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Patients can maintain their primary care physician when entering hospice care. The primary care physician works with HPCNC's Medical Director to coordinate care. Stephen Rust, MD, FACP, CMD is Hospice and Palliative Care of Northern Colorado's Weld County Medical Director. Dr. Rust is board certified in Hospice and Palliative Care, as well as geriatrics and internal medicine. Dr. Shaun Thompson is HPCNC's Medical Director in Morgan County. Our registered nurses, acting as the patient’s case manager, make regularly scheduled, personal visits to the patient to provide expert pain management and symptom control care. Our case managers also provide training to the primary caregivers so they can care for the patient properly and safely. During the time the patient is under hospice care, the case manager keeps the primary physician and family informed regarding the patient’s condition and provides the complete spectrum of nursing care. Our home health aides provide personal care and assistance with activities of daily living, feeding and bathing and hands-on care. They also perform limited household services to maintain a safe and sanitary environment in the areas of the home used by the patient. Our hospice care services are available 24 hours a day, 365 days a year. Patients can call our on-call nurse at any time (970)352-8487. Specifically, they help provide:
Individuals confronted with life-threatening illnesses, and their families, experience many changes in their lives. Hospice social workers help them assess their strengths and prioritize needs while providing supportive counseling. The social worker provides education about the importance of quality of life issues, as well as coordinating resources for financial and household needs, advanced directives, transportation, or planning special events. Bereavement counselors provide support which continues for up to 13 months following the death of a patient. Our social workers provide assistance with practical and financial concerns as well as emotional support, counseling and bereavement follow-up. They evaluate the need for volunteers and other support services needed by the family and facilitate communication between the family and community agencies. Hospice care embraces all aspects of life - physical, emotional and spiritual. Our staff, therefore, makes spiritual care a priority; and we are aware that all of us participate in spiritual care at some level. Issues of meaning, relationship/peace with God, among other things, can become quite focused, even to the point of struggle or crisis, during the time of terminal illness. The supportive presence, listening and appropriate intervention of a Hospice Chaplain can be a tremendous help to Hospice patients and their families. Our chaplains provide spiritual support to patients and families, often serving as a liaison between them and their religious community. They offer support services ranging from crisis help to private and group grief support. Chaplains also often assist with memorial services and funeral arrangements. Our Hospice chaplains are sensitive to the spiritual needs of individuals facing life-limiting illness. The spiritual care staff are available to Hospice patients and their caregivers and work closely with their clergy or other spiritual support systems in the community. Our Volunteers: Enriching Lives with Service! Our trained volunteers provide a number of important services. Volunteers offer direct patient support, companionship and practical, caring help. Volunteers often assist the primary caregivers by sitting with the patient to provide the caregivers respite from the often overwhelming task of providing around the clock care for a loved one. Volunteers also may assist us with clerical and administrative tasks in our office. The experience of grief is universal and unavoidable. The impact of grief affects all dimensions of existence: spiritual, physical, emotional, social and mental. For many people the death of someone loved can be one of the most significant traumas encountered in a lifetime. HPCNC operates the Chrysalis Grief Center, a specialized facility, offering individual bereavement counseling or grief support groups that can be very helpful to grieving people. Services we provide include:
Support groups are ongoing and individual counseling can be scheduled at any time. Services are available to hospice families, as well as the public. Call (970) 475-0130 to schedule a session or find out more about support groups.
Many hospice patients receive great comfort from caregivers who don’t say a word. Therapy animals can bring joy and relaxation to patients from their very presence. HPCNC offers all patients complimentary Animal Assisted Therapy provided by Delta Society approved dogs and their human partners. Volunteers with the Delta Society visit patients in their homes, nursing homes and our Inpatient Unit. back to complimentary therapies Comfort Touch (also called Healing Touch) is a form of alternative therapy that Hospice and Palliative Care of Northern Colorado, Inc. has found to be useful and effective in patient care. What is Comfort Touch? Comfort Touch involves one or more trained therapists working with the human energy field of both the patient and therapist (s). In hospice, our goals are to provide comfort, energetic rejuvenation and improved well-being for our patients. During a CT treatment session, the patient’s energy is sensed by the therapists with their hands, usually conducted a few inches over the patient’s body. Typically, patients are reclining (in a bed, massage table, or recliner chair) during the session and remain comfortably clothed. It is never painful. CT is non-invasive and there are no known side effects from this therapy. back to complimentary therapies Music affects us on many different levels, touching the mind, body and spirit simultaneously. Music promotes relaxation and can energize us. It has been shown to reduce the perception of pain and enhance physical comfort. Music therapy can alleviate anxiety and stress. The use of music for therapy can provide a means for expressing deep emotion, for reviewing life’s joys and sorrows, and creating positive interactions between people. All HPCNC patients are offered the opportunity to receive complementary music therapy, which is performed by a board certified Music Therapist. back to complimentary therapies Reiki is an ancient Japanese technique for stress reduction and relaxation. Reiki is “life energy” and promotes the movement of negative energy out of the body and channels healing energy into the body. Reiki addresses the physical, mental, emotional and spiritual aspects of our being. HPCNC offers complementary Reiki to all our patients, performed by a certified Reiki master volunteer. back to complimentary therapies Hospice patients may improve the quality of their lives by taking advantage of complementary massage therapy. HPCNC offers a complementary massage each month to all our patients. Massage therapy is performed by a certified massage therapist. Massage may benefit patients by improving circulation, promoting relaxation and reducing muscle tension. According to the American Massage Therapy Association, recent clinical research shows:
Being Prepared For Changes Caregiving often comes with new responsibilities and unfamiliar tasks, yet most caregivers never receive education. The following information may help you with a current situation or prepare you for what may happen. Decision Making - Has the person you are caring for told you their wishes for end-of-life care? In the event that you are asked to make or help make decisions it is important for you to talk about issues, including thoughts about potential life-prolonging treatments. Advance directives are tools that enable people to write down their preferences on a legal form and appoint someone to speak for them if they are no longer able. A living will, health care power of attorney, financial power of attorney, and a plan for funeral arrangements can help ensure peace of mind for the ill person as well as you, the caregiver. End-of-Life Care - Hospice is end-of-life care that involves a team-oriented approach to quality medical care, pain and symptom management, and emotional and spiritual support tailored to your family member or friends needs. Hospice is available to anyone who has a life expectancy of six months or less. Hospice provides medical equipment and medications related to terminal illness. Support is given to you as the caregiver, including counselors to talk to, nurses and aides to teach you how to provide hands-on care, volunteers to help lighten your load and non-denominational chaplains to aid with any spiritual issues and/or concerns. Home modifications include adapting the home to make it easier and safer for the person to be cared for in the home. Installing grab bars in the shower, a stool riser for the toilet or a wheel chair ramp by the front door are just a few examples of accessible home modifications. Your local durable medical equipment company (DME) or community organizations such as Centers for Independent Living or Area Agency on Aging may be able to assist you in finding a local organization to help. You’ve just reviewed a few of the basics you should know as a caregiver, including how to be prepared for new responsibilities and tasks, providing physical and comfort care and some of the services that are available to help caregivers. About Living With Side Effects Pain medications can cause side effects, including grogginess, nausea or constipation. You may decide that you would rather live with a little pain than experience the side effects; however many side effects will go away or lessen over time as your body becomes used to the medicine. It is important to let your health care professionals know if you have any problems taking your medicine so that they can find ways to help manage the side effects. You may also want to schedule visits from family, friends and health care providers so that you are at your best. If your pain is worse in the morning, ask people to visit later. If you feel sleepy 20 minutes after taking pain medication, ask people to visit a few hours later. How to talk with your loved ones about end-of-life care issues Remember, it's up to you to take the initiative and express your wishes. Your family or loved ones are not likely to raise the issue for you. Talking about end-of-life issues can be difficult for anyone. One way to approach the subject is to talk about why you have decided to talk about these issues. For example:
Sometimes sharing your personal concerns and values, spiritual beliefs, or views about what makes life worth living can be as helpful as talking about specific treatments and circumstances. For example:
One final point: reassess your decisions over time. These are not simple questions and your views may change. It is important that you review these issues and discuss your choices as your personal health or circumstances change in your life. How to Talk with Your Health Care Agent about Your End-of-life Care Wishes Your health care agent needs to know about the quality of life that is important to you and when and how aggressively you would want medical treatments provided. Talking to your agent means discussing values and quality-of-life issues as well as treatments and medical situations. Because situations could occur that you might not anticipate, your agent may need to base a decision on what he or she knows about your values and your views of what makes life worth living. These are not simple questions, and your views may change. For this reason, you need to talk to your agent in depth and over time. The following questions may help you discuss these issues with your health care agent:
One final point: reassess your decisions over time. These are not simple questions and your views may change. It is important that you review these issues and discuss your choices as your personal health or circumstances change in your life. How to Talk to Your Doctor about Pain Pain tends to be under-treated. Make sure your doctor knows you have a pain problem. Whether you are the person in pain, or a family or friend caregiver, you can help the doctor prescribe the most effective treatment plan. Write down the answers to the following questions before you talk to the doctor so you can best describe the pain:
Here is an example of what you might say when calling for help for someone you are caring for: "This is Margaret Smith, John Smith's daughter. My father is a patient of Dr. Troy. This morning he couldn’t get out of bed because his leg hurt so badly near the hip, and it hurts even if he tries to move just a little in bed. He said his pain is sharp. At 6:00 a.m. he took two Percocet TM but didn't feel any better. The next time for his medicine isn't until noon. We tried a heating pad, but it didn't help." The more you understand about the pain treatment prescribed, the better you will be able to advocate for yourself or the person receiving care, so do not hesitate to ask any questions you may have. Below is a list of suggested questions to ask your doctor:
Your Pain Treatment Goals It is important to speak up and voice to your doctor and others about your pain. Some people decide to live with some pain for personal, cultural, spiritual or other reasons. You have a right to have your wishes respected. Some people believe that they must suffer through pain to atone for sins, others feel that tolerating pain is a sign of courage and bravery. Whatever your beliefs are; you have a right to have your wishes honored. Most health care providers will ask you to rate your current pain level on a scale of 0-10, where 0 is no pain and 10 is the worst pain imaginable. They may also ask what your pain goal is, again on a scale of 0-10. Tell your physician if your goal is to get rid of all your pain, or if you can/choose to bear some pain. Be sure that your physician and family/friend caregivers are very clear about your pain goal. If your goal is to have as little pain as possible and yet you are still experiencing pain, be sure to let your caregivers know so that they can continue to work to manage your pain. How to Manage Your Pain There are many treatment methods that can reduce and manage your pain. Most pain can improve with treatment that usually consists of a combination of medicine and non-medicine strategies. And the good news is that new advances in pain treatments are happening every year. It is crucial to talk to your doctor about your pain so he or she can provide the help you need to feel better. To learn more about how to talk to your doctor about your pain and guidelines to help you manage your pain and other resources, click here. There are also healthy ways to deal with emotions people often have when they are living with pain. Living with chronic pain can take a toll on your mood, outlook, relationships and self-image. In addition to seeking medical help, it may be important to seek extra help from a psychiatrist, psychotherapist, social worker or your faith community leader if need. By getting additional emotional and spiritual support, you will learn new ‘life’ skills to become more effective at managing pain that can enhance your medical treatment. Pain associated with a terminal illness or at the end of life requires special treatment and can best be treated by a palliative care or hospice provider. For more information about palliative care or hospice, click here. Taking action to manage your pain will not only benefit you but also everyone around you. Your pain, and worrying about you, can take a toll on friends and family members as they, too, can experience worry, depression and exhaustion. Just as you need their support, they need yours so the best thing you can do for them is to take care of yourself and your pain. Remember your Pain Care Bill of Rights! Pain Checklist Get the information you need to make informed choices about pain management and treatments. If you are in pain, tell your doctor and caregivers. You don’t have to suffer in pain.
Ask for help from others if your pain makes it difficult to do household chores or other tasks. Discuss your choices often, especially when your medical condition changes. Learn about the resources that are available in your community, including your local hospice and palliative care providers.
The Truth about Pain Many people have incorrect information and concerns about treating their pain. The following questions and answers provide the truth about pain and pain management. "If I tell the doctor about my pain he or she will think I'm a complainer." Response: It is the doctor and nurse's job to work out the best way to control pain. To do this, they rely on you to tell them about your pain. They can't do their job unless you do yours. "Of course I have aches and pains. I’m old." Response: Pain is not a normal part of growing old. Pain in older adults, just like pain in any other age group, is a signal that something is wrong. You need to talk about this with a doctor or your family caregivers so the problem can be treated. "My father is confused. What he says doesn't make sense, so I can't tell whether he's in pain or not." Response: Even when people are confused, oftentimes they can let you know when they are in pain. It may be helpful to look for changes in mood, activity level, body language, and facial expressions. "I'm afraid of addiction." Response: It is very unusual for people who have pain to become addicted to pain medicines. They are taking the medicines for a good reason, to relieve their pain, not to "get high." People who have pain need to be treated, so concerns about addiction, in most cases, should not enter into the doctor's decision to prescribe these medicines. There is a difference between addiction, which is a psychological craving for medicine, and physical dependence. People who need opioids (narcotics) for a period of time may develop a physical dependence on the medicine, with uncomfortable symptoms, such as sweating, chills, and nausea, if the medicine is stopped suddenly. This is only a temporary situation that can be prevented by slowly reducing the medicine over a few days or a few weeks. Preparing Your Home for Caregiving Many caregivers are supporting and caring for disabled and terminally ill family and friends in their own homes. Typically, most homes are not designed for caregiving. Take some time to look closely at each room where your family member or friend may spend time, paying special attention to the bedroom, bathroom, and hallways. With advice from your family member or friend’s health care team, you may need to make some changes for the comfort and safety of all who live there, keeping these points in mind: Safety Checklist
If your family member or friend is weak, a tray that attaches to the wheel chair can prevent falls and gives your family member or friend a place for drinks, magazines, etc. It is important to ensure that the wheels are securely locked when doing transfers, or if the older person’s chair is on an incline. If the bed does not have guardrails, you can place the wheel chair or other guards next to the bed, and position your family member or friend in the middle of the bed so that she or he can turn over without fear of falling.
Supporting a Grieving Caregiver To support a caregiver who is grieving, ask how you can best help, and listen for what they seem to need. Express your concern for how the illness is affecting them personally. Even if you have been a caregiver yourself, don't say you know what they are going through. Empathize, by saying, “I am so very sorry,” but don't say you understand. Supporting Friends or Family Who Are Grieving When people are grieving, know that all emotions are often heightened.
Grief and the Holidays A suggestion for coping with grief during the holidays is to give yourself permission to do what’s comfortable. At a time of year often guided by tradition, find the way that feels right for you to make it through the season. Some people find it helpful to be with family and friends, emphasizing the familiar. Others may wish to avoid old traditions and try something different. Others will find new ways to acknowledge the season.
If you, or a loved one, are struggling with grief and loss, consider contacting your community hospice. Hospices have trained bereavement professionals on staff and may be able to offer some further suggestions or sources of support. Information for this article comes from Hospice Foundation of America and National Hospice and Palliative Care Organization. For more information on hospice, contact Caring Connections, a program of the National Hospice and Palliative Care Organization at www.caringinfo.org. or 800/658-8898. It is essential to allow oneself to feel all the emotions that arise, as painful as they may be, and to treat oneself with patience and kindness. Grieving people have two choices: they can avoid the pain and emotions associated with their loss and continue on, hoping to forget. This is a risky choice, since experience shows that grief, when ignored, continues to cause pain. The other choice is to recognize grieving and seek healing and growth. Getting over a loss is slow, hard work. In order for growth to be possible, it is essential to allow oneself to feel all the emotions that arise, as painful as they may be, and to treat oneself with patience and kindness. Give into the pain, even over other emotions and activities, because grief is a pain that will get in the way later if it is ignored. Realize that grief has no timetable; emotions may come and go for weeks, months, or even years. While a show of strength is admirable, it does not serve the need to express sadness, even when it comes out at unexpected times and places.
Formal and informal supportive services may be helpful to a person who is grieving. These support services can be guides through some of the challenges of grieving as the person adjust to their loss. Grief counseling can be provided by professionals. Consult a hospice in your local community, as all hospice bereavement programs provide grief support to the community, regardless of whether their loved one was cared for by hospice or not. Through learning about the grief process, you can help support a grieving loved one as well. Counseling and support services may be helpful to a person with normal grief reactions. They can be a guide through some of the challenges of grieving as they adjust to their loss. Grief counseling can be provided by professionals. Self-help groups are often available and are there for participants to support one another. Consult a hospice in your local community, as all hospice bereavement programs provide grief support to the community, regardless of whether their loved one was cared for by hospice or not. The goals of grief counseling include:
Grief therapy is sometimes indicated when individuals have more complicated grief reactions. The goal of grief therapy is to identify and resolve the conflicts of separation that interfere with the ability to mourn the loss. It is indicated when any of the previously described complicated grief symptoms are evident. Bereavement groups can help you recognize your feelings and put them in perspective. They can also help alleviate the feeling that you are alone. The experience of sharing with others who are in a similar situation can be comforting and reassuring. Sometimes, new friendships grow through these groups – even a whole new social network that you did not have before. There are specialized groups for widowed persons, for parents who have lost a child, for victims of drunk drivers, etc. There are also groups that do not specialize. Check with your local hospice or other bereavement support groups for more information. Many people discover that there is hope after death. Death takes away, but grief can give back. It is possible to recover from grief with new strengths and a new direction. By acting on our grief, we may eventually find peace and purpose. Grief is a chance for personal growth. For many people, it may eventually lead to renewed energy to invest in new activities and new relationships. After the loss, they find new emotional resources that had not been apparent before. • Supporting Friends Or Family Who Are Grieving
Hospice care is available to anyone, regardless of insurance or financial resources. No one who needs our services is turned away because they cannot afford to pay for care. Generous community support helps Hospice and Palliative Care of Northern Colorado, our community’s only not-for-profit hospice organization, provide quality care to all in need of hospice and bereavement services. For most Hospice patients, the cost of hospice care is fully covered by the Medicare Hospice Benefit (under Medicare Part A, or hospital insurance). The Medicare Hospice Benefit provides a daily allowance to the hospice organization. In turn, the hospice organization pays for all medical services, medications, durable medical equipment, supplies and treatments related to managing your serious illness and approved as part of your individual plan of care. The hospice plan of care focuses on comfort, rather than curative, measures. Like Medicare, Medicaid and most private insurance companies also provide coverage for hospice care and services. Private insurance benefits, deductibles and co-insurance requirements may vary by plan and are therefore reviewed and communicated on an individual basis. HPCNC does not turn away any eligible patient, regardless of ability to pay. For those not covered by private insurance, Medicare or Medicaid; a sliding fee scale is used. If a patient is unable to pay the sliding fee, care will be provided free of charge. Anyone may make a referral to Hospice and Palliative Care of Northern Colorado and the earlier the referral the more benefit to patients and their families. Final approval for our hospice program must come from the patients primary care physician. A hospice admissions nurse schedules a visit to explain the program and services and assesses the needs of each patient and his or her own unique situation. Together the patient and family make the choice to begin hospice care. Admission is available to patients regardless of race, religion, national origin, sexual orientation, handicap, age, diagnosis or ability to pay. Insurance coverage is available through Medicare, Medicaid, and most private insurance plans for services related to the admitting diagnosis. Practical tips you can use to help those facing serious illness When someone we know faces a serious illness, most of us find it hard to know what to do. Feeling helpless and uncertain, we say, "If you need anything just call," but we know that's not really enough. Here is a collection of truly useful ideas you can use to show your concern and support for people who are close to you.
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