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

ED-Sign

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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Do You Need Community Based Hospice or In-Patient Rehabilitation?

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By Victor Montour

When someone suffers from an injury or medical trauma, they may need to live at a rehabilitation center or skilled nursing facility for a short period of time. The goal for most people going to in-patient rehabilitation is to help the patient return to his/her maximum functional potential after suffering a life-altering event.

When someone is diagnosed with a life limiting disease they may need to look at a community based hospice. The goal for patients going into hospice is to provide physical, emotional and spiritual support to the patient and family while they enjoy life at home with family and friends while the patient’s disease process continues on a natural course.

In-patient rehabilitation is a rehabilitation service offered to people in a residential setting, rather than to people who travel to a clinic for rehabilitation appointments. These facilities are called skilled nursing facilities (SNF) or In-patient Physical Rehabilitation Centers. In-patient facilities could be located inside a hospital or senior housing, such as assisted living facilities and nursing homes.

These centers provide around-the-clock treatment and supervision. The patient’s progress is continuously monitored. In some cases, in-patient treatment programs stand a better chance of success for patients. Some common types of ailments that might be best treated (check with your doctor for the best advice) include:

  • Fractures
  • Joint injury or replacement
  • Aneurysm
  • Neurological conditions
  • Stroke
  • Arthritis of the spine and other joints
  • Brain injury
  • Nerve impingement
  • Amputation

Community based hospice services are offered to people in a residential home or home like setting. Hospice care can all so be provided in some community facilities. Some of these facilities are called skilled nursing facilities (SNF), senior housing, or assisted living facilities.

Most community based hospice care is provided at home — with a family member typically serving as the primary caregiver.  Medicare has strict clinical guidelines a patient must meet in order to receive hospice care in a hospital setting. This type of hospice care is very rare and should never be considered as the first line of treatment. Some common types of medical conditions that might be best treated in hospice (again check with your doctor for the best advice) include:

  • Stroke
  • Cancer
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Congestive Heart Failure (CHF)
  • Amyotrophic Lateral Sclerosis (ALS)
  • Alzheimer’s
  • Liver Failure
  • Renal Failure
  • Amputation

 

Duration of in-patient rehabilitation treatment varies depending on the severity of the condition and potential for improvement. The key words being potential for improvement. Families and patients should ask their doctors what the potential for improvement is for any treatment. If improvement is low or a decline in health continues then the next question should be, what about hospice?

Generally, significant results can be achieved in either program as long as you are placed in the appropriate program at the optimal time. People should enter into hospice as quickly as they do going into rehab. Hospice care should be a timely choice not a last resort. Currently this concept seems to differ widely depending on the condition being treated and the patient’s involvement in his/her care.

Many times, I see patients going to rehab who have a terminal diagnosis. I always ask myself, is this patient informed? Do they understand their diagnosis? Do they understand the diagnosis they have is terminal? Do they know they could spend their time with loved ones enjoying life instead of being alone or with strangers in a rehab facility?

As healthcare is everchanging it is the patient’s responsibility to know their diagnosis, to know best treatment options and to know when a diagnosis is terminal. Patient’s need to drive the conversation on what they want for care. Ask is hospice or rehab more appropriate? Ask what is the potential of cure or rehab? Let your doctor know what ‘enough’ looks like to you. Talk to your doctor about what you’re willing to do in rehab and what you’re not willing to do. You have to say ‘enough is enough’ when the time comes, so why not prepare people ahead of time.  I have seen many people with a terminal diagnosis sent to rehab and even continue until death because they weren’t fully aware of the choices they had.

You are in charge of your healthcare so take charge and research your options. Educate others on what you want, when you want it.

 

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A Precious Journey

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By Victor Montour

As a community liaison for Front Range Hospice and Palliative Care I’m blessed with many opportunities to meet some wonderful people. Just recently I was asked to meet with the patient and the family at one of our area hospitals to discuss palliative care and what services are provided with Community Based Palliative Care.

The next day I was called by the patient’s son and asked to come to the home to discuss hospice services. When I arrived at the patient’s home he was sitting outside enjoying the morning air, the fresh smell of the morning dew was heavy. I sat with the patient, his son, daughter-in-law and his daughter called in from out of state. I first talked with the patient to establish his goals for medical care. It was profound to discover the patient was asking for someone to talk with him openly and honest about his prognosis. He also was clear that his largest fear was losing his mind. He wanted to remain sharp and in control. After a long conversation with him and his family, reviewing the pros and cons of seeking treatment, the patient wanted to start hospice care.

Over the last week the team from Front Range Hospice and Palliative Care provided legendary end of life care. The patient was placed on daily Registered Nursing (RN) visits to ensure maximum comfort was obtained and maintained. The RN’s were called out to the home, as needed, a number of times day and night to help manage the patient’s terminal agitation. (To learn more about terminal restlessness / agitation read our blog “A Major Distressful Symptom in The Dying”) The nursing team from Front Range Hospice and Palliative Care provided endless support to the patient and the family.

A final call from the family came in the middle of the night informing the on-call nurse that the patient had passed away peacefully in his bed. The nurse made her way to the home and provided one last time the support this family came to expect from our team. The nurse completed her nursing functions and then turned to the family and sat with them a bit and provided them the reassurance they needed to hear.

As a liaison I frequently get calls from families for assistance of various kinds. I received a call from the patient’s daughter-in-law asking to meet with me at 10:00 am. I was asked to come to the home to meet in person with the family. When I arrived, I had the pleasure of meeting with the patient’s daughter from out of town, the son and daughter-in law. The three of them shared with me their experience while on this journey with their father. The wonderful things that the family had to say were just amazing.

They all agreed that their hospice RN Haley was the perfect nurse for their dad. She was amazing, they recounted with me how Haley helped their father get into his camper one last time. They shared that he loved his camper and spent more time in there than the house. The family voiced they will never forget this selfless act of kindness shown to their father.

As we talked more, the family made special mention of RN Heather. Heather brought them a sense of calm with her soft tone and warm smile. They shared that they felt Heather was there just for them, they never felt rushed or felt like she was in a hurry to move onto her next patient.

I could go on and on about this meeting and list every team member that provided legendary care to this patient and family. Over all the meeting was wonderful, they were impacted by this journey they traveled with us in such a positive way that they wanted to share their story. It was important for them to tell their truth and to validate how this experience has impacted them and us forever.

The end of life journey doesn’t have to be a scary. It can be filled with love, laughter, goodbyes and most of all wonderful memories till the end.

 

All of us at Front Range Hospice and Palliative Care send out heart felt thank you to this family and all of the other families for allowing us to be apart of this special time. It is an honor to be at your side during the most intimate time in your life.

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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Community Based Palliative Care: How does it work?

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By Victor Montour

Palliative Care (pronounced pal-lee-uh-tiv) is specialized medical care for people with serious illness. This type of care is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.

Community Based Palliative care is provided by a specially-trained team of doctors, nurses and other specialists who work together with a patient’s and their doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness, and it can be provided along with curative treatment.

  1. Where do I receive palliative care?

Palliative care is provided in a variety of settings including the hospital, outpatient clinic, at home, in assisted livings and nursing homes.

  1. Does my insurance pay for community based palliative care?

Most insurance plans, including Medicare cover palliative care. If costs concern you ask our liaison for a copy of our how to verify your insurance coverage form.

  1. How do I know if community based palliative care is right for me?

Community based palliative care may be right for you if you suffer from pain, stress or other symptoms due to a serious illness. Serious illnesses may include cancer, heart disease, lung disease, kidney disease, Alzheimer’s, amyotrophic lateral sclerosis (ALS), multiple sclerosis, Parkinson’s and many more. Palliative care can be provided at any stage of an illness and along with treatment meant to cure you.

  1. What can I expect from a community based palliative care program?

You can expect relief from symptoms such as pain, shortness of breath, fatigue, constipation, nausea, loss of appetite and difficulty sleeping. Palliative care helps you carry on with your daily life. It improves your ability to go through medical treatments. It helps you better understand your condition and your choices for medical care. In short, you can expect the best possible quality of life.

  1. Who provides community based palliative care?

Community based palliative care is provided by a team including palliative care doctors, nurses and other specialists.

  1. How does community based palliative care work with my own doctor?

The community based palliative care team works in partnership with your own doctor to provide an extra layer of support for you and your family. The team provides expert symptom management, extra time for communication about goals and treatment options, and help navigating the health system.

  1. How do I get community based palliative care?

Ask for it! Tell your doctors and nurses that you would like a referral to Front Range Hospice and Palliative Care for palliative services. Our liaison will contact you for a no obligation informational.

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Happy Nurses Week

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Nurses all over the country take pride in the fact that the public has rated nursing as the most honest and ethical profession for the past 16 years. Nurse’s commitment to protecting, promoting, and improving health care for all is well recognized, and they serve the public in a wide range of roles and work settings. Therefore, it is only fitting that we take one week each year to celebrate the nursing profession and the vital roles nurses play in health care.

I would use two words to describe a nurse. Nurses are Caring and Compassionate people.  You see, nurses encounter patients from all walks of life, many of whom are afraid of judgment they may receive from the medical community for one reason or another. A nurse can change a patient’s entire perspective by “showing them nurses value caring and compassion above all else,”

Nurses not only care for their patients they all so care for other nurses. Nurses inspire and mentor other nurses by providing them a springboard to elevate their practice and scope of other nurses and healthcare professionals they work with. They do so by recognizing the potential in people. This is just one way nurses inspire others in healthcare.

Nurses are innovators and act as agents of change to drive processes and policy and leverage technology to prove better, more affordable care for individuals and the community. Nurses have influenced innovation in the industry so much that the American Nurses Association (ANA) has updated the ANA scope and standards of practice document that calls for all nurses to be leaders within the profession, working to influence policies and encourage innovation (ANA, 2015a).

Lastly nurses are Influential; nurses must see themselves as professionals with the responsibility to influence current and future healthcare delivery systems. The nursing profession is based on the science of human health and the science of caring. It operates from a framework that values all people in a holistic way and seeks to foster and advance people’s health throughout their lifespans and across all levels of society. Through policy work, nurses can and do influence practice standards and processes to assure quality of care. Nurses who influence policy help shape the care that will be provided today and tomorrow.

Front Range Hospice and Palliative Care would like to take a moment to send a very warm THANK YOU and HAPPY NURSES WEEK to all the wonderful nurses who inspire, innovate and influence those who are currently working, retired, and those just starting out their journey into the healthcare profession.

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April is Stress Awareness Month

stress

By Victor Montour

The last month has been a bit stressful for me. In an effort to manage my stress I went on line looking for some great advice or ideas I could use to help decrease my stress level. Just like all of you, from time to time we feel stressed. If we leave this stress unchecked, it tends to be a real joy-killer. This, of course, makes it harder for us to live Complaint-Free, happy lives. Did you know stress can also lead to a number of major health problems, ranging anywhere from anxiety to severe depression, from mild acne to life-threatening heart attacks, so it is easy to see why it is so vitally important to keep life’s major stressors in check.

This blog comes at a good time being April is National Stress-Awareness Month, I thought this is perfect, I can share with you what I found on line to help me manage my stress. Now I know some of the items I list you may find silly or something you wouldn’t do. The important message in this blog is for you to manage your stress in a healthy way. So, here is a list I found on line of 10 positive ways you can respond to the stress in your life and keep your own stress levels in check or at a minimum.

Health

Taking control of your personal health can make a great difference in the amount of stress you feel. The best way to reclaim control of your life is by taking charge of your body. Whether it is through diet, exercise, or simply getting that checkup you’ve been putting off, let April be the month you put yourself back in control.

Change

It can be as simple as clearing the clutter off your desk or as elaborate as taking a well-deserved vacation, the important thing is that you do something different. Even a small change can make a big difference when it comes to stress.
 

Live in the Moment

Most folks live their entire lives in yesterday or tomorrow. In truth, however, there is only now. Focusing on this perfect moment, right now, provides a magical escape from the disappointment of what once was and the fear of what might be, and leaves stress stuck in a time warp.
Talk to Yourself

Sometimes a good pep talk is all that is needed to keep stress at bay. Maybe it is high time you gave yourself one by affirming what is right with your life instead of dwelling on what’s wrong
Get the Giggles

It’s true; laughter really is the best medicine. Watch a funny show or video, tell a funny joke, or go to a card shop and read funny cards. Whatever it takes, give yourself time for laughter each and every day.

 

Meditate

A still mind is a stress-free mind, so take a deep breath, quiet your thoughts and let the stress melt away. Even ten minutes of meditation done daily for the next 30 days will do wonders for releasing stress in your life.

 

Journal

Every evening for the next 30 days spend a few minutes reflecting on the day you just experienced and list five things about the day that delighted you.
 

Positive Spin

No matter what challenge you may be facing, do your best to think about it positively and then let that new positive mindset become your focal point.
Helping Others

Sometimes the best way to deal with stress is by providing relief to someone else. Putting your focus on others takes the focus off your own challenges leading to less rumination and stress. So, look around you, see who needs a hand up, and then offer yours.
I hope you find some of the items on this list helpful. If you or someone you know would like more information about stress and stress management, please contact your primary care doctor. Your primary care doctor will be able to direct you to other resources in your community.

 

 

By Victor Montour

The last month has been a bit stressful for me. In an effort to manage my stress I went on line looking for some great advice or ideas I could use to help decrease my stress level. Just like all of you, from time to time we feel stressed. If we leave this stress unchecked, it tends to be a real joy-killer. This, of course, makes it harder for us to live Complaint-Free, happy lives. Did you know stress can also lead to a number of major health problems, ranging anywhere from anxiety to severe depression, from mild acne to life-threatening heart attacks, so it is easy to see why it is so vitally important to keep life’s major stressors in check.

This blog comes at a good time being April is National Stress-Awareness Month, I thought this is perfect, I can share with you what I found on line to help me manage my stress. Now I know some of the items I list you may find silly or something you wouldn’t do. The important message in this blog is for you to manage your stress in a healthy way. So, here is a list I found on line of 10 positive ways you can respond to the stress in your life and keep your own stress levels in check or at a minimum.

Health: Taking control of your personal health can make a great difference in the amount of stress you feel. The best way to reclaim control of your life is by taking charge of your body. Whether it is through diet, exercise, or simply getting that checkup you’ve been putting off, let April be the month you put yourself back in control.

Change: It can be as simple as clearing the clutter off your desk or as elaborate as taking a well-deserved vacation, the important thing is that you do something different. Even a small change can make a big difference when it comes to stress.

Live in the Moment: Most folks live their entire lives in yesterday or tomorrow. In truth, however, there is only now. Focusing on this perfect moment, right now, provides a magical escape from the disappointment of what once was and the fear of what might be, and leaves stress stuck in a time warp.

Talk to Yourself: Sometimes a good pep talk is all that is needed to keep stress at bay. Maybe it is high time you gave yourself one by affirming what is right with your life instead of dwelling on what’s wrong

Get the Giggles: It’s true; laughter really is the best medicine. Watch a funny show or video, tell a funny joke, or go to a card shop and read funny cards. Whatever it takes, give yourself time for laughter each and every day.

Meditate: A still mind is a stress-free mind, so take a deep breath, quiet your thoughts and let the stress melt away. Even ten minutes of meditation done daily for the next 30 days will do wonders for releasing stress in your life.

 Journal: Every evening for the next 30 days spend a few minutes reflecting on the day you just experienced and list five things about the day that delighted you.

Positive Spin: No matter what challenge you may be facing, do your best to think about it positively and then let that new positive mindset become your focal point.

Helping Others:Sometimes the best way to deal with stress is by providing relief to someone else. Putting your focus on others takes the focus off your own challenges leading to less rumination and stress. So, look around you, see who needs a hand up, and then offer yours.

I hope you find some of the items on this list helpful. If you or someone you know would like more information about stress and stress management, please contact your primary care doctor. Your primary care doctor will be able to direct you to other resources in your community.

 

 

Posted in health, Health Information, hospice, Hospice & Palliative Care, illness, Uncategorized | Tagged , , , , , , , , , , , , , , , , , | Leave a comment