What is a Chaplain?

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By: Hope Golden

Chaplains are leaders in the spiritual ministry of patients in palliative care (PC) and hospice (HO). They are professionally trained clergy who recognize the spiritual needs of individuals facing the impact of a terminal illness. When patients and families are facing a life-limiting diagnosis, the prognosis can be intimidating and confusing.

During the last stages of life, spiritual issues can most assuredly rise to the top of the care list. It shows up in behavior like anger, anxiety, grief, and combativeness, as well as joy and acceptance. Each affected person will deal with reality differently. As each person reflects, a myriad of concerns can arise, needing the attention of a spiritual leader.

Palliative care and hospice chaplains are different from pastors and priests in that their single primary goal is to journey with a patient spiritually as they deal with a specific diagnosis. Hospice chaplains walk with patients and their impacted community of loved ones, and the caring staff members, all traveling and facing the trajectory of a patient’s life-limiting illness. The chaplains aim to bring comfort throughout the journey until the patient recovers in PC, or until the HO patient’s transition is complete.

Palliative care and hospice chaplains are members of an interdisciplinary team (IDT) that most often includes a Medical Director, Registered Nurse, Certified Nursing Assistant, and Social Worker. The team works together with other administrative staff, volunteers, and caregivers to promote excellent care for the whole person, mind, body, and soul. Chaplains specialize in listening, especially for the right place for a thoughtful comment or question that moves the traveler closer to peace.

People commit to spirituality through many means, chaplains help patients recall what brings them peace.  Are they members of any religious group? What are their personal beliefs, dreams and aspirations, rituals, family rites, and community experiences? Any of these might impact their thoughts or wishes at this time in their lives.

Spiritual healing can include referrals to more appropriate religious caregivers.  The patient may find hope in someone listening, playing music, playing cards, saying prayers, reading a devotion, a story, or performing a ritual ceremony, or life review.   Patients may desire to deal with hurts, habits, and hang-ups that are causing distress. The type of support a patient may need is tailored reasonably to each individual.

Chaplains are privileged to be part of some of the most precious moments in the lives of people. They, along with the whole team of caring people, provide an opportunity for the most pleasant and peaceful recovery during palliative care or transition on hospice.

If you would like more information on hospice or palliative care please contact us at 303-957-3101 or 970-776-8080, or by email at info@frhospice.com

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Assisted Living Communities and Hospice Care

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Many assisted living communities embrace an “aging in place” philosophy meaning that residents receive increasing levels of care without having to leave the community. This allows residents to stay in their community for as long as they choose – from assisted living to end-of-life hospice care – which removes a lot of the uncertainty from the long-term care planning.

To accommodate residents through end-of-life, many assisted living communities allow hospice care providers to visit residents who are terminally ill. Hospice care, which is covered by Medicare and most private health insurance plans, provides what’s known as comfort care in a team approach — care that eases pain, alleviates discomfort, provides psychological support and spiritual support  when a patient’s illness is no longer responding to treatment.

Hospice teams do much more than provide medications such as painkillers and sedatives. They educate the patient’s primary caregiver as well as provide emotional and spiritual support and counseling to the patient and the patient’s loved ones. The goal is to allow the patient to have a comfortable and dignified exit from this life.

Hospice Care

A common misconception about hospice is that it’s somewhere patients go. While there are some hospice facilities, they are fairly rare. Hospice teams visit patients in their own homes, wherever that happens to be. For assisted living residents, of course, the community is their home.

A growing number of assisted living communities are able to accommodate residents who need hospice care during their time at the community. No assisted living community can guarantee that they will be able to accommodate a resident until their last days. Certain scenarios may require that a terminally ill resident be moved to a nursing home or hospital. But if the resident doesn’t need the kind of care or attention that’s provided at a hospital or nursing home, he or she can very often remain at the senior community with the aid of the hospice team.

Your hospice team will work hard for the resident who is receiving hospice care, work hard for the community to ensure the community understands the specific needs of the resident receiving hospice services. Some of the items that will be addressed by the hospice team are:

  • Medication orders
  • Treatment orders
  • Diet orders
  • Wound Management
  • Medical Equipment Needs
  • ADL assistance
  • Counseling Support
  • Spiritual Support
  • Dignity
  • Privacy
  • Honoring Residents Wishes
  • Following or Developing Advance Directives for Residents
  • Monthly Care Coordination Meetings with the Assisted Living

 

All hospice care is customized care and tailored to the needs of the resident in need of hospice services. The hospice team will work together with the staff of the assisted living to coordinate a plan of care that works best for the resident.

For more information about Front Range Hospice and Palliative Care please call (303)957-3101 or (970)776-8080 or email us at info@frhospice.com

“When medicine cannot provide a cure, hospice can offer assistance; care and comfort that can help maintain a better quality of life for the patient.”

 

 

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Hospice Provides Comfort Care for Seniors

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As baby boomers get older, the need for senior services has increased, and geriatric medicine has become a booming business. When there is also a terminal diagnosis, the family must deal with the stress that comes with the illness and aging. Most people turn to hospice for medical and emotional support.

The Hospice Team

The National Hospice and Palliative Care Organization believes end-of-life services should be painless and compassionate. To support the patient and the family, they not only provide a team of professionals to help with medical treatment and pain management, but they also offer spiritual and emotional support. Their goal is to give patients and their families the resources they need to die with dignity.

The hospice team includes the following people:
• Patient’s personal doctor
• Hospice medical director or physician
• Registered nurses
• Certified nursing assistants
• Chaplain
• Social workers
• Trained volunteers

Hospice provides a wide range of services for families and patients:
• Treats pain and symptoms
• Provides medication, supplies and equipment
• Helps with spiritual and emotional aspects of dying
• Shows the family how to help
• Offers grief counseling to family and friends’

Hospice and the Senior Citizen

Hospice, also known as comfort care, makes patients comfortable instead of treating their illness. It is not, for example, for seniors who are undergoing chemotherapy for cancer. It is for those who don’t want further treatment or for those who no treatment is available. Whether someone has a rare disorder like mesothelioma, a fatal cancer caused by asbestos exposure, or a more common form of lung cancer, hospice will treat breathing difficulties and discomfort that comes from the disease, but it will not treat the disorder. In addition to medical services, hospice provides equipment like wheelchairs, oxygen and breathing treatments to make life easier for the patient.

Depending on the severity of the illness, seniors may receive hospice services at home or in care facility. Depending on the individual situation, private insurance, Medicare, Medicaid or the Veteran’s Administration may pay for the services. For patients who stay at home, hospice nurses and caregivers come into the home to provide intermittent care. Nursing homes collaborate with hospice teams when hospice is appropriate.

People who don’t understand what hospice does sometimes hesitate to offer or accept comforting care to dying seniors. Hospice does not take anything away from its patients. Instead, it gives them what they need to make their last days as comfortable as possible. Every patient is different, and each one has a special team to meet those needs.

Article by Tia Phelps: Accomplished writer and editor on cancer studies and research.

 

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What to Expect During the Hospice Journey

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By: Lucille Rosetti

When someone you love is entering hospice care, it can be hard to know what to expect.  If you haven’t been in this situation before, you might not even know what questions you want to ask, only that the path is unfamiliar.  I have assembled some important information to help you navigate the journey and feel more at ease.

What is hospice?

When someone starts hospice, this means doctors have determined that person could be in the final stages of life.  When starting hospice, both the patient and family have agreed to put quality of life over curative treatment.  Hospice provides peaceful methods for managing end-of-life pain to help your loved one savor the time they have left.  Your loved one will either remain at home or in a care facility.

If you haven’t done so already, it’s important to talk with your loved one about end-of-life arrangements.  Reader’s Digest points out this conversation can bring a surprising amount of comfort to you both, putting minds at ease.  It’s also important to know where to look for critical documents such as a will, medical durable power of attorney, CPR directive, and so forth.  If your loved one isn’t sure about the paperwork, locate it before it is needed and if you are unable to locate the appropriate documents you can initiate new ones.

Comfort in the care team

The hospice care team is comprised of various personnel who will work together to ensure your loved one’s optimal quality of life.  Doctors, nurses, CNAs, chaplains, and social workers typically play an active part in helping with hospice care.

Hospice social workers often play a particularly integral role, evaluating your loved one’s needs and desires, and developing a plan to meet them.  Don’t be afraid to ask questions about their background and education, since familiarity with their qualifications can put your mind more at ease. As an example, these individuals must complete an accredited Master’s of Social Work program.  Numerous universities throughout the U.S. provide classes both online and on campus, and in the course of completing their requirements, hospice social workers often perform anywhere from 900 to 1,200 hours of field work.

Throughout the hospice stay, the social worker will help coordinate the care team. Your hospice social worker can help with understanding the physical process of dying, and chaplains are often called upon for spiritual concerns.  The multidisciplinary approach of hospice helps alleviate distress, as well as pain and other symptoms.  Your loved one might receive a variety of supportive services while in hospice, such as special dietary considerations, prescriptions, or counseling.  If a potentially treatable issue should arise, such as a bladder infection or pneumonia, it can, in most cases, be treated.

End-of-life symptoms

If you have never been with someone who is dying before, it can be helpful to know how to recognize the signs someone has reached the end of their life.  As Verywell Health explains, there are 12 symptoms someone has entered the dying process, which are:

  • Pain
  • Shortness of breath
  • Anxiety
  • Reduced appetite and thirst
  • Nausea or vomiting
  • Constipation
  • Sleeping more
  • Changed social interaction; more withdrawn or more attached
  • Delirium or restlessness
  • Cold hands and feet
  • Mottled skin
  • Rattled breathing

When your loved one experiences these symptoms, it’s important to be accommodating.  The team can help with pain management, anxiety, and other symptoms, and if your loved one prefers time alone or more time with family and friends, try to respect those wishes. Under most circumstances, physical contact during the last moments is both acceptable and encouraged, and can console both you and your loved one.

The hospice journey is oriented toward your loved one’s peace and comfort.  While the patient is the focus, it’s important for family members and friends to learn what to expect.  The team is there to support your loved one, and you can feel more at ease through questions, understanding, and preparation.

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Your Own Memorial: How to Cope with Loss from a Distance

blogPhoto by Kristina Tripkovic on Unsplash

Guest Blogger: Janice Miller

When you’ve lost a friend or family member but you live a long distance away from them, it’s not always possible to make arrangements to be there for their memorial. You may not have the travel funds or be able to get the time off from work you need to get there — especially if the death was sudden. This can lead to feelings of guilt and helplessness on top of the many emotions associated with grief. That’s why it can be very helpful to lend a helping hand to those mourning in whatever way you can. Additionally, finding a way to honor to your loved one’s memory yourself can be a powerful source of healing and closure.

Managing Your Own Grief

If you don’t take care of yourself, you can’t care for anyone else. Whether you’re a novice when it comes to losing people or you’ve dealt with grief before, it’s never easy. Make sure you are caring for yourself and keeping up healthy habits that support your self-care habits and physical and mental well-being. It’s okay to let yourself feel bad when thinking about your loss, but balance out the time you spend grieving with activities that make you feel good. Exercise to get a rush of feel-good endorphins and release any stress you may be carrying. Enjoy the mood-boosting benefits of hanging out with your pets. Throw a small dinner party and nourish yourself with good food and company. Read to de-stress, get in touch with your emotions, and improve sleep. Whatever it is that comforts you during this difficult time, pursue it while avoiding unhealthy coping mechanisms like drinking, compulsive spending, and comfort eating.

Helping from Afar

The key to helping your grieving loved ones when you can’t be there in person is communication. Get in touch with one contact person with whom you can coordinate and ask if there is anything that the family needs. They may be able to include you on a meal train or ask you to contact other friends who do not have received the tragic news yet. It’s best to have a single point-of-contact rather than trying to coordinate with multiple people because the simplicity cuts down on the chance of miscommunication.

There isn’t one best practice for what to do when you miss a funeral. You can send a sympathy card or flowers, but it really depends on your style. Some people find that cards and plants are wasteful and prefer to donate to a charity in the deceased’s name. If you have the funds available, a great way to help is by paying for housekeeping services for the spouse or parents of the deceased. People who have lost an immediate family member often neglect everyday chores while they adjust to their new reality. Having someone come in to help with these tasks ensures they aren’t surrounded by stress-inducing messiness while they grieve.

A Long-Distance Memorial

Helping the loved ones they left behind is a wonderful way of honoring the deceased’s memory. However, finding ways to commemorate your loved one yourself can also be a helpful catalyst for moving on. Think of a way to do it that is both unique while reflecting your friend or family member’s values. For instance, if they were a staunch environmentalist, consider planting a tree in their memory. Or, if they left behind a young child with a bright future, set up a college fund where people can contribute. Or, simply spend a day committed to doing things that you loved to do when together and keep their memory with you through every moment. Your memorial should be as personal as your relationship with the deceased.

Grieving from afar isn’t easy, but sometimes it’s necessary and unavoidable. Tend to your own emotions, and keep up healthy habits that contribute to both your physical and mental wellness and self-care practices. Do what you can to help from afar, whether that’s sending food or contacting friends so the family doesn’t have to. Finally, make time to do a small memorial for yourself where you honor the deceased and provide an opportunity for closure.

 

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Family Experience Satisfaction Survey Results

Front Range Hospice and Palliative Care, your leader in Making Best Days Possible and providing Legendary End of Life Care once again comes out on top. Front Range Hospice and Palliative Care has been conducting post death family experience satisfaction surveys for years (see the image below for the most recent available data).

If you would like more information about Front Range Hospice and Palliative Care, or if you would like to see our Family Experience Satisfaction Survey Results on an ongoing basis please call 303-957-3101 or 970-776-8080 or email us at info@frhospice.com.

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Improving Palliative Care in Emergency Medicine

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By Victor Montour

Patients with a serious illness are likely to find themselves in an emergency department (ED) at some point along their trajectory of illness, and they should expect to receive high-quality palliative care in that setting. In the last five years, emergency medicine has increasingly taken a central role in the early implementation of palliative care. Widespread integration of palliative care into the day-to-day practice of emergency medicine, however, is often jeopardized by the demands of many competing priorities.

Although the ED is not considered an ideal place to begin palliative care, hospital-based physicians can assist in eliciting the patient’s goals of care and discussing prognosis and disease trajectory.

There has been and continues to be a large movement to educate emergency physicians on end-of-life care and improve palliative care in emergency medicine, leading to clinical practice guidelines. In reality, because of the acute symptoms that are often accompanied by significant emotional overtones and disposition issues, an emergency medicine physician, hospitalist or intensivist should quickly contact a community based palliative care team for consultation. Many patients present with serious and unrelieved symptoms such as pain, dyspnea, nausea, and vomiting that were not well controlled in the outpatient setting without a community based palliative care program involved. The ED or hospital may be the only option for them to receive intravenous (IV) fluids or medications, as well as immediate access for acute imaging or access to specialists, for example, radiation oncologists. Even if the patient’s goals are clearly non-aggressive, the patient may arrive in the ED because of family distress over uncontrolled symptoms.

Emergency room physicians are in a unique position to have early conversations can help with the identification of patients who may need palliation, discussing prognosis, eliciting goals of care and directives, symptom management in the ED, and making plans for further care. These efforts have been shown to improve outcomes and to decrease length of stay and cost in the hospital setting. The focus of palliative care is relieving “patient” symptoms and family distress, honoring the patient’s goals of care, and assisting in transition to a supportive approach and placement where this may be accomplished in the most conducive environment for the patient and family.

Front Range Hospice and Palliative Care has vast experience working with emergency room physicians and staff to meet the symptom management needs of patients in the communities we serve. If you or someone you know finds themselves in the emergency room, remember to ask the doctor to make a referral to Front Range Hospice and Palliative Care for palliative care services.

Characteristics of Patients Needing a Palliative Care Consult:

  • Patients with a serious, life-threatening illness and one or more of the following need a palliative care consult.
  • Bounce-Backs – The patient makes more than one ED visit or hospital admission for the same condition within a few months
  • Uncontrolled Symptoms – ED visit is prompted by difficult-to-control physical or emotional symptoms.
  • Functional Decline -There is decline in function or worsening of feeding intolerance, unintentional weight loss, or caregiver distress
  • Increasingly Complicated – Complex long-term care needs require more support.

Other patients that may benefit from early hospital medicine or palliative care consult include transfers from a long-term-care facility; patients with metastatic or locally advanced, cancer; patients with out-of-hospital cardiac arrest; advanced dementia patients; and frail, elderly patients with poor functional status.

Adults with chronic illnesses often visit an ED several times in their last year of life. A study of patients older than age 65 years by Smith et al revealed 75% visited an ED in the last 6 months of life and 51% in the last month, many with repeat visits. The transition community based palliative care, symptom management may greatly change the hospital trajectory of care. Here is the opportunity to initiate further goals of care that may change future plans. Research supports early palliative care in the ED to improve quality of life as well as to reduce costs that may have been associated with alternate treatments. Discussions surrounding goals and plan of care, symptom management, and aggressive pain control are some of the cornerstones of palliative care. Some additional benefits from early palliative care interventions in the ED include resource management, improved satisfaction for patients and their families, improved outcomes, decreased length of stay, less use of intensive care units and less cost, and increased appropriate direct hospice consults.

Goal-Oriented Patient Assessment

A goal oriented patient assessment is the first imperative step to find out why the patient is in the ED and to perform a rapid assessment of their palliative care needs. Emergency medicine physicians can begin goal-directed assessments and plans that can help avoid unwanted treatments, inappropriate resource expenditure, and undue suffering.

For more information about Front Range Hospice and Palliative Care and our Palliative care program call 303-957-3101 or 970-776-8080 or email us at info@frhospice.com

 

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