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Hospice for Veterans with PTSD

By: Portia Wofford

After dedicating their lives to our nation, our nation’s veterans often face difficulty as they near the end of their lives. While every veteran has different needs, those with post-traumatic stress disorder (PTSD) face unique challenges. PTSD, sometimes known as combat stress or shell shock, often occurs after a person experiences severe trauma or a life-threatening event.

According to the U.S. Department of Veteran Affairs, the number of Veterans with PTSD, in any given year, varies by service era:

  • Operations Iraqi Freedom and Enduring Freedom. About 11-20%
  • Gulf War (Desert Storm). About 12%
  • Vietnam About 15% were diagnosed at a time of a study in the 1980s. It’s estimated that about 30% have had PTSD in their lifetime

It’s becoming increasingly more evident that veterans have a greater need for quality end-of-life care. Hospice care is a benefit that the VA offers to qualified veterans in the final phase of their lives.

Understanding Symptoms of PTSD in Veterans

Dangerous or life-threatening experiences such as combat can cause veterans to relive frightening events. These experiences cause feelings of uneasiness, anger, irritability, or anxiety. While it’s normal to be alarmed by unsettling memories, veterans with PTSD may experience these symptoms for more than a few months. Additionally, they may have difficulty sleeping, experience nightmares, and feel on edge. The veteran may also lose interest or find it extremely hard to participate in everyday activities. Other symptoms include:

  • Recurrent, intrusive reminders of the traumatic event
  • Extreme avoidance of people or places
  • Negative changes in attitude, mood, and personality
  • Emotionally reactive to people, places, or situations that remind them of the traumatic event

Ways to Alleviate PTSD in Veterans

When providing hospice care for veterans with PTSD, there are several considerations for the hospice team. Some symptoms of terminal illnesses, like severe pain, shortness of breath, and anxiety, may trigger flashbacks or nightmares. Additionally, opioid pain medication can make PTSD symptoms worse. The hospice team will collaborate with the patient’s healthcare team to prescribe the appropriate and most effective medication regimen. The hospice team will work with the veteran’s physician, social worker, and other interdisciplinary team members to create a plan of care. This plan of care may include:

  • Connecting with others
  • Staying social
  • Personalized medication and treatments
  • Personalized and effective non-pharmacological treatments
  • Professional social, emotional, and mental support

How Can Hospice Help Veterans?

Veterans are eligible for hospice care if enrolled in benefits and meet medical needs for hospice (terminal illness with a prognosis of six months or less). As of 2019, because of the VA Mission Act, Veterans now have increased access to more community healthcare options. Those who must drive 30 minutes or more to a VA provider or 60 minutes for specialty care may choose a provider closer to home.

Hospice uses a multi-disciplinary team approach to support and provide Veterans with end-of-life treatment. The team works closely with the VA and can provide support and treatment in the home. Hospice offers the veteran and caregivers:

  • 24/7 on-call care
  • Medical equipment and supplies
  • Pain and symptom management
  • No co-pay for hospice care
  • Collaboration with the entire medical and healthcare team
  • Social workers
  • Spiritual and emotional support
  • Grief counseling
  • Medication management
  • Nurses
  • Hospice aides
  • Case managers

Dear Caregiver,

More Than a Cliché

You’ve heard the expression before – “laughter is the best medicine.” But it’s more than just a cliché phrase. There is some truth behind it. Think about it. We’ve all had a tough day where things just weren’t going right. Then, something made you laugh. You instantly felt better, right? This is because laughter is healing. There is actually science that backs this up.

Laughter is Good for Your Health

Besides just making you feel warm and fuzzy inside, laughter also has a ton of mental and physical health benefits that are proven to help you live a happier, healthier life.

It Reduces Stress

Let’s face it, we are all stressed for one reason or another. But as a caregiver, you have an added layer of stress. So you need a way to reduce that stress. Think about the last thing that made you laugh. Now think about how it made you feel. Happy and relaxed? This is because laughter reduces your level of stress hormones, such as adrenaline; and increases your level of health-enhancing hormones, such as endorphins. These ‘feel-good’ hormones are then released into the area of your brain that is responsible for emotion. So the more you laugh, the better you will feel!

It Boosts Your Immune System

Stress is tough on your body. Being over-stressed and burnt out can weaken your immune system and cause you to get sick more frequently. On the other hand, the stress relief and increase in positive emotions caused by laughter can actually strengthen your immune system.

It’s Good for Your Heart

We don’t have to tell you how important it is to take care of your heart. It’s what keeps us going by providing oxygen and important nutrients to our brain and other vital organs. Laughing increases your heart rate and the amount of oxygen in your blood. This improves the vascular function and can actually decrease your risk of heart attack.

It Improves Your Mood and Strengthens Relationships

Laughing is an excellent way to improve your mood. Nothing cures a bad mood quite like laughter. It can eliminate anger and depression and produce a general feeling of well-being. And people want to be around happy people. So when you are in a good mood and laughing, you are likely to attract other happy people. Sharing a laugh with friends and family can help you feel more connected to them, forming a strong and lasting bond.

Laugh More

So how can you add more laughter to your life? It’s not like it’s something you can just add to your schedule. Here are some ways to naturally increase laughter:

  • Find humorous entertainment. With podcasts becoming more popular over recent years, there are plenty of funny podcasts you can listen to. There are also plenty of silly shows on TV that will make you laugh out loud. If reading is your thing, read a light-hearted book that makes you laugh.
  • Spend time with pets. You had a tough day at work, got stuck in traffic on your way home, and realized you forgot plan dinner. You’re in a bad mood. But then you get home, and your pet greets you at the door. You instantly forget why you’re upset. Spending time with pets is proven to make you feel better.
  • Try laughter yoga. Yes, it’s a thing. Here is a link that tells you all about it.
  • Host a game night. If a game night with friends and/or family doesn’t get you laughing, what will? There are plenty of fun games to get you giggling like Apples to Apples or Charades.

When the stress feels like it’s piling up, take a deep breath and do something that makes you laugh. After all it is the best medicine!

Yours truly,

AT Home Care and Hospice

Video: Tips to Improve Communication with Alzheimer’s Patients

 

Changes in Communication

As Alzheimer’s and Brain Awareness Month continues, we want to discuss a very important topic- communication and Alzheimer’s. As the disease progresses, a person’s ability to communicate gradually diminishes. Changes in communication vary from person to person, but there are several common issues you can expect to see, including difficulty finding the right words and organizing words logically.  

Effective Communication

If someone you love is living with the disease, you know it can be challenging at times to communicate with them. The video above discusses the following ten tips for effectively communicating with your loved one.  

Help Make Communication Easier

In addition to these tips, there are steps you can take to help make communication easier, including: You also want to encourage the person to communicate with you. You can do this by doing things like holding their hand while you talk and showing a warm, loving manner. It is also important to be patient with angry outbursts and remember that it is just the illness talking.  

If The Person is Aware of Memory Loss

Since the disease is being diagnosed at earlier stages, many people are aware of how it is impacting their memory. This can make communication even more sensitive because they may become frustrated when they are aware of the memory loss. Here are some tips for how to help someone who knows they have memory problems.  

Additional Resources

For more information on Alzheimer’s disease and how it impacts communication, visit the links or reach out to the contacts below:   ** NIA Alzheimer’s and Related Dementias Education and Referral (ADEAR) Center 800-438-4380 (toll-free) adear@nia.nih.gov   ** Family Caregiver Alliance 800-445-8106 (toll-free) info@caregiver.org   ** Alzheimer’s Association

By: Patricia Hudak, RN and Chelsea Cassidy, LCSW 

Stephanie Meyer is a registered nurse and has been with AT Home Care since 2018.  Her nursing career began in 2003 as a Patient Care Technician in the hospital emergency room with Bon Secours Hospital.  Stephanie had a front row seat in this position to see how people were dying, and she knew it could be better.  Stephanie applied for several transfers within the hospital and was uncertain which unit she wanted to be on however she did know that she wanted the dying process to be different.  After speaking with her boss, she transitioned to a hospice RN Case Manager 14 years ago. Stephanie began educating the medical field and community on hospice and focusing on how people should have a dignified and peaceful death.  She has great compassion for quality of life and individuals experiencing a comfortable death. A hospice admission nurse is usually the first clinician that the patient or family will meet.  The patient or family will often have an initial conversation about hospice with a marketer or intake coordinator and once they are ready to be evaluated by a nurse for hospice criteria, the admission RN is sent to meet the patient.  There are three main factors to be considered when a patient is being admitted to hospice: (a) a doctor’s order for hospice evaluation and treatment needs to be obtained, (b) the patient needs to meet hospice criteria based on their terminal diagnosis, and (c) the patient/family needs to agree to the hospice philosophy and plan of care (Medicare). The admission nurse is the storyteller – they are collecting bits and pieces of a patient’s story and helping them see an option to transition from curative care to palliative care.  Stephanie takes each individual story and translates it into a beginning point of care for the entire hospice team. An admission nurse is collecting the medical, emotional, psychosocial, and spiritual aspects of a patients care.  Stephanie takes this personalized story and turns it into a picture that is not necessarily black or white but filled with parts of gray.
Stephanie beautifully stated, “The medical field, especially hospice, is not black or white.  It is often gray, and I have learned that gray is a very pretty color.”
Stephanie is very thorough in her evaluation and patient assessment.  During this time frame, she is providing education to the patient, family, and the facility staff if a patient resides in a facility.  Stephanie provides active listening which helps to build trust as this is often a big decision for a patient to make about their health. Part of Stephanie’s role includes completing hospice admission consent paperwork, educating on hospice, calling in medications and DME, and also obtaining approval from the Medical Director and the family if they are not present. Since COVID-19, many families are limited in being able to see their loved ones, especially in a facility. Stephanie often goes above and beyond to help connect the patient and family with one another. Non-admits can occur when the patient/family are not quite ready for comfort care.  Their mindset and goals are focused on curative treatments or aggressive options.  Families may be experiencing denial and see hospice as a last resort rather than the quality of life it can provide with pain management, physical, and psychosocial support. Alzheimer’s and dementia diagnosis is one of the top five admission diagnoses for hospice. Showing decline for hospice eligibility can be a challenge for the admission nurse.  Stephanie works closely with the Intake Department as they have the initial conversation with the patient/family and will obtain the necessary orders and medical information to determine a patient’s eligibility. Stephanie works a seven on / seven off shift Wednesday-Tuesday 9pm-7pm.  This allows her to complete multiple admissions throughout the day. Self-care can be a challenge for people, especially those that are working as a caregiver, such as a nurse.  Stephanie practices self-care by “wiping her feet at the door.”  She has promised herself to never sacrifice herself spiritually.  She remains mentally and emotionally prepared for each admission by being fully present in the moment.  When she ends her documentation and sends her report, she accepts her part is complete to the best of her ability. Stephanie is reliable, compassionate, genuine, and accountable.  She has served AT Home Care Hospice in numerous ways.  She courageously went out to take care of patients that were COVID positive without hesitation in the very beginning of the pandemic.  She voiced this is her calling, and when she became a nurse, it was in good times and even during unknown pandemic times.  She consistently shows up to work daily with a positive attitude and a heart to serve regardless of the circumstance.    

Dear Caregiver,

If you are caring for a loved one who is living with Alzheimer’s disease, you do not need us to tell you that it’s not easy. This progressive disease is difficult to cope with – for both the person living with it and their loved ones. People living with Alzheimer’s may become frustrated when they find themselves struggling to do things they used to do without any problem. And it is hard for you, as the caregiver, to watch the person they once were gradually fade away. They may have brief moments of clarity where it feels like they are themselves again; only to break your heart when the moment is gone. While there is nothing anyone can do or say to “fix” what you and your loved one are going through, we want you to know you do not have to face it alone. The Alzheimer’s Association has an abundance of resources for both those living with Alzheimer’s and their caregivers. There are support and educational programs available for both, as well. Take advantage of these resources. They are there to help make things a little easier.  

Understanding Alzheimer’s Disease

It all starts with gaining a better understanding of the disease and how it progresses. Alzheimer’s leads to nerve cell death and tissue loss throughout the brain. This results in the brain shrinking dramatically over time which impacts nearly all its functions. Although scientists are not completely certain what causes cell death and tissue loss in a brain affected by Alzheimer’s, plaques and tangles appear to be the culprits. Plaques form when protein pieces called beta-amyloid clump together, and tangles destroy a vital cell transport system made up of proteins. Plaques and tangles tend to spread through the cortex in a predictable pattern as Alzheimer’s disease progresses, but the rate of progression varies greatly.  

Early Stage

In the earliest stages, plaques and tangles begin to form in brain areas involved in learning and memory, as well as thinking and planning. In this stage, a person can still function independently but may start to notice they are sometimes forgetting familiar words or where to find everyday objects. Someone in this stage may struggle to:

 

Middle Stage

In the middle stage, more plaques and tangles develop in the regions of the brain important for memory, thinking, and planning. This leads to the development of problems with memory or thinking that are severe enough to interfere with work or social life. In this stage, someone with Alzheimer’s may have trouble handling money, expressing themselves, and organizing their thoughts. Plaques and tangles also spread to areas involved in speaking and understanding speech and the sense of where your body is in relation to objects around you. It is in this stage that many people are first diagnosed. Symptoms vary from person to person, but may include:

 

Late Stage

Most of the cortex is seriously damaged by the time someone reaches the late stage of Alzheimer’s disease. By this point, the brain shrinks dramatically due to widespread cell death. Individuals often lose their ability to communicate, recognize family and loved ones, and to care for themselves in this stage. In this stage, symptoms are severe and may include:

 

Resources for Each Stage

The Alzheimer’s Association provides excellent resources for caregivers for each stage. Visit the links below to learn more.

Early-Stage Caregiving 

Middle-Stage Caregiving

Late-Stage Caregiving

Additional Information on Stages and Behaviors

 

Yours truly,

AT Home Care and Hospice

   

LGBTQ Aging

A 2020 Gallup study observed Americans’ identification as lesbian, gay, bisexual, or transgender (LGBT), by generation. The findings report that only 1.3% of the Traditionalist generation (born before 1946) and 2.0% of Baby Boomers (born 1946-1964) identify as LGBT. This number increases dramatically over the generations, reaching 15.9% for Generation Z (born 1997-2002). The question is – does the higher percentage of younger Americans reflect a true shift in sexual orientation? Or is it simply reflecting a greater willingness to identify as LGBT?

Although those who make up the younger generations were born into a world where huge progress has been made in the gay rights movement, the older generations of the LGBTQ community experienced much less accepting times. It wasn’t until 1961 that Illinois became the first state in the United States to get rid of its sodomy law. It then took another ten years before 20 more states followed their lead. So even though Traditionalists and Baby Boomers were around to witness the progress that has been made, many may still have the mindset that society will not accept them for who they are. It is this fear of discrimination that may play a part in their hesitation to seek the help and support they need as they near the end of their life. As a result, the LGBTQ community has been historically underserved by hospice. A 2011 study reported that 20% of LGBTQ seniors that were surveyed did not even reveal their sexual orientation to their primary physician for fear of discrimination. Beyond hospice services for the patient, their grieving partner often misses out on bereavement support as they care for their partner in their final months and days.  

Resources for the Aging LGBTQ Community

Hospices are now working harder than ever to understand the specific needs of the aging LGBTQ community and to do all they can to accommodate those needs. The National Resource Center on LGBT Aging is a resource center focused on improving the quality of services and support offered to lesbian, gay, bisexual, and/or transgender older adults. Their website includes resources that cover a variety of topics, including end of life decisions. You can also use the interactive map to find resources in your area. No one should miss out on the benefits of hospice care for any reason, especially for fear of discrimination.  

Happy Pride Month!

   

June is…

June is Alzheimer’s and Brain Awareness Month. This month-long celebration provides the opportunity to focus on raising awareness for the 50 million people worldwide living with Alzheimer’s and other dementias.

Alzheimer’s Disease

Alzheimer’s disease is a degenerative brain disease and the most common form of dementia. It causes a slow decline in memory, thinking, and reasoning skills. Schedule an appointment with your doctor if you notice any of these ten signs and symptoms: Visit the website for the Alzheimer’s Association for more information on these signs and symptoms to be on the lookout for.

Take Action

There are several ways to get involved in Alzheimer’s and Brain Awareness Month! On June 20th, join the cause by celebrating ‘The Longest Day’ through a fundraising activity of your choice! There are a variety of ways to get involved, including virtually and in-person. So put on your purple gear, share your story of why you go purple, and join the fight to #EndAlz!  

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