Tag: Hospice Care
Articles about hospice care including how to manage comfort at end of life.
Rally as part of the dying process
Dying is an inevitable facet of life, a natural progression that touches us all. This journey towards the end of life can unfold in diverse ways—peaceful and graceful or turbulent and fraught with stress. Amid this journey, there exists a phase known as the "rally." It occurs just before the final moments of a person's life. This rally phase often shrouds itself in misunderstanding and misconceptions. It's imperative to unravel what it truly signifies.
Read MoreRally as part of the dying processEducating families on reporting changes in condition
When someone you love is sick and may not get better, you want to do everything possible to make them comfortable and happy. Sometimes, you may notice that they are acting differently or feeling worse. This is called a change of condition. Some changes in condition are very serious and need to be reported to the hospice provider right away. Other changes in condition are less urgent and can be written down in a journal until the next nursing visit. This article will help you learn how to tell the difference and what to do.
Read MoreEducating families on reporting changes in conditionAn example recertification template for hospice eligibility
Hospice recertification is a crucial step in which the registered nurse case manager can help make the case for continued hospice eligibility. May I encourage my fellow hospice nurses to start using a template to ensure your recertification visits are consistent and that you are leading early in the documentation portion regarding what declines have occurred since admission and last recertification?
Read MoreAn example recertification template for hospice eligibilityThe last hours of life
LUnderstanding the physical and emotional changes can be crucial as a loved one nears the end of life. This guide explores common signs of approaching death, offering insights on breathing changes, skin mottling, and decreased consciousness. Learn how to provide comfort and support during this final journey.
Read MoreThe last hours of lifeThe importance of caregiver journaling for the patient and family
Caring for a loved one in hospice is rewarding yet challenging. Keeping a caregiver journal benefits the patient, family, and hospice provider. It enhances care, coping, and creating memories. Get tips on starting and maintaining a meaningful journal to improve your caregiving experience.
Read MoreThe importance of caregiver journaling for the patient and familyAir hunger management at end-of-life
I can count the times I’ve run into air hunger at the end of life as a visiting RN Case Manager for going on five years on one hand. Over the years, I’ve managed patients with pulmonary fibrosis, lung cancers (diverse types), breast cancer, COPD, congestive heart failure, B-cell lymphoma, leukemia, and other diseases that can impact one person’s ability to breathe correctly. Air hunger is rare in my firsthand experiences, but it can happen.
Air hunger often sounds like the person is gasping for breath without regard to the actual respiratory rate (how fast they are breathing); it can also sound like stridor (YouTube videos below where you can hear the difference).
Read MoreAir hunger management at end-of-lifeHospice and the Pennsylvania Orders for Life Sustaining Treatment — POLST
A review of the implications of each choice for the terminally ill patient as well as the loved ones of those who are terminally ill. This form comes into practice typically under two conditions… no pulse and is not breathing OR has a pulse and/or is breathing (but while not mentioned is typically in the last two weeks of life if no measures are taken with the understanding that any and all measures do not guarantee a longer time frame). Let’s review the form below:
Read MoreHospice and the Pennsylvania Orders for Life Sustaining Treatment — POLSTUnderstanding Changes in Diet Texture for the Terminally Ill
Navigating the dietary needs at life’s end can be complex. This guide explores the progression of diet textures and liquid consistencies, ensuring comfort and safety for the terminally ill. Learn to adapt meals for loved ones as they approach this delicate phase.
Read MoreUnderstanding Changes in Diet Texture for the Terminally IllLiquifying Ativan pills for easier delivery
Ativan, generically called Lorazepam, pills can be easily melted into liquid, and given to your loved one in a syringe. This is typically done vs. putting the pill under the tongue if your loved one has a dry mouth, and the Ativan pills are not melting under the tongue.
The process of melting lorazepam into a liquid will require the following resources:
Read MoreLiquifying Ativan pills for easier deliveryHospice realistic expectations for on-call
This short article is meant for hospice patients, family members, and friends.
It’s common to read various social media posts where a patient, family member, or friend does the right thing by calling their hospice provider to alert them of a change of condition or otherwise significant issue for on-call to come out for an unscheduled visit. Also, common is follow up posts where the writer asked, “it’s been ______ (minutes, hours) since the call, I hope they show up.”
Read MoreHospice realistic expectations for on-callFood and Liquids During the Dying Process
This article explores the delicate balance of providing food and liquids to the dying and navigating the complexities of end-of-life care. It addresses the emotional and ethical considerations, offering guidance for caregivers during this profound phase.
Read MoreFood and Liquids During the Dying ProcessMy Loved One with Dementia
Caring for a loved one with dementia can be challenging. This article provides insights into understanding dementia, its stages, and practical tips for caregivers. Learn about the FAST Scale, validation therapy, and when hospice care might be appropriate to ensure compassionate and effective support.
Read MoreMy Loved One with DementiaUnderstanding Hospice Benefit Periods
There are several things that go on behind the scenes when you or your loved one is admitted to a hospice provider. Some of them you may never see because it doesn’t impact the care provided and received. Others like the hospice benefit periods may only come out of the woodwork (so to write) at certain times and can either cause joy or distress depending on one’s point of view.
The goal of this article is to keep it simple and smile (my version of the K.I.S.S. principal) understanding of hospice benefit periods. When a person is first admitted to a hospice provider (having never been on hospice), they start off (behind the scenes) in benefit period number one. This is the first half (90-days/3-months) of the estimated six-months or less to live. Benefit period number two is the second half (3 more months/90-days). And since a terminal illness doesn’t come with guarantees that one will pass in six months or less, Medicare allows for (with fine print through the entire journey) an unlimited number of sixty-day (two months at a time) benefit periods.
Read MoreUnderstanding Hospice Benefit PeriodsInterviewing and Observation as part of the assessment
There are observation and interviewing skills you can develop which will help you learn:
What could cause the current change in condition
Determining if a patient is having terminal restlessness
Determining if your patient is within two weeks or less of life to live
Knowing where your patient is in the dying process
While this article is primarily meant for new nurses, what I’m sharing is also valuable for family members and loved ones. Anyone with patience and love toward the person being observed and interviewed can hone and develop these skills.
Read MoreInterviewing and Observation as part of the assessmentFaith stories — yes, faith can be a part of nursing life
Faith and religion in the workplace: Yes, faith has a place in work, and when utilized to direct how one works and interacts with one's patients and families, it can result in a blessing that does not disrespect others.
This article came to be partly a response to one of my favorite YouTube nursing channels, where Nurse Katherine provides educational videos for new and experienced nurses. Her most recent episode at https://www.youtube.com/watch?v=N_lE9O1I3LQ asks the valid question relating to the place of “Religion, Beliefs, and the practice of Medicine | should & can they be combined?”
Read MoreFaith stories — yes, faith can be a part of nursing lifeThe Dying Process at the End of Life
The dying process involves physical and emotional changes as the body shuts down. As the heart weakens, circulation slows, leading to cold hands and feet, pale skin, and drowsiness. Breathing becomes irregular and shallow. The patient may experience delirium or visions. Providing comfort through pain management, emotional support, and spiritual care is crucial.
Read MoreThe Dying Process at the End of LifeIs my loved one starving or being dehydrated to death?
When a loved one nears the end of life, it’s natural to worry about their nutrition and hydration. This article explains why they may not need food or water and how you can provide comfort during this time.
Read MoreIs my loved one starving or being dehydrated to death?What exactly does home hospice cover?
Hospice care is a vital service that provides compassionate and specialized support to individuals with life-limiting illnesses, particularly when they receive care at home. Understanding what home hospice covers is essential for patients and their families to ensure comprehensive and personalized end-of-life care. This article aims to shed light on the various aspects of home hospice care, including medications, durable medical equipment, staffing support, and expertise in managing the natural dying process. By delving into these details, individuals can make informed decisions and better comprehend the valuable assistance hospice care provides during this sensitive time.
Read MoreWhat exactly does home hospice cover?Fall Reduction – Reducing Falls in Personal Care Homes and Private Homes
Falls among the elderly can have severe consequences, including hip fractures, which can be life-threatening. As an experienced hospice registered nurse case manager, I understand the importance of fall prevention, especially in private homes, personal care homes, and assisted living facilities. This article aims to provide practical tips for reducing falls in these settings by following the nursing process: assessment, diagnosis, planning, implementation, and evaluation.
Read MoreFall Reduction – Reducing Falls in Personal Care Homes and Private HomesGeneral Inpatient (GIP) Level of Care for Hospice Explained
GIP, or General Inpatient Hospice, is an often misunderstood aspect of hospice care. Both hospital staff and families sometimes have misconceptions about GIP. Families may assume it's readily available upon request, while hospital professionals may believe it allows patients to remain in the hospital indefinitely, even when death is weeks away. This article will clarify the basics of GIP for hospice, including eligibility requirements, doctor's orders, care plans, documentation, and education. We'll conclude with two real-life cases to illustrate these points.
Read MoreGeneral Inpatient (GIP) Level of Care for Hospice ExplainedWhat is a hospice house?
A hospice house is a peaceful, home-like residence where terminally ill people receive short-term hospice care. It is designed to provide a setting as close to home as possible, allowing for more freedom than a traditional facility. Hospice houses are typically run by not-for-profit organizations and are financed by donations, making them more economical for families who cannot afford skilled nursing facilities. Unlike inpatient hospice units (IPUs), hospice houses work with several hospice providers, allowing families to choose the provider that best suits their needs. They also follow a more flexible visitation policy, allowing families to visit 24x7 without appointments.
Read MoreWhat is a hospice house?Learning Psychosocial Skills as a Hospice Nurse
One of the hardest lessons to learn as a nurse, in my experience and opinion, is the psychosocial skills necessary to help patients and their families work towards their healthcare goals. These skills are applicable to every field. While I, myself, am still growing as a registered nurse (heading towards my 5th year at the time of writing this article), I would like to share with you some of the lessons learned. These lessons are based on real-life cases where I will present the scenario, what I did that worked, and what I internally thought of opposite scenarios.
Read MoreLearning Psychosocial Skills as a Hospice NurseCoughing Up Blood (hemoptysis) Symptom Management
Hemoptysis, or coughing up blood, can be a distressing symptom for patients at the end of their life journey. As a hospice nurse, your expertise in managing this symptom is crucial in ensuring a peaceful and comfortable experience for your patients and their families.
Read MoreCoughing Up Blood (hemoptysis) Symptom ManagementHospice is about living!
Hospice care is a specialized form of medical care for individuals with a life expectancy of six months or less, focusing on comfort, quality of life, and symptom management. It affirms life and recognizes dying as a natural process, neither hastening nor postponing death. The aim of hospice is to help patients live as fully and comfortably as possible, providing comprehensive support for both the patient and their family. This unique approach to care is exemplified by the stories of patients with terminal cancer who, with the help of hospice, were able to fulfill their final wishes, such as feeling the sun on their face or visiting the beach one last time. These experiences highlight that hospice is not just about dying, but about making the most of the time that remains, finding joy, and creating meaningful moments.
Read MoreHospice is about living!