Music Therapy Benefits in Hospice Care

A Music Therapy Case Study | Joshua Gilbert, MT-BC

Throughout life, song can positively affect us both physically and emotionally. It influences bodily functions that we believe are beyond our control, such as heart rate, blood pressure and release of the body’s natural pain relief chemicals. Music therapy offers significant benefits for patients, caregivers and families. We offer it as part of our hospice services.

In a case study conducted (by Joshua Gilbert) on the impact of music therapy over a four-month period, with an older adult in hospice care, results exhibited significant signs of improvement in the following categories:

  • Quality of life
  • Self-esteem
  • Emotional expression
  • Breathing patterns

Through involvement in music-based interventions, these improvements allowed the patient to benefit from music therapy during hospice care. The patient often smiled, laughed and made positive comments about the music. After participating in deep breathing exercises and harmonica playing, the patient’s breathing became deeper and less labored. Additionally, the patient developed increased confidence in improvising harmonica music, and more open about expressing her emotions surrounding death.

Despite patient status or level of consciousness, music therapists can console and comfort them through music. Research has shown hearing is the last outside sensation that registers with a dying patient. Let us help your loved one make this experience more soothing.

To read the full case study, please click here.

Common Hospice Diagnoses

AT Home Care Hospice is here for you – 24/7/365.

Choosing Hospice is often a difficult decision. We help lead this conversation and can ease the anxiety of the transition from cure to comfort for patients who are appropriate for hospice care. If two or more of these potential indicators are present, hospice should be considered.

Common Hospice Diagnoses

End Stages of: Cancer, Heart Disease/CHF, Pulmonary Disease/COPD, Dementia/Alzheimer’s Disease, Neurological Disease/CVA, Renal Disease & Liver Disease.

If your loved one is requiring increased assistance with Activities of Daily Living (ADLs) such as bathing, dressing, grooming, oral care, toileting, transferring to their bed/chair, walking, eating, etc.; this may be an indicator that hospice should be considered.

Additional indicators include:

  • Muscle Loss/Weakening or Weakness
  • Multiple Falls
  • Multiple ER Visits/Hospitalizations
  • Recurrent/Multiple Infections
  • Altered Mental Status
  • Unintentional Mental Status
  • Unintentional Weight Loss
  • Difficulty at Mealtime
  • Increasing Shortness of Breath
  • Multiple Medication/Frequent Medication Changes
  • Sleeping Longer/Napping More
  • Skin Breakdown/Wounds
  • Other Diagnoses that Contribute to Decline

If you have questions about the hospice benefit or when to elect your benefit, please contact AT Home Care Hospice at 804-359-3400.

One Word: Hospice

One word… One word that’s the most solidifying word you will ever hear. A word that can often be misinterpreted.

One word… Hospice.

This means you are dying. Maybe not dying today, tomorrow or the next day – but it is a word not many want to hear. As a hospice liaison, helping people understand to not be afraid is part of what makes my job so rewarding. Watching potential patients and their family member begin to ease as I explain the role of hospice is an incredible feeling.

As a hospice liaison, I help ease all your previous notions about what we do and assure you that we are here to help.

Hospice doesn’t mean you will die tomorrow. It does not mean you will be taken off all your medications or stay home while waiting for the end. What it does mean is that you have a terminal illness and instead of continuing to seek aggressive treatment, it is better for you to be comfortable and have a quality of life with loved ones, however that may be defined by you.

It is shown that a hospice patient lives more comfortably when: a nurse visits to manage pain and symptoms, a home health aide provides personal care, a social worker assists with community resources and counseling, a chaplain offers spiritual support, volunteers play cards with and a physician oversees it all to ensure you are as comfortable as possible for however long that may be.

That one word… Hospice. Let’s look at it in a more positive way, focusing on the benefits we can offer a patient and their family.

So, I ask both professionals and patients – Why would you not want to live more comfortably with support from hospice?

-Tracy Wagoner, Hospice Liaison

Our COVID-19 Response: A Letter from Our CEO Mike McMaude

To the Abode Healthcare Community,

I hope this note finds you and your loved ones safe and healthy. The COVID-19 pandemic is affecting each of us in different ways. As we navigate the current situation together, I want to provide an update on the steps we have taken to be there for our community, our employees, and our patients.

All of us at Abode Healthcare are focused on providing the highest quality of care to our patients. I provided an update at the end of March outlining the changes we implemented to prioritize safe patient care in this new environment. Every decision we have made, and continue to make, has been based on the priority of the health and wellbeing of our patients and employees.

I am deeply grateful for our employees who display incredible dedication by continuing to fulfill their commitment to our patients during this especially challenging time. These individuals, and everyone working on the frontlines of care, deserve to feel protected, confident, and taken care of.

In recent weeks we have made informed decisions and taken actions that ultimately support and benefit our entire community:

  • PPE: At the first sign of COVID-19, we prioritized spending where it’s needed most and to date, have purchased $1 million of Personal Protection Equipment (PPE) so no one reported to work without protection. I’m proud to say that we’ve not had to turn down any patients due to lack of PPE. We’ve even been able to assist other homecare and hospice organizations, and hospitals serving the Navajo nation as well as other underserved populations, in providing supplies for their employees by donating thousands of PPE items. In addition to our company’s commitment, several executives on our team have made personal PPE donations for local health organizations so they can work safely.
  • Paid Leave: To support employees who risk their own health and safety to care for patients, we instituted a special paid-time-off policy modeled after the Families First Coronavirus Response Act designated for companies with fewer than 500 employees. In Abode’s plan, employees receive unlimited leave for issues relating to COVID-19, including a newly instituted emergency paid time off (EPTO) benefit that is in addition to the PTO employees accrue with regular benefits. These additional benefits allow employees to potentially recover from COVID-19, care for a family member who is ill with the virus, or care for children whose schools and daycares have closed.
  • Business Investment: Rather than cut back, we’ve leaned into the business to make sure that we are even better prepared to care for patients. Some of these actions include:
    • Building out our telehealth and remote care solutions
    • Retaining a dedicated, talented workforce
    • Hiring new employees and growing our team locally and nationally
    • Expanding our team’s knowledge with the addition of an infectious disease physician, Dr. Shannon Thorn
  • Charitable Donations: As we have every year, we continue to support charitable organizations in our communities. That will not stop just because of COVID-19. Support for neighbors, near and far, is needed now more than ever.

I am extremely proud of how everyone at Abode has reacted and handled the unique situation that the COVID-19 pandemic has presented. It’s difficult to adequately express my appreciation for our community—patients, employees, and partners. I have been reminded, once again, what an incredible organization we have—one that is driven by a common purpose of caring for, and serving, vulnerable patients. Every member of our team has come together to do what’s right, and I thank you. We look forward to continuing to work together and supporting each other through this challenging time.

Stay safe and healthy,

Mike

Celebrating Nurses | Stephany Cochran

AT Home Care & Hospice is celebrating nurses during the month of May! Meet Stephany and learn about her passion for nursing as she describes her path to hospice nursing.

“It started when I was young; my father was the Chief Orthopedic Technician at Richmond Memorial Hospital (the old one on Westwood Ave). I would go to the hospital with him when he was called in and sit with the nurses at the nurse’s station or go with him to see a couple patients (he of course asked them first). I watched him put casts and halos on patients and adjust traction on some, so I always knew I wanted to do something to help people.

At first, my circumstances didn’t allow me to pursue a nursing career. Then, I began working my way towards my Associates Degree for my RN. At first, I worked in a hospital, and loved the people I worked with on nights. Eventually, the night shift interfered with other parts of my life, so I became a RN/CM at a home health company, shortly after I transferred to their Richmond location, and eventually made my way to ATHC. I finally made the decision that I needed a change and have loved the people I work at ATHC ever since. They have been so supportive and mentoring on how to do things that I had not done before; it has been amazing!

Although I am sitting in a home office right now, I know that my job is essential in order to make sure each patient under my team is taken care of to the best of our ability. I miss seeing patients at times; seeing how they look at you when they are feeling sick or when you are there to brighten their day by being someone to talk to.

Teaching patients how they can better take care of themselves and make themselves feel better is what it’s all about! It’s all worth it when one patient tells you that you’re a life saver, or just thanks you and smiles at you. Now, I love receiving those same phone calls and letters from patients about my team members!”

Happy Nurses Day!

Today, we recognize our nurses for their hard work, support, and compassion. Because of you, we live in a happier, healthier world. Happy Nurses Day!

Your hard work and dedication does not go unnoticed. Now, more than ever, we appreciate you!

COVID-19 & Hospice

Pandemic Relief via legislation, CMS waivers, and enforcement discretion

  • Telehealth
  • Waived requirement to use volunteers
  • Waive non-core services (physical, occupational, and speech pathology) *hospice only
  • Waive on-site visits for hospice aide supervision

Telehealth and Telephonic Visits

  • CMS permits hospices to provide telehealth to a Medicare patient receiving routine home care during the emergency period, if it is feasible and appropriate to do so.
  • Face-to-face encounters for purposed of patient recertification for the Medicare hospice benefit can now be conducted via telehealth (must be 2-way audio-visual)
  • Must be physician-ordered and on the plan of care

In an effort to protect patients, some SNF, LTC, hospice, and other facilities are limiting the number of visits that Abode Healthcare staff may make to patients in their care. Some patients are even requesting fewer in-person visits to reduce their exposure to the outside world.

Abode Healthcare understands and joins in these protection measures by offering telehealth visits. In some cases where access has been limited or is desired, Abode staff are utilizing telehealth on a weekly or bi-weekly basis in order to maintain contact with high-risk patients.

In all cases, telehealth visits are meant to be supplementary to in-person patient visits. Telehealth visits should not replace in-person visits altogether.

Telehealth Tools

Our commitment, as always, is to serve our patients as best we can. Our clinical team has been trained in effective ways to utilize telehealth systems to streamline patient care through our own remote access system using the following tools:

  • Phone: Abode Healthcare staff may conduct remote visits with patients through phone calls.
  • Video: Abode Healthcare staff may conduct remote visits with patients through Doxy.me. (All F2F between NPs or MDs, DOs must be done through a 2-way type of technology. This is for both HH and Hospice)
  • me can be utilized via tablets or phone and has been selected by Abode due to the ease of use for both the clinician and the patient/family/caregiver as well as its ability to capture/validate that the tele visit occurred, and its security features.

Though telehealth is never our first choice, it is the right choice during this time. Abode Healthcare continues to partner with providers to preserve the health and wellbeing of all of our patients.

COVID-19 & Home Health

Pandemic Relief via legislation, CMS waivers, and enforcement discretion

  • Telehealth
  • Waived requirement to use volunteers
  • Face to Face encounters to establish HH services
  • Non-physician practitioners (NNP) certification authority accelerated

Telehealth and Telephonic Visits

  • CMS permits HHAs to provide all necessary telehealth during the emergency period
  • Must be physician-ordered and on the plan of care
  • Does not replace in-person visits (telehealth or telephonic visits are not billable visits)
  • Allows for HHA to supplement in person visits for patients who might refuse more frequent visits or senior living or other congregate living facilities that might be restricting access to HHA personnel.
  • The Home Health Face to Face visit may also be provided by telehealth but must be performed utilizing 2-way audio and visual programs.

In an effort to protect patients, some SNF, LTC, hospice, and other facilities are limiting the number of visits that Abode Healthcare staff may make to patients in their care. Some patients are even requesting fewer in-person visits to reduce their exposure to the outside world.

Abode Healthcare understands and joins in these protection measures by offering telehealth visits. In some cases where access has been limited or is desired, Abode staff are utilizing telehealth on a weekly or bi-weekly basis in order to maintain contact with high-risk patients.

In all cases, telehealth visits are meant to be supplementary to in-person patient visits. Telehealth visits should not replace in-person visits altogether.

Telehealth Tools

Our commitment, as always, is to serve our patients as best we can. Our clinical team has been trained in effective ways to utilize telehealth systems to streamline patient care through our own remote access system using the following tools:

  • Phone: Abode Healthcare staff may conduct remote visits with patients through phone calls.
  • Video: Abode Healthcare staff may conduct remote visits with patients through Doxy.me. (All F2F between NPs or MDs, DOs must be done through a 2-way type of technology. This is for both HH and Hospice)
  • me can be utilized via tablets or phone and has been selected by Abode due to the ease of use for both the clinician and the patient/family/caregiver as well as its ability to capture/validate that the tele visit occurred, and its security features.

Though telehealth is never our first choice, it is the right choice during this time. Abode Healthcare continues to partner with providers to preserve the health and wellbeing of all of our patients.

Though telehealth is never our first choice, it is the right choice during this time. Abode Healthcare continues to partner with providers to preserve the health and wellbeing of all of our patients.

CMS clarification on homebound status for COVID-19 patients and those at high risk of contracting:

Non-Physician Home Health Certification Authority

  • Allows patient to be under the care of an NPP to the extent permitted under state law
  • NPP= Nurse Practitioner (NP, ARNP), Physician Assistant (PA) and Clinical Nurse Specialist (CNS)
  • Authorities
  • Order Home Health Services
  • Establish and review POC (Plan of Care)
  • Certify and recertify eligibility
  • CMS utilizing discretionary authority not to enforce rules
  • Must also check state HHA licensure for any barriers to implement
  • CARES Act makes this relief permanent, but CMS needs to implement

For more information, contact Jon Wilder.

Our “Why” During COVID-19

Times of uncertainty often bring about reflection on our individual mission and purpose – our “why” in life.  We all have a different “why” that has been formed through our passions and life experiences.  Maybe your mission and purpose in life is teaching and mentoring the youth in your community, or maybe it is working in law enforcement to keep your community safe.  Across the company, we are fortunate to have some of the healthcare industry’s most talented professionals whose “why” also aligns with our mission to provide first-class care to our patients and their families.

While we all adjust to changes in our daily lives, our employees are continuing to fulfill their commitment to our patients.  From conducting music therapy in outdoor nursing home courtyards to providing meals for hospital staff and first responders, the current pandemic has even given us the opportunity to be creative in carrying out our mission.

As stated by Rosie Avila, Community Liaison at our Nurses in Touch location, “our purpose here is not for ourselves; it’s for others and in turn their purpose was for us.”  This rings true throughout the company, and our employees are living out their mission and purpose every day.

What is your mission and purpose – your “why” in life?  Perhaps it will be uncovered during these times.  Perhaps it will align with ours.  Perhaps it will provide an opportunity for us to partner in carrying out our missions to support our communities.  We are all in this together!

Making the Hospice Decision

Before a baby is born, planning around the baby’s life begins. The parents prepare for the baby by creating a registry. Friends plan and host a baby shower. Family helps decorate the nursery. As the baby grows, the parents teach the baby, now a child, how to read. They prepare the child for kindergarten, then elementary school, then middle school, and then high school. The child, now a young adult, decides on a trade school versus entering the work force directly after high school versus college, and if college is selected, the young adults selects a major, and prepares to earn a degree. Then the young adult applies for and accepts a job, decides to get married, and chooses when to start a family. He or she then decides how many children to have and how to raise those children.

We spend so much of our life preparing and planning—so why should it be any different when making a hospice decision? Ideally, from the start of a diagnosis of a life-limiting illness, people should begin planning their goals and priorities with their physician. By having these conversations early, the person with a life-limiting illness can be fully involved in planning and making decisions regarding their wishes before the stress of a medical crisis.

Hospice is a continuation of care that shifts the goals of the patient from curative to comfort. When you or a loved one has a life-limiting illness and medical treatment is no longer effective, the doctor may refer you to hospice care. It should not be seen as a last resort but rather as an opportunity to focus on managing pain and other symptoms to find relief. This approach lets you dedicate your attention to what truly matters: living the rest of your life to the fullest.

A study by the National Palliative Care Organization found that patients who spent their final days on hospice reported having a better life experience than those who spent the end of their lives in intensive care. The researchers found that the patient’s choices often influenced the end-of-life care they got, which is why it is so important for people to plan for hospice, long before the need arises.

So, when should you make the hospice decision? Talk to your physician about signs and symptoms to consider prior to electing hospice care. Frequent hospitalizations, frequent infections, a decline in functional status, and an increase in uncontrollable symptoms or pain can all be indicators. Decide what you wish to do when treatment is no longer effective. Consider the benefits of managing symptoms from home rather than frequent visits to the physician or hospital. Consider the benefit of having a team of specialists available to you in your home—from a registered nurse to an aide, your doctor, a medical director, a social worker, and a chaplain. Consider access to your hospice team by phone 24 hours a day, 7 days a week, 365 days a year, where you could call your team if you had a question or a medical need. Consider the benefits of having medications related to your diagnosis and medical equipment made available to you in your home. These are all resources included in the Medicare hospice benefit, at no cost to the patient or their family.

If you have questions about the hospice benefit or when to elect your benefit, please call us at 1 (804) 612-3737.