us to the We Honor Veterans Program.  Front Range Hospice has been aligned with the We Honor Veterans Program for just over 2 years now. The special training and support provided to our nations Veterans by the We Honor Veterans Program and Front Range Hospice is legendary. Below is a press release published by the National Hospice and Palliative Care Organization announcing their recent award. Front Range Hospice is honored to be a part of this wonderful program. We congratulate the National Hospice and Palliative Care Organization and the We Honor Veterans Program for your endless support for end of life care and for ensuring our military veterans receive the end of life care they deserve.

We honor Veterans

(Alexandria, VA) – We Honor Veterans, a program of the National Hospice and Palliative Care Organization, is being recognized by the American Society of Association Executives with a 2015 Summit Award.  The Summit Awards are ASAE’s highest honor for associations.   We Honor Veterans is a national campaign conducted in collaboration with the Department of Veterans Affairs to engage and support community hospice providers in better understanding and addressing Veterans’ needs at the end of life.

summit winner

We Honor Veterans has successfully grown to include the involvement of over half of the hospice community nationwide, the fastest growing program in the history of NHPCO. This effort provides for continued engagement of the hospice community in the We Honor Veterans program and extends current efforts to include non-hospice community health care providers. Currently there are 2,713 hospice partners and 960 non-hospice community partners enrolled in the program.

“We are thrilled and honored to be recognized as an ASAE 2015 Summit Award winner,” says NHPCO President and CEO, J. Donald Schumacher. “We thank ASAE for recognizing our continued efforts to improve care for seriously ill veterans who have given so much for this country.”

NHPCO and the Department of Veteran Affairs launched We Honor Veterans in 2010 to address the growing need for veteran-centered care, especially as Veterans are aging and need access to palliative and hospice care.

“The Department of Veteran Affairs and its Hospice and Palliative Care program are basking in the glow of NHPCO’s Power of a Summit Award for the We Honor Veterans campaign,” says Scott T. Shreve, DO, National Director, Hospice and Palliative Care for the Department of Veterans Affairs.  “Partnering to improve the care of seriously ill Veterans has been a wonderful alignment of missions and this award recognizes the efforts of more than 3,000 organizations across the US in honoring and serving those who’ve served.”

We Honor Veterans’ partners address the unique healthcare needs of Veterans, both physical and emotional, including the psychological toll of war and how it impacts their end-of-life journey.  In some cases, Veteran patients are paired with volunteers who have also served their country and share a unique and honorable bond.  Many partners also recognize the military service of Veterans with special pinning ceremonies and awards.

“Congratulations to NHPCO for helping to make the world a better place,” said Hugh “Mac” Cannon, MPA, CAE, Executive Director of ACEC of Metropolitan Washington, and 2015 chair of ASAE’s Power of a Awards Judging Committee. “Their story exemplifies how associations make a difference every day – not just to the industry or profession they represent, but to society at large.”

NHPCO is one of only six associations to receive the award this year. Part of ASAE’s Power of A program, the Summit Awards recognize the association community’s valuable contributions on the local, national and global level. The awards reward outstanding efforts of associations to enrich lives, create a competitive workforce, prepare society for the future, drive innovation and make a better world.

About National Hospice and Palliative Care Organization
NHPCO is the oldest and largest nonprofit membership organization representing hospice and palliative care programs and professionals in the United States. The organization is committed to improving end-of-life care and expanding access to hospice care with the goal of profoundly enhancing quality of life for people dying in America and their loved ones.

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Hospice General Inpatient Care (GIP)

Hospice General Inpatient Care (GIP)
By Victor Montour

Everyday someone will ask us about the GIP level of care available to patients while receiving hospice care or at the time of enrolling in to hospice services. It has become clear that most healthcare professionals do not understand the GIP level of care or the criteria that must be met before a patient can receive this level of care. Front Range Hospice follows the requirements set before use by the Medicare Benefit Policies without exception. Following the policies set by Medicare as they are written places Front Range Hospice in the best position to deliver legendary care to our patients when they need it most. Below is a copy of the Medicare Benefit Policy for the GIP level of care.

Medicare Benefit Policy Manual
Chapter 9 – Coverage of Hospice Services Under Hospital Insurance

40.1.5 – Short-Term Inpatient Care
(Rev. 188, Issued: 05-01-14; Effective: 08-04-14; Implementation: 08-04-14) Short-term inpatient care may be provided in a participating hospital, hospice inpatient unit, or a participating SNF or NF that additionally meets the special hospice standards regarding patient and staffing areas. Medicare payment cannot be made for inpatient hospice care provided in a VA facility to Medicare beneficiaries eligible to receive Veteran’s health services. Services provided in an inpatient setting must conform to the written plan of care. However, dually eligible veterans residing at home in their community may elect the Medicare hospice benefit. See §60.

Medicare covers two levels of inpatient care: respite care for relief of the patient’s caregivers, and general inpatient care which is for pain control and symptom management. General inpatient care (GIP) may only be provided in a Medicare participating hospital, SNF, or hospice inpatient facility. Respite care may only be provided in a Medicare participating hospital or hospice inpatient facility, or a Medicare or Medicaid participating nursing facility.

General inpatient care is allowed when the patient’s medical condition warrants a short-term inpatient stay for pain control or acute or chronic symptom management that cannot feasibly be provided in other settings.

General inpatient care under the hospice benefit is not equivalent to a hospital level of care under the Medicare hospital benefit. For example, a brief period of general inpatient care may be needed in some cases when a patient elects the hospice benefit at the end of a covered hospital stay. If a patient in this circumstance continues to need pain control or symptom management, which cannot be feasibly provided in other settings while the patient prepares to receive hospice home care, general inpatient care is appropriate.

Other examples of appropriate general inpatient care include a patient in need of medication adjustment, observation, or other stabilizing treatment. It is not appropriate to bill Medicare for general inpatient care days for situations where the individual’s caregiver support has broken down unless the coverage requirements for the general inpatient level of care are otherwise met. For a hospice to provide and bill for the general inpatient level of care, the patient must require an intensity of care directed towards pain control and symptom management that cannot be managed in any other setting.

Respite care is short-term inpatient care provided to the individual only when necessary to relieve the family members or other persons who normally care for the individual at home. Respite care may be provided only on an occasional basis and may not be reimbursed for more than 5 consecutive days at a time. Payment for the sixth and any subsequent day of respite care is made at the routine home care rate, and the patient would be liable for room and board. Respite care cannot be provided to hospice patients who reside in a facility (such as a long term care nursing facility). Provision of respite care depends upon the needs of the patient and of the patient’s caregiver, within the limitations given.

Several examples of appropriate respite care for a patient who does not reside in a facility include providing a few days for the caregiver to rest at home, to visit family, attend a wedding, or attend a graduation for a needed break, or providing a few days immediately following a GIP stay if the usual caregiver has fallen ill. See also, section 40.2.2.

Note that hospice inpatient care in an SNF or NF serves to prolong current benefit periods for general Medicare hospital and SNF benefits. This could potentially affect patients who revoke the hospice benefit.

If a hospice patient receives general inpatient care for 3 days or more in a hospital, and chooses to revoke hospice, then the 3 day stay (although not equivalent to a hospital level of care) would still qualify the beneficiary for covered SNF services.

To view the Medicare Benefit Policy Manual in its entirety visit http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c09.pdf

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World Hospice and Palliative Care Day

World Hospice and Palliative Care Day

World hospice

What is World Hospice and Palliative Care Day?

  • World Hospice and Palliative Care Day is a unified day of action to celebrate and support hospice and palliative care around the world. Voices for Hospices is a wave of concerts taking place on World Hospice and Palliative Care Day every two years.

What is this year’s theme?

  • The theme for World Hospice and Palliative Care Day which will take place on October 10, 2015 is “Hidden Lives / Hidden Patients“. This year’s theme will focus on the patients living in unique conditions that often struggle with access to palliative care including children, LGBT individuals, HIV prisoners, soldiers and those living in rural settings.

When does World Hospice and Palliative Care Day take place?

  • World Hospice and Palliative Care Day takes place on the second Saturday of October every year and Voices for Hospices takes place on the same date every two years. The next World Hospice and Palliative Care Day with Voices for Hospices is on October 10 2015

What are the aims of World Hospice and Palliative Care Day?

  • To share a vision to increase the availability of hospice and palliative care throughout the world by creating opportunities to speak out about the issues. To raise awareness and understanding of the needs – medical, social, practical, spiritual – of people living with a life limiting illness and their families. To raise funds to support and develop hospice and palliative care services around the world.

Who organises World Hospice and Palliative Care Day?

  • World Hospice and Palliative Care Day is organised by a committee of the Worldwide Palliative Care Alliance, a network of hospice and palliative care national and regional organisations that support the development of hospice and palliative care worldwide.

world hospice 2

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Death of a Friend


By Victor Montour

Losing a loved one weather it’s your mother, father, brother, sister; aunt, uncle or a friend can have a huge impact on the loved ones left behind. It goes without saying the family of the person who has died feels the loss the most. Knowing this shouldn’t over shadow the loss felt by friends of the person who has died. A close friend in most cases is an extension of the family.

If one of your friends has died, it might be tough for you to know how to help or what to say to their family. These feelings are normal and it’s O.K. to feel unsure about how to help. Below are ideas about how you might be able to help and support your friend’s family.

Let your friend’s family know you care. Friends and family are a great support for the people who are experiencing the loss.  Let them know that you care. If you’re planning to talk face-to-face, it’s a good idea to call first and let the person know you would like to come over. If you’re uncomfortable dealing with emotional people then you could try showing you’re support over the phone, or through a card, letter or flowers. The smallest gesture speaks volumes.

Know what to say. Knowing what to say or what not to say can be hard. First and for most It’s okay to be honest and let your friends family know that you don’t know what to say. You can start by asking if there’s anything you can do to help. Your friends family might appreciate knowing that you’re around to talk, or if he or she just wants someone to hang out with. It’s okay to just be silent, don’t feel like you have to talk the whole time you’re visiting. Allow yourself to be present and in the moment. Sometimes just sitting with someone says more than words. The truth is, there’s nothing we can really say or do to ease the pain of losing a friend or someone we love.

Stay in touch. Keeping in contact can be a way to let your friend’s family know that you’re supportive. If you’re planning to hang out with other people, ask them to come along. Remember that your grieving friends and families are probably going to cope better in quieter situations, like going to the movies or hanging out at someone’s house, rather than huge parties.

Be understanding. Experiencing a loss can cause people to feel lots of different emotions, including anger, sadness and denial. Try to be understanding of your friend’s families reactions.

Listen. Your friend’s family might want to talk about how they are feeling, or about the person who has died. This is often a sign a person is managing grief. Give your friends family the chance to talk. Try to be patient if you’ve heard the stories before; it’s not uncommon for people who are grieving to want to go over the same stories a number of times. Let your friend’s family know that you can handle listening to the ugly emotions that go along with grieving. Allow them to express their anger, their guilt, and their fury over this unfair death.

It’s okay if you and your friend’s family cry. It might be hard to see someone you care about upset or crying. It’s okay for your friend’s family to cry, and for you to cry as well. This is often a good way to express sadness, and it might help both of you feel better.

Take Care of yourself It can be exhausting for you to share a loss with your friend’s family. Taking time out for yourself is important. Do something special for yourself, and make sure you can talk to someone about how you’re feeling.

Time. Remember that there’s no timetable on grief – grief can last months or years, and no one person can predict how a person is supposed to be grieving.

Remember. Talk about the friend or loved one and don’t act uncomfortable. Understand that talking about your deceased friend or loved one helps everyone remember them. Share your stories of the deceased – remember them and celebrate them with the bereaved. Talk about the good times with your friend.  Help remind them of how meaningful their friend’s life was to everyone. Share your stories and allow your friends and family to share theirs.

Professional Help. If you a friend or a family member of the deceased discusses suicide, dying, or taking their own life, THIS IS A SERIOUS EMERGENCY. Take that individual to the nearest emergency room or Call 911. Depression from the loss of a loved one is very common and a mental health professional should be sought out for continued treatment.

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

Watch out for our next blog:

World Hospice and Palliative Care Day

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A Major Distressful Symptom in the Dying

A Major Distressful Symptom in the Dying
By Victor Montour

blog 8.13

Caregivers may be surprised when a terminally ill (and usually calm) patient becomes restless or even agitated. The restlessness or agitation varies from patient to patient. When caregivers see this change they may be completely bewildered and feel helpless: not knowing what to do. It is common knowledge in hospice when a terminal illness not only initially strikes, but is now nearing the end, patients may experience profound mood changes. Such mood changes are often difficult for caregivers. Causes and treatment for restlessness and agitation are well-known among the hospice professionals.

What is Terminal Restlessness or Agitation?

Those of us who work with the dying know this type of restlessness or agitation almost immediately. However, the public, non-hospice professionals and patient’s family may have no idea what is going on and often become quite alarmed at this change in condition. What does it look like? Although it varies in each patient, there are common themes that are seen over and over again. Patients may be too weak to walk or stand, but they insist on getting up from the bed to the chair, or from the chair back to the bed. Whatever position they are in, they complain they are not comfortable and demand to change positions, even if pain is well managed. They may yell or strike out using uncharacteristic language, sometimes angrily accusing others around them. They appear extremely agitated and may not be objective about their own condition. They may be hallucinating, having psychotic episodes and be totally “out of control.” At these times, the patient’s safety is seriously threatened. Your hospice professionals are experienced with managing these symptoms and will help the caregiver focus on the patient as a whole person and not the behaviors being exhibited.

Need to Eliminate Other Obvious Causes of Distress

Just as in all symptoms, other causes must first be ruled out or eliminated. Your hospice nurse will and must make sure that the physician’s orders are being followed, that if any other symptoms are not well managed, the physician is contacted or adjustments are made in order to relieve those symptoms. Physicians and nurses must continually re-assess the patient’s total overall condition, monitoring everybody system’s function. Checking pain levels is a first step. Is the patient breathing effectively? Is oxygen being given if appropriate for the patient’s disease condition? Carefully evaluating, recording and reporting all outward signs must be habitual with those caring for the dying. Any changes must be understood, evaluated and responded to if appropriate.

For example, patients experiencing intense pain may become agitated. The initial thought to use sedatives immediately might make sense if one is not thinking clearly: “… the patient is agitated; I’ll use a sedative…” However, that may be a very short-sighted and uneducated approach. Why? Because sedating the patient is not the first action to take. One must first determine what other causes might exist. When pain is severe, sedatives will not eliminate agitation! However, relieving the pain eliminates the agitation. On a more basic level, removing a hard object such as a syringe or catheter tubing that may have drifted underneath the patient may be all it takes to relieve the agitation. Common sense must first be applied!

Questions to be asked

The following are examples of questions that nurses and physicians should ask themselves as they approach this problem:

  • Is there anything physically interfering with the patient’s comfort?
  • Does the patient have pain that is not being well-managed? Observing outward facial expressions and body posture are important to evaluate.
  • If the patient has a urinary catheter, is it “patent” (meaning open) and is urine flowing freely through it? If it is plugged, that could cause extreme pain from pressure in the bladder.
  • Is the patient having regular bowel movements? When was the last bowel movement and what consistency did it have? Could the patient be constipated?
  • Is there some other sudden change in function that may be causing distress to the patient?
  • Is there an infection causing the agitation?
  • Is the infection an expected effect of the disease, such as brain cancer?
  • Is the patient going through obvious psychological and emotional distress? Has a counselor or minister’s services been offered to the patient and family? Is the restlessness purely psychological or is it metabolically based?
  • Has a new medication been added? Has a medication dosage been recently increased or decreased? Is this a side-effect from a medication?
  • Has the patient entered the pre-active phase of dying?

Metabolic Changes Causing Restlessness and Agitation

As the terminally ill near death, body organs and systems begin to fail to a greater and greater degree. Kidneys stop producing as much urine and function poorly, the liver and other organs also start to shut down. Waste products from the cells and tissues of the body begin to build up in the tissue spaces and blood stream. Biological and chemical balance is lost. The pH in the blood and other areas may change dramatically. In many patients, these changes alone may cause restlessness and agitation that may be quite severe.

Medications for Terminal Restlessness and Agitation

The physician may have written standing orders for certain medications to be given for these conditions. Such medications include anti-anxiety medications such as Lorazepam (Ativan) and Diazepam (Valium) and anti-psychotic medications such as Haloperidol (Haldol), Chlorpromazine HCl (Thorazine) and others.

The hospice nurse and physician will be extremely careful not to give a medication that might be contraindicated for the patient’s condition. It is not appropriate to give all patients Ativan and Morphine, for example, if they become agitated. It they are in pain, then pain medication is appropriate. If their pain is well-managed and they are still agitated, then the other medications may be applied. Certain disease conditions respond well to these medications while others have an opposite or no effect.

As mentioned earlier in this blog, hospice care varies according to the patient, the disease, the stage of the disease and the exact situation being encountered. Some believe that hospice care is less demanding than say, acute care in the hospital or intensive care. I can assure you that is not the case. Excellent hospice care requires the same degree of professionalism as in other specialties in health care. Constant patient assessment and re-assessment are necessary to achieve the goal of comfort.

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

Watch out for our next blog: Death of a Friend

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Going the Extra Mile

Going the Extra Mile

By Pam Ware and Victor Montour

It’s simple… go the extra mile and you will stand out from the crowd.
A quote from Robin Crow.

Recently Front Range Hospice received a referral from one of our hospital partners that we currently have a General in Patient contract with. The patient is the matriarch of her family and had been in the hospital or an Acute Long Term Care Hospital for a little over a month. She had endured a lot in that month and so had her family. Multiple surgeries, multiple infections, the need for a ventilator, central lines and a number of other interventions. It was a constant roller coaster of emotions for her large and loving family.

When the decision was made for hospice, the patient was not conscious. Front Range Hospice received the referral at the end of the work day for most people, but Front Range Hospice is open 24/7. We are keenly aware that when a decision is made to move away from aggressive treatment and just focus on comfort, it is important for the family to see and be able to talk to a caring hospice representative.

Our hospice liaison arrived within an hour of receiving the referral and our admitting nurse was not far behind. Our liaison gathered all the family together and provided a detailed informational session about hospice and the services provided by hospice. During this meeting our liaison was able to establish the family had further clinical questions that needed answered before they could agree hospice care is the best approach. After this meeting our liaison met with the physician caring for the patient and updated the physician about the questions the family has and worked out a plan to have the physician meet with the family immediately. After all the questions, concerns and fears were answered by the physician the family agreed to move forward with hospice care. Our liaison met with the family again to review services again and to establish goals the family would like the hospice team to achieve while caring for their loved one. This family had two number one goals, comfort and to get the patient home. The liaison meeting with the family is also a nurse; the liaison was able to provide education to the family about the risk of moving the patient in the fragile medical state their loved one is in. The liaison educated the family about the risk of the patient expiring in the ambulance on the way home. Knowing the risks, pros and cons the family made it very clear that they wanted the patient kept comfortable and wanted to take her home in the morning. They knew that their loved one wanted to die at home and they were prepared to do whatever needs to be done to grant her that request.

At the time of the admission, Front Range Hospice nurse was concerned that she might not live until the morning but we at times underestimate the will of an individual’s soul. Her care was switched from aggressive treatment to comfort care and the family was told that we are available 24/7. We were just a phone call away and that our staff would plan to be in the hospital at 8am if not called sooner.

She lived through the night. The Front Range Hospice nurse, liaison and Chaplin arrived at the hospital at 8 am and began ensuring the patient was comfortable, supporting the anxious family with the big change to home and started to arrange for a rush delivery of the needed durable medical equipment (oxygen, hospital bed, etc), got written orders from the physicians so medications could be picked up at a local pharmacy, completed a Colorado MOST form, scheduled an ambulance to take her home. During this organized chaos, the nurse took the time to slow things down to meet with the family and gently informed them again that their loved one might die in the ambulance. She was that close to death. Knowing this the family remained firm, they wanted to take their loved one home. Our nurse with the patient on an ambulance gurney and the family following behind made their way out of the hospital to the ambulance. Our nurse followed the ambulance to the patients home and resumed caring for her immediately upon arrival.

She was home, surrounded by her family, and comfortable by 12noon. She then woke up and spent the next 3 hours talking to her family in her very familiar role as the matriarch. She then closed her eyes, went to sleep, and gently her soul left her body and she died. Her peaceful passing in her home surrounded by her loved ones was what we call a “good death”. Although the family members will miss her and mourn her loss they have those last 3 hours of pure joy that they were able to spend together.

The goals set before us at Front Range Hospice were simple. Keep her comfortable and get her home. Going the extra mile to meet the needs of a patient and their family is what we do best. Front Range Hospice exists to provide Legendary End of Life Care. Going the extra mile is the only way to meet this goal/expectation.

Front Range Hospice will always go that extra mile.

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

Watch out for our next blog: A Major Distressful Symptom in the Dying

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When to Call Hospice

When to Call Hospice

Hundreds of times each year, patients and families say: “We wish we’d entered hospice sooner.” Patients and families can benefit most from hospice care when they seek support earlier rather than in a crisis.

Will your physician tell you when it’s time for hospice?

Often times your physician is the first to mention the possibility of hospice care. Not always, however. Some physicians hesitate to bring up hospice because they sincerely want to preserve hope for a cure. Frequently, they will continue to pursue treatment because they think that’s what the patient and family want. In other cases, such as with congestive heart failure or lung disease (COPD), it may be difficult for them to predict the rate of a patient’s decline. When a doctor does mention hospice care, he or she is simply presenting an option for comfort, which in many cases may actually lengthen life by increasing the quality of the time remaining. It is important that you and your doctor talk openly and share the same goals for maintaining quality of life.

What are some signs that a person may be ready for hospice care?

  • An increase in pain, nausea, breathing distress or other symptoms
  • Repeated hospitalizations or trips to the emergency room
  • Failure to “bounce back” after medical set-backs occur
  • Decrease in function requiring assistance for walking, eating, bathing, dressing and/or going to the toilet
  • Decreasing alertness – patient is emotionally withdrawn, sleeping more or having increased difficulty with comprehension
  • Significantly decreased appetite and weight loss

What are some signs that our family could benefit from hospice?

Caring for yourself as your loved one’s caregiver is one of the most important things you can do. Front Range Hospice supports the family in conjunction with the patient. How do you know if you or your caregivers could benefit from hospice care?

  • You or your caregivers are physically and/or emotionally exhausted from caring for you or your loved one.
  • Your family is feeling isolated because of caregiving demands or the uncertainties you feel about your loved one’s future.
  • You or members of your family appear to need emotional support to cope with the sadness of the situation.
  • You are overwhelmed by the myriad of physical, financial, emotional and spiritual concerns arising because of the illness.

Can we call Hospice even if we don’t think it’s “time”?
Absolutely. An important part of our mission is providing guidance to families about any end-of-life care issue, whether or not they’re in our program. You don’t need a physician referral to call us for information. If it appears that hospice care would be beneficial, we will, with your permission, contact your doctor to discuss it.

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