Moving Made Memorable: Senior Move Management Brilliance

By Faith Protsman, MD, Regional Medical Director, VITAS HealthcareTwo recent studies highlight how sepsis impact often extends well beyond the acute event that led to a patients hospitalization. The studies emphasize two particular points that should inform physicians and clinicians as they consider referring these patients to specialized care: Medicare patient data gathered between 2012-2017 shows that sepsis patients face considerably poorer health outcomes following hospital discharge when compared to non-sepsis patients, including elevated risk for death and increased use of advanced healthcare services. Sepsis survivors exhibit strong indicators of persistent inflammation and immunosuppression for up to a year after hospital discharge, increasing their risk of readmission or death. Both studies indicate a significantly elevated risk of death among sepsis patients after they have been discharged and ostensibly cured. Of course, sepsis patientsparticularly those of the Medicare cohort, who are largely of advanced agerarely leave the hospital in better condition than they entered.The Yende study, in particular, shows that neuroendocrine and inflammatory responses to sepsis can continue long after the patient survives a septic episode. For patients with advanced or chronic diseasesas was the case with nearly 78% of participants in the studythese biomarkers are associated with decline.Post-sepsis Discharge: A Critical JunctureIn many cases, these individuals life expectancies upon discharge will be less than six months. This is a critical juncture: While comfort-focused hospice care could provide an ideal source of support for the eligible patient, their family, and their caregiver(s), most sepsis patients are simply sent home without even a discussion about palliative end-of-life care and its benefits.Frankly, such an oversight is a disservice to everyone involved. The sepsis patient is left with physical and/or cognitive dysfunction, often without significant options for symptom management. Their partner or family will either need to assume caregiving duties or turn to costly private services. And the physician and hospital staff will likely see the patient again following another acute event, a readmission that impacts performance scores, strains resources, and unnecessarily fills beds.By no means do I intend to lay the blame for these unfortunate circumstances on physicians. Timely hospice referrals require ongoing education about end-of-life care, and open, ongoing communication between hospice providers and referral sources.More Help: How to Talk About Hospice Care >Those of us in hospice are working hard to bridge the gap, but even as our healthcare system transitions to a value-based model, the mentality of fee-for-service still permeates our nations acute-care facilities, and many hospitalists see a discharge home as a success.Hospice: A New Way Of Judging SuccessIn hospice, we judge our successes on the patients quality of life and the fulfillment of their goals and wishes near lifes end. Usually, that means going home with 24/7 support from an interdisciplinary hospice team. Whether home is a traditional residence, an assisted living facility, or nursing home, the hospice team will assist caregivers (and/or facility staff) with direct clinical care and education, integrative services, bereavement support, and delivery of medication, equipment, and supplies.In other cases, improving quality of life means remaining in a general inpatient setting with hospice support, taking the burden off hospital staff until the patient is able to transition home or until the patient dies. Hospice offers complex modalities in any setting, so patients who would otherwise be confined to an ICU can usually return home to be among loved ones.With support from hospice, a sepsis patient and their family are more likely to report higher satisfaction of care and greater quality of life. The patients emotional and spiritual needs can be met alongside their physical needs, thanks to care from chaplains, social workers, music and massage therapists, and other integrative specialists. Finally, the patient is more likely to die at home, surrounded by loved ones, rather than in the hospital.Because sepsis is most common in patients with advanced or chronic diseases that indicate hospice eligibility, acute incidences of sepsis should always trigger a hospice eligibility assessment. We owe it to our patients, their loved ones, and our colleagues in healthcare, all of whom can benefit from the support that timely end-of-life care offers. 

By Henri Nammour, MD, Regional Medical Director, VITAS HealthcareWinter has arrived, and with winter comes lower temperatures. The increased cold presents particular danger to people with advanced lung disease (ALD) in general and chronic obstructive pulmonary disease (COPD) in particular, leading to increased exacerbation frequency and worsening of symptoms.With the chronic and life-limiting nature of these conditions, patients with ALD and COPD can benefit immensely from timely palliative care and hospice referral and involvement.Decreased Temperatures, Increased ExacerbationsEvidence in the literature shows the seasonality of COPD exacerbations. A retrospective analysis of the large-scale TIOSPIR trial found marked seasonal variation in COPD exacerbations, hospitalization, and mortality. The authors note that in the northern hemisphere, the peak for exacerbations is early winter, followed by the peak for hospitalizations in midwinter.15 An analysis of numerous COPD-related studies worldwide saw a pattern of clear seasonality in COPD [primary care] consultations and increased hospital admissions for COPD exacerbations.8As the temperature drops, the rate of COPD exacerbations increases. A study comparing meteorological variables with health system registry data showed an inverse correlation between temperature and COPD exacerbation rate.14A Prevalent But Underdiagnosed DiseaseIn 2020, 12.5 million people reported a diagnosis of COPD, chronic bronchitis, or emphysema.6 COPD is the fifth disease-related cause of death.5 In 2019, there were close to 536,000 COPD hospitalizations and 1,320,000 COPD emergency department visits.4These are staggering numbers, but COPD remains a disease with under-reported prevalence and potential underdiagnosis; according to the CDC, more than 50% of adults with low pulmonary function were not aware that they had COPD.2With early diagnosis and proper use of advance care planning (ACP) and goals of care (GOC) discussion, the opportunity to involve palliative care early on in the disease course and hospice at the appropriate time can make a tremendous difference in ALD/COPD patients and their families and caregivers lives.An Opportunity for ImprovementHospice is underutilized in ALD/COPD patients. While more COPD patients are using hospice and palliative care, they are a small minority of this large patient population. A significant proportion of patients with COPD are not hospice users; consequently, they often receive a disproportionate amount of aggressive interventions at the end of life.13While there has been a general trend of increased use of palliative care and hospice among COPD patients in the past two decades, only a minority of patients with COPD die at home or in hospice. Early PC [palliative care] involvement in patients with severe COPD may improve the end-of-life experience and increase hospice use.16 A greater proportion of decedents from pulmonary disease die in the hospital than individuals dying of cancer, cardiovascular disease, cerebrovascular disease, or dementia.7For ALD/COPD patients, discussion of ACP and GOC are typically provided too late, if at all. They were less likely to have advance directives in place, leading to higher and more aggressive healthcare utilization near end-of-life that offers little benefit in the face of advanced disease.11 What Patients WantPatients with advanced respiratory illness want to learn more about end-of-life care. However, patients report feeling frustrated by poor communication and discussion surrounding ACP, and often feel that important therapeutic and symptomatic goals are not discussed.3Notably and concerningly, fewer than one-third of patients with COPD and their caregivers had even heard of palliative care. Only a minority of these patients received formal palliative care referrals, and many are only referred after ICU admission or prior to hospice initiation.7ACP happens rarely in advanced lung disease, with only about 20% of patients engaging in these conversations on average and almost 30% of these discussions occurring in the last three days of life.9 With timely and appropriate discussion of ACP and GOC, patients were less likely to receive unnecessarily intensive care towards end of life.11Hospice and Palliative Care Improve Clinical OutcomesWhen asked about their goals and needs, patients with advanced illness desired controlling pain and symptoms, avoiding inappropriate prolongation of the dying process, having a sense of control, relieving burdens on family, and strengthening relationships with loved ones. Greater utilization of hospice during the last 6 months of life is associated with improved patient experience and clinical outcomes.10 Patients with ALD and their families experience improved overall satisfaction with their care, improved symptom control and quality of life, fewer unnecessary procedures and interventions near the end of life and higher likelihood of dying at home. Earlier hospice referral has even been associated with prolonged survival.1Hospice Cost Savings: A Matter of Dollars and SensePer a recent report from NORC, hospice provides significant cost savings. The cost for Medicare beneficiaries who used hospice was lower than the cost for those who did not use hospice, with a 20% lower average total cost of care seen in beneficiaries with respiratory disease.12NORC's findings show clear quantitative cost-saving benefit with the use of hospice in patients with respiratory diseases; however, the principal benefits of hospice remain the improvements in quality of life and in patient, family, and caregiver satisfaction.Hospice Can HelpHospice alleviates symptom burden and improves quality of life for patients suffering from ALD and COPD; it promotes goal-concordant care with decreased readmissions, reduced in-hospital mortality, lower total costs of care, and improvement in patient satisfaction.Related: Hospice Eligibility Guidelines for Patients with ALD/COPDIf your patient does not yet qualify for hospice, bringing palliative care onboard early in the patient's disease course can help facilitate advance care planning and goals of care discussion, and ease a patient's transition into hospice when the time is right.The prevalence of ALD in general and COPD in particular means that there is a large patient population that is not currently taking advantage of the myriad benefits that hospice can provide. There is ample opportunity for hospice to improve the quality of life for millions of patients and for their caregivers and loved ones.1. Adler ED, Goldfinger JZ, Kalman J, Park ME, Meier DE. Palliative care in the treatment of advanced heart failure. Circulation. 2009;120(25):2597-2606. doi:10.1161/circulationaha.109.869123  2. Basics about COPD. Centers for Disease Control and Prevention. June 30, 2023. https://www.cdc.gov/copd/basics-about.html.  3. Brown CE, Jecker NS, Curtis JR. Inadequate palliative care in chronic lung disease. an issue of health care inequality. Annals of the American Thoracic Society. 2016;13(3):311-316. doi:10.1513/annalsats.201510-666ps  4. COPD trends brief - burden. COPD Trends Brief - Burden | American Lung Association. https://www.lung.org/research/trends-in-lung-disease/copd-trends-brief/copd-burden.  5. COPD trends brief - mortality. COPD Trends Brief - Mortality | American Lung Association. https://www.lung.org/research/trends-in-lung-disease/copd-trends-brief/copd-mortality.  6. COPD trends brief - prevalence. COPD Trends Brief - Prevalence | American Lung Association. https://www.lung.org/research/trends-in-lung-disease/copd-trends-brief/copd-prevalence.  7. Cross SH, Ely EW, Kavalieratos D, Tulsky JA, Warraich HJ. Place of death for individuals with chronic lung disease. Chest. 2020;158(2):670-680. doi:10.1016/j.chest.2020.02.062  8. Donaldson G, Wedzicha J. The causes and consequences of seasonal variation in COPD exacerbations. International Journal of Chronic Obstructive Pulmonary Disease. Published online 2014:1101. doi:10.2147/copd.s54475  9. Jabbarian LJ, Zwakman M, van der Heide A, et al. Advance care planning for patients with chronic respiratory diseases: A systematic review of preferences and practices. Thorax. 2017;73(3):222-230. doi:10.1136/thoraxjnl-8552-147202  10. Kleinpell R, Vasilevskis EE, Fogg L, Ely EW. Exploring the Association of Hospice Care on patient experience and outcomes of care. BMJ Supportive & Palliative Care. 2016;9(1). doi:10.1136/bmjspcare-8552-147202  11. Lee RY, Curtis JR, Kross EK. Physician orders for life-sustaining treatment and ICU admission near the end of lifereply. JAMA. 2020;324(6):608. doi:10.1001/jama.2020.8654  12. NORC at the University of Chicago (2023). Value of Hospice in Medicare. Available at: https://www.nhpco.org/wp-content/uploads/Value_Hospice_in_Medicare.pdf 13. Shen JJ, Ko E, Kim P, et al. Life-sustaining procedures, palliative care consultation, and do-not resuscitate status in dying patients with COPD in US hospitals. Journal of Palliative Care. 2018;33(3):159-166. doi:10.1177/0825859718777375  14. Tseng C-M, Chen Y-T, Ou S-M, et al. The effect of cold temperature on increased exacerbation of chronic obstructive pulmonary disease: A nationwide study. PLoS ONE. 2013;8(3). doi:10.1371/journal.pone.0057066  15. Wise RA, Calverley PM, Carter K, Clerisme-Beaty E, Metzdorf N, Anzueto A. Seasonal variations in exacerbations and deaths in patients with COPD during the TIOSPIR trial. International Journal of Chronic Obstructive Pulmonary Disease. 2018;Volume 13:605-616. doi:10.2147/copd.s148393  16. Yaqoob ZJ, Al-Kindi SG, Zein JG. Trends and disparities in hospice use among patients dying of COPD in the United States. Chest. 2017;151(5):1183-1184. doi:10.1016/j.chest.2017.02.030  

Spring cleaning represents more than just an annual tradition - it's an opportunity to create a safer, healthier, and more organized living environment while preserving cherished memories and precious belongings.  As we age, our homes become more than just living spaces; they become repositories of life experiences and comfort zones that deserve thoughtful care and maintenance.  This comprehensive resource helps seniors and their caregivers approach spring cleaning systematically, ensuring both safety and effectiveness while respecting the emotional connection we have with our homes.  Whether you plan to tackle the cleaning yourself, work with family members, or coordinate with professional caregivers, this step-by-step approach will help you achieve a refreshed living space withouth feeling overwhelmed.  Senior Spring-Cleaning: Tips and StrategiesCreate a manageable schedule: A well-planned schedule is the foundation of successful spring cleaning. Breaking tasks into smaller chunks makes the process less daunting and helps prevent physical and mental fatigue. Think of it as a gradual transformation rather than a rushed overhaul. Instead of tackling everything at once, break down your spring cleaning into smaller, manageable tasks spread across several weeks. This approach prevents exhaustion and makes the process more enjoyable. Some ideas:Start by assessing your home, noting areas that need attention and creating a room-by-room checklist.Schedule specific tasks for different days, allowing plenty of rest between sessions.Build flexibility into the schedule for unexpected events or days when energy levels might be lower.Plan more demanding tasks when family members or caregivers can help.Set priorities: Not all cleaning tasks carry the same weight or urgency. By identifying and focusing on the most important areas first, you can ensure that essential spaces are addressed, even if you need to spread the work over a longer period. Your everyday comfort and safety should guide these choices. Begin with areas that impact daily life and safety the most, such as:High-traffic areas like the kitchen and main living spaces.Spaces where clutter tends to accumulate.Areas that might pose fall safety risks, such as cluttered stairs, hallways, or poorly lit rooms.Seasonal items that need to be rotated or reviewed.Consider a Room-by-Room Cleaning ApproachDivide tasks between you and your helpers to make each rooms cleaning process manageable and safe. This collaborative approach ensures thorough cleaning while respecting physical limitations and preserving independence. Each person contributes according to their abilities and comfort level. Here are some ideas on how to approach this.Kitchen: The heart of every home deserves special attention during spring cleaning. Since the kitchen is used daily for food preparation and often serves as a gathering place, kitchen safety and maintaining cleanliness and organization are crucial for both health and enjoyment. Focus on making this space both functional and accessible. Here is an example of how to divide up the tasks.Senior-appropriate tasks:Sort through pantry items and check expiration dates.Wipe down accessible countertops and cabinet fronts.Organize frequently used items for easy reach.Clean out refrigerator shelves at a comfortable height.Tasks for caregivers:Deep-clean upper cabinets and high shelves.Move and clean behind heavy appliances.Scrub floor corners and hard-to-reach areas.Clean oven and under-sink areas.Living areas: Living spaces are where we spend most of our waking hours, making them prime candidates for thorough spring cleaning. A well-maintained living area not only provides comfort but also helps prevent accidents and promotes relaxation. These rooms often contain treasured belongings that deserve careful attention during cleaning. Here is an example of how to divide up the tasks.Senior-appropriate tasks:Dust accessible surfaces and decorative items.Sort through magazines and papers.Organize remote controls and frequently used items.Review and organize photos and memorabilia.Tasks for caregivers:Move and clean under furniture.Vacuum or clean carpets thoroughly.Clean windows and high shelves.Rotate or flip mattresses.Safety and Organization Tips When CleaningSafety should always come first when tackling spring cleaning tasks. Here are some safety practices to keep in mind.Follow safe cleaning practices: Cleaning-related accidents can be prevented with proper precautions and smart choices about tools and techniques. Start with these essential safety practices to make cleaning easier and more effective:Use nontoxic, clearly labeled cleaning products.Keep cleaning supplies at waist level to avoid bending or reaching.Work in well-ventilated areas.Take frequent breaksat least 10-15 minutes every hour.Essential cleaning tools: Having the right tools at your disposal can make cleaning tasks significantly easier and safer. Modern cleaning tools are designed with ergonomics in mind, reducing strain and allowing you to maintain independence while cleaning. Investing in appropriate tools is an investment in both safety and efficiency.Use lightweight, ergonomic cleaning tools with extended handles.Find stable step stools with handrails for slight reaches.Source microfiber cloths that require minimal wringing.Consider investing in a rolling cart for cleaning supplies to avoid carrying heavy items.Decluttering Strategies To Consider When NeededIf your home has an overabundance of belongings, causing a potential safety hazard or preventing a full cleaning, it may be the right time to declutter. Here are some ideas for tackling the challenge.Sorting method: Decluttering can feel overwhelming without a clear system in place. So, to keep the process organized when sorting through belongings, consider using four clearly labeled boxes:Keep (items used regularly).Donate (items in good condition but rarely used).Store (seasonal or sentimental items).Discard (damaged or expired items).This practical sorting approach helps break down the decision-making process into manageable choices while ensuring nothing is overlooked.Making decisions about belongings: Letting go of possessions can be emotionally challenging, especially if items have sentimental value. A thoughtful, structured approach to these decisions can help balance emotional attachment with practical needs. Remember that keeping memories doesnt always require keeping physical items. Consider these questions when deciding what to keep:Has this item been used in the past year?Does it serve a specific purpose in daily life?Does it have significant sentimental value?Could someone else benefit from it more?Tips for Family Caregivers Assisting a Loved One With Spring CleaningWhether youve been asked to help your loved one who is aging in place, or it is your idea to tackle spring cleaning, use effective communication strategies to ensure your aging loved one knows you support their independence. Here are some tips to help you be effective and respectful.Utilize effective communication: When helping your loved one with spring cleaning, approach the task with sensitivity and clear communication. Your role is to support them in maintaining both a clean home and their sense of autonomy. Take time to establish mutual understanding before diving into tasks.Focus on tasks that feel comfortable and safe.Listen carefully when they share physical limitations or concerns and adjust your assistance accordingly.Work together to choose appropriate times for cleaning activities, being mindful of their energy level and daily routine.Show genuine appreciation for their input and participation in the process, reinforcing that their involvement matters.Support their independence: Remember that providing help doesnt mean taking over. Your goal is to support your loved one in making choices that maintain their autonomy while ensuring their home remains clean and safe. Finding the right balance helps create a sustainable cleaning routine for both of you.Encourage them to lead the way on tasks they feel comfortable and safe performing.Offer assistance with more challenging activities without being overly insistent.Acknowledge and celebrate their contributions to the cleaning process, no matter how small.Let them maintain control over decisions about their belongings and spaces; act as a supportive guide rather than taking charge.Goal Accomplished: A Refreshed Home for the Year AheadSpring cleaning as a senior aging in place or in conjunction with a family caregiver or professional caregiver should be more than just a seasonal taskits an opportunity to create positive change in the living environment. By taking a methodical, manageable approach, the living space can be transformed into a cleaner, safer, and more organized home that can be enjoyed throughout the year. Whether tackling one room or the whole house, your efforts to create a cleaner, safer space will be worth celebrating.How Right at Home Can HelpRight at Home helps seniors and their families navigate the aging journey. We offer a wide range of in-home care services. Our professional caregivers can provide anything from light housekeeping, medication reminders, and transportation to appointments to help with ambulation, grooming, and hygiene. To find out more, click on our listing below or call 205-874-9424.