Loneliness and Isolation Can Affect Senior Health

Hospice supports people near the end of life with compassionate care by:Developing individualized care plans focused on each patients goals and wishesManaging symptoms and painImproving quality of life in the patients preferred setting of careEncouraging patients and their families to make the most of their time togetherAt VITAS, our care model is inclusive and is designed to meet the unique needs of diverse patients facing a broad array of advanced illnesses, medical conditions, and accompanying symptoms.Once a patient is deemed eligible for hospice by their physician, the transition can start as soon as theyor the person who is designated to make healthcare decisions on their behalfagrees to shift from a curative focus and begin hospice services.Whether youre a patient, family member, or clinician who treats patients with serious illnesses, having correct information about hospice services can help you make the best decisions about whether hospice care is appropriate.Table of Contents:What Services Does Hospice Provide?What Is Usually Not Included in Hospice Care?What Is the Difference Between Hospice and Palliative Care?Who Is Eligible for Hospice Care?Where Can You Receive Hospice Care?How Long Does Hospice Last?How Do You Pay for Hospice?Begin the Hospice Conversation EarlyWhat to Ask Your Hospice ProviderWhat VITAS Will Do for You in Hospice CareWhat Services Does Hospice Provide?Hospice offers compassionate care to improve the quality of life for seriously ill patients who have a prognosis of six months or less if the disease runs its course as expected.Because hospice is not a place, patients can remain in their home, whether that is a private home or senior living community such as senior living, memory care, or a nursing home. Services include:Clinical symptom and pain management, including medications to help with symptoms.Care coordination, including the delivery of home medical equipment and supplies related to the cause of the illness. This includes shower chairs, oxygen tanks, hospital beds, toileting supplies, and more.Training for family members or friends who are the primary caregiver(s).An expert, multi-disciplinary team makes regular, scheduled visits to the patients household. For patients who live in senior living communities and nursing homes, the hospice team works with the facility staff.Therapies, including physical and occupational therapy. VITAS also offers respiratory therapy, music therapy, and spiritual and complimentary therapies in many programs.Spiritual support and bereavement care.Around-the-clock access to a clinical expert who can treat and triage over the phone or via a telehealth visit.When medically necessary as per Medicare guidelines, VITAS offers Intensive Comfort Care(R), a higher level of care when patients experience symptom exacerbation. Care is delivered at the patients bedside in temporary shifts of 8-24 hours until symptoms stabilize.Short-term care in an inpatient hospice unit as needed (for patients) or respite care (for caregivers)A minimum of 13 months of grief and bereavement support for patients loved ones.What Is Usually Not Included in Hospice Care?Below are some items that are not included in the hospice benefit:Medications unrelated to the patients serious illness.Emergency room care not arranged by the patients hospice care provider.Curative treatments intended to heal the patient. If a new curative medication, therapy, or treatment for the patients serious illness becomes available, they can withdraw from hospice care to receive it.Housing or room and board, aside from an inpatient unit hospice stay when medically necessary. The patient and their loved ones remain responsible for their home, assisted living community, or nursing home and related costs such as rent, mortgage, and food.What Is the Difference Between Hospice and Palliative Care?Palliative care can occur at any point in life, for any duration, and it can occur in conjunction with curative care.Hospice is for patients who are not responding to disease-directed treatments and are expected to live six months or less.Both types of care offer pain and symptom relief with clinical and psychosocial services. Hospice is the only one of these options covered by the Medicare Hospice Benefit (Medicare Part A).Who Is Eligible for Hospice Care?A patients physician will determine hospice eligibility based on the patients prognosis. Hospice becomes an option when curative treatments are no longer effective and the patient has a life expectancy of six months or less as certified by their attending physician and a hospice doctoreither the hospices medical director or the directors designee. Increased hospitalizations or emergency department visits, typically more than three per year, may be a sign of hospice eligibility.Diseases that may lead to functional decline and hospice eligibility include:CancerCardiac and circulatory diseasesDementia/AlzheimersEnd-stage liver or kidney diseaseRespiratory diseasesStroke, neurological diseases, ALS (Lou Gehrigs disease)Sepsis and post-sepsis syndromeHospice care remains a patients choice. Patients can choose to stop receiving hospice services or revoke hospice without a physicians consent. They can then resume curative efforts. If they decide to return to hospice, they can do so as long as they meet eligibility guidelines.Where Can You Receive Hospice Care?Hospice is a service provided by a team of experts that comes to the patient in the place they prefer to receive end-of-life care. This means patients can remain surrounded by the faces and things they know and love:In a private homeIn a senior living communityIn a nursing homeWhen medically necessary, shortterm treatment in an inpatient unit is available for some hospice patients.How Long Does Hospice Last?There is no limit to the amount of time a patient can receive hospice care. Although hospice is for patients who have six months or less to live according to a physician, the patients stay can be extended when necessary.Eligible patients benefit most from hospice services if they are referred early in their end-of-life journey. In surveys, family members often say, We wish we had known about hospice sooner.How Do You Pay for Hospice?Most hospice patients do not have any out-of-pocket expenses. Medicare Part A covers up to 100% of the cost of hospice care related to a hospice-eligible patients illness, with no deductible or copayment.Private or employer-provided health coverage can vary. Check with your insurance provider for details about hospice eligibility, coverage, and out-of-pocket expenses. Medicaid provides hospice coverage, but specific services and eligibility criteria vary by state.Begin the Hospice Conversation EarlyHospice care provides the most meaningful improvement to the patients quality of life when it begins sooner in their disease process rather than later.VITAS recommends end-of-life care conversations begin as soon as a serious diagnosis is made. Patients can ensure that they receive the care they wantand when they want itby having early and ongoing discussions about their care goals and preferences with their family, physicians, or facility staff.Physicians can help patients understand their options and identify their preferences during advance care planning sessions and goals-of-care consultations. These Medicare-reimbursed discussions result in advance directives, medically binding documents that indicate how a patient should be treated, under what circumstances they should be resuscitated, who can make medical decisions on their behalf, and more.Everyone over the age of 18 should have an advance directive to maintain control over their care in case they become unable to speak for themselves. Advance directives include living wills, durable/medical powers of attorney, a Five Wishes document, physician/medical orders for life-sustaining treatment, and other important documents.Questions to Ask Your Hospice ProviderWhen considering hospice care for yourself or a loved one, understanding a potential providers capabilities, history, and philosophy will enable you to make a more confident care decision. These questions can clarify whether a provider is a good fit for a patient:How are hospice costs covered? Does the provider accept Medicare, Medicaid, VA benefits, and private insurance?What levels of care are provided? How often will care team members visit the patient at home?What is the admissions process? How quickly can care begin?What happens in the case of an emergency or an episode of aggressive symptoms? Does the provider offer 24/7 support?Can the provider manage complex symptoms at home? Do they offer specialized services for respiratory disease, dementia, cancer, heart disease, sepsis, HIV/AIDS, etc.?Is population-specific care available for veterans, LGBTQ+ patients, religious minorities, etc.? Can the provider accommodate and honor specific religious or cultural traditions?What VITAS Will Do for You in Hospice CareVITAS is guided by a core value: Patients and families come first. Every VITAS service is designed to surround patients, their families, and caregivers with support that elevates quality of life, manages their symptoms and pain, and ensures comfort and dignity during one of lifes most difficultbut meaningfulperiods.Once a patient is ready to consider hospice care, VITAS can typically conduct an eligibility assessment within 24 hours and, if appropriate, begin an immediate transition to our services. We can take on new patients day or night, even on holidays and weekends.This always-available approach defines our entire care model. Clinical support for patients, families, and caregivers is never more than a phone call away.A VITAS interdisciplinary care team is assigned to each patient, working from an individualized care plan built around the patients unique needs, goals, and preferences.Members of the teamincluding a physician, nurse, aide, social worker, chaplain, bereavement counselor, and other specialistswill visit routinely to manage the patients clinical, psychosocial, and spiritual symptoms. Visit frequency depends on the needs of each patient and family.Upon the patients death, spiritual staff and other members of the care team can be present to assist with end-of-life rituals, funeral home arrangements, and the challenges of grieving.For at least 13 months after the patients death, VITAS bereavement specialists continue to help the family navigate their loss with personal check-ins, grief support groups, and other practical measures.

The Centers for Disease Control and Prevention (CDC) names heart disease as the leading cause of death for men, women, and people of most racial and ethnic groups in the United States. Yet, heart failure is underrepresented in hospice care. Studies suggest only one in 10 patients with advanced heart failure is referred to hospice1.Instead, hospice is often considered for patients with advanced cancerthough both illnesses present similar symptom burden and psychological strain2. With better care for patients with heart failure, they can experience a higher quality of life. Hospice offers improved pain and symptom management and emotional well-being to maximize the end-of-life journey for patients and families.With industry-leading hospice services, trust VITAS to care for your patients with advanced cardiac disease. All VITAS programs throughout the US have earned the American Heart Associations Palliative/Hospice Heart Failure Certificationthe first nationwide hospice organization to receive this achievement.This certification ensures that VITAS clinical practices align with the American Heart Associations science-based, evidence-driven standards for heart failure care at the end of life. With this trusted endorsement, patients with advanced cardiac disease can be confident VITAS will provide best-in-class cardiac care from initial admission through bereavement.Our clinicians trained in cardiac care serve patients wherever the patient calls homean assisted living facility, nursing home, or private home. In some locations, a VITAS inpatient unit is available for symptoms that cannot be managed at home. In each setting, a multidisciplinary team works together to ensure the patient receives clinical, emotional, spiritual, and social support.Throughout their care trajectory, VITAS helps patients and families navigate advanced heart disease with both dignity and comfort.1. Kheirbek, et al. (2015). Discharge hospice referral and lower 30-day all-cause readmission in Medicare beneficiaries hospitalized for heart failure. Circulation: Heart Failure, 8(4), 733-740.2. Bekelman, et al. (2009) Symptom burden, depression, and spiritual well-being: a comparison of heart failure and advanced cancer patients. Journal of General Internal Medicine 24.5: 592-598.

It is a sad commentary on our current cultural worldview that sunlight is widely perceived to be harmful, a cancer-causing threat. But what does the research actually say? And does this research affect older adults differently than other people?Spectrum: For starters, we should understand that sunlight is a complex combination of photons, with different wavelengths and properties. The sun is the original full-spectrum illumination, while both incandescent and LED lights emit, as one might expect, mostly visible-spectrum light.Intensity: The other important variable is the intensity of light, measured in LUX units (a foot away from one candle): direct sun comes in at 100,000; a cloudy day at 1,000; a kitchen or office measures 500; and a living room only 50. Thats why you need to get outside.UV: At one extreme is ultraviolet light (UV), whose wavelength is slightly shorter than visible violet. With regard to our health, UV is a mixed bag.It does cause sunburns, damages DNA, and triggers the aging of skin. It is also statistically associated with malignant melanoma, although, curiously, not with increased deaths from melanoma (because these cancers are mostly treatable).On the other hand, there are numerous health benefits: UV lowers the risk of hypertension, diabetes, atherosclerosis (hardening of the arteries), blood inflammation, and COVID infections. UV also stimulates Vitamin D synthesis in the skin. A large-scale study of 500,000 Brits, with a 12-year follow-up, found that frequent UV exposure lowered all-cause mortality by 14%, with cardiovascular deaths down 21% and total cancer mortality decreased by 13%. It gives one pause to reconsider the vast sums spent on sunscreen lotions. Just wearing light summer clothing blocks 80% of UV.IR: UV radiation represents only about 3% of the sunlight that strikes the surface of the earth, while about 50% is infrared (IR), whose lightwaves are just beyond (longer) than visible reds. IR radiation is more predominant at the beginning and end of days, while UV is strongest when the sun is overhead. A thick cloud cover reduces IR significantly more than UV. In a recent superb Huberman Lab podcast, Dr. Roger Seheult touted the many benefits of IR radiation. Most severe and chronic diseases also involve mitochondrial dysfunction (mitochondria are the small organelles within a cell that produce the energy-generating chemical ATP). One aspect of aging is that we lose 70% of our mitochondrial functioning after age 40. Unlike UV, IR radiation passes through light clothing and the surface of the skin to penetrate deep into body tissues, where it significantly stimulates mitochondrial ATP synthesis.Effects: The effects of improved mitochondrial functioning are pervasive, correlated empirically with sun exposure. Dr. Seheult cited statistics demonstrating that the greatest number of all-cause mortality comes soon after the shortest day of the year, and the lowest number of deaths occurs close to the longest days.People who live far north or south of the equator where days are particularly short in winter have higher overall mortality rates, particularly in mid-winter. In a study of almost 30,000 Swedish women, avoidance of sun exposure carried the same risk of premature death, as did smoking.There is well-replicated rigorous research that moderate IR exposure lowers the risk of cancer, heart disease, diabetes, hypertension, and it reduces blood lipids and chronic inflammation. IR increases immune system response to infections, such as influenza, COVID and pre-cancerous cells.On a sunny day, just 15 minutes outside can make a big difference. If youre in a green space with lots of grasses, leaves, bushes, and trees, you can receive two to three times the IR dose because plants reflect much of the IR that strikes them (notice that most leaves dont get hot in the sun because of these reflective properties).Red Light Therapy: There are many red-light therapy devices now available if you are considering them, be sure to carefully research IR wavelengths, dosage, safety, and therapeutic benefit. One study, utilizing an IR desk unit shining only on face, neck, and hands, proved to be quite therapeutic.Forest Bathing? Dr. Seheult delighted in reminding us of the wisdom of the ancient beliefs that sunlight and fresh air promote convalescence. Forest bathing has become a thing the air around trees is infused with phytoncides that defend plants from bacteria, fungi, and insects. When inhaled by humans, they up- regulate immune functioning and lower stress levels, and reduce stress hormones. The beauty and serenity of such an environment further enhances these benefits, some of which are detectable by lab tests a month later. Furthermore, getting up with the sun (and out from behind the filtering effects of plate glass windows) helps to set your circadian rhythm, which can improve sleep patterns. Take home message: forests, parks and even golf courses soothe the soul, and the body. And early morning and late afternoon may be particularly beneficial.Sweat Benefits: Dr. Seheult is a pulmonologist who treats many respiratory infections he also reminded us about how previous generations treated patients with hot baths and hot packs, as if to sweat out infections. Its been recently discovered that body temperatures a little over 100 degrees Fahrenheit actually accelerate the production of interferon, a powerful anti-viral protein. Maybe weve been a little too quick to reduce our fevers with aspirin, Tylenol, and Advil. And maybe the saunas so favored by Scandinavians and Russians are more therapeutic than weve realized.Conclusion: As spring has sprung, we encourage everyone to get away from your screens, go outside and enjoy the benefits of the sunshine that so amply surrounds us. Residents at Kavod Senior Life have a myriad of ways to get outside, whether it be on the sunlit patio areas, in the resident gardens, on the nearby walking paths in Cherry Creek or on the many benches and sitting areas surrounding the campus. Come for a visit and see for yourself!Ben and Scott  https://theagingwiselyproject.com/