Congestive Heart Failure and Palliative Care

chf

By: Victor Montour

Congestive Heart Failure and Palliative Care

Congestive heart failure (CHF) is a chronic condition in which the heart is unable to pump your blood properly. It can cause breathing problems and other symptoms, such as weakness, shortness of breath and swollen feet and ankles.

How Palliative Care Can Help

Palliative care is specialized medical care for people facing serious illnesses like CHF. The goal is to improve quality of life for both you and your family to create the best day possible. You can receive palliative care at any age and at any stage of your illness. You can also have it together with curative treatment, rehab or home health. Front Range Hospice and Palliative care provides palliative services with the use of a team that consists of a Doctor, Nurse Practitioner, Social Worker and a Chaplin who work together with your other doctors to give you an extra layer of support.

Our Palliative Care team works in close partnership with your cardiologist (heart specialist) and other specialists. In addition to prescribing medications for your pain and other symptoms, team members have a wide variety of approaches to treating congestive heart failure that do not involve drugs. For example, palliative care teams are expertly trained to perform highly effective lymphatic drainage, a technique for reducing leg swelling and its associated pain. They’ll educate you about how to stand, sit and lie down to improve your breathing comfort. They’ll also train you in the use of fans, relaxation methods, meditation and breathing exercises to decrease any anxiety or panic that may accompany feelings of breathlessness.

Palliative care is also there to guide you and your loved ones through the distress caused by CHF. The team will help you navigate the complex health care system and keep you and your family informed, up to date and in control. Because episodes can become worse, sudden and unpredictable, palliative care specialists can help you plan in advance for the next time it happens. In fact, one of the most important things your palliative care team can do is to help you fully discuss your health situation with your family.

Understanding that every patient and every family is different, the team uses its communications expertise to work with you, one-to-one, to help you develop a realistic idea of what congestive heart failure is, how it works, where it might lead and what it means, specifically, to you. Our team can help you and your family clarify your personal goals for care and guide you in expressing your values and concerns. In the end, the team’s most important goal is to help you and your family achieve the best possible quality of life as you live with CHF.

If you or a loved one is living with CHF and would like more information about Palliative Care, please call 303-957-3101 or 970-776-8080 or email us at info@frhospice.com

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Thank you, patients.

thank-you-patients

By Victor Montour

Do you know who founded National Patient Recognition Week? With a little help from google, this is what I found out. National Patient Recognition Week was founded by John O’Malley in 1995. The Week is intended to promote observance of health care patients. This is rather unique since most health care awareness dates focus on health care personnel or specific health issues. This very special week revolves around patients, patient satisfaction. Observing patient satisfaction, health care providers can use the time to consider ways in which they can enhance the patient experience.

Front Range Hospice and Palliative care continues its long-standing commitment to providing exceptional customer service to the patients and families we serve. Our hospice and palliative care programs not only improve patient care through enhancing services and updating technology, but also by focusing on a much more personal level that allows greater comfort and attention to small details. It’s something that I think patients truly appreciate.

Patient needs go beyond the technical aspects of care. As professionals, it’s imperative we include the emotional, physical, spiritual needs of patients and families while displaying compassion, empathy, and a connection with our patients and families.

All of us at Front Range Hospice and Palliative Care Thank you for the opportunity to reflect on how our actions affect the well-being and satisfaction of the patients and families we serve. We thank you for inviting us into your homes so we can provide you the support you need to make great days possible.

Happy National Patient Recognition Week from all of us at

Front Range Hospice and Palliative Care.

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Employees of the Year

Congratulations to our Employees of the Year- Jessica Mosness & Andi Boss!

Jessica Mosness, RN

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Holding the hand as someone takes their last breath…there is nothing in the world quite like the honor, peace, and beauty in this.  As I reflect on the months, weeks and days that lead up to someone’s last breath, it makes it that much more incredible as it takes a team approach and effort to get a patient and family to that point.  We as a team control patient’s symptoms, educate on end of life with family, support family, provide spiritual support and guidance, amongst other things, to get us to that last peaceful moment…it is a job I take very seriously and a job I do with my heart and soul every day.  It would be selfish to say one team member does it all, because that is not true.  I believe all of our work together makes what we do so magical and amazing.  Being Employee of the Year is the greatest accomplishment I have had as an RN and it is something I am very proud of, but thank you to my team and all of our staff for helping me and our patients because without that, I would not be what I am and do as well as I do.

I am often asked why do you do hospice nursing.  Aren’t you sad all the time?  And, my answer is this:  I believe being a hospice nurse is a calling.  It is a calling I believe I am blessed with.  I remember as a child I always thought I wanted to be a doctor.  I even started off college Pre-Med at the University of Wyoming.  However, life happened and my path and vision of what I wanted to do changed.  I had a best friend from high school that was in a terrible car accident that left her completely debilitated with significant brain damage.  I would drive up to see her as much as I could to spend time with her, give her arm/hand massage and I was so drawn into the hospice’s nurse’s role at the end of her life.  There was also my Grandmother and Great Aunt that I was blessed enough to help care for towards the end of their life.  I feel God has put “moments” into my life that have directed and paved my path towards hospice nursing.  My career gives me fulfillment in more ways than I could ever describe.  Helping someone and their family at the end of their life is an honor, a privilege and I am so beyond blessed to do this for a living.  I am even more grateful to get to do this for Front Range Hospice and Palliative Care

 

Andi Boss, RN

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I’ve been a nurse for 15 years and never have I received an honor such as this. I never thought about Hospice as being a career path for me, but after losing my dad almost 3 years ago from a long battle of cancer I feel he sent me in this direction of being a Hospice nurse.  Being a hospice nurse is probably one of the most challenging jobs I have done in my nursing career.  It is incredibly rewarding to be part of a person’s final days, not only being there for the patient but I also get to help families find a way to cope with losing their loved ones and being a shoulder for them to cry on.  I don’t really deserve to be employee of the year for Front Range Hospice, I feel it’s a team effort and without the whole team I could not do my job.  Thank you all for the support you provide to me and to our patients.

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National Hospice & Palliative Care Month

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Most people have heard of hospice care and have a general idea of what services hospice provides. What they don’t know or what may become confusing is that hospice provides “palliative care,” and that palliative care is both a method of administering “comfort” care and increasingly, an administered system of palliative care offered most prevalently by hospices and hospitals. As an adjunct or supplement to some of the more “traditional” care options, both hospice and palliative care protocols call for patients to receive a combined approach where medications, day-to-day care, equipment, bereavement counseling, and symptom treatment are administered through a single program. Where palliative care programs and hospice care programs differ greatly is in the care location, timing, payment, and eligibility for services. Do you know your options when it comes to Hospice and Community Based Palliative Care? The information in this blog will give you a brief summary of what options are available.

Place:

Hospice
Hospice programs far outnumber palliative care programs. Generally, once enrolled through a referral, a patient’s hospice care program, which is overseen by a team of hospice professionals, is administered in the home. Hospice often relies upon the family caregiver, as well as a visiting hospice interdisciplinary team. While hospice can provide round-the-clock care in a nursing home, a specially equipped hospice facility, or, on occasion, in a hospital, this is not the norm.

Community Based Palliative Care
Palliative care has been enjoying significant growth in the US during the past several years, primarily within hospital settings. This approach has significant value and there is now ample evidence showing positive outcomes for patients receiving hospital-based palliative care. Waiting for a hospitalization to trigger discussions of goals of care, however, may lead to unnecessary suffering. Intervening earlier in the continuum of care for patients with chronic and advanced illnesses can significantly reduce the burden of illness, improve quality of life and prognosis as well as reduce overall healthcare expenditures, while at the same time, aligning expense with meaningful care. Thus community-based models of palliative care are emerging. Generally, once enrolled through a referral, a patient’s community based palliative care program, which is overseen by a team of hospice professionals, is administered in the home. Hospice programs are well versed in providing home-based services to patients with far advanced illness and their families in an interdisciplinary, holistic manner that attends to multiple facets of need; physical, emotional, social and spiritual. Involving the interdisciplinary team earlier in the care of patients with advanced illness presents unique challenges and requires new competencies and systems of care delivery. Community based palliative care programs ensure patients and their families have access to care options that best meet their individual needs while in their home, an assisted living or even a nursing home.

Timing:

Hospice
You must be considered to be terminally ill or have a prognosis of six months or less to be eligible for most hospice programs or to receive hospice benefits from your insurance.

Community Based Palliative Care
There is no time restrictions to receive community based palliative care. The patient must have a life limiting disease to be eligible for Community based palliative care. Community based palliative care can be received by patients at any time, at any stage of illness whether it be terminal or not.

Payment:

Hospice
Before considering hospice, it is important to check on policy limits for payment. While hospice can be considered an all-inclusive treatment in terms of payment (hospice programs cover almost all expenses) insurance coverage for hospice can vary. Some hospice programs offer subsidized care for the economically disadvantaged, or for patients not covered under their own insurance. Many hospice programs are covered under Medicare, Medicaid and most private Insurances.

Community Based Palliative Care
Since this service will generally be administered through a hospice medical provider; it is likely that it is covered by your regular medical insurance. It is important to note, however, that each item will be billed separately, just as they are with regular doctor visits. If you receive outpatient palliative care, prescriptions will be billed separately and are only covered as provided by your regular insurance. For more details, check with your insurance company, doctor, or hospice administration.

Treatment:

Hospice
Most programs concentrate on comfort rather than aggressive disease abatement. By electing to forego extensive life-prolonging treatment, hospice patients can concentrate on getting the most out of the time they have left, without some of the negative side-effects that life prolonging treatments can have. Most hospice patients can achieve a level of comfort that allows them to concentrate on the emotional and practical issues of dying.

Community Based Palliative Care

Since there are no time limits on when you can receive community based palliative care, it acts to fill the gap for patients who want and need comfort at any stage of a life limiting disease, whether terminal or chronic. In a community based palliative care program, there is no expectation that life-prolonging therapies will be avoided.

If you would like 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

#hpm #hospicemonth #hospiceawareness

 

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Press Release

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Press Release:

Front Range Hospice, a leading hospice in the Front Range, has changed its name to reflect the addition of Community Based Palliative Care. Front Range Hospice & Palliative Care has developed its program to bring comprehensive palliative care to the home environment. Palliative Care is now common within hospital settings. Yet, waiting for an emergency room visit or a hospitalization to trigger discussions of goals of care can lead to unnecessary suffering.  The Joint Commission, which is considered the Gold Standard in healthcare announced on July 1, 2016 that it was now offering a certification for Community Based Palliative Care. “Front Range Hospice & Palliative Care’s program was developed to meet the Joint Commission standard and we will be applying for that certification”, says Pam Ware, CEO and Founder of Front Range Hospice & Palliative Care.

Martha Twaddle, M.D. stated at a recent National Hospice and Palliative Care conference that “intervening earlier in the continuum of care for patients with chronic and advanced illnesses can significantly reduce the burden of illness, improve quality of life and prognosis as well as reduce overall healthcare expenditures, while at the same time, aligning expense with meaningful care.” After much research, Pam Ware came to the conclusion that a well-designed community based palliative care program was needed if the healthcare community in the Front Range was going to be able to reach the Triple Aim which is the goal of healthcare. The Triple Aim refers to improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.

Under the guidance of a Hospice and Palliative Care certified physician, Dr. Mark Sanazaro, the Community Based Palliative Care program will provide nurse practitioners, clinical social workers, chaplains and volunteers to individuals with life threatening diseases. The goal is through symptom management, education, and counseling, individuals and their families in the program will learn how to Make Best Days Possible while living with a life threatening illness. For further information please call 303-957-3101 or 970-776-8080 or email at info@frhospice.com.

 

3770 Puritan Way, Suite E – Frederick, CO 80516

p 303.957.3101   970.776.8080   f 303-957-3113

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What to Ask When Looking For a Hospice

What to Ask When Looking For a Hospice
We Are Not the Same

By Victor Montour

questions

When people are trying to make decisions about which hospice to enroll in, most want to choose a hospice that will deliver the best possible care for whatever time they have left. With the vast number of hospices in the area and the ongoing local press grouping the area hospices as if we are all the same, we thought it was time to revisit this very important topic.

Hospice care is not just hospice care. The care you receive from a hospice agency will vary. WE ARE NOT ALL THE SAME. Each hospice agency has their own staffing model, policies and procedures, response time to a patients needs and so on. As you may know from our Hospice Survey blog, in the past not all hospices measure patient outcomes or quality improvement. Just recently all hospices are required to collect this data and make it public to the consumer. The down side to this is the consumer will not see these results until sometime in 2017 unless they ask. If you haven’t read our blog “Hospice Survey” I encourage you to read it next. Front Range Hospice has been collecting data for years so we can prove that our patients and families receive legendary end of life care. So in an effort to assist you again, here is a list of questions you or your family need to know and ask while looking for a hospice agency to help you.

  • A a consumer you have the right to choose the hospice of your choice. It is unlawful for a healthcare professional to pressure you or make you use a hospice that you have not chosen.
  • You can ask your doctor for advice. Your doctor may be able to tell you the names of the hospices he or she have used in the past and their experience working with them. But also ask your doctor if he or she has a financial relationship with that hospice. Some doctors are employed by hospices, and may have a financial incentive to refer. Patient’s choice trumps doctor’s choice. That is the law.
  • If a referral to hospice needs to be made while you’re in an acute care hospital setting, again you will want to ask if the hospice is affiliated to or owned by the hospital. Some hospital systems strongly encourage their staff to refer to the hospital owned hospice with little regard to the patient’s wishes or choice. Remember you have the right to choice and must be allowed to choose the hospice you want to use.
  • A hospice that is owned or affiliated with a hospital is not the same as a hospital that has a preferred provider relationship with a hospice. These relationships are developed over time and are the result of the hospital’s experience with that hospice. Do not be afraid to ask how that decision came about. A hospital usually makes that decision based on the responsiveness, the feedback they receive from patients and families, the quality data and

As you are doing your due diligence I recommend you call the hospices in your area. Set up a time to interview your choices. During this interview you as a consumer should find out what you can expect from the hospice. Use this scorecard as a guide: Scorecard

  • What services they provide? And when are the services provided? Listen to see if the hospice will work around your needs and preferences or are you put into a model of care that is centered around the hospice and its staff.
  • What is the nurse to patient ratio? The National Hospice and Palliative Care Organization staffing guidelines recommend 10-12patients per registered nurses, 30 patients for social workers and 40 patients for chaplains.
  • Does the hospice provide all four levels of hospice care?” (That’s routine home care, inpatient care, continuous care at home, and respite care). Medicare-certified hospices are required to provide all four, but many don’t. To learn more about the four levels of care in hospice check out our blog Do You Know The Four Levels of Care
  • One of the most important questions to ask: “Is your hospice certified by The Joint Commission (TJC) or the Community Health Accreditation (CHAP)?” This is voluntary participation by the hospice and a commitment to meet the highest standards in the industry. TJC is considered the Gold Standard. Surveyors from these organizations visit and inspect hospices regularly. As a consumer you have the right to see the results from the inspections. You will want to look for any patient care issues. A hospice with a large number of deficiencies, especially in patient care should be avoided as a consumer.
  • Another very important question to ask is “Are your physicians board-certified in hospice and palliative care?” This is a good indication that a hospice takes its medical care very seriously.
  • You will want to ask the hospice “do you allow your patients to utilize their primary care physician (PCP) while receiving hospice services?” If the hospice tells you that you have to use the hospice physician, beware again. As a consumer you have the right to use your PCP as the physician to direct your care on hospice. This being said, you may have to change physicians if you choose to be placed in a skilled nursing facility or are receiving care in a facility that only allows physicians to provide care that are credentialed to provide care in the said facility.
  • Ask “Does the hospice measure and improve the quality of care that they provide to their patients”? If they reply yes your next question needs to be How?” Any hospice that doesn’t have a quick and clear answer for this question probably isn’t serious about patient care. Then ask “can I see the results?” If no, move on. If yes look at the data, ask questions, and make sure that the data comes from an independent 3rd
  • Does the hospice have any special programs or other certifications?
  • You could ask what makes their hospice stand out among the rest.

Finally, one last word of advice. Choosing wisely takes time. So start thinking early about what hospice you’d want when the time comes. How early? People typically enroll in hospice very late. More than half of patients in the U.S. enroll in the last three weeks of life, and about a third enroll in the last week. That’s too late to make careful decisions. So start asking questions now. Think of it as insurance, so when the time comes — as it will, for most of us — you’ll be ready to make a thoughtful choice that is consistent with your preferences.

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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Liver Disease

By Victor Montour

liver disease

The liver plays an important role in many bodily functions from protein production and blood clotting to cholesterol, glucose (sugar), and iron metabolism. A variety of illnesses can have a negative effect on the liver causing liver disease.

The Progression of Liver Disease

There are many different types of liver disease. But no matter what type you have, the damage to your liver is likely to progress in a similar way.

Whether your liver is infected with a virus, injured by chemicals, or under attack from your own immune system, the basic danger is the same – that your liver will become so damaged that it can no longer work to keep you alive.

Anything that keeps your liver from doing its job may put your life in danger.

The Healthy Liver

Your liver helps fight infections and cleans your blood. It also helps digest food and stores energy for when you need it. A healthy liver has the amazing ability to grow back, or regenerate, when it is damaged. Anything that keeps your liver from doing its job – or from growing back after injury – may put your life in danger.

Inflammation

In the early stage of any liver disease, your liver may become inflamed. It may become tender and enlarged. Inflammation shows that your body is trying to fight an infection or heal an injury. But if the inflammation continues over time, it can start to hurt your liver permanently.

When most other parts of your body become inflamed, you can feel it – the area becomes hot and painful. But an inflamed liver may cause you no discomfort at all.

If your liver disease is diagnosed and treated successfully at this stage, the inflammation may go away.

Fibrosis

If left untreated, the inflamed liver will start to scar. As excess scar tissue grows, it replaces healthy liver tissue. This process is called fibrosis. (Scar tissue is a kind of fibrous tissue.)

Scar tissue cannot do the work that healthy liver tissue can. Moreover, scar tissue can keep blood from flowing through your liver. As more scar tissue builds up, your liver may not work as well as it once did. Or, the healthy part of your liver has to work harder to make up for the scarred part.

If your liver disease is diagnosed and treated successfully at this stage, there’s still a chance that your liver can heal itself over time.  But if left untreated, your liver may become so seriously scarred that it can no longer heal itself. This stage – when the damage cannot be reversed – is called cirrhosis.

Cirrhosis can lead to a number of complications, including liver cancer. In some people, the symptoms of cirrhosis may be the first signs of liver disease.

Liver cancer that starts in the liver is called primary liver cancer. Cirrhosis and hepatitis B are leading risk factors for primary liver cancer. But cancer can develop in the liver at any stage in the progression of liver disease.

  • You may bleed or bruise easily.
  • Water may build up in your legs and/or abdomen.
  • Your skin and eyes may take on a yellow color, a condition called jaundice.
  • Your skin may itch intensely.
  • In blood vessels leading to your liver, the blood may back up because of blockage. These blood vessels may burst.
  • You may become more sensitive to medications and their side effects.
  • You may develop insulin resistance and type-2 diabetes.
  • Toxins may build up in your brain, causing problems with concentration, memory, sleeping, or other mental functions.

Once you’ve been diagnosed with cirrhosis, treatment will focus on keeping your condition from getting worse. It may be possible to stop or slow the liver damage. It is important to protect the healthy liver tissue you have left.

Liver failure

Liver failure means that your liver is losing or has lost all of its function. It is a life-threatening condition that demands urgent medical care.

The first symptoms of liver failure are often nausea, loss of appetite, fatigue, and diarrhea. Because these symptoms can have any number of causes, it may be hard to tell that the liver is failing.

Liver failure is a life-threatening condition that demands urgent medical care and symptom management.

But as liver failure progresses, the symptoms become more serious. The patient may become confused and disoriented, and extremely sleepy. There is a risk of coma and death. Immediate treatment is needed. The medical team will try to save whatever part of the liver that still works. If this is not possible, the only option may be a liver transplant.

When liver failure occurs as a result of cirrhosis, it usually means that the liver has been failing gradually for some time, possibly for years. This is called chronic liver failure.

Chronic liver failure can also be caused by malnutrition. More rarely, liver failure can occur suddenly, in as little as 48 hours. This is called acute liver failure and is usually a reaction to poisoning or a medication overdose.

Cirrhosis, liver cancer, and liver failure are serious conditions that can threaten your life. Once you have reached these stages of liver disease, your treatment options may be very limited. If your doctor has told you treatment options are limited or not an option, remember you always have Front Range Hospice as an option. We may not be able to cure your liver disease, but we can manage the symptoms of your illness.

If you would like more information about Front Range Hospice and how we can manage your symptoms from liver disease please call 303-957-3101 or 970-776-8080 or email us at info@frhospice.com

 

 

 

 

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