New Blog on Caring for Aging Parents

Jane Gross of the New York Times has started a new blog, The New Old Age, that deals with the challenges of caring for your aging parents. In the blog’s second post, “Our Parents, Ourselves,” Gross discusses the difficulties she and her brother encountered when their mother began to need more assistance. She has struck a cord with readers, who have already contributed hundreds of comments. Reading the comments is as eye-opening as reading her post, as people share their stories of struggling to provide care for their aging parents.

Unfortunately, Gross' experience is not unusual. HFA is ready to help answer any consumer-related questions you have, or we will get you to the place that can help.

Discussion of Changes to the Medicare Hospice Benefit

The Washington Post covers the changes in store for hospices who participate in Medicare. Reporter Alicia Ault pays particular interest in the move toward providing quality measures of hospice providers.

Beginning Dec. 2, hospice organizations will also have to implement a quality assessment and improvement system. Hospices will have to show the Centers for Medicare and Medicaid Services, the agency that administers Medicare, that they are trying to improve in problem areas.

Initially, quality data will be available only to each hospice organization and Medicare. Eventually, providers and advocates expect, data will be shared with the public, as the federal government has done with information on nursing homes, hospitals and home health agencies.

The June 2008 Report to Congress by MedPAC, the Medicare Payment Advisory Commission, also discussed the potential changes in detail and options for how to provide quality measures, starting on p. 227 of the report.

Hospice Professionals Help Ease the Burden of Loss

The Delta County Independent (CO) published an article about how hospice professionals help families dealing with a terminal illness. Hospice honors the patient’s values and eases the physical, emotional, and spiritual challenges as death approaches.

In 2007, 100 percent of the families served by Hospice & Palliative Care of Western Colorado said that they would refer a friend to hospice.

And Delta resident Dottie Boyd feels the same way. In fact, she wishes more people knew about the “absolutely wonderful” care that is provided to patients and families.

“When my husband Bill was admitted to hospice, the process was very smooth. Our family doctor made the referral and the hospice staff immediately became a great source of support to both of us,” says Boyd.

“They spoke to him in a way that was comforting, to make sure that his needs were met. They also allowed him to express his fears and discuss his care,” she said.

Hospice Staff Given Recognition in Tucson

The Arizona Daily Star reports on a local award, Ben's Bells, started to honor people who make the Tucson community a better place to live. Last week the employees of Casa de la Luz Hospice received the "belling" after a dying man asked his family to honor the hospice staff. The Ben's Bells project began after the death of Ben Maré Packard in 2003, who was almost three years old. The boy's family hopes the project will remind people to be kind, to help ease one another's pain.

The recognition was a huge accolade for the staff, said Dasa Schmidt, the marketing director for Casa de la Luz.

"It was such an honor and we are so grateful for the recognition and the support," she said.

About 15 people were there for the ceremony, she said, everyone from the social worker to the spiritual counselor who had helped the family with Daniel Arvayo's transition.

"They brought his picture, so it almost felt like he was present," Schmidt said.

The hospice is in its 10th year and is locally owned and operated, she said. Most of its patients remain in their homes, but the hospice also has an inpatient unit and a residential home.

In all of its services, she said, the hospice follows a model of care that treats the whole patient, and family members, too. For example, the facility has a bereavement-services program that cares for families for a year after their loved one's passing.

"We just try to make sure they can process their grief properly and with lots of love and support," Schmidt said.

She also praised the Arvayos.

"We just feel so honored to be recognized by Ben's Bells and Del and it was a privilege to take care of Mr. Arvayo and his family. They're very special, as is every single person we have the opportunity to be with."

Communication Tips for Caregivers

RNCentral offers this list of 50 communication tips and techniques, for professional nurses as well as for family caregivers. The tips are grouped by areas, including memory loss, speaking, attention, nonverbal, behavior, and with others. Each item links to more detailed information from a variety of websites.

Lessons from a Dying Patient

Last week in the Wall Street Journal's online column, The Doctor's Office, Benjamin Brewer, MD writes about lessons he learned from a dying patient. Dr. Brewer has a family practice in the rural village of Forrest, Ill. There were also follow-up questions answered in the WSJ forums.

Even though death is an inevitable part of the human condition, it's not something that most doctors, including me, ever get too comfortable with. We get used to pushing it off until another day.

When death is approaching, the natural tendency is to avoid situations that are uncomfortable, emotionally detach, visit less often, fill our time with something that seems more productive.

It's during those times when I remind myself to slow down, sit down and listen. What I have to offer when there is nothing more that medicine can do is some comfort and companionship.

Emergency Planning for Hospices and Eldercare Agencies

The recent floods in the Midwest have highlighted the need for hospices and other agencies that provide care to the elderly to have an emergency plan in place in case of a natural disaster. This post from Caregiverlist.com provides a checklist for those providing care in an elderly person's home. Pallimed conducted an interview with David Wensel, DO, hospice & palliative medicine physician for Hospice of North Iowa. Dr. Wensel discussed the challenges of providing care to their hospice patients after the flooding.

Pallimed: What are the important lessons learned from the flooding to share with other hospice agencies as they look at their own disaster planning?

Dr. Wensel: The greatest lesson learned is to plan for the worse case scenario. As a hospice think about if you lost half your staff, some of your patients had to be evacuated, and you had no safe water. You can never plan for every possible problem that might come up, but it would be very helpful to talk through different disaster plans with your staff. You never realize how wonderful it is to wash your hands, brush your teeth or take a bath until you can't. I had never thought about all the things we do to care for patents that require water.

Helpful Way to Think About Caregiving: Six Stages

I came across an online radio broadcast about the Six Stages of Caregiving that aired earlier today (Thursday). The stages are described on the Caregiving.com website, and were developed by Denise M. Brown, who runs The Center for Family Caregivers in Park Ridge, Ill. The site is a little difficult to navigate but stages of caregiving she describes: expectant, freshman, entrenched, pragmatic, transitioning, and godspeed - can be useful to those starting on the caregiving journey and offers some excellent suggestions for handling your changing role. The radio broadcast dealt with the first three stages and the next three stages will air next week.

Hospice Social Worker Addresses Ethical Questions

In this article from The Ithaca Journal, hospice social worker Jeff Collins discusses some of the ethical questions that can arise for hospices while caring for their patients. He says these ethical questions can create 'dynamic tension' for hospice staff and the patient's family, and that ". . . this is a tension we need to accept to truly meet the patient where they are."

In our day-to-day work, most ethical questions we face turn on issues of patient choice. One fairly common example can arise in home care. Most of our patients live at home and have sufficient day-to-day care from family and friends. Sometimes, though, we will have a patient who lives alone or has a frail caregiver. Staying at home might be incredibly important to that patient, but because of growing weakness, the patient's self-care capacity may diminish and the whole situation may become riskier. Sometimes, insurance pays for the kind of custodial care that the patient needs, but that is rare. The hospice staff wants the best and safest care for the patient and starts to think of a transfer to a nursing home or the hospice residence. But the patient wants to be home and often sees a fall or even death as far less of a concern than leaving home. This sort of situation can create a great deal of dynamic tension. How much risk is too much risk, and who has the right to say that the risk is too much? What leverage do we have to impel changes, especially with a rational patient? Do we need to call Adult Protective Services? We live with this tension and explore the situation among ourselves and with the patient and family. Things usually turn out OK, in no small part because of that dynamic tension.

The Role of Music Therapy

Music therapy can have a role in caring for the seriously ill and dying; it is one method that can help to ease pain and stress at the end of life.

• From Growth House's Goodbyes blog, by Deborah Bradley Ruder, she relates the role of harpist Nancy Kleiman. Kleiman shares her music across a variety of settings.

She doesn't have an assigned spot but goes where she is needed, whether to patient rooms or common areas. While riding in a crowded hospital elevator one day, a woman turned to her and said, "Do you ever play for patients? My mother is dying." "I'm right behind you," is Nancy's typical reply.

• Pallimed's new Case Conferences blog takes cases from the University of Pittsburgh Institute to Enhance Palliative Care and posts them twice a month, allowing comments and discussions. In the latest post, Andrea Scheve, MM, NMT, MT-BC, writes about the use of music and musical life reviews for a heart transplant patient.

Musical life reviews are a way for people to celebrate their lives, their love for each other, and their family traditions. Just as certain olfactory sensations can trigger memories and emotional reactions, auditory sensations (music) are linked to memories and emotions, making the life review process seamless in musical form.