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By: Laura Mantine, MD
“Wear the white coat with dignity and pride, it is an honor and privilege to get to serve the public as a physician.”― Bill H. Warren
Physicians display heroism and courage every day in hospitals, nursing homes and clinics. National Doctors’ Day, celebrated on March 30th, is an annual observance aimed at appreciating physicians who help save lives everywhere. The holiday first started in 1933 in Winder, Georgia, and since then it has been honored every year. The idea came from Eudora Brown Almond, wife of Dr. Charles B. Almond, and the date was chosen as it marked the anniversary of the first use of general anesthesia in surgery. This month, National Doctors’ Day continues to highlight many questions, concerns and fears about what the future of medicine holds. The COVID-19 pandemic has already left its indelible mark on American’s health and well-being. Many doctors have courageously set aside their own fears to help those in need, lend a hand to an overburdened colleague, gather supplies and equipment for those who may soon go without, and accelerate the research to develop a vaccine or medication that may bring an end to this pandemic once and for all.
As the COVID-19 pandemic continues to unfold and upend American life, physicians, nurses, and the health care workforce are leading a remarkable response effort by putting their health and safety on the line every day. There have been many cases in the U.S and around the globe in which physicians have fallen seriously ill or died after treating patients for COVID-19. The physical toll alone is daunting with extremely long and taxing hours at a patient’s bedside. The emotional toll is just as significant, and enough to overwhelm even the most seasoned and experienced doctor. Ultimately, no one can say for sure how long this health threat will last or how much more our nation’s physicians will be asked to give.
The COVID-19 pandemic reminds physicians of the obligation to place a patient’s welfare above our own, the need to protect and promote public health, and the ethical considerations involved in providing care under the most urgent and trying circumstances. Physicians embrace all these responsibilities and more as a routine part of their professional lives. This fact does not diminish the burden a physician will undertake on a patient’s behalf. The selflessness displayed in the face of a deepening health crisis is truly extraordinary.
When physicians are asked why they chose their profession, answers will of course vary. One theme tends to underlie all the responses: a profound commitment to helping others. Physicians are called upon to help in moments like the COVID-19 pandemic. Dr. Patrice A. Harris, former president of the American Medical Association, said in her inaugural address “Physicians don’t run from challenges. We run toward them.” Physicians undertake these efforts because they are called to do so, not to earn public recognition or thanks. People should thank them and offer heartfelt gratitude and praise, not on National Doctors’ Day but every day.
By: Dr. Laura Mantine
Love is all around this month, especially on Valentine’s Day, when we take time to turn to those closest to us and say those three magical words. However, if you have a loved one who suffers from advanced cardiac disease, one of the best ways to show how much you care may not come in a sentimental card or a box filled with chocolates. Instead, it may come from calling hospice. Oftentimes, people don’t realize that hospice care is an option for people who suffer from advanced cardiac disease. Instead, these patients often spend their final days and months in and out of the hospital, receiving treatments that do little to improve the course of the disease. Hospice offers a supportive program of holistic care designed to help patients manage symptoms, forego emergency room visits and receive convenient, compassionate care right in their places of residence.
The estimated annual cost of heart disease is about $200 billion each year. Heart disease is the leading cause of death in the United States across all demographics. Heart disease accounts for 17.8% of hospice deaths, second only to cancer (30.1%). During hospice care, cardiac patients are monitored by a team of physicians and nurses, who administer medications and treatments to keep them as comfortable as possible. Social workers can access valuable community resources. Chaplains and counselors provide emotional and spiritual care for the patient and family. Volunteers can sit with patients, read to them or help them with light household chores, and allow caregivers to get some much-needed respite.
End-stage heart failure is often marked by an abrupt, dramatic decline, followed by recurring recovery and stability until sudden death. Patients are ideal candidates for goals-of-care conversations when they have severe refractory heart failure or extensive symptoms of cardiac insufficiency, have tried or cannot tolerate maximum medical management and are not candidates for curative therapies or surgical interventions. Hospice care addresses a wide range of symptoms, including shortness of breath, chest pain, weakness and functional decline. Eligibility for hospice may require documentation of progressive loss of functional capacity over years, progressive failure to respond to therapies and a desire to discontinue curative treatment. Patients should check with their physician to see whether they are eligible for hospice based on their history of congestive heart failure, arrhythmias or heart attacks. The physician may also consider any coexisting diseases like HIV, diabetes, respiratory illness or kidney disease when transitioning a patient to hospice care.
In addition to increasing a cardiac patient’s quality of life, hospice often increases the cardiac patient’s quantity of life as well. In a study reported in the March 2007 Journal of Pain and Symptom Management, congestive heart failure patients who chose hospice survived 81 days longer than those who did not. Even when modern-day technology or surgery can no longer offer hope, patients with late-stage cardiac disease need to know that help is always available. Hospice allows these patients to experience as much joy as possible in their remaining days while minimizing their discomfort and pain.
Centers for Disease Control and Prevention, National Center for Health Statistics. (2016). Multiple Cause of Death 1999-2015 on CDC WONDER Online Database. Data are from the Multiple Cause of Death Files, 1999-2015, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program.
Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association. Circulation. 2017;135:e1–e458. DOI: 10.1161/CIR.0000000000000485.
National Hospice and Palliative Care Organization. (2018). NHPCO Facts and Figures 2018 edition.
Ziaeian, B., & Fonarow, G. C. (2016). The Prevention of Hospital Readmissions in Heart Failure. Progress in cardiovascular diseases, 58(4), 379–385. doi:10.1016/j.pcad.2015.09.004
By: Angelique Riley
My name is Angelique Riley, and I have been at Grane Hospice Care, King of Prussia (an Abode Healthcare and BrightSpring Health Services company), for a little over two and a half years. I joined Grane after spending twenty years managing Life Enrichment in Continuing Care Retirement Centers. I found Life Enrichment rewarding, but it was time to hang up that hat and move on to another venture.
I chose to work in Hospice Care to share my natural gift of helping people during the most difficult time of their lives. I take pride in sharing compassion, support, and a great deal of care with our patients. It is a great honor to be spotlighted in our employee newsletter, and to share what Black History Month means to me.
Black History Month is an annual observance originating in the United States, where it is also known as African American History Month. It began as a way of remembering important people and events in the history of the African diaspora. Now that you have the Wikipedia definition of Black History Month; let me tell you what Black History Month really means…
Black History cannot be contained or limited to a single month. I grew up in a family where we honored and embraced our heritage year-round. My siblings and I were educated by our father on the rich history of African Americans. He taught us about inventors, writers, educators, musicians, and other notable Black figures.
It was important to my father that we had knowledge of our own history. We grew up as military children and were exposed to many different cultures and environments. My father prided himself in educating us on African American studies because he knew our schools and society, would more likely teach us an inaccurate version of our history, if they mentioned African Americans at all.
American schools teach students about Dr. Martin Luther King, Rosa Parks, and the enslavement of African American people in the US. Those are important topics to cover, but that barely scrapes the surface of African American contributions to our society. Sparse lesson plans fail to mention the large numbers of African American scientists, physicians, attorneys, and professors who have made huge contributions to American progress.
A quick funny story: When I was in World History Class my junior year in High School in Lawton, Oklahoma, the teacher presented a lecture about religion in the African American community. I remember cringing in my seat, my spirit stirred with frustration because the lesson was filled with errors about my history and my culture. I could not remain silent.
Each time that the teacher mispronounced a name, gave an inaccurate date, or worse, attributed an accomplishment to the wrong person, I spoke up and corrected him. After I contradicted him four or five times, the teacher grew so frustrated that he shouted,
“DO YOU WANT TO TEACH THE CLASS?”. I rose to my feet and said, “Yes, I do”.
It did not end well for me that day. I was sent to the office immediately and punished with an In-House Suspension. Despite the repercussions, I never regretted what I did.
My experience confirmed my father’s prediction that the school was not going to teach the proper information on African American History. Since my father took the time to teach me, I knew my history and had the conviction to share it with my peers.
I shared this story to illustrate the importance of teaching African American History and embracing it as an ongoing celebration in the African American Community. I am grateful to see schools, businesses and the community recognize Black History.
The month of February is a time to honor our ancestors and their hidden or overlooked contributions. It is also a time to reflect on the work still to be done.
Black History Month is a reminder that Black Is Love. I love being an African American woman and getting to reflect with others who are also proud to be African American. Black History Month is an invitation for others to join in the ongoing celebration of black excellence. It is unity in its highest form.
It can be stressful when an elderly loved one is admitted to a hospital or healthcare facility. You likely have a lot on your mind, and what to do when they are discharged may be one of the last things you are thinking about. However, it’s best to think about it early on so you are prepared to bring your loved one home.
You won’t know if you don’t ask. Don’t be afraid to ask your medical team any questions you may have. There are no silly questions when it comes to your loved one’s well-being.
While every person and situation is different, here are some questions you might want to ask (or might help you think of other questions you have):
Oftentimes, bringing someone home from a hospital or facility is more involved than simply getting in the car and driving them home. Whether they are going to their own home or to yours, there may be steps you need to take to make the home safe and accessible. A safe return home can be the difference between being readmitted to a hospital and a full recovery.
Let’s start with the first place your loved one will encounter when coming home: the entry. Make sure there are no cracks or other damage to sidewalks or steps that could cause them to trip. If there are steps (and they can use them), make sure there are sturdy railings for them to hold onto. If they cannot use steps, have a ramp installed.
Falls are a leading cause of injury for seniors, so it is important to reduce the risk for falls as much as possible.
The majority of seniors’ falls occur in the bathroom, so it’s an important room to focus on when preparing the home for your loved one. You can help make the bathroom safer by:
Remove fire hazards from the home, including:
Remember to check the batteries in and test all smoke detectors.
If your loved one lives in a home with multiple floors, make sure railings are sturdy and safe. Look into stairlifts if they are not able to use the steps. If possible, eliminate the need to use the steps at all and set up a one-level living environment.
If your loved one is able to live at home alone, medical alert systems can be great for their safety and your peace of mind. There are many options available that can be worn around their neck. If they fall, they can press a button and be connected to help right away.
Depending on your loved one’s needs, special equipment (known as durable medical equipment) may be needed when they return home. This can include:
Durable medical equipment (DME) that is prescribed by your doctor is covered by Medicare Part B. Medicare offers a great tool on their website that can help you find places near you to get the DME you need.
Have a plan for the day your loved one comes home. Who will be picking them up? What time? Do you need to get any medications or supplies on your way home? Having a plan will make the transition home go smoothly.
Talk to your loved one’s medical team about any other information you need to know. Ask them to go over things like medication and warning signs to look out for and when to call the doctor’s office.
If you can, include your loved one in conversations with the doctor about what to expect when they get home. Life at home will likely be different for them, and that can be difficult to cope with. Hearing it from the doctor and having the chance to ask questions can help make the transition easier for them.
There can be a lot to do before bringing a senior home from the hospital or a facility. Having conversations and starting preparations early can help make the transition smoother for everyone.
There are a lot of things to take into consideration when considering hospice for yourself or for someone you love. In our previous blog post, we discussed the important topic of who pays for hospice. Now, we want to talk about who makes up the hospice care team.
It’s a common misconception that you cannot continue to use your primary care physician (PCP) when you choose hospice. This is not true. The patient’s PCP will continue to be as involved in their care as you want them to be, working closely with the hospice team to determine the best care plan options. The hospice team will keep them informed of all the patient’s wants and needs.
A Hospice Medical Director will also be part of the hospice care team. They oversee all clinical aspects of hospice care and provide medical education to community and facility staff. The Medical Director also actively participates in the admission, eligibility, and recertification decisions and provides overall direction to the rest of the hospice team.
Although they receive guidance from the Medical Director, the hospice nurse is the one who manages the patient’s care. The nurse will visit based on a schedule that meets the patient’s individual needs. Their main purpose is to provide pain and symptom management, keeping the patient as comfortable as possible. They will also administer medication as necessary and will tend to any wounds the patient may have.
There is always a hospice nurse on call – 24/7, 365 – to answer any questions that may arise.
A Certified Nursing Assistant (CNA), also referred to as an Aide, plays a pivotal role in the hospice care team. They are trained caregivers who work under the supervision of a registered nurse to assist with personal care and other duties around the home. CNAs will help the patient with things like bathing, dressing, grooming, and feeding. They will also help with light housekeeping.
CNAs also provide education to family/caregivers so they can feel confident in caring for their loved one when hospice is not there. This can include how to safely transfer your loved one from bed to a chair and back or the best way to help them get from room to room.
CNAs provide a special level of care for hospice patients and their family/caregivers.
Dealing with a terminal illness can be delicate and difficult for the patient and family. The hospice social worker is here to provide emotional support for you and your family, as well as to help with things like:
Our pastoral care team is comprised of ordained ministers with various religious affiliations who provide spiritual support to the patient and their family throughout the entire hospice journey. They provide an interfaith forum where the spiritual needs of the individual come first, not the denomination. Services they provide include praying with the patient/family, reading scripture, or even just sitting quietly with the patient. Chaplains can provide or arrange for religious sacraments or other religious rites. They may also help with funeral or memorial service arrangements.
The grieving process doesn’t wait until the patient has passed to begin. It is completely normal to feel grief when facing the impending loss of someone you love. Bereavement coordinators are here for you and your family whenever you need them most. Their support begins at the time the patient is admitted to hospice and continues for up to 13 months after death. Everyone grieves differently, but no one should ever have to go through it alone.
Volunteers are specially trained to support the patient and their family by providing services such as reading, art/music therapy, pet therapy, and so much more. There are also Veteran volunteers for Veteran patients who would like visits from a volunteer who served in the military.
Volunteers can have such a huge impact on a patient’s hospice journey.
The final and most important part of the hospice is care team is you, the patient’s family/caregiver. You will be involved in your loved one’s care every step of the way. Starting from the very first discussion about our services, our team will coordinate with you throughout your entire hospice journey to care for your spouse, parent, or other loved one as though they are our own.
If you’d like to learn more about the hospice care team, please contact us. We are here to answer any questions you may have.
‘Who pays for hospice?’ It’s a very common question. And it’s a very good question. If you are considering hospice care for someone you love (or maybe for yourself), you have a lotof things to think about. Worrying about how you are going to pay for hospice care should not be one of them.
At Apreva Hospice, we strive to provide exceptional care for our patients and their families. This begins with providing education and resources to ensure everyone involved understands what to expect when choosing our hospice services. That being said, we want to dive into how hospice is paid for.
Medicare Part A covers hospice through the Medicare Hospice Benefit, which states you pay nothing for hospice care. To qualify for hospice care, a hospice doctor and your own doctor (if you have one) must certify that you are terminally ill. This means you have a life expectancy of 6 months or less, should the disease run its natural course. When agreeing to hospice, you will sign a statement that confirms you are choosing hospice care rather than other benefits Medicare covers to treat your terminal illness and related conditions. Simply put, you are agreeing that you are choosing comfort care instead of curative treatment.
Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. It also pays for hospice care for terminally ill individuals in many states. Similar to Medicare, hospice services through Medicaid include:
To qualify, a hospice provider must obtain a physician certification that a patient is terminally ill, and hospice services must be reasonable and necessary for the management of the terminal illness and related conditions. A hospice plan of care must be established prior to services being provided.
The Department of Veteran Affairs (VA) covers hospice care for Veterans who are in the final phase of their lives. They work closely with community and home hospice agencies to provide care in the home. Since hospice is part of the VHA Standards Medical Benefits package, all enrolled Veterans are eligible for services as long as they meet the clinical need for service.
There are no copays for hospice care, whether it is provided by the VA or an organization with a VA contract.
Many private insurance companies provide some coverage for hospice care. Check with your insurer to determine whether hospice is covered. Qualifications and covered benefits vary based on the private insurer.
If you don’t have insurance coverage and cannot afford hospice care, it may be provided free of charge through financial assistance such as donations, gifts, grants, or other community sources.
Please feel free to contact us if you’d like more information about how hospice care is paid for. Our team is always here to answer any questions you may have.
By: Dr. Margarita David Ph.D., RN
Pancreatic cancer affects over 60,000 people in the United States. Continue reading to learn more about pancreatic cancer in honor of Pancreatic Cancer Awareness Month.
Pancreatic cancer is a cancer that develops in the pancreas. The pancreas helps regulate the metabolism of sugar and aids in the digestion of foods.
Although the exact cause of pancreatic cancer is still unknown, some risk factors that may contribute to the development of pancreatic cancer include:
Many of the symptoms of pancreatic cancer are also common with other types of cancers. These may include:
There are several ways that pancreatic cancer is diagnosed:
Three blood tests can help diagnose and treat pancreatic cancer:
If blood work and imaging indicate the possibility of having pancreatic cancer, a biopsy (a tissue sample from the pancreas) is taken to confirm the diagnosis. A biopsy is the gold standard for a definitive pancreatic cancer diagnosis.
Pancreatic cancer can be extremely painful, making your quality of life more difficult toward the end of life. Hospice care allows people to live their final stages in peace by providing:
The end of life can be a very stressful, uncomfortable, and anxiety-provoking time. A hospice team can help provide the comfort the patient needs physically, emotionally, and spiritually.
Hospice care takes care of you physically and emotionally during the end of life. The team consists of a social worker and chaplain who will work with you and your family to ensure your spiritual needs are met. Hospice provides compassionate care that is supportive of both the patient and their families through the end of life and throughout the grieving process.
Caring for sick loved ones can be an exhausting endeavor, which is why hospice care takes over your care so that your family gets a much-needed break. Your hospice team can also coordinate respite periods for your caregiver.
In 2020, an estimated 41.8 million adults in the United States were caregivers of someone 50 years of age or older. That’s one in six Americans. In honor of National Family Caregivers Month, we want to take the opportunity to applaud all these caregivers for all they do for those they love.
You work round the clock to care for someone you love. Maybe it’s a parent. Maybe it’s a spouse or partner. No matter who it is, you are committed to doing the best you can for them because you love them. And because you know they would do the same for you. But it’s not easy. We know that. So, we want you to take a minute to yourself right now to read this. Because this is for YOU.
You have taken on the responsibility of being the primary caregiver for a loved one who is ill. That’s no small task. You are there for them at all hours of the day and night- whenever they may need you.
Being a caregiver can be stressful on its own, but many of you are not only a caregiver. Whether you have a full or part-time job, volunteer, have children to care for, or anything in between – you have other responsibilities also. Juggling all those responsibilities can be overwhelming at times, and with all these things to take care of, you don’t often have time to stop to take care of yourself.
You don’t have to do it all on your own. Lean on friends and family for help and support. When it starts to feel like it’s too much, call a friend or loved one. Ask them for help or just to talk or listen. A strong support system is essential.
Maybe you feel like your friends and family don’t understand what you’re going through, and you want to talk to someone who has a similar situation. There are support groups available for caregivers. Through these, you can meet others who have similar situations as you. You can share stories with them or share tips with one another. At the end of the day, having someone you can lean on is so important.
With everything you need to get done in a day, we understand that it can be easy to neglect yourself and your own needs. However, it’s incredibly important that you take time for yourself. Do your best to carve out time to do something you enjoy. Do something that is for you and no one else. It’s not selfish. You NEED to do it.
It’s important to be able to take some time to do something that helps you decompress. Go for a walk. Read a book. Listen to a podcast. Whatever helps you unwind after a long day- do it! You need this opportunity to recharge so you can be at your best.
We understand it can feel overwhelming at times, but we want you to know you are doing great! You aren’t going to be at 110% every day. You may have an ‘off day,’ and that’s okay. We all have them. Just remember to show yourself some grace. You have taken on a huge role, and it’s not easy. You won’t be perfect – no one is. But each day, you rise to the challenge and do what you need to do to be there for your loved one. That’s what matters.
Don’t give up. And don’t ever doubt yourself. You are amazing!