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Pain and Terminal Illness: Pain is a prevalent symptom in terminal illnesses, with studies indicating that up to 80% of cancer patients experience pain at some point during their illness . Effective pain management is essential to improve the quality of life for these patients. Hospice care provides a comprehensive approach to pain management, utilizing a combination of pharmacological and non-pharmacological interventions tailored to individual patient needs.
Pharmacological Interventions: Hospice care employs various medications to manage pain, including opioids, non-opioids, and adjuvant analgesics. Opioids remain the cornerstone of pain management in terminal illnesses due to their efficacy. However, there is often hesitation from families regarding their use due to myths and misconceptions. It is important to communicate that when used appropriately under medical supervision, opioids can significantly enhance comfort without hastening death .
Non-Pharmacological Interventions: In addition to medications, hospice care incorporates complementary therapies such as relaxation techniques. These interventions can help alleviate pain and enhance overall well-being, providing a holistic approach to patient care.
Managing Terminal Agitation
Terminal agitation, characterized by restlessness, confusion, and anxiety, affects many patients nearing the end of life. It can be distressing for both patients and their families. Hospice care professionals are skilled in identifying and managing terminal agitation through personalized care plans that may include:
Frequent hospitalizations can be traumatic for terminally ill patients and their families. Hospice care focuses on providing comprehensive care at the place the patient calls home, thus minimizing the need for hospital admissions. Research has shown that patients receiving hospice care have fewer hospitalizations and emergency room visits compared to those not enrolled in hospice programs .
One of the barriers to hospice referrals is the misconception that pain medications, particularly opioids, are harmful or hasten death. It is crucial to educate families that:
Hospice care is vital in managing pain and terminal agitation, ensuring that patients can spend their final days in comfort and with dignity. Let’s talk about your patients who can benefit from the pain and symptom management techniques that hospice can provide.
By: Joelle Jean, FNP
Caring for a loved one who is terminally ill and on hospice is emotionally and physically taxing. In 2015, an estimated 39.8 million caregivers provided unpaid care to an adult with a disability or illness. The estimated value of the service supplied by caregivers is up to $470 billion since 2013.
Caregivers may deny help from others, perhaps out of guilt or obligation. However, 1 out of 6 caregivers report not being asked what they need to care for themselves. Caregivers can work up to 8.3 hours per day or 66 hours per week during their loved ones’ last days of life. Often, this is in addition to working a full-time job and caring for their own immediate family.
Caregivers are at risk for depression, severe fatigue, or burnout, or even health issues such as hypertension, stroke, obesity, or weight loss due to stress.
A caregiver, also known as an informal caregiver, is an unpaid individual or group of individuals who provide care to a loved one. Caregivers can be a spouse, family members, partner, friend, neighbor, or combination of these individuals.
A caregiver assists their loved ones with activities of daily living which include:
A caregiver can also play a significant role in coordinating care for their loved ones. Many are appointed power of attorney or the primary decision maker for their loved ones, managing finances, property, and most suitable medical care for the individual.
There is no clear definition of caregiver stress. The Merriam-Webster dictionary defines stress as “a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation.” Burnout can be a response to stress, defined as extreme emotional exhaustion. According to stress.org, stages of burnout are:
A caregiver with stress or burnout exhibits signs of feeling overloaded, overwhelmed, emotionally drained, tiredness, detachment from the person they are caring for, and a reduced sense of accomplishment.
Caregiver stress affects the person or people directly caring for their loved one. Stress can also affect caregivers in different ways. For example, one caregiver may find specific tasks stressful or overwhelming while another caregiver may find the task relaxing and rewarding.
Often, caregivers are not aware of their stress or feeling of burnout. Signs and symptoms of caregiver stress can be subtle or obvious. It is important to identify caregiver stress so it can be eased.
Anxiety is a stress response, activating the fight or flight response that happens chemically in the brain. Physically, anxiety can be described as:
Caregivers suffering from stress may not realize they are fatigued. Fatigue is the body’s response to burnout and can be physical, emotional, or psychological.
Stress can cause weight changes and affect eating patterns. Weight change can occur when dealing with caregiver stress. Rapid weight gain or unexplained weight loss is a warning sign of caregiver stress and should be addressed appropriately.
Caregivers may become easily annoyed or short-tempered with loved ones, family members, or friends. Feeling irritable may be a warning sign of caregiver stress.
Feeling overwhelmed or anxious is normal. Caregivers may become overwhelmed with the amount of care needed to provide to their loved ones. Trouble concentrating, changes in sleep patterns, and changes in eating habits may occur.
Losing interest in activities can be a sign of depression due to the demanding responsibilities of caregiving. Signs of depression include:
Chronic stress (or stress lasting for more than six weeks) can have lasting health problems. Caregivers exhibiting signs and symptoms of stress and burnout have a higher chance of developing health risks.
Caregivers can suffer from high blood pressure due to the stress of caring for a loved one in hospice. If caregivers have already been diagnosed with high blood pressure, stress can make the disease worse. Uncontrolled high blood pressure puts caregivers at higher risk for:
The immune system is in place to protect the body from illness and disease. Stress can cause a weakened immune system. With a weakened immune system, caregivers can become sick or develop chronic illnesses such as:
Studies have shown that a symptom of chronic stress is the shrinking of the brain. Shrinking of the brain causes short-term memory loss. Short term memory loss affects learning, judgement, and memory process.
Stress can cause headaches and body pains. On a hormonal level, the increase of cortisol causes headaches even at rest. The physical nature of caring for a loved one on hospice- lifting, standing, walking, and rotating- can cause severe body pain or injury.
Self-care is imperative for caregivers caring for their loved ones in hospice. Self-care means caring for yourself, so you can improve your health to care for others.
Finding the time and the energy to exercise might sound difficult. However, even carving out 30 minutes a day has positive effects on your health. Exercising whether it is running, walking, swimming, or doing yoga will lower blood pressure, increase energy, and improve mood.
Accepting help can be difficult for some caregivers. It is important to ask and accept help so that you are available for your loved one mentally and physically.
Under most insurances and Medicare, respite care is available to relieve the burden of caregiver stress. Respite care will give short term caregiver relief to those who are in need.
Eating and sleeping well are fundamental in protecting your physical and mental health. A well-balanced meal of fruits, vegetables, and plant-based foods is important for physical and mental well-being. Adding vitamins such as a multivitamin, vitamin D, or vitamin B-12 can also help improve your mood and energy.
Having a good night’s sleep has many health benefits. Feeling well-rested and energized will only benefit you, as the caregiver, and your loved one. Improved memory, mood, and overall well-being are all benefits of quality sleep.
Support groups add immense value to caregivers who are caring for loved ones in hospice. Joining support groups reassures caregivers that they aren’t alone. Support groups:
Maintaining personal relationships is as important as joining support groups. Meeting up with friends or family members allows you to relax. It also allows you to take time for yourself and time away from your loved one.
Awareness of caregivers’ stress and burnout must be addressed and acknowledged for caregivers to feel supported and recognized for their challenging work. The hospice team and its services are a fundamental part of bringing this awareness to the forefront.
The terms ‘hospice’ and ‘palliative’ care often get confused. Although they are similar, there are differences between these two types of care.
The focus of hospice care is on quality of life when a cure is no longer possible or when the burden of treatment outweighs the benefits. In general patients receiving hospice services have a life-expectancy of six months or less if the illness runs its usual course. Many people think hospice care is just for elderly people or cancer patients, but that is not the case. Hospice benefits people of any age, with any life-limiting illness. The goal of hospice is to provide comfort care by managing pain as well as providing emotional and spiritual support to the patient and their family.
Hospice care can be provided anywhere the patient calls home, including nursing facilities in which they may reside. It involves an interdisciplinary team that includes:
The interdisciplinary hospice team will focus on things like:
Palliative care, like hospice, focuses on quality of life. The difference is that palliative care is appropriate at any stage of a serious illness, not just at end-of-life. It’s an extra layer of support that treats the symptoms of an illness and supports the entire family. Patients who are receiving palliative care can continue to receive curative care such as chemotherapy, radiation, dialysis, and surgery.
Patients can receive palliative care in settings such as hospitals, nursing homes, specialized clinics, and at home from a team of specially trained doctors, nurses, and other specialists. This team will work closely with the patient, their family and caregivers, and the patient’s other doctors to ensure everyone is on the same page.
The palliative care team offers services such as:
The chart below can be used to help gain a better understanding of the difference between hospice and palliative care.
Please contact us if you have any questions about the quality hospice services Grane Hospice provides.
By: Dr. Margarita David DNP, RN
Having a hospice provider working as a partner with a nursing home may improve the quality of care a nursing home resident receives during end of life. Many studies have shown that having a hospice presence in nursing homes reduces hospital readmissions, improves the facility’s performance scores, and facilitates conversation between the resident and their families regarding end-of-life treatment options.
When a loved one’s health condition declines, the decision to transition to comfort care is not an easy one. However, before a decision is made you must know the difference between a nursing home and hospice.
Hospice is an approach to care for people experiencing a life-limiting illness. It offers comprehensive services that address the physical, spiritual, social, and emotional needs and preferences of the patient and family. The hospice team includes nurses, doctors, social workers, certified nursing assistants, and chaplain and bereavement services to ensure that the patient receives medical, physical, emotional, and spiritual support in any place the patient calls home.
Nursing homes and long-term facilities serve as a place where the patient lives and needs assistance with activities of daily living such as bathing, dressing, and toileting. Care is provided by trained nurses that are ready to handle the nursing and medical requirements of the residents.
For a resident to qualify for hospice care, the resident must meet the hospice eligibility requirements that have been established by the U.S. Centers for Medicare & Medicaid Services (CMS). Although there is not a standardized list to qualify, CMS guidelines help with determining if a resident’s condition is appropriate to receive hospice care.
Hospice care is provided wherever an individual resides, which includes long-term care facilities and nursing homes, and provides specific services at the end of life to residents and their families. The long-term care facility staff provides residential, custodial services to the resident, while hospice care tends to the end-of-life needs. This is what makes hospice and the long-term facility mutually beneficial to each other. Here are few examples of the role hospice plays in long-term care facilities:
The hospice team and the nursing home staff share the responsibility for the resident’s end-of-life care.
The nursing home’s staff has a key role in the care of residents since these professionals are often the first individuals to notice changes in the resident. It is important to educate nursing home staff on recognizing signs and symptoms of end-of-life and when to notify the proper healthcare provider. The hospice team provides education that focuses on the resident’s condition, symptoms, and medications, and how to best care for a resident’s medical needs.
Hospice staff helps in the coordination of the resident’s care and medications needed across all their healthcare providers, hospice team, and nursing home staff. This coordination of care assures proper communication and gives the resident’s family the ability to have questions answered.
Find expert hospice care with Grane Hospice. Contact us to learn more.
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Joint Commission-accredited hospices are the partner of choice throughout the care continuum because of their deep abiding commitment to quality end-of-life care. Apreva Hospice is one of the few hospices in San Diego County with this distinct and honorable title. An accreditation from Joint Commission shows dedication to the optimum patient experience, commitment to strong interdisciplinary care management, and a robust patient safety initiative.
Apreva Hospice prides itself by partnering with the We Honor Veterans Program. We have a team of highly-trained individuals who work with our Veteran patients during their time of need.
Patient services are provided without regard to race, color, religion, age, sex (an individual’s sex, gender identity, sex stereotyping, pregnancy, childbirth and related conditions) , sexual orientation, disability (mental or physical), communicable disease, or national origin.
Read our Notice of Nondiscrimination here.
