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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 Springhill Hospice provides.
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 Springhill Home Care. Contact us to learn more.
By Joelle Y. Jean, FNP
Due to its busy nature, providers in the Emergency Room (ER) may not immediately identify patients for hospice care. Approaching patients or family members about hospice can also be challenging-especially if they have specific questions. This hospice checklist can help guide providers on when they should consider a patient for hospice.
Hospice is for patients who are at the end of life. Patients can have a terminal illness or declining health from a chronic illness. The hospice team can coordinate care with health care providers to manage and treat patients.
Initiating hospice early in the disease process has many benefits for the patient and family members. Hospice is there to improve the quality of life and provide comfort for patients during their end of life. Benefits of hospice include:
Studies have shown that providers initiate hospice too late- patients die within weeks of entering hospice. There are barriers that cause ER providers to wait or not consider hospice. Some barriers include:
Patients in the late stages of Alzheimer’s disease or dementia are candidates for hospice. At this stage, they start to lose activities of daily living (ADLs) and cannot complete basic functions on their own. These functions include:
Other signs providers should consider patients with Alzheimer’s disease or dementia for hospice are:
Patients in their late stages of heart failure (HF) are candidates for hospice. Providers should consider hospice if the patient has:
Patients with end-stage lung disease and lung cancer are hospice candidates. Providers should consider hospice if the patient:
Patients with end-stage liver disease are candidates for hospice. Liver disease is the 12th leading cause of death in the United States. Patients with liver disease are often overlooked for hospice care. Providers should consider hospice for patients with end-stage liver disease if they are:
ER providers can opt for hospice for patients with cancer if treatment is no longer working or there are no other treatment plans. Patients also at the end stage of their cancer can benefit from entering hospice early. Other signs a patient is ready for hospice are if the patient:
It’s not always easy to identify patients with sepsis who qualify for hospice. However, some patients meet the criteria. Providers should consider patients with sepsis for hospice if the patient:
Hospice is available to patients who are at the end of their life. They can entire at any stage in their disease process. Initiating hospice early benefits the patient. Studies have shown that hospice improves mood, decreases medical interventions, and enhances the patient’s overall quality of life.
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. Living with the symptoms of COPD, such as difficulty in breathing, can induce stress for both the patient and the family. Due to this, Doctors are beginning to call for earlier hospice referrals for these patients with COPD. If elected early, the benefit of hospice care can assist with symptom management, prevent unnecessary hospitalizations, and help patients achieve a 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. When hospice care is chosen early, 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 discussing the appropriateness of a hospice referral for a COPD patient include:
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.
Electing the hospice benefit early allows for the expertise of a focused team of professionals:
Hospice services are available 24/7/365. The hospice care team will provide medical, emotional, psychological, and spiritual support to the patient and family. Here are eight benefits of early hospice referral:
Early hospice referrals means early management of symptoms by:
Don’t wait, make the referral to hospice early. An early hospice referral can provide extra support for both the caregiver and the patient. If you or a loved one is struggling with COPD, consider the benefit of hospice services.
Care at no cost to Veterans and their families.
Springhill 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
Springhill 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:
Veteran-To-Veteran Volunteer Program
Springhill 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?
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.
If you or a loved one are experiencing any of these symptoms and have questions about our services at Springhill Hospice, please contact one of our office locations near you to speak with a staff member about these Hospice qualifiers.
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.
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:
If you have questions about the hospice benefit or when to elect your benefit, please contact Springhill Hospice at 251-725-1268 (Mobile) · 251-626-5895 (Baldwin).
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 contact Springhill Hospice at 251.725.1268 (Mobile) · 251.626.5895 (Baldwin)
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 Hearts for 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.