Here is the link from a local newspaper that lead our COO to reflect on her experience as a nurse.
Read her thoughts below.
”Now you know why in my 26th year of nursing I no longer work in a hospital. The emotional component of nursing is real and present in all disciplines. It will not diminish until we eliminate tragedy, suffering and death (this is why we need activities with things such as trees with golden leaves). As for the nursing shortage, I represent (in age and length of career) greater than half of the current nursing work force. Most sad is that if I had a daughter ready to determine her future career I would not necessisarily recommend a nursing degree. Staffing models are tight to a point of questionable safety, it is a 365/7day a week job which can intrude on marriage and family and who knows where healthcare will be 25 years from now? After having said all that, I have enjoyed a “charmed” and very satisfying career. I am truly grateful for the opportunities I have had to assist in ways like, placing the garments back on a dying hospital patient and to have participated in Level IV Cardiac Care in the CICU. I have carried dead newborn babies to their grieving mothers and held the hands of the dying. I have learned not all people have common sense. I have laughed a lot. I have felt the joy of lifting up entry level employees and helping them find self worth and new talents. I have stressed about budgets and learned to work under intense pressure. Through it all I have peace and feel I have served as He would have me do.
Do you have any experience in nursing that you would like to share?
This is a true story about a man who is himself a cancer survivor many times over, has lost a child to cancer and many other family members to cancer as well. He is trying to enter an iron man race in Hawaii but needs to be voted in. Go to the link below and watch the video for Travis Hess and vote yes to support him. You don’t have to enter any personal info and no money is being requested, just need a couple minutes of your time.
What is Colorectal Cancer?
It is cancer of the colon and rectum. It is the second leading cancer killer in the United States of America.
How can you reduce your risk of getting colorectal cancer?
The main thing that can be done to help prevent colorectal cancer is getting screenings. If you are 50 or over you should be getting screened annually. There are several types of tests that are avaliable. These are a
- Colonoscopy (Every 10 years)
- High-sensitivity fecal occult blood test (FOBT), also known as a stool test (every year).
- Flexible sigmoidoscopy (every 5 years) with high sensitivity FOBT (every 3 years)
Now, that you know a little more about Colorectal Cancer and how you can help reduce your risk. Do you know anyone who has had colorectal cancer? There are many people who survive because they find it early because of screening. Then there are others who could have saved their life if they would have got screened.
Doug Miller was a Utah citizen and an outdoors man. He could have reduced the severity of his disease by getting a screening. http://www.youtube.com/watch?v=avQAscV5RAoDoug Miller Outdoors Man
- According to Vicki Gottlich, a senior policy lawyer at the Center for Medicare Advocacy, hospice benefits won’t change, but there are required plans to offer voluntary end-of-life counseling
- The healthcare act will impose a new tax/fee on the sale of brand name drugs in Medicare and other government health programs
- There will be less access to physicians – the American Association of Medical Colleges estimates a shortage of approximately 124,000 physicians by 2025. Also, Medicaid will expand dramatically and is expected to account for about half of the 34 million Americans that will become newly insured (See source.)
- In 2011, payments to Medicare Advantage plans will be frozen and by 2017 estimates, enrollment in the program will be cut in half. This means larger co-payments and deductibles, as well as more seniors needing to pay two separate premiums for two health programs in order to cover their needs. (See source 1 and source 2.)
- According to the Centers for Medicare and Medicaid Services, “Over time, a sustained reduction in payment updates, based on productivity expectations that are difficult to attain, would cause Medicare payment rates to grow more slowly than, and in a way that was unrelated to, the providers’ costs of furnishing services to beneficiaries. Thus, providers for whom Medicare constitutes a substantive portion of their business could find it difficult to remain profitable and, absent legislative intervention, might end their participation in the program (possibly jeopardizing access to care for beneficiaries). Simulations by the Office of the Actuary suggest that roughly 15 percent of Part A providers would become unprofitable within the 10-year projection period as a result of the productivity adjustments.” (See source.)
- Taxes will be increased on drugs (effective 2011) and medical devices (effective 2013). (See source.)
- In 2013 tax deductions for medical expenses are being raised from 7.5 to 10 percent of the adjusted gross income – this will effect older adults because they often have much high medical costs than younger individuals, but there will be no changes for those who are at least 65 years and older by the end of that year. (See source.)
Words from our chaplains
“Spirituality in Hospice is often thought of as religious tradition as it relates to the dying; however, it is this and so much more. The facilitation of I Love you, I forgive you, Thank you and Goodbye helps to provide spiritual peace and freedom. Life review, finding value in one’s life experience, loss and fear are inherent in the dying process. Unresolved issues can contribute to a complicated death. The traditional medical model is very limited in it’s ability to provide treatment for the spiritual component of care. This is what makes hospice unique.”
“There are certain times when a person thinks more about spiritual matters. Certainly one of these times is at death or approaching death. It coincides with the questions “Where did I come from?” “Why am I here?” and “Where am I going?” When I initially was approached by a hospice company to become a hospice chaplain, I was amazed that someone would pay me to give spiritual counsel and support to patients and families of the dying. Some of the most memorable and satisfying moments of my life have been providing people spiritual direction. I knew from the instant I was asked to do this that it was the right thing for me to do. It was a peaceful, serene and absolute feeling. Only a few times in my life have I had such overwhelming feelings of “right” and this was one of them. I have now been a hospice chaplain for 7 ½ years. Everyday I still can’t believe I get paid for doing something that makes me feel so good. During this time I have often wondered about the various aspects of providing hospice service. Hospice care is the nurturing of physical, emotional, and spiritual well-being of patients and their families. Certainly, nursing is the most integral part of this. Providing health and comfort to hospice patients requires monitoring by loving nurses under the direction of the patient’s doctor. They provide such needed and loving end of life care. There is a lot of physical, emotional and spiritual difficulty during the dying process. All of the nurses I have worked with have been excellent providers of spiritual care. It seems you can’t work in hospice without having spiritual tendencies and qualities.”
Stories from our chaplains
- “A man who had been a [strong member and leader in his faith] called for me the day before he died. I had been seeing him and his family for several months. We had shared many spiritual discussions. He had actually been more of a mentor and teacher for me than I had been for him. I think this gave him great satisfaction. The day he called for me he was really close to death. He asked his family if he could talk with me alone. I was deeply touched but a little apprehensive about this. After his family had left the room he looked at me and in his slow, weakened voice asked,” Dan, can you tell me everything I have believed and testified to is true?” My thoughts were going a hundred miles an hour. This man had deeply blessed my assurance of the eternal plan of the [LDS] gospel. I admired him and his Christ-like life. But for this brief moment when he knew that his death was imminent his faith was weakened. He didn’t feel comfortable sharing these thoughts with family and friends. He needed someone outside that circle to express this to. He was looking for reassurance that his life offering was acceptable for being in the presence of Jesus Christ. I am not exactly sure of the words I said to him that day. I know they were words not unfamiliar to him. As we both expressed our love and gratitude for our Savior a sense of peace came over him. After he had regained his composure he thanked me and asked for his family to return to the room. We had a very nice family prayer followed by a Priesthood blessing. He died the next day.”
- “A family I became acquainted with were not very spiritual inclined. They questioned the eternal nature of man and didn’t have any particular religious faith to lean upon. It was the second marriage for both. The wife was around 20 years younger than the patient. In fact, she was near the age of his three children from the first marriage. Initially, they did not want to meet with a Chaplain. However, I called them several time and finally persuaded them to let me visit one time. When I walked in the home I immediately recognized the wife. I had previously been a Deputy Sheriff and for 11 years I had supervised the Davis County Jail. She had been involved in drugs and alcohol which led to some criminal behavior. I became acquainted with her when she was in a court ordered drug program offered for those incarcerated at the jail. It turned out to be a life changing experience for her. This gave us an immediate positive connection. I became quite close to this couple. As they began to trust me more I learned that the patient had become estranged from his children because of this second marriage. It had been nearly 15 years since he had spoken to his children. He had a desire to reconcile this before his death. Things were very tense between his wife and the children. I asked if I could try to help. Reluctantly, they gave me the children’s phone numbers. I called them and explained their father’s desires. I facilitated a family meeting where they could come and meet with their father. Everyone was more than apprehensive about this. It turned out to be one of the most satisfying and spiritual experiences I have witnessed. As broken hearts were healed, hardened feelings were softened, and relationships reconstructed I knew this man could die in peace, which he did less than one week later.”
1) Look at ownership
- Who owns it and their background
2) Look at how management is set up
- Communication with main office if the office closest to you is a branch
- Know where the on-call nurse lives
- You want a short distance if something were to go wrong
- Know how many square miles the nurse is expected to cover
4) Look at pharmacist/hospice relationship
- Does the pharmacist know enough to answer any difficult questions that may come along
- Look again at location and how long will it take you to receive necessary medications
5) Look at size
- Anything over 90 patients per office is too big, anything less than 20 is too small
- Find out how many patients each case manager has
- It should be between 10-14 patients each
- Find out how many patients each nurse has
- More than 10 patients is considered to have a heavy case load and could decrease the quality of care
- Choose a hospice that does not use too many licensed practical nurse (LPN)
- Most visits should be made by a registered nurse (RN)
- Frequency of visits
- Nurse should come twice per week and it should be the same nurse each time unless that individual is sick or on vacation
- Also find out the length of their typical stay
- There should be a full-time medical director
- Ideally there should be at least one full-time social workers and one chaplains
- Hospices with more volunteers are generally better as volunteer
- Ask people who have used a hospice
- Ask more than 1 person
- One amazing recommendation does not mean that hospice is the “one”
8) Why some things matter and others don’t
- What does not matter
- Profit vs. non-profit status of the hospice company – the intentions of the company when it comes to patients is the important thing
- What does not always matter
- Membership in the National Hospice and Palliative Care Organization (NHPCO) – anyone can pay the necessary fees
- It is important to see if they are an active member – that will increase the quality of care
- Membership in state hospice organization – same as above, this does not matter unless they are an active member
- What does matter
- Medicare certification
- If they take your insurance – ask them
- Specialty accreditation for staff members (nurses, etc) – hospices that encourage/allow time to be taken to get these are generally concerned about the quality of care they are giving
- NHPCO Quality Partners Program – this is a program that attempts to quantify quality
- Optional program that takes time and effort – any hospice actually participating in this program is moving in the right direction
- Medicare Hospice Cap
- You do not want to choose a hospice that has a cap problem, meaning they owe Medicare money
*To see where Utah Hospice Specialists stand on these issues, please click this link.
What is hospice?
- Hospice, also known as “end of life” care, is health care that is provided to terminally ill patients and encompasses all aspects of patient care such as physical, emotional, and spiritual.
- Hospice serves are provided in four locations – a hospital, in the patient’s home, in an assisted living center, or in a separate facility.
When is hospice care ordered?
- Doctors generally order hospice care when the patient is expected to live six months or less
What are the different levels of hospice care?
- Inpatient care – patients are admitted to a hospital or nursing facility and receive around-the-clock care until symptoms are controllable
- Respite care – patients receive care when their usual caregivers need a break or are burnt out
- Comfort care – patients receive care for 8-24 hours per day when their symptoms are not being controlled by their regular care
- Routine home care – patients receive care in their home as needed to manage terminal illness and pain management
What are the types of hospice available?
- Adult hospice
- Prenatal hospice – for a baby who will die before or after birth
- Pediatric hospice – for children 1-21 years old