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Hospice has long been known for the ability to provide comfort and dignity throughout the dying process. Sadly, too few people are aware that they or their loved ones do not have to be dying from cancer or be in excruciating pain in order to take advantage of this end-of-life care.
Hospice care can be just as effective for a much wider range of patients suffering from chronic conditions. This can include those affected by heart failure, chronic obstructive pulmonary disease (COPD), amyotrophic lateral sclerosis (ALS), stroke, renal failure, liver failure and even dementia.
Unlike these other serious illnesses, Alzheimer’s disease (AD) and dementia are extremely difficult to categorize into neat stages of progression that are typically used to determine whether hospice care is appropriate. Life expectancy is difficult, if not impossible, to pinpoint for a patient affected by AD and related conditions like vascular dementia, Lewy Body dementia, and frontotemporal dementia. Furthermore, patients in the later stages are usually unable to communicate things like pain or discomfort. This means that family caregivers and even their loved ones’ physicians can have a tough time deciding when to call in hospice.
Estimating how long a person has to live is nearly impossible. It simply cannot be done with absolute accuracy in most cases. Dementia can complicate this process, but taking a person’s personality prior to their diagnosis into consideration can help. I had a patient many years ago who had Lewy Body dementia (LBD). His daughter was his primary caregiver and was experiencing an immense amount of stress over the worsening of his symptoms.
He would often lose track of time, and it had become hard to hold his attention. The daughter and I sat together and through tears she told me about her dad while she was growing up. We were able to look at some of his current symptoms and link them back to his earlier self to get a better idea of his disease progression. Doing this seemed to take some of the fear away for her. We still did not know exactly what the future held for her dad, but we were able to look at him as himself and rather than a group of scary symptoms.
What criteria are used to admit someone with dementia into hospice care under Medicare guidelines?
For a patient to be admitted to a program using a diagnosis of dementia, Medicare requires that we are more specific than typical hospice requirements involving a 6-month life expectancy. Most programs use the following as a standard in assessing if a dementia patient is appropriate for hospice services:
Determining eligibility can be a very difficult task for clinicians and physicians, and the current means of measurement and classification absolutely have room for improvement. However, by patients, families, hospice teams, physicians, and Medicare continuing to all work together, we open the doors for many more dementia patients to receive the comfort care they deserve, but may not be able to request.
How do you know when to seek hospice for a dementia patient?
Very simply put, ask now! I am a big advocate for early hospice/palliative care intervention. I believe that if a family caregiver is thinking their loved one needs help, has questions, and needs guidance, then that is the time to seek out assistance. I encourage families to talk to their doctor, other family members and friends who have used a hospice or palliative care program and to begin their own research using sites such as AgingCare. It is never too early to begin gathering information and forming a plan as a family. Hospice is here to support the patient as well as their family members. It is important to know that there are people out there whose passion is helping families navigate these very trying waters.
But, I will get off my soapbox for a moment and give a more detailed answer to your question. Those suffering from dementia decline slowly over time. This can sometimes cause family members to not seek help because their loved one's condition has changed so gradually. While a physician must make the official determination of life expectancy, it is time to request hospice enrollment if an individual with dementia exhibits the following signs:
Are there providers that specialize in end-of-life dementia care?
While all hospices have the ability to provide care for someone with dementia, there are providers that actively specialize in this. These hospices typically have tailored programs that are designed to support everyone involved in the life of a patient affected by this disease and help them cope with the challenges it brings to patients, family and caregivers alike.
Regardless of the program’s specialty, family caregivers can ask the following questions of a provider to help ensure their loved one will receive the highest level of care:
1. Is your program certified by Medicare?
2. Is your staff experienced in providing care to patients with dementia-related illnesses?
3. Do you offer specialized services to improve a dementia patient’s comfort?
4. What services do you offer to the families, caregivers and friends of patients with dementia?
I also find that you cannot underestimate the importance of well-trained and loving hospice nurses and aides. They are the true backbone and unsung heroes of these end-of-life programs. This is the disciple that will spend the most time with your loved one and help them complete the most intimate tasks like bathing, dressing, toileting, brushing their teeth, etc. Many individuals with dementia have a fear of water, so having patient aides with a keen understanding of this disease is a must.
When I was choosing a hospice provider for my own father, I asked the most questions about their aides! We see them three times a week, and if you ask my dad what he likes most about hospice, he will say Bridgette and Carol (his aides).
What are the benefits of comfort care over hospitalization at the end of life for common issues like urinary tract infections (UTIs) or pneumonia?
To answer this question, you need to refer to your loved one's end-of-life preferences. Hopefully this was a conversation that took place early on while they were still mentally competent and resulted in appropriate planning measures such as a living will, a do not resuscitate (DNR) order, a voluntarily stopped eating and drinking (VSED), POLST form, or advance directive.
Hospice is provided wherever the patient is. This can take place in people’s homes, nursing homes, hospice houses, homeless shelters, and anywhere else a person is comfortable and wishes to remain. This is something that providers and employees take very seriously. I have visited patients in all of these settings.
Many people want to die at home, and by the time they enter a hospice program, they are completely over hospitals. Then there are people that want to stay at home for most situations, but wish to die in a hospital or hospice house. We respect all of these situations and work to make this happen for each patient and family.
The situations that break my heart are when patients are not being cared for by a hospice team and an infection occurs. This is common in those with late stage dementia and infections are often the actual cause of death. This is primarily due to the patient’s inability to clear bacteria from their body and notify others of their symptoms or pain. Urinary and fecal incontinence, difficulty swallowing and breathing, and an overall reduced immune system all contribute to illness.
When these infections persist, and the patient resides at home or in a facility without the benefit of hospice care, they are often moved to an acute care hospital for treatment. In these scenarios, hospitals typically go to great lengths to treat the infection, including treatments and medications that may not be efficient in the long term and result in discomfort, such as feeding tubes. These patients can be hospitalized multiple times for recurring issues, and the stress and discomfort that accompanies constant illness and changes in environment can quickly take a toll on them.
Hospice ensures that the family is kept knowledgeable and involved, and all treatment methods are focused on the patient’s comfort and dignity. Unlike hospitalization, this care is dedicated to the comfort and nurturing of a patient’s whole person—physically, spiritually, mentally and emotionally.
Can a dementia patient stay on hospice for longer than 6 months?
Yes. However, if the patient stays on service longer than 6 months, their eligibility must be re-determined by a physician to again qualify for the provision of services and related coverage options, such as Medicare, Medicaid or other health insurance. This is not specific to dementia patients, though. This applies all individuals who have elected hospice.
This article content has been submitted by Commonwealth Hospice. Contact us to learn more at 412-489-5893.
Wheelchair ramps and other accessibility products are crucial for individuals who have suffered from a stroke or heart attack. These conditions can lead to physical limitations, such as difficulty with mobility, balance, and coordination, which can make everyday tasks and activities a challenge.A stroke or heart attack can impact a persons life in many ways, including the ability to enter and exit their home. The installation of a wheelchair ramp can provide a safer, more convenient means of access to and from the home, improving overall independence and quality of life.In addition to being useful for individuals who have suffered a stroke or heart attack, wheelchair ramps and other accessibility products can also be beneficial for those with other physical limitations, such as arthritis, multiple sclerosis, and spinal cord injuries.Here, we will discuss the importance of wheelchair ramps and accessibility products for those who have survived a stroke or heart attack, and how they can make a significant difference in improving overall independence and quality of life.The Benefits of Wheelchair Ramps for People with Stroke or Heart AttackImproved MobilityThe primary benefit of a wheelchair ramp is improved mobility and independence. A ramp allows individuals who use a wheelchair or walker to safely enter and exit their home, which can increase their independence and reduce the risk of falls and other accidents. Additionally, ramps can provide a convenient means of accessing public buildings, such as grocery stores, doctors offices, and other essential locations.ConvenienceWheelchair ramps are also convenient for individuals who experience mobility challenges as a result of a stroke or heart attack. Traditional steps can be difficult to navigate, especially for those who have limited mobility, balance, or coordination. A ramp eliminates the need to navigate stairs, reducing the risk of falls and other accidents. Additionally, ramps are typically wider than steps, making it easier for individuals to maneuver and move about regardless of whether or not they use a mobility aid.Increased SafetyOne of the most important benefits of wheelchair ramps for individuals who have suffered from a stroke or heart attack is increased safety. Steps can be slippery, especially in inclement weather, increasing the risk of falls and other accidents. A ramp provides a stable, slip-resistant surface that can be used in all weather conditions. Additionally, ramps typically have handrails, providing additional support and stability for individuals who need it.Cost-Effective SolutionWheelchair ramps can also be a cost-effective solution for individuals who have suffered from a stroke or heart attack. Traditional home modifications can be expensive and may not be covered by insurance. A ramp is a more affordable option and may be covered by Medicaid or other insurance programs. Additionally, ramps can be installed quickly and easily, reducing the disruption to the home and daily routines.The Importance of Accessibility ProductsIn addition to wheelchair ramps, there are many other accessibility products available that can make a significant difference in the lives of individuals who have suffered from a stroke or heart attack. These products can improve overall independence and quality of life, making it easier for individuals to perform everyday tasks and activities.Grab BarsGrab bars are a simple but effective accessibility product that can be installed in the bathroom, bedroom, and other areas of the home. They provide a secure and stable surface for individuals who need support when getting in and out of the shower or bath, when using the toilet, or when sitting and standing in various areas around the home. Grab bars are available in a variety of styles and finishes, making it easy to find a product that complements the dcor of the home.Stair LiftsStair lifts are a more advanced accessibility product that can be installed in homes with multiple levels. These devices allow individuals to safely navigate stairs, eliminating the need to climb steps. Stair lifts come in a variety of styles and designs, including straight and curved options, to accommodate different types of staircases. There are also options for both indoor and outdoor staircases.Transfer BenchesTransfer benches are another useful accessibility product for individuals who have suffered from a stroke or heart attack. These benches provide a safe and stable surface for individuals to transfer in and out of the shower or bath. Transfer benches have a slip-resistant seat and backrest, and can be adjusted to accommodate different heights.ElevatorsFor individuals who live in multi-level homes, elevators can be a convenient and cost-effective solution for improving accessibility. These devices can be installed in the home, providing individuals with a safe and secure means of accessing different levels of the home. Elevators can be customized to meet the specific needs of the individual and can be equipped with safety features, such as emergency stop buttons and intercoms.ConclusionWheelchair ramps and other accessibility products are essential for individuals who have suffered from a stroke or heart attack. These products can improve overall mobility, convenience, safety, and independence, making it easier for individuals to perform everyday tasks and activities. Whether you are looking to install a ramp, grab bars, stair lifts, transfer benches, or elevators, it is important to work with a reputable and experienced provider to ensure the best possible outcome. Amramp Accessibility is a leading provider of accessibility solutions and is dedicated to helping individuals with physical limitations live a more independent and fulfilling life. Contact us at 800-649-5215 to learn more.
Every day at Harmony at Diamond Ridge we serve families with loved ones who are diagnosed with dementia, Alzheimers disease, and other memory loss diseases. There is a lot of information about memory loss in seniors and the research process can be overwhelming. Dementia is not a specific disease but rather a general term for the impaired ability to remember, think, or make decisions that interfere with everyday activities. Alzheimer's disease is the most common type of dementia The exact cause of Alzheimer's disease is not fully understood, but it is believed to be a combination of genetic, environmental, and lifestyle factors. Some of the known risk factors for Alzheimer's disease include a family history of the disease, head injuries, and certain medical conditions such as high blood pressure, high cholesterol, and diabetes. The symptoms of Alzheimer's disease typically develop slowly over time and worsen as the disease progresses. Some Alzheimers indicators include: Memory loss, especially of recent events Difficulty with language and communication Impaired judgment and decision-making Difficulty with problem-solving and planning Mood changes, such as depression or irritability Personality changes, such as becoming more withdrawn or aggressive Loss of interest in activities or hobbies Difficulty with basic activities of daily living, such as dressing and grooming Research into the causes and treatments of Alzheimer's disease is ongoing, and there is hope that future developments may lead to a better understanding of the disease and new treatments that can improve the lives of those affected by it. Harmony Senior Services Signature Memory Care Program Harmony Reflections is built on elements that support a senior living with Alzheimers disease. The Reflections Program has 5-Key Components; Family Focused, Wellness, Reflections Program: Art and Music, Dining with Dignity, and Harmony Square. Each component engages the resident's present-day experiences while stimulating positive memories through therapeutic visual and tactile aids. We partner with each resident's family to create their individual life story profile - a process for collecting and sharing the resident's life history, preferences, routines, and habits. If you are researching solutions for a loved one living with dementia or you would like to learn more about Harmonys Signature Memory Care Program, call a Harmony community today to speak with one of our dedicated caregivers.
Ellen Latham, the visionary founder of Orangetheory Fitness, has a remarkable story of resilience and determination that continues to inspire fitness enthusiasts worldwide. In a recent interview, Latham opened up about her journey, revealing how she turned career setbacks into a multimillion-dollar fitness empire. Her success story highlights the power of perseverance, adaptability, and a strong belief in ones abilities.Lathams journey began when she faced a significant career challengeshe was unexpectedly let go from her job as a physiologist at a prestigious spa. This setback could have been devastating, but Latham chose to channel her energy into creating something new. Drawing on her expertise in fitness and physiology, she began hosting Pilates classes in her spare bedroom. This modest start would eventually blossom into the foundation of Orangetheory Fitness.The concept behind Orangetheory emerged from Lathams deep understanding of the science of exercise. She developed a heart rate-based interval training system designed to optimize calorie burn and boost overall fitness. The program combines cardiovascular and strength training exercises with heart rate monitoring to ensure participants stay within a target "orange zone," where their metabolism remains elevated even after their workout ends. This unique method has been key to the brand's success, appealing to fitness enthusiasts seeking measurable results.Despite the challenges of building a business, Latham's unwavering dedication kept her motivated. She partnered with fitness professionals and business experts to expand Orangetheory into a global franchise. Today, Orangetheory boasts over 1,500 studios worldwide and continues to grow rapidly. Latham's ability to innovate and respond to market trends has been instrumental in this expansion.In addition to her entrepreneurial achievements, Latham has been an advocate for empowering women in business and fitness. She frequently shares her insights on overcoming obstacles and finding success, encouraging others to pursue their passions fearlessly. Her story resonates with individuals from all walks of life, demonstrating that setbacks can be stepping stones to greater achievements.Lathams advice for those facing professional or personal hurdles emphasizes the importance of persistence and adaptability. She highlights the value of focusing on what you can control, building on your strengths, and embracing new opportunities. This mindset, combined with her innovative fitness model, has solidified her legacy in the health and wellness industry.Orangetheory Fitness has earned a loyal following due to its science-backed approach and welcoming community. Members appreciate the structured yet flexible workout format, which allows individuals of all fitness levels to participate. The brand's focus on results-driven exercise continues to attract thousands of new members each year, solidifying its reputation as a leader in the fitness industry.In summary, Ellen Lathams inspiring journey from professional setback to entrepreneurial success is a testament to the power of resilience and innovation. Her story encourages individuals to embrace challenges, focus on their strengths, and pursue their dreams with confidence. Orangetheory Fitness remains a powerful example of how dedication, creativity, and a passion for helping others can transform an idea into a global phenomenon.
At Commonwealth Hospice, your well-being is our number one priority. We recognize you have many choices available for a hospice provider, and our goal is to provide a team of healthcare professionals that will fill these days with care, compassion, and support. Our experienced team is committed to giving our clients the care they want, while offering guidance through some of life's most challenging circumstances. We strive to make a positive difference in the lives of our patients, families, and the communities we serve. We invite you to find out more about our hospice program, our staff, and what makes Commonwealth Hospice a preferred provider.Experience matters. The leadership group at Commonwealth has decades of experience. We've seen what works and, more importantly, what could be done better. All of us have personally experienced hospice with a loved one, so we know what you're going through. Quality over quantity. Commonwealth is not a large, profit-driven healthcare network that treats people like numbers. We are smaller, local, and our only goal is to provide unparalleled care for our patients, their families and to support the facilities where many of our patients reside. Commitment to caregiver and family support. Being the primary caregiver to a family member on hospice is difficult. It is natural to experience self-doubt, anxiety and worry, in addition to the tremendous sadness associated with the impending loss of someone dear to you. At Commonwealth, we understand the challenges primary caregivers and other family members face, and have made it our mission to provide the best possible support and education. Our nurses and aides will take the time to sit with you, craft a comprehensive care plan, and make sure you have a full and complete understanding of what to expect. We'll discuss medications, any equipment that may be, or may become, necessary, as well as likely disease progressions so you are as prepared as possible for the road ahead. Should something come up between regular visits, staff are available 24 hours a day. Caregiver, facility and community education. Commonwealth has a dedicated Education Department to support primary caregivers and families, and to provide Pennsylvania Department of Human Services approved in-services for staff in facilities where our patients reside. Trainings cover a variety of topics, including infection control and proper transfer techniques, as well as First Aid/CPR, and medication administration. We also offer 'virtual dementia' training, designed to help us all better understand the struggles and challenges experienced by people suffering from dementia. Our goal is to support and educate our patients' caregivers in every way we can, whether that caregiver is an aide in a facility or a family member in the home.