By: Wilma Peterson, RN
According to the American Lung Association, Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in the United States. Due to the distress and panic caused by difficulty in breathing, living with COPD can be stressful for both the patient and the family. Doctors are beginning to call for earlier hospice referrals for these patients. If accessed at the right time, hospice care can better manage symptoms, prevent unnecessary hospitalizations, and better quality of life.
Patients with advanced COPD are eligible for hospice care, which is fully covered by Medicare, some private insurances, as well as assistance from Veterans Affairs. Hospice patients have access to the appropriate care and medications, allowing for more restful periods and easier breathing. Identifying these factors early can relieve symptoms such as anxiety, panic, labored breathing, and intractable coughing that are uncontrolled with regular medications and traditional therapies.
Factors to consider when deciding whether a COPD patient is appropriate for a hospice referral include:
The patient has a projected life expectancy of 6 months or less
All therapies, including medications and rehabilitation, have been exhausted
The patient has frequent emergency room visits and hospitalizations due to exacerbation of COPD
At this point, the patient is considered to be in the advanced stages of COPD, and the discussion for hospice and end-of-life care should begin.
Eight benefits of early hospice referral for those with COPD
Receiving hospice care early allows for the expertise of a focused team of professionals:
Hospice services are available 24/7. The team will provide medical, emotional, psychological, and spiritual support to the patient and family. Here are eight benefits of early hospice referral:
Early intervention. The earlier the referral is made, the more it allows the patient and the family to choose the right hospice company and be a part of the care plan.
Managed care. A physician leads the hospice care team. The physician can order the appropriate medications and therapies and cater to a plan to meet the patient’s specific needs.
Skilled Nurses. A registered nurse will meet with the patient and family and can admit the same day. The nurse will also reconcile all medications, put together a plan that focuses on managing symptoms, and provide relief of pain and respiratory distress.
Hospice Aides. Health aides assist with normal daily activities:
Other household chores
Medical Social Worker. A social worker will assist with accessing support in the community, such as respite care and other services. The end-stage of COPD causes a severe reduction in personal and social quality of life with increased stress levels for all involved.
Chaplain. Clergy to meet the patient and their family’s psychological and spiritual needs, assisting them through the grieving process.
Ancillary services. Other ancillary services like physical therapy and occupational therapy, strengthen muscles to assist with safety and allow for a sense of independence.
Respite Care. Allows time for self-care and rest, which can help with a change in attitude and mindset in caring for your loved one.
Living easier with hospice care
Early hospice referrals allow for the early management of symptoms by:
Having the appropriate therapy and staff when needed
Avoiding the stress of emergency exacerbations and hospital visits
Providing a more focused approach to the patient and caregiver
Alleviating stress and encouraging future planning like spending quality time and making plans
Early referral can provide more support for both the caregiver and the patient as they go through the grieving process.The holidays can be a challenging and bittersweet time for those with a seriously-ill loved one. Electing the hospice benefit may seem like one more item on your to do list, but hospice can ease the burdens of facing a life-limiting illness. If a loved one has unmanageable symptoms, they could end up spending their holiday in the hospital, away from family and friends.
AT Home Care Hospice helps families manage their loved one’s pain and symptoms so they can spend the holidays in the comfort of home–whether that means in their own home, in a loved one’s home, or in a skilled nursing facility or assisted living facility that they’ve made their home.
Hospice Care in the Comfort of Your Home
Whether your loved one is being cared for at home or in a facility, the additional layer of support that hospice can provide can make all the difference. Hospice care can help manage complex symptoms of pulmonary disease, cancer, dementia, Parkinson’s, heart disease, stroke, liver or kidney disease.
Our interdisciplinary approach, which includes care from a nurse, aide, social worker, chaplain, medical director, and the patient’s primary care physician, is designed to support patients and their families physically, psychologically, and spiritually. With the assistance of this personalized care team and the guidance of the patient’s primary physician, your family can have the support necessary to keep your loved one comfortable and supported without unnecessary hospital visits or doctor appointments.
AT Home Care Hospice’s team is local and available 24 hours a day, 7 days a week, 365 days a year to provide care for our patients and for admissions.
Hospice can also provide necessary durable medical equipment, such as a hospital bed; medications related to the patient’s primary hospice diagnosis; and incontinence products and nutritional supplements. By utilizing hospice services, families have more time to enjoy the most meaningful moments of the holidays — time spent together with family.
Family & Caregiver Support this Holiday Season
With holidays comes stress, as time runs out to shop, run end-of-year errands, and attend special events. Combine that with caring for a seriously-ill loved one during these unprecedented times, and life can become overwhelming quickly.
Our hospice care extends beyond the patient. AT Home Care Hospice works closely with family members to assure they have the tools necessary to cope with stress or caregiver burnout surrounding what may be the final holiday with someone they love. In addition to scheduled visits, patients and their families will have access to a dedicated hospice nurse by phone who is available to answer your questions and dispatch a nurse to your home as needed.
Our team of chaplains and social workers collaborate to address patient and family members’ emotional, psychological and spiritual needs. They make certain our patients’ families have a plan for the holidays, so they can make the most of the holidays without piling up additional stress.
Caring for a loved one facing a terminal illness can be demanding, but it can also be incredibly fulfilling. AT Home Care Hospice can partner with you or your loved one’s facility to ensure everyone – patient and family alike – is supported and cared for this holiday season.
If you have a loved one with a life limiting illness, please contact us to learn more about how AT Home Care Hospice can help your family this holiday season, because home should be more than a holiday wish!Care at no cost to Veterans and their families.
AT Home Care Hospice collaborates with local VA agencies and programs to raise awareness about the benefit of hospice services for Veterans. As a Veteran, expenses for hospice-related services or enrolled veterans are covered in full.
We Honor Veterans Program
AT Home Care Hospice partners with the We Honor Veterans program to give veterans the best care possible. This program provides resources and training to meet the needs of our veteran patients and their families through respectful inquiry, compassionate listening, and grateful acknowledgement so that veterans can have a peaceful end-of-life experience.
VA Hospice Program Benefits
Hospice is a benefit that the VA offers to qualified Veterans who are in the final phase of their lives. This multi-disciplinary team approach helps Veterans live fully until they die. The VA also works very closely with community and home hospice agencies to provide care in the home. The VA hospice benefit includes:
Care available wherever you call home
No co-pay for hospice care
Medical equipment, medication and personal care supplies
Personalized pain and symptom management
Care coordinated with your doctors
Physical, occupational and other therapy services
Spiritual care and support
Volunteers with military experience (when available)
Ongoing grief counseling for patients and family
Veteran-To-Veteran Volunteer Program
AT Home Care Hospice’s Veteran-to-Veteran volunteer program pairs Veteran volunteers with hospice patients who are Veterans as well. Veteran volunteers have the ability to develop a unique connection with patients and their families through their common experiences and stories, establishing a strong relational bond.
How can Veteran Volunteers Help?
Reminisce or tell life stories
Educate and answer questions regarding Veteran benefits
Assist in pinning ceremonies, distribute certificates and help with other recognition events
Assist in replacing lost medals
For many people, the decision to receive hospice care is made following the diagnosis of a life-limiting illness. Even so, some families still question this decision. Here are some common Hospice qualifiers to help determine when it might be time to elect the hospice benefit.
Frequent physician, ET and/or Hospital visits
Weight loss and or BMI < 22
Decline aggressive therapy or is not a candidate
EF < 20%
NYHA Class IV symptoms at rest
Little or no response to Bronchodilators
Serum < 2.5
Dysphagia and/or aspiration pneumonia
Shortness of breath and/or o2 sat of 88% or less
Upper respiratory infections, bronchitis or pneumonia
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 ER Visits/Hospitalizations
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
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… 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 LiaisonPandemic Relief via legislation, CMS waivers, and enforcement discretion
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.
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.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.The hospice benefit is a multi-disciplinary approach to end of life care. When hospice patients are able to utilize the benefit, in its full capacity, self-fulfillment needs, psychological needs, and basic needs are met. At AT Home Care & Hospice, we seek to meet all levels of needs for each hospice patient in order to maximize their end of life journey and hospice benefit utilization. 180 days on hospice not only allows for better end of life transitions for patients, but allows family members to be family members and our team to become caregivers. Thank you for allowing us to be a part of your journey.This time of year can be challenging for those who have a terminally ill loved one. If this friend or family member is in hospice, the holiday season may feel “off” or a little less joyous this year.
While there are certainly challenges you will have to face, there are still ways you and your family can celebrate the season with your loved one in hospice. We’re here to provide you with some encouragement to navigate this time of year.
Coordinate with hospice staff.
Those working in hospice are not just there for the patients during this time, they are also there for the families. Hospice staff serve as a crucial resource for trying times like these and are more than willing to assist. They can help coordinate visiting schedules to work around holiday events, offer suggestions for support groups, and make arrangements for any holiday traditions you’d like to celebrate with your loved one. Among many other tasks, hospice staff are there to aid you this holiday season.
Adjust your holiday traditions.
While it may seem difficult to change any holiday traditions you have to better suit your loved one in hospice, just know that it will be wroth it. Including your loved ones in these traditions is what the season is all about, so making certain they are a part of some of the traditions you enjoy the most will bring everyone closer together and create a special meaning this year.
Above all, enjoy time with your loved ones.
We know this may sound hard – maybe even impossible. It’s important to use this time to bring everyone together and create memories while you can. Surrounding yourself with friends and family can serve as a reminder that you are not alone in this process.
We’ll leave you with this question – What’s your reason for this season? Is it to cherish another holiday with your loved one?