Heart Failure

Heart Failure
By Victor Montour

heart frh

The term “heart failure” makes it sound like the heart is no longer working at all and there’s nothing that can be done. Actually, heart failure means that the heart isn’t pumping as well as it should be. The body depends on the heart’s pumping action to deliver oxygen- and nutrient-rich blood to the body’s cells. When the cells are nourished properly, the body can function normally.

With heart failure, the weakened heart can’t supply the cells with enough blood. This results in fatigue, shortness of breath and in some people coughing. Everyday activities such as walking, climbing stairs or carrying groceries can become very difficult.

What is heart failure?

Heart failure is a chronic, progressive terminal condition in which the heart muscle is unable to pump enough blood through to meet the body’s needs for blood and oxygen. Basically, the heart can’t keep up with its workload.
At first the heart tries to make up for this by:

  • When your heart chamber enlarges, it stretches more and can contract more strongly, so it pumps more blood. With an enlarged heart, your body may start to retain fluid, your lungs may get congested with fluid and your heart may begin to beat irregularly.
  • Developing more muscle mass. The increase in muscle mass occurs because the contracting cells of the heart get bigger. This lets the heart pump more strongly, at least initially.
  • Pumping faster. This helps to increase the heart’s blood output.

The body also tries to compensate in other ways:

  • The blood vessels narrow to keep blood pressure up, trying to make up for the heart’s loss of power.
  • The body diverts blood away from less important tissues and organs like the skin and kidneys, and diverts to blood to the heart and brain.

It is important to know that these temporary measures mask the problem of heart failure, but they don’t solve it. Heart failure continues and worsens until these substitute processes no longer work thus making heart failure a terminal disease.

Eventually the heart and body just can’t keep up, and the person experiences the fatigue, breathing problems or other symptoms that usually prompt a trip to the doctor.

The body’s compensation mechanisms help explain why some people may not become aware of their condition until years after their heart begins its decline.

Types of Heart Failure

Heart failure can involve the heart’s left side, right side or both sides. However, it usually affects the left side first.

heart failure

Left-sided heart failure

The heart’s pumping action moves oxygen-rich blood as it travels from the lungs to the left atrium, then on to the left ventricle, which pumps it to the rest of the body. The left ventricle supplies most of the heart’s pumping power, so it’s larger than the other chambers and essential for normal function. In left-sided or left ventricular (LV) heart failure, the left side of the heart must work harder to pump the same amount of blood.

There are two types of left-sided heart failure. Drug treatments are different for the two types.

  • Systolic failure: The left ventricle loses its ability to contract normally. The heart can’t pump with enough force to push enough blood into circulation.
  • Diastolic failure (also called diastolic dysfunction): The left ventricle loses its ability to relax normally (because the muscle has become stiff). The heart can’t properly fill with blood during the resting period between each beat.


Right-sided heart failure

The heart’s pumping action moves “used” blood that returns to the heart through the veins through the right atrium into the right ventricle. The right ventricle then pumps the blood back out of the heart into the lungs to be replenished with oxygen. Right-sided or right ventricular (RV) heart failure usually occurs as a result of left-sided failure. When the left ventricle fails, increased fluid pressure is, in effect, transferred back through the lungs, ultimately damaging the heart’s right side. When the right side loses pumping power, blood backs up in the body’s veins. This usually causes swelling or congestion in the legs, ankles and swelling within the abdomen such as the GI tract and liver (causing ascites).

 

Congestive heart failure

Congestive heart failure is a type of heart failure which requires seeking timely medical attention, although sometimes the two terms are used interchangeably.

As blood flow out of the heart slows, blood returning to the heart through the veins backing up, causing congestion in the body’s tissues. Often swelling (edema) results. Most often there’s swelling in the legs and ankles, but it can happen in other parts of the body.

 

Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when a person is lying down. This is called pulmonary edema and if left untreated can cause respiratory distress.

Heart failure also affects the kidneys’ ability to dispose of sodium and water. This retained water also increases swelling in the body’s tissues (edema).

Doctors usually classify patients’ heart failure according to the severity of their symptoms. The table below describes the most commonly used classification system, the New York Heart Association (NYHA) Functional Classification. It places patients in one of four categories based on how much they are limited during physical activity.

 

Class Patient Symptoms
I No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath).
II Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath).
III Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.
IV Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.

 

Class Objective Assessment
A No objective evidence of cardiovascular disease. No symptoms and no limitation in ordinary physical activity.
B Objective evidence of minimal cardiovascular disease. Mild symptoms and slight limitation during ordinary activity. Comfortable at rest.
C Objective evidence of moderately severe cardiovascular disease. Marked limitation in activity due to symptoms, even during less-than-ordinary activity. Comfortable only at rest.
D Objective evidence of severe cardiovascular disease. Severe limitations. Experiences symptoms even while at rest.

For Example:

  • A patient with minimal or no symptoms but a large pressure gradient across the aortic valve or severe obstruction of the left main coronary artery is classified:
    • Function Capacity I, Objective Assessment D
  • A patient with severe anginal syndrome but angiographically normal coronary arteries is classified:
    • Functional Capacity IV, Objective Assessment A

Advanced Heart Failure

When heart failure (HF) progresses to an advanced stage, difficult decisions must be made by yourself or your loved ones. You may need to ask yourself, Do I want to receive aggressive treatment? Is quality of life more important than living as long as possible? How do I feel about resuscitation?

What is advanced heart failure?
Of the 5.7 million Americans living with heart failure, about 10 percent have advanced heart failure. The condition is considered advanced when conventional heart therapies and symptom management strategies no longer work. You feel shortness of breath and other symptoms even at rest.

In the American Heart Association and American College of Cardiology’s A-to-D staging system, advanced heart failure is stage D. Another classification system, developed by the New York Heart Association, grades the severity of symptoms on a 1-to-4 scale. Your symptom severity number can fluctuate, even within a single day, depending on how you feel.

In its early stages, heart failure can often be managed with medication and a healthy lifestyle. As the disease progresses and the heart becomes weaker, treatment gets more complex. This is the most common time people have the difficult, yet important, conversations with your family and doctor about the care you want to receive. We encourage you to have these conversations early in your disease process. You and your family will be under a large burden of stress and information overload hearing your disease has run its course. The less you and you’re your family have to worry about at this time the better.

The Highlights to take away from this blog are;

Heart Failure is a terminal disease

Heart Failure is treatable

Treatment options will be customized to the patients needs.

Conventional heart therapies and symptom management strategies may no longer work as the disease progresses.

If treatment fails, or if treatment is not an option, supportive care is available from Front Range Hospice, your heart failure symptom management experts.

If you would like more information about Heart Failure or 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: Zika Virus

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Patient Recognition Week

Patient Recognition Week
By Victor Montour

Frequently, we receive letters of thanks from patients, their families and friends. We are very touched by these kind words and appreciate the time and effort made to reach us. I would like to take a moment to share excerpts from some of these letters with you.

“Thank you so much for the time, the love and concern you gave both my husband, myself and our family. You will never know how much it meant to me to know that he was so well taken care of when I could no longer do it.”

“We couldn’t have asked for a better group of people, you all were so helpful all around, even down to explaining the situation to the children and patiently answering all questions. Your jobs are extremely tough and you all handle them so well. Thank you from the bottom of our hearts!”

“To the wonderful people at Front Range Hospice: We wish to thank you for the excellent care, comfort and compassion that you gave to dad during the last months of his life. We are so grateful to you all and appreciate your kindness to us, his family.”

The kind words our patient’s families and community partners share with us are appreciated and are shared with every employee at Front Range Hospice. You’re probably wondering why I’m going on about the wonderful testimonials. Well, this week is Patient Recognition Week with Patient Recognition Day being February 3rd. What better way to recognize our patients then to show their kindness and appreciation for us. After all, it is our patients and their families that matter most to us. On a daily basis you give us the profound privilege of being invited into your home, your life, your family.

We want to thank all of our current, past, and future patients and families for sharing with us your most cherished secrets, you’re most horrific fears or you’re most profound love. Thank you for the trust, respect and confidents you have bestowed on us during our time together. These times are forever engraved in our hearts.  Thank you for trusting Front Range Hospice

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

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Cervical Cancer

Cervical Cancer

By Victor Montour

The American Cancer Society has the following to say about cervical cancer. Cervical cancer can often be found early and sometimes even prevented entirely, by having regular Pap tests. If detected early, cervical cancer is one of the most successfully treatable cancers.

What is cervical cancer?

Cervical cancer starts in cells lining the cervix. The cervix is the lower part of the uterus (womb). It is sometimes called the uterine cervix. The body of the uterus (the upper part) is where a fetus grows. The cervix connects the body of the uterus to the vagina (birth canal). The part of the cervix closest to the body of the uterus is called the endocervix. The part next to the vagina is the exocervix (or ectocervix). The 2 main types of cells covering the cervix are squamous cells (on the exocervix) and glandular cells (on the endocervix). The place these cell types meet is called the transformation zone. The exact location of the transformation zone changes as you age and with childbirth. Most cervical cancers start in the cells in the transformation zone.

These cells do not suddenly change into cancer. Instead, the normal cells of the cervix gradually develop pre-cancerous changes that turn into cancer. Doctors use several terms to describe these pre-cancerous changes, including cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL), and dysplasia. These changes can be detected by the Pap test and treated to prevent cancer from developing.

Cervical cancers and cervical pre-cancers are classified by how they look under a microscope. There are 2 main types of cervical cancer: squamous cell carcinoma and adenocarcinoma. About 80% to 90% of cervical cancers are squamous cell carcinomas. These cancers form from cells in the exocervix, and the cancer cells have features of squamous cells under the microscope.

Most of the remaining types of cervical cancers are adenocarcinomas. Adenocarcinomas are cancers that develop from gland cells. Cervical adenocarcinoma develops from the mucus-producing gland cells of the endocervix. Cervical adenocarcinomas seem to have become more common in the last 20 to 30 years.

Less commonly, cervical cancers have features of both squamous cell carcinomas and adenocarcinomas. These are called adenosquamous carcinomas or mixed carcinomas.

Although cervical cancers start from cells with pre-cancerous changes (pre-cancers), only some women with pre-cancers of the cervix will develop cancer. The change from pre-cancer to cancer usually takes several years − but it can happen in less than a year. For most women, pre-cancerous cells will remain unchanged or even go away without any treatment. Still, in some women pre-cancers turn into true (invasive) cancers. Treating all pre-cancers can prevent almost all true cancers.

Signs and symptoms of cervical cancer

Women with early cervical cancers and pre-cancers usually have no symptoms. Symptoms often do not begin until a pre-cancer becomes a true invasive cancer and grows into nearby tissue. When this happens, the most common symptoms are:

  • Abnormal vaginal bleeding, such as bleeding after sex (vaginal intercourse), bleeding after menopause, bleeding and spotting between periods, and having longer or heavier (menstrual) periods than usual. Bleeding after douching, or after a pelvic exam is a common symptom of cervical cancer but not pre-cancer.
  • An unusual discharge from the vagina − the discharge may contain some blood and may occur between your periods or after menopause.
  • Pain during sex (vaginal intercourse).

These signs and symptoms can also be caused by conditions other than cervical cancer. For example, an infection can cause pain or bleeding. Still, if you have any of these problems, you should see your health care professional right away − even if you have been getting regular Pap tests. If it is an infection, it will need to be treated. If it’s cancer, ignoring symptoms might allow it to progress to a more advanced stage and lower your chance for effective treatment.

Even better, don’t wait for symptoms to appear. Be screened regularly.

How is cervical cancer staged?

The process of finding out how far the cancer has spread is called staging. Information from exams and diagnostic tests is used to determine the size of the tumor, how deeply the tumor has invaded tissues in and around the cervix, and the spread to lymph nodes or distant organs (metastasis). This is an important process because the stage of the cancer is the key factor in selecting the right treatment plan.

The stage of a cancer does not change over time, even if the cancer progresses. A cancer that comes back or spreads is still referred to by the stage it was given when it was first found and diagnosed, only information about the current extent of the cancer is added. A person keeps the same diagnosis stage, but more information is added to the diagnosis to explain the current disease status

A staging system is a way for members of the cancer care team to summarize the extent of a cancer’s spread. The 2 systems used for staging most types of cervical cancer, the FIGO (International Federation of Gynecology and Obstetrics) system and the AJCC (American Joint Committee on Cancer) TNM staging system, are very similar. Gynecologists and gynecologic oncologists use the FIGO system, but the AJCC system is included here to be complete. The AJCC system classifies cervical cancer on the basis of 3 factors: the extent of the tumor (T), whether the cancer has spread to lymph nodes (N) and whether it has spread to distant sites (M). The FIGO system uses the same information. The system described below is the most recent AJCC system, which went into effect January 2010. Any differences between the AJCC system and the FIGO system are explained in the text.

This system classifies the disease in stages 0 through IV. Staging is based on clinical rather than surgical findings. This means that the extent of disease is evaluated by the doctor’s physical examination and a few other tests that are done in some cases, such as cystoscopy and proctoscopy − it is not based on the findings during surgery or on imaging tests.

When surgery is done, it might show that the cancer has spread more than the doctors first thought. This new information could change the treatment plan, but it does not change the patient’s stage.

Tumor extent (T)

Tis: The cancer cells are only found on the surface of the cervix (in the layer of cells lining the cervix), without growing into deeper tissues. (Tis is not included in the FIGO system)

T1: The cancer cells have grown from the surface layer of the cervix into deeper tissues of the cervix. The cancer may also be growing into the body of the uterus, but it has not grown outside the uterus.

T1a: There is a very small amount of cancer, and it can be seen only under a microscope.

  • T1a1: The area of cancer is less than 3 mm (about 1/8-inch) deep and less than 7 mm (about 1/4-inch) wide.
  • T1a2: The area of cancer invasion is between 3 mm and 5 mm (about 1/5-inch) deep and less than 7 mm (about 1/4-inch) wide.

T1b: This stage includes stage I cancers that can be seen without a microscope. This stage also includes cancers that can only be seen with a microscope if they have spread deeper than 5 mm (about 1/5 inch) into connective tissue of the cervix or are wider than 7 mm.

  • T1b1: The cancer can be seen but it is not larger than 4 cm (about 1 3/5 inches).
  • T1b2: The cancer can be seen and is larger than 4 cm.

T2: In this stage, the cancer has grown beyond the cervix and uterus, but hasn’t spread to the walls of the pelvis or the lower part of the vagina. The cancer may have grown into the upper part of the vagina.

T2a: The cancer has not spread into the tissues next to the cervix (called the parametria).

  • T2a1: The cancer can be seen but it is not larger than 4 cm (about 1 3/5 inches).
  • T2a2: The cancer can be seen and is larger than 4 cm.

T2b: The cancer has spread into the tissues next to the cervix (the parametria)

T3: The cancer has spread to the lower part of the vagina or the walls of the pelvis. The cancer may be blocking the ureters (tubes that carry urine from the kidneys to the bladder).

  • T3a: The cancer has spread to the lower third of the vagina but not to the walls of the pelvis.
  • T3b: The cancer has grown into the walls of the pelvis and/or is blocking one or both ureters (this is called hydronephrosis).

T4: The cancer has spread to the bladder or rectum or it is growing out of the pelvis

Lymph node spread (N)

NX: The nearby lymph nodes cannot be assessed

N0: No spread to nearby lymph nodes

N1: The cancer has spread to nearby lymph nodes

Distant spread (M)

M0: The cancer has not spread to distant lymph nodes, organs, or tissues

M1: The cancer has spread to distant organs (such as the lungs or liver), to lymph nodes in the chest or neck, and/or to the peritoneum (the tissue coating the inside of the abdomen).

Stage grouping and FIGO stages

Information about the tumor, lymph nodes, and any cancer spread is then combined to assign the stage of disease. This process is called stage grouping. The stages are described using the number 0 and Roman numerals from I to IV. Some stages are divided into sub-stages indicated by letters and numbers. FIGO stages are the same as AJCC stages, except that FIGO staging doesn’t include the lymph nodes until stage III. In addition, stage 0 doesn’t exist in the FIGO system.

Stage 0 (Tis, N0, M0): The cancer cells are only in the cells on the surface of the cervix (the layer of cells lining the cervix), without growing into (invading) deeper tissues of the cervix. This stage is also called carcinoma in situ (CIS) which is part of cervical intraepithelial neoplasia grade 3 (CIN3). Stage 0 is not included in the FIGO system.

Stage I (T1, N0, M0): In this stage the cancer has grown into (invaded) the cervix, but it is not growing outside the uterus. The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage IA (T1a, N0, M0): This is the earliest form of stage I. There is a very small amount of cancer, and it can be seen only under a microscope.

The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).

  • Stage IA1 (T1a1, N0, M0): The cancer is less than 3 mm (about 1/8-inch) deep and less than 7 mm (about 1/4-inch) wide. The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).
  • Stage IA2 (T1a2, N0, M0): The cancer is between 3 mm and 5 mm (about 1/5-inch) deep and less than 7 mm (about 1/4-inch) wide. The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).
  • IB (T1b, N0, M0): This includes stage I cancers that can be seen without a microscope as well as cancers that can only be seen with a microscope if they have spread deeper than 5 mm (about 1/5 inch) into connective tissue of the cervix or are wider than 7 mm. These cancers have not spread to nearby lymph nodes (N0) or distant sites (M0).
  • IB1 (T1b1, N0, M0): The cancer can be seen but it is not larger than 4 cm (about 1 3/5 inches). It has not spread to nearby lymph nodes (N0) or distant sites (M0).
  • IB2 (T1b2, N0, M0): The cancer can be seen and is larger than 4 cm. It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage II (T2, N0, M0): In this stage, the cancer has grown beyond the cervix and uterus, but hasn’t spread to the walls of the pelvis or the lower part of the vagina.

Stage IIA (T2a, N0, M0): The cancer has not spread into the tissues next to the cervix (called the parametria). The cancer may have grown into the upper part of the vagina. It has not spread to nearby lymph nodes (N0) or distant sites (M0).

  • IIA1 (T2a1, N0, M0): The cancer can be seen but it is not larger than 4 cm (about 1 3/5 inches). It has not spread to nearby lymph nodes (N0) or distant sites (M0).
  • IIA2 (T2a2, N0, M0): The cancer can be seen and is larger than 4 cm.
  • IIB (T2b, N0, M0): The cancer has spread into the tissues next to the cervix (the parametria).

Stage III (T3, N0, M0): The cancer has spread to the lower part of the vagina or the walls of the pelvis. The cancer may be blocking the ureters (tubes that carry urine from the kidneys to the bladder). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

  • IIIA (T3a, N0, M0): The cancer has spread to the lower third of the vagina but not to the walls of the pelvis. It has not spread to nearby lymph nodes (N0) or distant sites (M0).
  • IIIB (T3b, N0, M0; OR T1-T3, N1, M0): either:
  • cancer has grown into the walls of the pelvis and/or has blocked one or both ureters (a condition called hydronephrosis),

OR

  • cancer has spread to lymph nodes in the pelvis (N1) but not to distant sites (M0). The tumor can be any size and may have spread to the lower part of the vagina or walls of the pelvis (T1 to T3).

Stage IV: This is the most advanced stage of cervical cancer. The cancer has spread to nearby organs or other parts of the body.

  • IVA (T4, N0, M0): The cancer has spread to the bladder or rectum, which are organs close to the cervix (T4). It has not spread to nearby lymph nodes (N0) or distant sites (M0).
  • IVB (any T, any N, M1): The cancer has spread to distant organs beyond the pelvic area, such as the lungs or liver.

Survival rates for cervical cancer, by stage

Survival rates are often used by doctors as a standard way of discussing a person’s prognosis (outlook). Some patients with cancer may want to know the survival statistics for people in similar situations, while others may not find the numbers helpful, or may even not want to know them.

The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Of course, many people live much longer than 5 years (and many are cured). Also, these are observed survival rates and include deaths from any cause. People with cancer may die from things other than cancer, and these rates don’t take that into account.

In order to get 5-year survival rates, doctors have to look at people who were treated at least 5 years ago. Improvements in treatment since then may result in a more favorable outlook for people now being diagnosed with cervical cancer.

Survival rates are often based on previous outcomes of large numbers of people who had the disease, but they cannot predict what will happen in any particular person’s case. Many other factors can affect a person’s outlook, such as their general health and how well the cancer responds to treatment. Your doctor can tell you how the numbers below may apply to you, as he or she is familiar with the aspects of your particular situation.

The rates below are based on the stage of the cancer at the time of diagnosis. Your doctor can give you information about what kind of survival you may be able to expect if your cancer has come back or progressed.

The rates below were published in 2010 in the 7th edition of the AJCC staging manual. They are based on data collected by the National Cancer Data Base from people diagnosed between 2000 and 2002. These are the most recent statistics available for survival by the current staging system.

Stage 5-Year
Observed
Survival Rate
0 93%
IA 93%
IB 80%
IIA 63%
IIB 58%
IIIA 35%
IIIB 32%
IVA 16%
IVB 15%

The important messages to take away with you from this blog are. Cervical Cancer is treatable with early detection. Treatment options will be customized to the patients needs. If treatment fails, or if treatment is not an option, supportive care is available from Front Range Hospice.

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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Long awaited Hospice Payment Reform goes into effect on 1/1/2016

Long awaited Hospice Payment Reform goes into effect on 1/1/2016

Pam Ware, MSW, LCSW CEO of Front Range Hospice

Rate Information obtained for National Hospice and Palliative Care

For years the Center for Medicare Services, CMS, has been talking about reforming the hospice payment.  Since the hospice benefit was carved out in 1983 there have been no significant changes in reimbursement. The hospice benefit has (4) levels of care: Routine, Respite, Continuous Care, and General Inpatient.  Hospice has seen some reinterpretations in our regulations but we have not seen a major structural change. An example of a reinterpretation was when CMS decided that hospice was responsible for all costs related to the palliation of the terminal diagnosis and related to the 6 month prognosis. This change was officially made on Oct 1, 2014. Prior to this, and you may still see articles referring to the old way, hospice was responsible for all costs related to the palliation of the terminal diagnosis and related conditions.

What CMS has been grappling with is what I would refer to as payment fairness.  The cost to care for patients costs each hospice more at the beginning and at the end of care. How do you adjust hospice payment to reflect this? After many years of conversations, the inverted “bell shaped curve” will come into effect on Jan 1, 2016. This will apply to Routine Home Care only.

County Routine Home Care

Rate 10/1/15-12/31/2015

Routine Home Care

Rate effective 1/1/2016

Days 1 – 60

Routine Home Care

Rate Effective 1/1/2016

Days 61 on

Service Intensity Add On per hour for a maximum of 4 hours (last 7 days of life only)
Adams $166.66 $192.35 $151.16 $40.53
Boulder $160.86 $185.65 $143.26 $38.41
Larimer $155.82 $179.83 $141.32 $37.89
Weld $157.95 $182.33 $143.29 $38.41

Rates taken from National Hospice and Palliative Care  FY 2016 Hospice Wage Index Table

This rate reform applies to Routine Home Care only. The patient’s home can be an assisted living, a skilled nursing facility, or a private home. It does not affect the Respite, Continuous Care, or General Inpatient rates since these are short term in nature. The Service Intensity Add on is an hourly rate paid for a RN and/or Social Worker who are at the bedside delivering skilled services that are care planned. This cannot be used for unskilled services such as sitting with the patient so the spouse can go grocery shopping.

Some hospices are worried that this is a significant rate cut disguised as rate reform. It will be a rate cut for those hospices that have long lengths of stays and/or do not provide a lot of skilled care. For hospices that are close to the National Average for both their average length of stay (73 days) and median length of stay (19 days) and are providing skilled visits by an RN and a social worker in the last 7 days of life this actually comes close to our current rate structure if not more. Consumer beware – do not settle for less skilled care, medications, supplies, or durable medical equipment because “Medicare cut our rate”. For most hospices, this is not the case. For those that will see less revenue, their median length of stays may suggest that they are caring for a lot of chronically ill not terminally ill with a prognosis of 6 months or less.

As a family member told me recently, “not all hospices are the same”.

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Employee of the Year 2015 – Amanda Christenson

Employee of the Year 2015 – Amanda Christenson

EOYAmanda’s supervisor Lydia Appling writes: This award has a special place in my heart.  I love that Front Range Hospice recognizes a monthly employee for the excellent job they do at Front Range Hospice in taking care of our patients, our families, our communities, and each other.  At the end of the year we get to look back at all the Employees of the Month over the past year and choose someone who stands out in many ways and reflects what Front Range Hospice stands for.

This year our CEO Pam Ware, asked me to recognize an employee that Front Range Hospice is very blessed to have on our team.

Amanda is proud to work with our team and loves the job. She is invested in not only being an exceptional employee but an exceptional professional.  Always looking for ways to improve their skills and provide hospice services in an ethical way.  Amanda has incredible communication and relational skills.  With all the skill and talent she shares with us, Front Range Hospice has benefited greatly and has been very blessed since they joined our team a few years ago.  I am very proud to announce that our Employee of the Year is Amanda Christenson!

Amanda writes: As long as I can remember, I have always wanted to be a social worker.  After graduating high school in Northwest Indiana, I entered the social work program at Ball State University where I completed my BSW.  A year later, I attended the University of Michigan where I earned my MSW.  The year in Michigan was a rough one, and not just because I pushed through the master’s program in a year; it was more the gloomy and freezing winter that did me in.  I vowed to never live in snow again and moved to Savannah, GA where I began my social work career in the beautiful, hot, humid, south.

While in Savannah I worked as a director of an adult day care center, caring for those with memory loss.  I later transferred to a local hospital where I worked on the oncology and general medicine floor.  While working in the hospital, I had two amazing social work mentors that taught me more than anything I had learned in the classroom.  I also gained an incredible amount of medical knowledge, which has contributed to my success in my current role as a hospice social worker.  After five years at the hospital, I moved to nearby Charleston, SC where I worked in long-term care.

During my career at the hospital and the nursing home I often referred patients to hospice.  I saw the difficult journeys they had been on and always saw hospice as an incredible gift to make them comfortable; something I couldn’t do at that time.  It was during my last two years at the nursing home that I knew I wanted to work in hospice.

Knowing that I love the mountains and enjoy spending time in nature, it seemed only right to move to CO (despite the fact that I’d have to live in snow again).  I flew to CO and researched a variety of hospices.  I already knew in my heart that Front Range Hospice was the hospice for me.  I took a chance and dropped off a good-old fashioned paper resume to the office, and to make a long story short, everything fell perfectly into place.  I am so blessed to work for this agency doing what I love to do.   When I’m not working, I’m either camping, hiking, or traveling across the world, meeting people from all different walks of life as well as spending time with family.

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NEWS RELEASE: Front Range Hospice partners with Angels Care Home Health to expand services.

NEWS RELEASE: Front Range Hospice partners with Angels Care Home Health to expand services.

Front Range Hospice is pleased to announce that it has entered into a preferred provider agreement with Angels Care Home Health to provide pre-hospice services.

Our current healthcare system is very robust when it comes to preventive care, diagnostic services, operative services, treatment services, and hospice care. What is lacking for most of us is that bridge between aggressive care with the intent of a cure and aggressive care with the intent of a comfortable and dignified death. A few insurances, such as Kaiser, have this program and it is called Palliative Care.

What is Palliative Care?  According to Medline Plus, a National Institute of Health (NIH) website, palliative care is comfort care, end of life care, hospice care. The definition is clear and ambiguous at the same time. Hospice Care is Palliative Care because we focus on comfort care and end of life care for individuals with a prognosis of 6 months or less. Hospice care is delivered in the environment of the patient’s choice. The emerging specialty of outpatient Palliative Care is best looked at as pre-hospice care. It is multidisciplinary medical care for individuals that have a life threatening illness and are still pursuing aggressive treatment or for individuals that are just not ready to enroll in hospice. As health care consumers, you need to ask the provider exactly what is the care they provide and what is it going to cost you. Some insurance do not cover this at all. Some will cover a Nurse Practitioner for an occasional consultative visit. Some will cover a licensed clinical social worker to come to your residence and provide short term counseling.

Front Range Hospice does hospice care and we do it well.

Angles Care Home Health does home health care and they do it very well.

It is a natural fit. For those individuals that have a life threatening illness and meet the criteria for home health, Angels Care has developed a transitions care program called Care Connections. They will provide a nurse who makes weekly visits, a 24/7 phone support program that focuses on keeping the individual home and not going to the Emergency Room. The nurse’s role is to assist with education, symptom management, and support. A Medical Social Worker is also available if needed for resource procurement and education. The cost of this program is covered by Medicare in the Home Health Benefit. Angels Care has successfully offered this program in several communities that they serve.  The owners of Angels Care insist that their branches have a positive working relationship with a hospice in order to provide this program.  The owner of Front Range Hospice has insisted that they stick to their core business, hospice. This relationship between Angels Care and Front Range Hospice will have a positive impact on the community and will assist in reducing the total cost of care to individuals at the end of life. The last hospitalization is often extremely expensive and not something that ultimately the patient or the family wanted if they had been educated and provided with another option.

For more information from Angels Care Home Health about Care Connections please call 303-650-3003 or 970-353-2449. For more information about Front Range Hospice please call 303-957-3101 or 970-776-8080.

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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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