(Left to Right) Chuck Lee, President & CEO of Cornerstone Hospice & Palliative Care; Paul Ledford, President & CEO of Florida Hospice & Palliative Care Association; Representative Travis Cummings (R), Orange Park; and Susan Ponder-Stansel, President & CEO of Community Hospice & Palliative Care.

JACKSONVILLE, Fla., Sept. 10, 2018, /PRNewswire/ — Florida Hospice & Palliative Care Association presented Rep. Travis Cummings (R), Orange Park the “2018 Hospice Champion Award” on August 23^rd.

The “Hospice Champion” Award is granted to those who display dedication to public service in assuring access to quality hospice care for Floridians and their loved ones.

Rep. Cummings currently serves as the Chair of the Health and Human Services Committee and has a long-standing record of supporting hospice care. He was instrumental in helping pass SB 474 in 2017 that assures the public easy access to Hospice Quality Measures.

“It is fitting that Travis Cummings receive the Hospice Champion Award. Throughout his time in the Legislature, he has… [READ FULL PRESS RELEASE]

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Support Hospice in Florida today. Learn more about the specialty license plate by clicking the image above.

Orlando, Fla.—Today, during the Florida Hospice and Palliative Care Association’s (FHPCA) quarterly Board Meeting in Orlando, the Board presented Liz Dudek with the Outstanding Public Service Award in recognition of decades of dedicated public service and her commitment to assuring the highest quality of hospice care for Florida residents. Dudek served as the Secretary for the Agency of Health Care Administration from 2010 through 2016 and held a number of other senior management positions at the agency since it was created in 1992. Dudek currently serves as Director of Healthcare Affairs in the Tallahassee office of the Greenberg Traurig law firm.

FHPCA’s President and CEO Paul Ledford said, “During her decades of public service at AHCA, Liz Dudek has always been an accessible and candid partner to FHPCA and the hospice providers in Florida. During that period, in each regulatory role Liz held, she matched stride with Florida’s hospice providers and played a key role in contributing to what has long been the state with the most comprehensive hospice services offered in the nation.”

FHPCA presents the Outstanding Public Service Award to former public officials who demonstrated excellence in their previous public service roles and contributed to the betterment of hospice care in Florida.

Liz Dudek said, “I sincerely thank the FHPCA for honoring me with this award. In my years as a public servant, the FHPCA and hospice providers were important partners in promoting the highest standards for the industry and were very involved in helping to develop strong regulations, rules and laws to govern the industry. I commend the FHPCA for continuing to help ensure that Florida’s hospice services remain a model for the rest of the nation.”

Following today’s quarterly Board Meeting, FHPCA will hold its 32^nd annual conference, Forum 2017: Hospice Keys, on Thursday, May 25 and Friday, May 26 also in Orlando at the Hyatt Regency Grand Cypress. The annual conference is designed to help hospice clinical professionals unlock the key fundamental practices for providing excellent end of life care.

FHPCA, whose board is comprised of the executives of 41 hospice organizations in Florida, strives to assure excellence in, and expand access to, hospice and palliative care, and advocate for the needs of those in the final phases of life. The vision of the FHPCA is to make Florida the model state for hospice and palliative care services.

Today, FHPCA’s House Bill 539- “An Act Relating to Hospices” passed the Florida House Health Innovation Subcommittee. This bill addresses quality measures, prescription drug disposal after a patient’s death, and palliative care services to non-hospice, seriously ill patients.

Here’s the moment the bill passed:

Learn more information about FHPCA’s 2017 Legislative Advocacy (HERE)

Video: Our Forum Planning Committee is preparing for you!

Our Forum Website is now live and you can register for your spot at FHPCA’s Annual Forum!

Whether you are a seasoned hospice professional or have just begun your career in hospice, having a solid foundation is key to your success.

Social workers, chaplains, physicians, nurses, aides and anyone who works in end of life care is invited to join us for the 32nd annual FHPCA Forum to unlock the key fundamental practices that equip all hospice professionals for providing excellent end of life care.

You can book your hotel at the Hyatt Grand Regency here.

Take a sneak peek at our Agenda

Or

Just Register right away here!

For more information, you can visit our Forum Website.

In a span of a month, two hurricanes have battered Florida’s coast. Recently, Hurricane Matthew left the Northeast Coast with damaged homes, fallen trees, dangerous flooding, and power outages. Severe weather can come to our doorstep at anytime and that’s why Floridians must prepare –including hospice programs around the state.

Forty-five hospice programs currently serve the state of Florida and each program has had an Emergency Preparedness Plan in place since the 1990s. Hospice programs serve over 127,800 patients in Florida each year.

At Community Hospice of Northeast Florida, staff worked together to safely evacuate their patients, family members, and pets.

“We made sure that each of our approximately 1,200 patients had a plan for their care during and after the storm; enough medicine, medical equipment, and other needed supplies to get them through that period of time,” explained Susan Ponder-Stansel, President and CEO of Community Hospice.

She went on to say, “Our plan worked. The care to our patients and support for their needs did not falter during the storm. The reason we were able to do so well is because of the dedication, professionalism, and tireless work of our staff.”

Another program affected by Hurricane Matthew was Cornerstone Hospice. Leadership at Cornerstone operated from an abundance of caution, remembering that Polk County was hit by three hurricanes in 2004.

Rhonda White, Cornerstone Hospice Chief Operations Officer shared, “We activated our plan a little earlier than normal. We contacted all of our patients, educated them on what was going on in case they weren’t watching the news. We made sure that they had a certain amount of medication and supplies on hand so we didn’t have delivery issues.”

Due to the unpredictable nature of the storm and challenges of navigating curfews set by local officials, safety was a top priority. Some of the programs, like Cornerstone Hospice, cover multiple counties where the watches and warnings were different.

As storms begin to approach the state it’s important to maintain constant communication with patients to verify medications and ensure they evacuate safely. Part of a hospice program’s preparedness plan is the ‘Tuck in Process’, which ensures patients have seven days worth of medication, evacuation plans, alternative power for any medical equipment and assistance to a special needs shelter.

The goal is to make sure each patient has a plan and is safe.

Rhonda White’s team used this process during Hurricane Matthew, “We really wanted to verify medications in the home – how much, how many supplies, those kinds of things. Did they understand how to use their oxygen tanks because that is confusing if you’re not used to transferring over to a tank.”

After the storm, there was a feeling of relief because hospice patients and programs did not suffer any catastrophic impact and staff returned to regular operation this week.

You can’t wait to develop a plan. Being in the midst of a serious weather event demands a concrete emergency plan to be in place. Some hospice patients are cared for at an in-patient facility, but the majority are cared for in homes. For hospices, service areas may cross several counties and requires not only a high level of preparedness but also organization.

The care and safety of patients is always a top priority – even during a severe storm.

To learn more about hospice programs in Florida, check out LetHospiceHelp.org or call the hospice helpline at 800-282-6560.

Charles Suggs lII, MD Medical Director of Gulfside Hospice & Pasco Palliative Care

So you have heard about palliative care, but are unsure of what it is. Palliative care (pronounced pal-lee-uh-tiv) is specialized medical care for people with serious and chronic illnesses. It focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness—whatever the diagnosis. The goal is to improve quality of life for both the patient and the family.

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

If you are considering looking into palliative care but need to know more, below is some information that can help you to decide if palliative care is right for you. There are many benefits of palliative care (comfort care) for both patients and their families.

Pain and symptom control: The palliative care team identifies sources of pain and discomfort. These may include problems with breathing, fatigue, depression, bowel/bladder or insomnia. The team will provide treatments that can offer relief, including medication, along with massage therapy or relaxation techniques.

Communication and coordination: Palliative care teams are extremely good communicators. They put great importance on communication between you, your family and your doctors in order to ensure that your needs are fully met. These include establishing goals for your care, help with decision-making and coordination of care. Palliative care teams also can help families develop advance care plans, including healthcare directives.

Emotional support: Palliative care focuses on the entire person, not just the illness. The team members caring for you will address any social, psychological, emotional or spiritual needs. During the initial consult, the palliative care team member goalis improve patient satisfaction.

Family/caregiver support: Caregivers bear a great deal of stress too, so the palliative care team supports them as well. This focused attention helps ease some of the strain and can help you with your decision-making.

How do I know if palliative care is right for me? Palliative care may be right for you if you are experiencing pain, stress and other symptoms due to a serious illness. Serious illnesses include but are not limited to: cancer, cardiac disease, respiratory disease, kidney failure, Alzheimer’s, AIDS, amyotrophic lateral sclerosis (ALS) and multiple sclerosis. Palliative care is appropriate at any stage of a serious illness and you can get it along with treatment meant to cure you.

Other signs that palliative care may be helpful for you include: frequent ER visits or hospital admissions for the same condition, functional or cognitive decline, weight loss, increased safety and behavioral concerns, caregiver stress, chronic home oxygen use or limited social and home resources and service support.
Will my insurance cover palliative care? Most insurance plans cover all or part of the palliative care treatment you receive, just as with other hospital and medical services. This is also true of Medicare and Medicaid. If costs concern you, a social worker or financial consultant from the palliative care team can help you with payment options.

Do I have to give up my own doctor? The palliative care team provides an extra layer of support and works in partnership with your primary doctor. Your primary doctor will continue to direct your care and play an active role in your treatment.

Can I have curative treatment together with palliative care? Absolutely. Your treatment choices are up to you. You can get palliative care at the same time as treatment meant to cure you.

Where is palliative care provided? Palliative care can be provided in a number of places. These include hospitals, outpatient clinics, long-term-care facilities or home.

This month the New York Times  contributor Jane Hoffman delves into the centuries old curiosity surrounding dreams and visions for patients at the end of their life. It’s an area of interest that has been documented for thousands of years,  even showing up in prominent 19th-century literature. The fascination with these particular dreams  has led to studies conducted by nurses, neurobiologists and psychologists.

The following article follows a team of medical professionals headed by Dr. Christopher Kerr from Hospice Buffalo while they embark upon understanding what these dreams might mean. Dr. Kerr and his team commenced the study with the participation of 59 terminally ill patients receiving acute care at Hospice Buffalo. The results of the study show some surprising trends yet,  still led to more questions.

The actual study that was published in the Journal of Palliative Medicine can be found HERE.

To read this eye opening article, continue HERE.

For questions about hospice, advanced directives and grief counseling, visit lethospicehelp.org or click the image below:

Are you renewal ready? The Florida Department of Health has changed the license renewal process, and clinicians are now required to report continuing education (CE) and continuing medical education (CME) course completions prior to license renewal.

To view licensing requirements by profession go to: http://www.flhealthsource.gov/.

Hear Surgeon General John Armstrong speak about the new requirements:

https://www.youtube.com/watch?v=dKscaPyWSXM&feature=youtu.be

 By Avow

It was a beautiful day in May when Jessica received the call informing her that her father had succumbed to a fatal heart attack. “Dad” was 77 and apparently suffering from undetected heart disease. The loss came as a surprise to Jessica along with the discovery that her father had never put his affairs in order – a shocking realization considering “Mom” was suffering from advanced dementia.

With Dad gone, caring for Mom would fall to Jessica, the oldest of the couple’s eight children – a nurse by training and one of two siblings living locally. Jessica promptly moved Mom into her home and was ready to become a supportive caregiver – confident that she could handle it since she worked from home and her two grown children were off at college.

Following her father’s death, however, Jessica found herself wading through what seemed to be an insurmountable mound of red tape required to close her parents’ estate. Dad had no will or funeral plan and had not prepared a living will or power of attorney plan for her mother. Jessica did not even know which bank her parents used. At the same time, Jessica was facing the heartbreaking truth that her mom was steeped in dementia and required 24-hour care and supervision – clearly Dad had provided much more support than he ever let on.

In the years leading up to her father’s death, Jessica brought up the topic of getting affairs in order, but most often, her father would dismiss the topic and say, “I’ll get to it.” He never did of course and now Jessica would need to turn to an attorney for help. The process would be long and exhausting and she would spend thousands of dollars in legal fees. Jessica wished she could have spent these funds on enhanced care for her mother who experienced a rapid deterioration from Alzheimer’s disease and eventually required placement in a nursing facility.

Unfortunately, Jessica’s story is not unique and her father’s avoidance of getting his affairs in order is common. For many of us, the idea of illness or death touching our lives is easily avoided or dismissed for attention later¬. Plus, getting your affairs in order is work and often carries some expense. It also requires some serious decision-making and hard conversations.

If “getting your affairs in order” is still on your to-do list, learn from Jessica’s story and move it up in priority. If you have aging parents, find out what plans they’ve made, if any. Don’t let perceived youth delay your actions – accidents and serious illnesses have no age qualifiers.

Need some help getting started? Avow has some free tools available on its website including:

• “My Life Dossier,” a tool designed to help you organize important documents needed in times of emergency or following a death. This resource also walks you through some important considerations to help you prepare for your final life chapter.
• “Living Will Kit” to help you document your advance directives.

Both resources are provided in PDF format and may be downloaded at avowcares.org. To go directly to the resource links visit: http://avowcares.org/docs/living-will-resources

Avow delivers the promise of life by providing comfort, care, understanding and dignity to those who are seriously ill, caring for a frail or sick loved one or mourning someone’s passing. They are knitted into their community, providing supportive services to anyone who needs them, including those whose loved ones were not in our programs. Find out more at avowcares.org

November is Hospice & Palliative Care Month (read Governor Scott’s proclamation) and a great time to learn more about the wonderful services hospice and palliative care provides patients and families.

What is hospice and palliative care?  Hospice and palliative care regards dying as a natural process. The goal of hospice and palliative care is to achieve the best possible quality of life through coordinating and/or managing the Plan of Care with goals to: relieve  suffering, and control symptoms, and while remaining sensitive to personal, cultural and religious values, beliefs and practices.

Four take aways about hospice and palliative care:

• To be eligible for hospice, a patient must have a life-limiting terminal illness that puts their life expectancy within six months or less. Palliative care can offer some of the same types of services that hospice does, but it is provided to anyone, no matter the diagnosis or life expectancy.

• Hospice is a supportive service, meaning it is up to the family to provide the majority of day-to-day care. Hospice supports the family in various ways which may include end-of life education, therapy, grief counseling, and volunteer services. There are four levels of that will provide service additional care as the patient is eligible.

• Hospice can be provided anywhere the patient considers home. This could be a family member’s home or a nursing home, anywhere the patient resides. Though currently not as widely available as hospice, palliative care may be found in a variety of forms including hospital consultations, clinics, Home Health, and doctor offices.

• The sooner hospice and palliative care are elected, the more benefit a patient and their family will receive. Research has proven a patient’s condition often improves once their physical and psychosocial pain are managed. Hospice offers a wide variety of services that allows a person quality days at the end of life. However, these services can only be fully realized if started early, not just in the last few days when a patient is in the most critical condition.

How can you support hospice and palliative care in Florida? 

There are numerous ways you can support the mission and services of hospice and palliative care. You could volunteer at a hospice program, donate to a program in your area, donate to FHPCA, or purchase the Hospice Specialty License Plate.

About the Specialty Hospice License Plate:

When you purchase a license plate, $25 a year goes a long way by providing support towards the following:

• Programs related to hospice, including a new model of care for very ill children, and improving and increasing access to end-of-life care for Florida’s veterans.
• Education and outreach for hospice volunteers, patients, families, and healthcare professionals
• Free Advance Directives and educational materials for the public
• A toll-free Consumer Help Line
• Florida Hospice & Palliative Care Association’s website

Florida Hospice & Palliative Care Association (FHPCA) is a not-for-profit, IRS Section 501(c)(3) organization representing hospice patients and families, hospice professionals and hospice providers. FHPCA strives to assure excellence in, and expand access to, hospice and palliative care, and advocates for the needs of those in the final stages of life. One of the ways we are able to accomplish our mission is through the sales of the Specialty Hospice License Plate. Visit HERE for more information or to purchase your plate.

By Paul Ledford, President & CEO, FHPCA

In 2010, Florida Hospice & Palliative Care Association adopted a position in opposition to physician-assisted suicide. It is our commitment to the value of life and to the optimization of the quality of life for all people at the end of life, that keeps us from supporting such legislation in Florida. An appropriate plan of care, commitment of hospice staff and family, and proper documentation of the patient’s care wishes should allow for a dying loved one to receive the end-of-life care needed that allows for dignity, quality, and respect.

We support the advancement of practical tools like the Physician Orders of Life Sustaining Treatment (POLST) and believe this type of physician documentation of a patient’s care wishes is a vital step towards ensuring that a patient’s wishes are honored, and unfortunate situations, such as Barbara Mancini experience with her father, do not occur. Receiving quality end of life care is not just a matter of having the right documents in place, but also about receiving quality care early enough to make a difference. Hospice care can begin when a loved one has a life expectancy of 6 months or less, if the disease runs its normal course. The sooner a patient is enrolled in hospice care after diagnosis, the sooner a terminally ill patient can begin receiving quality palliative, psychosocial, spiritual, and emotional care. This care involves intensive case management, nurse, social worker, chaplain, and CNA visits, assistance from volunteers, and may include a variety of ancillary services that improve quality of life, such a music and other therapies. It is not uncommon for patients to quickly show improvement from the ravages of a disease given the quality of care they are receiving. Research shows that many patients actually live longer and have a better quality of life under hospice care than they would have pursuing aggressive acute care.

We believe that life, no matter in what state, is valuable and hospices in Florida strive everyday to ensure that end of life patients are free from pain and can live their remaining days with dignity surrounded by those they love. Every day is a gift.

Watch 60 Minute’s “Ending Life“

The recent article, “How Dying Became a Multibillion-Dollar Industry” published by the Huffington Post, spoke on the increasing business of hospice care. This article attempted to prove that hospice is turning big business and quality of patient care is suffering because of it. Unfortunately, this article’s reporting is misleading and sensational.

Ultimately, the quality of care a patient receives is the most important factor when in hospice care. Florida is ahead of most states by offering the “Hospice Provider Family Satisfaction Survey” as a way to help inform patients and families about quality of care provided by hospice providers. When reviewing the results, there is no significant difference in the quality provided by the for-profit or not-for profit hospices. The business model may be different, but ultimately the goal to provide excellence end of life care to dying patients is the same.

If you are seeking hospice care, we encourage you to consider a few things:

+Be an informed consumer. As with any product or service, you should be informed about what you will receive. Ask the right questions and talk to others in similar circumstance. Not sure what to ask? Visit FHPCA’s “Choosing a Hospice” page for questions to consider when seeking end-of-life care. It’s your right as a consumer to choose the best option available. To find a provider in your area, visit our “Find a Provider” page.

+What is hospice? Hospice is a special kind of care for people who no longer pursue a cure for their illnesses at the end of life. With hospice, care priorities shift to support patients and the caregivers with end-of-life decision-making to reach the best quality possible for each day. If a patient wishes to receive palliative and curative treatment simultaneously, the service they should be seeking is palliative care, not hospice.

The goal of hospice is to comfort the patient, and to educate and train the patient’s family on how to care for their dying loved one. Hospice does not provide 24/7 custodial care, but instead educates and empowers the family to provide the care. Responsibilities family members may have include, but are not limited to, bathing, medication distribution and emotional support. There are four levels of care in hospice, and providers must follow federal guidelines to determine which level is appropriate for the patient. If the patient’s situation changes and they need a different level of care, the provider will adjust accordingly.

+Understand the plan of care. When a patient enters hospice, the provider creates a plan of care with the family. The plan of care reflects patient and family goals and interventions based on the needs identified in the initial, comprehensive, and updated assessments. If the patient or their medical proxy wishes to obtain treatment that moves beyond comfort care to life sustaining, their goals deviate from the type of service hospice provide and they should seek a different kind of care.

The hospice benefit is available to patients for up six months, sometimes longer depending on the patient’s prognosis, but too often patients receive this care only within a few days of death. The sooner a patient enters hospice, the more benefit they can receive thru pain management, spiritual care, and possibly complimentary therapies such as massage or music therapies. The family can also benefit from the grief and bereavement counseling that hospice provides.

What Can You Do? The National Hospice and Palliative Care Organization has been working hard to pass legislation aimed at increasing hospice surveys conducted by regulatory agencies as a means to ensure quality nation-wide. If you would like to participate in effecting positive change in hospice nationally, contact your local congressional delegate and tell them to support the Hospice HELP Act (S. 1053/HR 2302).

Additional Resources:

What is Hospice?

FHPCA’s Consumer Hotline: 800-282-6560

FHPCA’s email: info@nullfloridahospices.org

How to Choose a Hospice by Dr. Casarett

by Joyce Baldrica, President and CEO of the VNA of the Treasure Coast

and Nightingale Private Duty Nursing

Do you, a loved one, or a neighbor feel unsafe at home due to a medical condition or age-related issues? Are you having difficulty preparing food, bathing, or getting into or out of bed? Are you unable to manage your medications and take them as prescribed? Is it a struggle to do your grocery shopping or errands? If you answered yes to just one of these questions, you should learn more about private duty care.

Private duty services are for individuals of all ages who need assistance with daily living within the comfort, security, and privacy of their own home. Private duty services foster independence and help create and maintain a safe living environment. Private duty caregivers offer peace of mind, also provide respite for a family caregiver, and may work alongside with home health and hospice care teams.

Unlike the intermittent home care paid for by Medicare, Medicaid, or private insurances, private duty care is paid for by the client and/or family, trusts, and some long-term care insurance plans. While private duty care is always tailored to the individual client’s needs, services are provided by nurses, home health aides, and trained caregivers, and often include:

• Client advocacy and care management
• Skilled nursing care
• Medication management
• Bed and bath assistance
• Companion and homemaker services
• Personal transportation
• Help with laundry, meal preparation, and errands
• 24-hour care, if needed

There are three types of organizations that can provide private duty care in the home; a private duty agency, a nurse registry, and private care giver. Each type of agency provides in-home care, however there are differences regarding how the care is managed, licensure, and employment laws. I will include more information on these three types of organizations in a future article.

Many private duty home care organizations provide a broad range of services. The goal is to provide whatever a client needs to remain safe and independent in their home. Care Management may also be provided, along with a wide array of other services such as home health aides and specialty nursing programs including wound care and pain management.

As more Americans choose to remain in their homes while they age, finding the right type of private duty care for loved ones can be a challenge. To find a qualified private duty agency in your area, turn to the National Private Duty Association (NPDA), the nation’s leading association for providers of private duty home care.

You deserve the peace of mind, trust, and security that working with a member of the NPDA can provide. All NPDA members must adhere to the organization’s policies, procedures and ethical standards for home care. They have an “Agency Educator” to provide consumers with a comprehensive list of NPDA members nationwide. Visit www.privatedutyhomecare.org for more information, or visit the Private Duty Homecare Association at www.pdhca.org .

VNA provides compassionate, innovative care of the highest quality, setting the standard for patients and caregivers needing home health, hospice, and community health services.

www.vnatc.com

By: Paul A. Ledford, CAE, CHA, Executive Director of  

Florida Hospice & Palliative Care Association

When you think of hospice, do you think of life? Chances are probably not. Often people think of hospice as a place you go to die, but that is an unfitting way to define what hospice actually is. Hospice is a special kind of care for people who no longer pursue a cure for their illness at the end of life. To be eligible for hospice, a patient must have a terminal illness with a prognosis that puts their life expectancy within six months or less (in Florida, some private pay insurers allow for a year or less). With hospice, care priorities shift to the support of patients and the care givers with end-of-life decision-making to reach the best quality possible for each day.

Imagine you have stage IV cancer. You have been through multiple radiation treatments that have left your body wrecked. You don’t eat, everything hurts all the time, and you don’t enjoy spending time with your family anymore because you are battling depression. Technically you are alive, but with a quality of life so poor, could you really say you are living? The simple fact of the matter is we all die. Everyone knows it, yet there is still this innate belief that we can evade the inevitable. How and when we die is something we have no control over, yet if we get the opportunity, how we live those last precious months is something we might have a say in. If you were dying with little hope for recovery, would you choose to live out your life in the acute care setting, continuing curative treatments, or would you choose to be comfortable at home with your pain managed and surrounded by loved ones? According to a 1999 Harvard Public Opinion Poll, 71 percent of Americans would prefer the latter and to die at home.

So how does hospice help one to live well? First, hospice uses a team approach. Each patient admitted, receives care from a physician (who works with patient’s current physician), nurse, medical social worker, spiritual counselor, therapist, home health aid, and volunteer. Hospice uses this approach to manage the complexities of end-of-life care by covering all aspects of a patient’s needs, including pain and symptom management, fulfilling end-of-life wishes, providing education, working towards reconciliation with family and friends, grief and bereavement support, housekeeping, respite for caregivers, and much more. Each member of the hospice team is crucial for the care of the patient, extending both the quality and quantity of life. Studies show that patients with hospice/palliative care interventions will have a better quality of life, and will on average live up to 29 days longer.

Pain is not the only symptom that needs to be regulated, a patient’s emotional and spiritual issues need to be addressed as well. People with heart disease, diabetes, cancer, stroke, Parkinson’s disease, and HIV/AIDS are at much greater risk for depression than the overall population, up to 75%. Effects of untreated depression can have dangerous consequences including a lack of hope and peace, withdrawal of interaction with loved ones, limited ability to organize end-of-life affairs, increased interest in terminating life early, and can also make managing pain and other symptoms more difficult. Because depression is both emotional and physical, palliative medicine can only go so far. Along with medication, hospice provides spiritual counselors and grief support counselors to help patients overcome their depression so that they can live out the rest of their days in peace.

Hospice patients often worry about the stress of family caring for them and what will happen to their family when they are gone. Caregiving for a hospice patient can be an enormous and difficult task, and often caregivers are at a high risk for psychological and physical disorders of their own. However when caregivers are given support, end-of-life care of a loved one can actually be a positive experience. Hospice helps provide support by nurse intervention, educating caregivers on end-of-life, providing respite care, grief and bereavement support counseling. Hospice also provides family and loved ones the option of bereavement counselors and/or support groups for after their loved one has passed away.

Hospice is a great resource and service for those who are dying, yet out of the 71% who say that they want to die at home, only a small fraction of that number actually do. Why is that? Besides having to overcome a society’s general fear of death, there is the stigma that a patient will soon die after electing hospice. As mentioned above, hospice may actually add days to your life by managing the pain and symptoms associated with a terminal illness. Patients can elect hospice up to 6 months before they are expected to die, even though the average length of service was 67.4 days in 2010, the median length of service was only 19.7 days, which means that half of hospice patients received care for less than three weeks. This short time frame does not allow for a patient or their family to really benefit from the many services hospice provides, and makes it difficult for family members and patients to prepare themselves emotionally and physically for the end. Being unprepared for death is hard on the patient and results in a longer grieving period for the family.

Research shows that when physicians are planning for their own personal care they tend to plan ahead, reject CPR, and die in peace more than the general public. Physicians know what quality end-of-life is. Yet, it is often difficult for these physicians to have a candid discussion with a patient and their family about the patient’s trajectory toward death. This difficulty is understandable when a doctor’s main goal and desire is to make their patients well. However, there are ways in which having the end-of-life discussion can be made easier and more meaningful. Quality-of-life discussions are helpful for ICU patients and for their families when end-of-life discussions need to be made. Communication about end-of-life is best handled early, before aggressive treatments begin and the patient is more stressed and less likely to really reflect on their end-of-life options. Hospice is prepared for all types of end-of-life discussions, especially the difficult ones. Physicians can call their local hospice to come and speak with patients and their families, so that they can know all of the options available to them and make well informed decisions for if and when the time comes.

With the country focusing on quality healthcare more than ever, there is much to be gained when all parts of the healthcare spectrum collaborate to serve patients. The purpose of hospice is to allow death to come naturally, with the goal that each remaining day be one of quality. People can only live for so long, healthcare has cared for them through their entire lives, but when the end is near, hospice can be there to help make the final journeys of dying patients a pleasant experience. A life well lived to a peaceful and graceful end is what hospice is about.

By: Vicki Arant, RN, BSN, Vice President of Clinical Services, Hospice of the Comforter

When someone is diagnosed with a terminal illness, where do they and their loved ones turn for support? A hospice cares for patients and families on their end-of-life journey by providing medical, emotional, spiritual and physical support wherever the patient calls home. Care is provided by a team that includes a physician, nurse, social worker, non-denominational chaplain, certified nursing assistant and trained volunteers.

Hospice care focuses on improving quality of life with pain control and symptom management so that patients can maximize the quality of the time that remains. Each patient and his or her caregivers receive individualized care that meets their unique physical, emotional and spiritual needs.

Hospice is not a single place or organization. Some hospices are independent and others are part of a large company. Hospices are not all connected together. Both for-profit and non-profit hospices provide care. Hospices care for patients with many different diseases such as Alzheimer’s/dementia, ALS (Lou Gehrig’s Disease), cancer, congestive heart failure, COPD, emphysema, liver disease, Multiple Sclerosis, renal disease, stroke or failure to thrive.

A patient is immediately entitled to hospice care once he or she is diagnosed with an end-stage illness that has a prognosis of six months or less. It is most ideal for patients in the last six months of life, not just for people in the last 24-48 hours of life. Selecting hospice care early lets patients achieve control of their environment and symptoms. A 2004 Journal of Pain and Symptom Management article, “Medicare Cost in Matched Hospice and Non-Hospice Cohorts,” showed that patients enrolled in hospice cost Medicare less. The research also showed that hospice patients lived longer on the average than similar patients who did not choose hospice care.
Hospice care eases caregiver burdens and provides cost savings for weeks, months and sometimes years. Hospice care also decreases costly hospitalizations. According to the Journal of the American Medical Association, patients not enrolled in hospice care spend 23 or their last days in the hospital, while patients enrolled in hospice spend only eight days in acute care settings.

Choosing hospice care shifts the focus of treatment from aggressive medical curative measures to medical comfort measures. Hospice does nothing to speed up or slow down the dying process, but accepts death as a natural and inevitable event. Although some mistakenly see hospice care as giving up all hope, studies have demonstrated that hospice patients improve physically and emotionally, because their home and family situations have stabilized, their economic worries are reduced and lastly, but most significantly, their pain is better controlled.

Hospice care is most beneficial for patients who enroll early rather than in the last days and weeks of life. “With earlier referral to a hospice program, patients may receive care that results in better management of symptoms, leading to stabilization of their condition and prolonged survival,” wrote the authors of a 2010 New England Journal of Medicine study. The study reported patients were happier, more mobile, in less pain and lived nearly three months longer.
The National Hospice and Palliative Care Organization (NHPCO) reports that eight out of 10 Americans want to be cared for in their homes when facing a life-limiting illness. And, almost 70 percent of patients receive care in their place of residence. More than 1.5 million people with a life-limiting illness get help from the nation’s hospice and palliative care providers every single year.

People choose hospice so that their final months and days are spent comfortably with loved ones. Family members, friends, physicians and even patients themselves can refer to hospice, but a physician’s order is still required. Finding a hospice in your area is as simple as using NHPCO’s website, www.NHPCO.org, or Florida Hospice and Palliative Care’s site, www.FloridaHospices.org. It’s never too early to call a hospice for help, to ask a simple question or to refer a patient.

Since 1990, Hospice of the Comforter has provided compassionate care to tens of thousands of patients and families who are our friends and neighbors. As a local, nonprofit hospice, our support and resources come from our supportive community. We stand behind our mission of being compassionate people providing compassionate care. For more information on Hospice of the Comforter, please visit www.HospiceoftheComforter.org.