Response to: This was not the good death we were promised.

A response to the NY Times article from a hospice Director of Nursing. Link to the original article:  https://mobile.nytimes.com/2018/01/06/opinion/sunday/hospice-good-death.html?referer=https://www.google.com/

 

Dear Don,

Thank you for sharing this article with me. I have read it several times over the last few days and have been thinking of the best way to respond. This article raises many questions and concerns for me as a hospice professional. I do want to start by saying that hospice is highly regulated by CMS (Centers for Medicare and Medicaid Services), we also have over sight by the OIG (Office of the Inspector General).  I do not believe that most hospices are running amuck with little government oversight as the article seems to imply.

We have seen a shift in our area (Northern Colorado) in the last few years with larger corporations purchasing smaller hospices. I have not heard great things about this shift, which makes me very happy that I work for a small privately owned hospice.

Another concern that I have with this article is the statement about for profit hospices. I spent the first nine years of my career working in a nonprofit hospital. I believe that people misinterpret the word nonprofit to mean that particular business is charitable and not out to make money. That is not the case at all; it simply means that a certain percentage of the profits must be used for the betterment of that business. Nonprofit healthcare companies typically pay their leadership team exorbitant salaries while the bedside personnel are under paid and overworked. Ultimately the patient and family suffer from lack of care when bedside personnel are stretched too thin. You can see this throughout the healthcare system.  One of our competitors was in the news in the last few years with these issues it ultimately lead to the dismissal of one of their Administrators.

Front Range Hospice is a privately owned hospice, however, that does not mean that we do not provide charity care. We also have a nonprofit memorial fund that is used to help patients and their families to obtain things that they cannot afford. We use our memorial fund for things such as propane to heat homes, books, slippers, art and craft materials, anything necessary to help improve the quality of life for the patients that we serve.

Our CEO Pam Ware believes strongly in always doing the right thing. We follow Medicare regulations to a tee and we strive to provide excellent end of life care to all that we serve. We know that there are no do- overs in end of life care, so we work to get it right every time.  I believe to the core of my being that hospice is a far better alternative than dying in a hospital with unnecessary interventions being performed. I have seen both ways, I have performed those unnecessary interventions and watched people miss the last precious few moments of their loves one’s life. I have also sat at the bedside and watched a young Wife lie in bed holding her Husband as he took his last breaths in the comfort of his own home. There is no question in my mind that the second scenario is a more kind and dignified way to pass from this world. Death is a beautiful, natural process. A patient’s Wife once told me, “Our Mother’s birth us into this world and we birth ourselves out of it.”

Hospice allows a person to pass at home in the care of their loved ones, with dignity and comfort. We cannot always anticipate every issue that may arise for each patient, but we are experts in end of life care. Our staff is highly trained and most end of life journeys do have many similarities, so we typically know what to expect based on normal disease progression. We provide comfort medications to each patient to ensure that we avoid as many “crisis” situations as possible. When a crisis does arise, we are experts at symptom management and can typically get any symptom under control very quickly, without relying on IV medications. Our team of nurses, social workers, chaplains, community liaisons and home health aides provide education on the dying process and what to expect to all patients and their caregivers and support for any and all emotional or spiritual issues that arise along the way. We ask each individual to define what excellent end of life care means to them and we strive to help them obtain their goals throughout their end of life journey. I believe that overall, hospice professionals are the most caring, compassionate group of individuals you will ever have the pleasure to meet. We laugh with, cry with and love our patients and their families and the last thing any of us want to see someone passing with uncontrolled pain.

 

Jesse Harmon, RN

Director of Nursing, Front Range Hospice and Palliative Care

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2017 Employee of the Year

EOM 2017

By Victor Montour

The last year all of us at Front Range Hospice and Palliative Care were faced with some very challenging times. As a team we all worked together to overcome the challenges and put before us our primary focus, the patients we serve.

I found last year that all of us at Front Range Hospice and Palliative Care are here for something greater than a paycheck or a job. We are all here to make the world a better place for those in need of our service. We are all here to serve others in a way most people are unable to or don’t know how.

I consider myself very fortunate to work for a company that is so patient centered. For a company that truly cares about the staff that works here. For a company that truly wants to make a difference in the communities we serve. This makes it easy for me to step up and do a little more for our patients and my colleagues.

A lot goes into a fantastic year at Front Range Hospice and Palliative Care: Referral sources calling on the liaisons to help provide support to patients in the community. Our admission intake coordinators work hard to complete the endless tasks they are called upon to complete in a sometimes very short period of time. Our nurses, certified nursing assistants, chaplains and social workers work tirelessly every day to attend to patient needs 24/7. Last but not least our leadership team work endless hours supporting our patients and staff.

The Only Way to Love What You do is to Love Where You Work. Thank you, Pam, Tara and Jesse, for making Front Range Hospice and Palliative Care a place I love to come to everyday.

I am extremely honored and am very grateful to have been awarded the Employee of the Year for 2017.  I have to give thanks to all of my team mates at Front Range Hospice and Palliative Care. You all put up with me and others during some not so pleasant times. But, we all got through it and have made a difference in the lives of many families this last year. I’m looking forward to another incredible year working with all of you helping families in the communities we serve.

 

Please remember “A simple act of caring creates an endless ripple that comes back to you.”

 

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Grief During the Holidays

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How to Help a Grieving Loved One During the Holidays

Twelve Practical Tips for Saying, Doing the Right Things 

From the National Hospice Foundation and the National Hospice and Palliative Care Organization

While many people look forward to yearly holiday traditions, gatherings with family and friends and the general good feelings associated with the season, some people dread the holidays. For those who have lost a loved one during the past year, the holidays may emphasize their grief.

The holidays, especially the first ones after losing a loved one, are especially difficult for people who are grieving. Often, friends and family members of those affected by a loss are unsure how to act or what to say to support their grieving loved one during the holidays.

Here are some suggestions: 

  1. Be supportive of the way the person chooses to handle the holidays. Some may wish to follow traditions; others may choose to change their rituals. Remember, there is no right way or wrong way to handle the holidays.
  2. Offer to help the person with baking and/or cleaning. Both tasks can be overwhelming for one trying to deal with raw emotions.
  3. Offer to help him or her decorate for the holidays.
  4. Offer to help with holiday shopping or give your loved one catalogs or on-line shopping sites that may be helpful.
  5. Invite the person to attend a religious service with you and your family.
  6. Invite your loved one to your home for the holidays.
  7. Help your loved one prepare and mail holiday cards.
  8. Ask the person if he or she is interested in volunteering with you during the holiday season. Doing something for someone else, such as helping at soup kitchens or working with children, may help your loved one feel better about the holidays.
  9. Donate a gift or money in memory of the person’s loved one. Remind the person that his or her special person is not forgotten.
  10. Never tell someone that he or she should be “over it.” Instead, give the person hope that, eventually, he or she will enjoy the holidays again.
  11. If he or she wants to talk about the deceased loved one or feelings associated with the loss, LISTEN. Active listening from friends is an important step to helping him or her heal. Don’t worry about being conversational…. just listen.
  12. Remind the person you are thinking of him or her and the loved one who died. Cards, phone calls and visits are great ways to stay in touch.

In general, the best way to help those who are grieving during the holidays is to let them

know you care. They need to be remembered, and they need to know their loved ones are remembered, too. Local hospice grief counselors emphasize that friends and family members should never be afraid of saying or doing the wrong thing, because making an effort and showing concern will be appreciated.

Many people are not aware that their community hospice is a valuable resource that can help people who are struggling with grief and loss. Hospices provide bereavement support to the families they serve and often offer services to other members of the community as well.

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We Are Not All the Same

Every day people are trying to make decisions about which hospice or palliative care to enroll in, most want to choose a hospice or palliative care agency that will deliver the best possible care for whatever time they have left. The care you receive from a hospice agency will vary. WE ARE NOT ALL THE SAME.

Because of our staffing model, policies and procedures, and response time to patients needs we continue to have patient and family experience satisfaction survey results that meet or exceeds the national average. As a reminder this data is collected from an outside third party agency. Surveys are mailed from the third party agency to families 30 days after a patient has passed away on service with Front Range Hospice and Palliative Care. Families mail the survey with their answers back to the outside agency that collates the data and sends it to Front Range Hospice and Palliative Care.

As you may remember from our Hospice Survey Blog not all hospices measured outcomes or quality improvement.  Front Range Hospice and Palliative Care has been collecting data for years so patients, families and community partners can be assured they will receive legendary end of life care and palliative care that helps patients live well with as many best days possible.

Below you will find the most current Patient and family experience survey results. If you would like more information please feel free to call our office at 303-957-3101 or 970-776-8080 or send us an email to info@frhospice.com

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How Seniors Can Survive Losing A Spouse

blogImage Source: Pixabay

Author: Ms. Waters is a mother of four boys, and lives on a farm in Oregon. She is passionate about providing a healthy and happy home for her family, and aims to provide advice for others on how to do the same with her site Hyper-Tidy.com.

Losing your husband or wife is a traumatic experience at any age. Since you built your life around that person for decades or more, losing a spouse as a senior becomes devastating. There really are no words to convey your grief and pain.

Although your pain is real, you can get through this. It may take some time, but your grieving process will run its course and eventually end. You can help by understanding what’s healthy and what’s not. You also have to watch for substance abuse problems, as many seniors become addicted while grieving.

Sadness & Anger Are Normal For A Senior

Research has identified five stages of grief: denial, anger, bargaining, depression, and acceptance. However, the AARP shows how a senior can fluctuate between those stages. It’s entirely normal to feel sadness, anger, and even happiness as you process your grief. Don’t feel like any negative emotions have to be changed. You have the right to feel whatever emotions come up.

Caring.com also explains how your grief is unusually strong as a senior. You can start feeling worried about the future, not just how you will get through this mourning, but how you’ll live your life without your spouse. Being suddenly alone like this is traumatic and even frightening at times. Again, all of that is normal. You will get through this.

When A Senior’s Grief Turns Bad

If sadness, anger, and the like are normal, when should you worry about how you’re grieving? It’s when grieving turns into chronic depression. That’s not due to any fault of your own. It’s natural to fall into depression after losing a spouse. But that doesn’t mean it’s healthy for you.

How can you tell the difference between grieving and depression? Look at the intensity and duration. With healthy grieving, you tend to have bad days but good ones. You also tend to return to being social and generally happier in the months that follow the death. But with depression, negative feelings are very strong and do not go away over time.

The Josh Rojas Foundation lists some unhealthy ways to grieve:

  • Pretending that your life now is normal or “just fine.”
  • Trying to get over your grief quickly.
  • Telling yourself to “grow up” and handle it like an adult.

In other words, you cannot rush the grieving process. But if your depression becomes intense or doesn’t get any better, you may need some help. That’s when you need to talk to someone you trust or a professional like a therapist. That may feel embarrassing for some seniors, but it’s important to get help when you need it.

Watch For Substance Abuse

When those negative emotions get intense, many seniors turn to alcohol or drugs to help them cope. While it’s often fine to have a drink to calm your nerves, you have to be careful. Using these as crutches can quickly turn into substance abuse. Even if you don’t have a history of addiction, you can still have a problem.

When this happens, a treatment center is often the best option for seniors. Recovery.org has excellent advice on finding the right one for you. Any such program should have case management services, a strong social network, and treatment services specifically designed for seniors.

It Won’t Happen Overnight

Losing a spouse at any age is traumatic, but losing a spouse as a senior is worse. That’s why your grief is so intense. That’s not just expected, it’s also healthy as long as your negative emotions don’t become a persistent part of your life. You also have to make sure you don’t start abusing drugs or alcohol to numb the pain.


Your grieving process won’t end quickly, but it will end. Until then, accept your feelings and let them happen.

 

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Palliative Care … What’s the point??

PalliativeCare2

By Victor Montour

Day after day as my colleague and I are pounding the pavement going from one community partner to the other and we hear “What is the point of Palliative Care?” I hope today I can shed some light on what palliative care is and why it is a vital role in the wellbeing of patients dealing with a life-limiting disease.

If you were to look up a definition of palliative care it would read something like this:

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

It is important to know that palliative care should be given throughout a patient’s experience with their life-threatening illness. It should begin at diagnosis and continue through treatment, follow-up care, and the end of life. Palliative care intends neither to hasten nor postpone death.  The primary goal of palliative care is to enhance quality of life and positively influence the course of and individual’s illness.

Research shows that palliative care and its many components are beneficial to the patient and family health and well-being. A number of studies in the recent years have shown that patients who have their symptoms controlled and are able to communicate their emotional needs have a better experience with their medical care. Their quality of life and physical symptoms improve.

Now let’s get down to the real substance of what palliative care can offer. To help answer the questions of “What is the point of Palliative Care?” I want to make sure to address some very specific topics or items. You see palliative care can address a large range of issues that integrates an individual’s needs into their care. The physical and emotional effects of a life-limiting disease and its treatment may vary differently from person to person.

For example, differences in age, culture background, or support systems that result in very different palliative care needs.  A comprehensive Joint Commission Certified Community Based Palliative Care program like the one at Front Range Hospice and palliative care will take the following issues into account for each patient and work to help the patient set goals to address the issues that will provide them with The Best Days Possible.

Below I have listed some common issues addressed physically, emotionally and spiritually in order to paint a better picture of how palliative care can help you or your patients.

Physical – Common physical symptoms that are managed in palliative care include fatigue, loss of appetite, nausea, vomiting, pain, shortness of breath, insomnia, water weight gain, and many others. This list is not inclusive of all symptoms that can be managed. The Physician or Nurse Practitioner working in conjunction with your primary care doctor and your specialty doctors can develop a plan that is tailored to the individuals needs with the focus being to manage symptoms early so the patient can have the best quality of life at home and prevent exacerbations and returns to the hospital Emergency Department.

Emotional and coping – Our palliative care specialists can provide resources to help patients and families to deal with the emotions that come with a life-limiting diagnosis and treatment. Depression, anxiety, fear and loss are only a few of the concerns that can be addresses in our palliative care program. Again, this list is not all inclusive of our services. Our experts may all so provide counseling, advanced care planning, recommend support groups, hold family meetings or make referrals to mental health professionals, affirm life and regard dying as a normal process.

Spiritual – With a life-limiting disease, patients and families tend to look more deeply for meaning in their lives. Some feel their diagnosis brings them closer to faith; others might question their faith as they work to understand why this disease happened to them. Our experts in palliative care can help the patient and family find a sense of peace or reach a point of acceptance that is appropriate for the patient and the family’s situation.

Hospice – Making the transition from curative treatment to end-of-life care is a key part of palliative care.  The Community Based Palliative Care team at Front Range Hospice and Palliative Care can help patients and their loved ones prepare for physical changes that may occur near the end of life and address appropriate symptom management for this stage of care. The team can also help patients cope with the different thoughts and emotional issues that arise, such as worries about leaving loved ones behind, reflections about their legacy and relationships, or reaching closure with their life. In addition, palliative care can support family members and loved ones emotionally and with issues such as when to withdraw cancer therapy, grief counseling, and transition to hospice.

Patients and their loved ones should ask their doctor about palliative care. In addition to discussing their needs for symptom relief and emotional support, patients and their families should consider the amount of communication they need. What people want to know about their diagnosis and care varies with each person. It’s important for patients to tell their doctor about what they want to know, how much information they want, and when they want to receive it.

For more information on our Joint Commission Certified Community Based Palliative Care please contact our office at (970)776-8080 or (303)957-3101 to speak to one of our community liaisons.

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Choices

choices

By Victor Montour

Today I want to talk about choices. Life is all about choices, most of the time we all make good choices. Then we have moments in life we think we are making good choices but in fact are making a bad choice. The choices we make affect you or maybe a loved one in a positive or not so positive way.

In today’s modern world we tend to get caught up in the glamour of things or the newest trends, myself included. It’s hard not to when you have people coming to you offering you the newest and greatest product or enticements to use their services.

Unfortunately, this same model of marketing or sales has penetrated the healthcare industry in an astronomical way. People are being sold on the glamour of a skilled nursing facility, or a weekly delivery of Starbucks or muffins or some other tantalizing goodies given to healthcare professionals to persuade them to refer patients to them. I have to ask, what does this have to do with the care you or your loved one is receiving? More and more people make healthcare choices based off of this type of marketing. I ask you is this a good choice or bad choice?

In my opinion people think they are making a good choice but in fact their choice may not be as good as they thought it would be. Once they are in the middle of care they may be seeing short comings in the care their loved one is getting. Things like, meds not being given on time, equipment is not readily available for use, and staff are not as well trained to provide the care needed and so on.

As healthcare consumers we all must be educated on the things that matter. What matters more than knowing what kind of care can be expected?  I’m going to share a case with you today that will demonstrate how excellent care should be the focus and not the colors on the walls in a facility or goodies delivered this week. Patient care should be everyone’s primary focus.

Front Range Hospice and Palliative care received a referral for Palliative care services for a patient who at the time was at a local hospital. Our Community Liaison contacted the discharge planner and began the dialog on what the goals were for this patient and family upon discharging to home. The administrative team at Front Range Hospice and Palliative Care began the clinical review process to determine if this patient met criteria for Palliative Care. It was determined rather quickly Palliative Care would not be the correct level of care, in fact this patient need more care then what Palliative Care would have provided.

This is a 45 year old patient who was diagnosed with cancer in the middle of the year in 2015. This cancer was inoperable and the patient did not tolerate chemotherapy. The patient and the patient’s mother started working on the patients bucket list. The patient had places to see and things to do so they did that for a while. Once back in Colorado the patient had intractable pain that put the patient into the hospital several times. On this last admission in patient Palliative Care was brought in to help manage the patients symptoms. With the help of the inpatient Palliative Care team at the hospital they found a medication regimen that was working. However, it was such a high dose of pain medication that was almost impossible to find in the community on short notice.

Now, I talked earlier about how the care a patient receives is the most important item we all need to be looking at. Well, that is true, with that comes the patient as a whole person and the wishes the patient may have. While the clinical teams in the hospital and at Front Range Hospice and Palliative Care worked on the clinical needs. The Community Liaison at Front Range Hospice and Palliative Care was able to clarify some very important needs and wishes from the patient and family. Don’t forget this patient is very young and has a lot to accomplish in what maybe a short period of time. This patient first and foremost wants to go home to die. No nursing homes, not inpatient unites, just home.

Now most hospice agencies and acute care hospitals would have said this patient is too complex to manage outpatient at home and would have insisted the patient be moved to an inpatient hospice unit. Now don’t let me miss lead you, inpatient care is wonderful when appropriate and it’s the choice you make for yourself or your loved one. This patient was directed to an inpatient hospice unit and was not happy with the plan of care given to them for placement. Plus, it’s just not what the patient wanted. This patient wanted to go home and be present at the birth of the new niece expected any day.

We all have choices; our choices are not taken away because we have a terminal illness or are actively dying. This patient had made their choices clear, it is our responsibility as professionals to help patients achieve their goals, their wishes, and honor their choices.

Knowing the choices and wishes that this patient has expressed the team at Front Range Hospice and Palliative care started working in overdrive. The team had some insurmountable tasks to accomplish in a short period of time. Infusion Company had to be located who could start this patient on a home CADD pump with a large specific cocktail of medications. A discharge plan from the hospital had to be developed that would ensure the safest most effective care at home. The challenges kept coming; it took two tries to find an infusion company that can meet the patient’s needs. The patient lives in the mountains with windy one lane roads leading to the house. This was a major barrier for the nursing team especially with snow fall. The Front Range Hospice and Palliative Care team was able to think outside the box and come up with a solution to ensure nurses can get to the patient safely when needed. The team worked tirelessly with the mother who was the primary caregiver to her son to teach her how to give the medications, how to operate and trouble shoot the IV CADD pump and any other nursing care duties she may need to perform in the nurses absence. Now please know, Mom wanted to carry out this last wish from her child, she was the soul caregiver for the patient and she has others in the home she has to care for as well.  But she has somehow found the strength and manages all the medication administration, including caring for the IV and the CADD pump which she was scared to death of.  But after hours of teaching and support from the nurse the mom is comfortable providing the care needed for this patient knowing she has support when needed 24 hours a day 7 days a week.

Knowing mom had some anxiety about the volume of care this patient needed. Front Range Hospice and Palliative care worked on a couple of alternative plans. One, if the patient and mom need help and are not able to care for the patient at home we have arranged for placement in a skilled nursing facility not too far from their home. We also had set up, if needed, a non-medical agency to come in and help with cares. Again, these options are available if the patient or family chooses to use them, not required or mandatory.

We are so happy to say this patient passed at home, receiving the needed care to ensure the best days possible while receiving legendary care. This family and patient chose Front Range Hospice and Palliative Care to provide the care needed because we focus on patient care. We pride ourselves on our ability to support the choices people make while respecting their wishes. Muffins, candy and other novelty items are not the foundation of Front Range Hospice and Palliative Care and we will never use the smoke and mirror trick to get you to choose us as your palliative care or hospice provider. Honest conversations and excellent patient care will always be the information you receive when calling or meeting with our admissions team.

So I close this blog with this… Choices; in order to make the best choices for you or your loved one, you have to be informed. You have to look past the goodies, the glamor, and the awe, and really ask the tough questions to get the real answers you need to make the best choices for you or your loved one.

 

Please reference our blog: What to ask when looking for a hospice.

https://frhospice.wordpress.com/2016/08/24/what-to-ask-when-looking-for-a-hospice-2/

 

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