Grief is part of the human condition. According to the Family Caregiver Alliance, many loved ones of patients who receive hospice and palliative care experience anticipatory grief before losing a family member or friend. Experts agree grief isn’t linear or time-limited.

Helping Your Patients Understand the Transition from Palliative Care to Hospice

The transition from palliative care to hospice care can be a confusing time for patients and their families. It is likely they will feel many complex emotions including — sadness, fear, anger and more. As their provider, you have an opportunity to empower and educate them by keeping them informed of their options as they navigate the transition.

When someone is diagnosed with a terminal illness, treating and managing their symptoms becomes a top priority. A large part of successfully caring for someone with a terminal illness is understanding how palliative and hospice care play a role in treatment and what the transition from palliative to hospice entails. 

End-of-life planning is a difficult topic to discuss under any circumstances. For family members, the topic can be tough to broach because they don’t want to imagine a reality without their loved one or don’t know how their loved one will react to this type of conversation. For those who are terminally ill, it can be just as hard or intimidating to approach the topic with their children or loved ones. They may be worried about burdening their children with sorting out care options or may be waiting for a physician or caretaker to initiate the conversation for them.

In the face of coronavirus, we are looking at a difficult and tumultuous time for healthcare professionals, patients and their families.

Caregiving is a 24/7 job and sometimes that's on top of your existing 9-5.

Not only is being a caregiver a huge time commitment, but it's also emotionally demanding. That being said, caregiving is also incredibly rewarding and truly makes a difference in the lives of so many people.

But, how do you provide care to someone else and manage your daily life without sacrificing your own health and well being?

Everyone wants to think that they'll have a little more time with their aging family members. It's hard to think about losing someone you love, so a lot of families tend to put off talking about end-of-life care. Having an open and honest conversation with your loved one about their wishes for care is important, and having that conversation early is imperative to providing them with the best quality of life.

“Hospice” is a word that can strike fear or provide a feeling of peace, depending on the individual. For those who don’t fully understand what hospice care is and what it provides, they tend to fall into the former category rather than the latter. I want to dispel the misconceptions and the common myths about hospice. This speciality end-of-life care focuses on comfort and celebrating life, because every day is a gift.

The ending of life is an inevitability for all living beings, but it’s never easy to part ways. It can be even harder to have a conversation about the ending of a loved one’s life. According to The Conversation Project, 90 percent of people say that talking to their loved ones about end-of-life care is important, but only 27 percent actually do. Too often, we fail to plan for this certainty and leave tough decisions to be made after a loved one has already passed away, rather than learning their true choices and wishes about how to handle their death. You don’t have to wait until the end is imminent; talking about this natural part of life and how to handle it can happen well before it’s time and put everyone’s questions and fears to rest. All you have to do is get started.

In-home primary care is for anyone homebound with a serious injury or illness, regardless of age or prognosis. It’s a personalized experience, in the comfort of one’s own home. This type of care focuses on managing symptoms and providing treatment to promote a better quality of life. In-home primary care is offered by Hospice of Southwest Ohio’s partner organization, CareBridge Primary and Palliative Care.

As an older adult, or as an adult child or caregiver of one, it can be overwhelming to know what senior living and healthcare options exist and where to begin when looking into them. The good news is that there are experts who can help you and your family navigate the major life decisions that need to be made as you age.

Many people think of hospice as a physical building you go to when you are nearing the end of your life. But hospice is not a place, even though there are hospice care centers around the country that specialize in end-of-life care. Hospice care most often takes place in the home or in a place that is currently home, such as an assisted living facility, skilled nursing center or long-term care community. While hospice care is typically reserved for the last six months of life, it can extend beyond that timeframe. Rather than a cure, hospice focuses on comfort and improving the quality of life.

There are likely multiple options available to you when it’s time to choose a hospice provider. It can sometimes be an overwhelming choice to make and one that should not be taken lightly. Doing research beforehand can make the process smoother and less stressful. Here are ten reasons why Hospice of Southwest Ohio should be at the top of your list if you live in Clermont, Butler, Warren and Hamilton counties in the greater Cincinnati area.

When a parent, relative or friend receives a terminal cancer diagnosis, you may quickly find yourself stepping into the role of a hospice caregiver. In recent years, many adults have taken on this role much earlier than anticipated. In some cases, the individual with cancer may not yet be eligible to receive Medicare benefits, potentially putting the caregiver in a difficult place financially as they deal with medical costs. Discover resources to help you prepare and care for your loved one as you step into your new role of caregiver.

It’s not easy taking care of a hospice patient in a home setting. Sometimes, caregivers suffer from physical or emotional exhaustion from taking care of a loved one around the clock. It’s important to maintain a healthy balance between supporting a loved one in hospice and tending to the rest of your life and responsibilities. Don’t give up activities that are important to you, such as your work or your hobbies. To prevent burnout, here are some tips for hospice caregivers.

When a loved one is diagnosed with a terminal illness, it can be hard to know where to begin. You want to ensure they receive the best care possible and are comfortable during the rest of their life, while also understanding what the options are for care and how everything will be covered financially. First things first, it’s important to define the criteria for who can receive hospice care.

Verena Shiflett, a 48-year-old Cincinnati-area mother in hospice care for a lung disorder, had one final dream: to see her 18-year-old daughter, Rhonda, graduate from high school.

The Ohio Council for Home Care and Hospice (OCHCH) presented the Hospice Award of Excellence Joe McDermott, LPN for his compassionate dedication of more than 7 years of service to the patients, family members and staff at Hospice of Southwest Ohio.

Hospice of Southwest Ohio is proud to have one of our volunteers, Paul Carlson, honored by Honor Flight Tri-State. Paul is better know around our community as Santa's Elf "Sparkles" during the holiday season. Paul was escorted by his son Erick. HSWO thanks Paul for his service!

The Ohio Council for Home Care and Hospice (OCHCH) presented the State of Ohio Hospice Aide of the Year to Tabetha Morelock, STNA for her dedication of more than 6 years of service to the patients, family members and staff at Hospice of Southwest Ohio.

The fear of the unknown is always greater than the fear of the known.

If you qualify for hospice care, you and your family will work with your hospice team to set up a plan of care that meets your needs. For more specific information on a hospice plan of care, call your national or state hospice organization.

Hospice of Southwest Ohio is pleased to offer visits from Seven Oaks Farm Miniature Therapy Horses. We are the only hospice in Greater Cincinnati providing loving visits from these miniature horses for our patients and their families.

A chaplain at a New York hospital has designed a board that lets the critically ill communicate their spiritual pain and needs.

What is Palliative Care?
Palliative care is a multidisciplinary approach to medical care for people with both acute and chronic serious illness. Patients may have physical, psychological, social, or spiritual issues because of their disease or treatment. Palliative care serves to lessen pain, control symptoms and improve stress for the both the patient and family. Ultimately, the goal is improving quality of life, assisting with medical decisions and more importantly navigating the healthcare system.

Being a caregiver to your loved one is a vital aspect to their well-being, but it can be exhausting, overwhelming, and sometimes thankless. Your loved one may lash out at you and make it difficult by refusing to comply with what needs to be done. Your loved one may see you as the person who has taken away his or her freedom and life choices. Most people do not give up making their own decisions easily. But there are things you can do to keep a positive perspective and lower your stress level.

For both the elderly and their caregivers, the ailments and struggles that come with aging shadow a more carefree, happy past. We’re busy focusing on medication management, installing new handles in the shower or researching assisted living facilities. As dementia, Alzheimer’s or other cognitive issues strengthen their grip on a loved one, many feel as if they’re losing that person they once knew. A similar identity crises may be going on inside for them, as well.

What happens if I cannot stay at home due to my increasing care need and require a different place to stay during my final phase of life?

A growing number of hospice programs have their own hospice facilities or have arrangements with freestanding hospice houses, hospitals or inpatient residential centers to care for patients who cannot stay where they usually live. These patients may require a different place to live during this phase of their life when they need extra care. However, care in these settings is not covered under the Medicare or Medicaid Hospice Benefit. It is best to find out, well before hospice may be needed, if insurance or any other payer covers this type of care or if patients/families will be responsible for payment.

Can I be cared for by hospice if I reside in a nursing facility or other type of long-term care facility?

Hospice services can be provided to a terminally ill person wherever they live. This means a patient living in a nursing facility or long-term care facility can receive specialized visits from hospice nurses, home health aides, chaplains, social workers, and volunteers, in addition to other care and services provided by the nursing facility. The hospice and the nursing home will have a written agreement in place in order for the hospice to serve residents of the facility.

What role does the hospice volunteer serve?
Hospice volunteers are generally available to provide different types of support to patients and their loved ones including running errands, preparing light meals, staying with a patient to give family members a break, and lending emotional support and companionship to patients and family members.

How does the hospice work to keep the patient comfortable?
Many patients may have pain and other serious symptoms as illness progresses. Our Hospice staff receive special training to care for all types of physical and emotional symptoms that cause pain, discomfort and distress. Because keeping the patient comfortable and pain-free is an important part of hospice care, many hospice programs have developed ways to measure how comfortable the patient is during the course of their stay in hospice. Hospice staff works with the patient’s physician to make sure that medication, therapies, and procedures are designed to achieve the goals outlined in the patient’s care plan. The care plan is reviewed frequently to make sure any changes and new goals are in the plan.

Will I be the only hospice patient that the hospice staff serves?
Every hospice patient has access to a hospice volunteer, registered nurse, social worker, home health aide, and chaplain (also known as the interdisciplinary team). For each patient and family, the interdisciplinary team writes a care plan with the patient/family that is used to make sure the patient and family receive the care they need from the team. Typically, full-time registered nurses provide care to about a dozen different families. Social workers usually work with about twice the number of patients/families as nurses. If needed, home health aides, who provide personal care to the patient, will visit most frequently.

To our valued staff, volunteers, friends and partners ~~

Another year has swiftly passed and this brings us to the brink of a new year – a year that will bring significant challenges, to which we will, no doubt, rise above. This year has shown that despite the enormity of the challenges facing us as part of the health care reform, we are resilient and will remain so.

It's commonly known that morphine and related medications are used in palliative and hospice care and we're often asked about their role in the dying process. Morphine and other medications in the morphine family, such as hydromorphone, codeine and fentanyl, are called opioids and may be used to control pain or shortness of breath throughout an illness or at the end of life. A patient's doctor may prescribe morphine if the person is experiencing moderate to severe pain or shortness of breath, which helps maintain a level of comfort up to the time of death.

Now is always the best time to learn more about hospice and ask questions about what to expect from hospice services.  Although end-of-life care may be difficult to discuss, it is best for family members to share their wishes long before it becomes a concern.  This can greatly reduce stress when the time for hospice is needed.  By having these discussions in advance, patients are not forced into uncomfortable situations.  Instead, patients can make an educated decision that includes the advice and input of family members and loved ones.

True heroism is remarkably sober, very undramatic.  It is not the urge to surpass all others at whatever cost, but the urge to serve others at whatever cost.

Arthur Ashe

The Ohio Council for Home Care and Hospice (OCHCH) presented the Award of Excellence in Hospice to Chaplain Tracy Paul Downs for her more than 10 years of service to the patients, family members and staff at Hospice of Southwest Ohio.

Packing for one last visit with her dying father in Ohio, an Illinois woman gets the call that her father is rapidly declining. It is clear she will not be able to reach him before he passes away at the Patient Care Center at Hospice of Southwest Ohio (HSWO) in Cincinnati.

Then, the HSWO nurse on duty proposes that the daughter log onto her computer to be connected to HSWO’s VGo (pronounced VEE go) robot, virtually bringing her into the room with her father. She converses with her father and is able to say a final goodbye. 

If you think that payers are the ones who will answer all the sticky questions about implementation and reimbursement for telemedicine, you are doomed to disappointment. That was the consensus among several industry leaders at an Industry Council Executive Session yesterday at the ATA’s annual conference in Baltimore. Dr. Joe Peterson, the CEO of Specialists on Call, said that 2013 was the tipping point for telemedicine when the conversation moved from “if” to “when.” Read more.

UPMC is experiencing a growth spurt in telemedicine as the hospital network expands use of the technology to consumers seeking urgent care or consultation with a doctor or nurse. Telemedicine is shaping up to be the next big thing in health care and UPMC is establishing a beachhead in the new model of care, increasing the number of patient visits by 49 percent to 10,000 visits in 2013 when compared to 2012. In addition, UPMC has dramatically reduced unnecessary hospital readmissions through the use of remote monitoring. Read more.

The 30-day preventable readmissions penalty instituted by CMS in 2012 might not be very popular with hospitals, but it has been effective in ramping up the focus on how to keep patients from coming back to the emergency room after being discharged. The looming financial repercussions have forced hospitals to look beyond the care their patients receive while admitted, and have fostered more integrated partnerships with long-term care organizations, hospice facilities, and other post-acute care programs to provide more robust patient education, medication adherence, skilled monitoring, and palliative care proven to aid patients after hospitalization without additional inpatient intervention. Read more.

The reality is that too many of us spend our last days in ways we would never choose. According to a recent poll by the California Health Care Foundation, more than 90 percent of people think it’s important to talk about their wishes for end-of-life care, yet less than 30 percent of people have discussed what they want. Expressing our end-of-life wishes relieves our families and loved ones from the burden of making tough decisions for us.

Sadly, but with conviction, I recently removed breathing tubes from three patients in intensive care. As an I.C.U. doctor, I am trained to save lives. Yet the reality is that some of my patients are beyond saving. And while I can use the tricks of my trade to keep their bodies going, many will never return to a quality of life that they, or anyone else, would be willing to accept. Read more.

Nobody likes talking about death, but experts say having a conversation is an important part of making sure death is as comfortable as possible. This week on WRVO's health and wellness show "Take Care," hosts Lorraine Rapp and Linda Lowen speak with Amy Tucci, president and CEO of the Hospice Foundation of America. Tucci explains how hospice can help ease suffering for those who are dying and their families. Read more.

Great-aunt Margaret was 95. She had no children and her husband had been dead for decades. Always efficient, she had outlined her requirements at the end of her life to a favorite niece. Read more.

A relic from the medical past — the house call — is returning to favor as part of some hospitals’ palliative care programs, which are sending teams of physicians, nurses, social workers, chaplains and other workers to patients’ homes after they are discharged. The goal is two-fold: to provide better treatment and to cut costs. Read more.

Statistically, the average person who enters hospice care uses its services for about two weeks before death occurs. Darla Wilson, executive director of Hospice and Home Care of Reno County/McPherson, thinks that’s a shame. Read more.

A community open house on Feb. 13, 2014, celebrated the opening of Hospice of Southwest Ohio's Care Center at 7625 Camargo Road in Madeira. The center's first patient was accepted on February 20.