The Crucial Role of Certified Nursing Assistants in Hospice and Palliative Care

As the summer heat intensifies across the country, dehydration becomes a common and potentially dangerous concern. This condition can have severe implications, particularly for seniors who are more vulnerable due to several physiological factors. Seniors face unique challenges, especially when it comes to the impact of their medication on hydration. Why Are Seniors More Prone to Dehydration?Seniors are at an increased risk for dehydration for several reasons:     Reduced Thirst Signal: As people age, their bodies lose their ability to recognize thirst, making it harder to drink fluids.      Lower Body Water Volume: Older adults generally have a lower total volume of body water, meaning they have less fluid to lose before dehydration sets in.      Kidney Function Decline: Kidneys become less efficient at conserving water with age, further contributing to fluid loss.     Chronic Illnesses: Conditions such as diabetes can worsen the risk of dehydration since they affect the body's ability to control water. In addition to these factors, medication plays a significant role in influencing fluid balance in seniors.The Impact of Medication on DehydrationAs a clinical pharmacist, I've seen firsthand how medications can contribute to dehydration, especially in older adults. One of my clients, an active senior, nearly passed out while cycling in the summer. As it turned out, he was on a diuretic medication, commonly referred to as a "water pill." Diuretics are a class of drugs that increase urination, leading to reduced fluid levels in the body. These medications, often prescribed for conditions like hypertension and heart failure, can inadvertently lead to dehydration if fluid intake isn't carefully managed. Some commonly used diuretics include bumetanide, chlorothiazide (Diuril), hydrochlorothiazide, and furosemide (Lasix). But diuretics aren't the only medications that can cause dehydration. Other drugs like these can also affect your body's water balance.     Antihistamines: Often used for allergies, these can cause dry mouth and reduced fluid intake.     Blood Pressure Medications: Certain blood pressure medications can increase urine output.     Laxatives: They can cause fluid loss through increased bowel movements.     Chemotherapies: These treatments often lead to side effects like vomiting and diarrhea, contributing to dehydration.Managing Dehydration RisksIt's important to be aware of dehydration risks, particularly for those taking medications that impact fluid balance. Regardless of whether one feels thirsty, its important to drink water throughout the day. Staying alert to the signs of dehydrationsuch as increased thirst, dry mouth, dark urine, fatigue, and dizzinesscan also help address the issue early. These symptoms are early warning signs that the body may need more fluids.  Finally, anyone concerned about dehydration should consult a healthcare provider. They can adjust medication and advise seniors on managing fluid intake to prevent dehydration.   At Deeper Dive Horizons, one of my priorities is to guide you and your loved ones through the complexities of medication management to improve your well-being. With over 22 years of experience, my goal is to dive deeply into your health and ensure you maintain a balanced and healthy life, even in challenging conditions like extreme heat. Schedule a consultation today to get started 888-984-8895.

How Long Can You Be on Hospice Care?One of the most common questions about hospice care is, how long can someone be on hospice? Understanding the duration and criteria for hospice can help patients and their families make informed decisions during challenging times.While most patients only experience its benefits for days and weeks, hospice is available when a patients physician certifies that they have six months or less to live, as explained further below, with recertification available if the patient outlives that six-month period and continues to meet hospice criteria.What is Hospice Care?Hospice is defined as supportive care that focuses on comfort and quality of life. Hospice is available for patients with a terminal illness and a life expectancy of six months or less if their illness runs its normal course, as certified by a physician.Can hospice help?Hospice services include:Skilled nurses making intermittent visits to assess the patient, provide care and coordinate care from other disciplines.Hospice aides to support activities of daily living.Medical social workers to support the patient and family and make connections to community resources.Chaplains for spiritual support.Hospice volunteers for companionship and support.Bereavement support for the family for up to 13 months following the patients passing.Some companies like Amedisys also offer specialized programs to care for certain diagnoses like dementia, heart failure and more. Eligibility Criteria for HospiceUnderstanding how long hospice care can be provided first starts with having a strong grasp of the eligibility criteria.To be eligible for hospice, the patient must be considered terminally ill with a life expectancy of six months or less if the disease runs its normal course, as certified by a physician. The hospice physician uses their clinical expertise and information from a comprehensive assessment to determine life expectancy. Signs the patient is declining from the terminal illness include progressive weight loss, frequency of hospitalizations, increasing weakness or fatigue, difficulty with daily activities and more.The patient must also elect to stop curative treatments in favor of the comfort and quality of life measures hospice provides. The physician will work closely with the hospice care team on a personalized plan of care focused on pain and symptom management and comfort so patients and families can make the most of their remaining time together.How Long Can Patients Receive Hospice Care?Patients can receive the benefits of hospice care as long as they continue to meet the eligibility criteria. If a patient lives longer than the original six-month certification period, physicians can re-certify them to remain on hospice care if the disease progression still indicates a life expectancy of six months or less.Although patients cannot receive curative treatment while on hospice care, if a patients condition improves significantly so that they are no longer considered terminally ill, they will be discharged from hospice care. Patients can also choose to opt out of hospice care at any time during the service.One of the most famous examples of how hospice can extend beyond six months is former President Jimmy Carter. As of this publication, Jimmy Carter has received hospice care for more than a year, spending that precious remaining time with his family in his home. His legacy will be one of normalizing end-of-life conversations, sparking hope that more patients and families will seek out the benefits of hospice and embrace them sooner rather than later.What are the Benefits of Hospice Care?One of the most common phrases we hear from families is, we wish we had chosen hospice sooner. By accepting help early, patients and families can expect a range of benefits at the end of life:Pain and Symptom ManagementPain and symptom management is a central tenant of hospice care, providing comfort and the best quality of life possible for patients at home. Hospice care combines pharmacological and non-medication tactics to manage physical, emotional, psychosocial and spiritual pain for the patient and caregiver.Holistic CareHospice is a unique Medicare benefit providing care with a full, interdisciplinary care team. Holistic care is a patient-centered approach that focuses on caring for the whole person, including their physical, emotional, psychosocial, and spiritual well-being.Supportive Care EnvironmentHaving hospice care at home fosters a sense of security, familiarity and peace, which can contribute to a patients overall sense of well-being.Advance Care PlanningHospice care encourages open communication and advance care planning discussions, allowing patients to express their desires for the final weeks and months of their life. This can help avoid unwanted medical interventions that could diminish quality of life by ensuring patients are getting the care they need and want.How Do You Know When Its Time for Hospice?If youre caring for a loved one with a terminal diagnosis, there are several key signs that it may be time to start talking about hospice care:Their doctor has given a prognosis of six months or less.Their health or disease symptoms are worsening with frequent trips to the hospital or doctors office.They have decreased appetite or pain/nausea interfering with their ability to eat and drink.They sleep more throughout the day and night.There are noticeable behavior changes in mental clarity, confusion, forgetfulness, or irritability.Activities of daily living like feeding oneself, bathing and dressing independently become more difficult.Caregivers are overwhelmed and unable to manage care on their own.What Are the Four Levels of Hospice Care?As you research hospice, you may come across different levels of hospice care. Moving into different levels can be triggered by changing circumstances or needs of the patient or caregiver. Here are the four levels of hospice care all Medicare-certified agencies provide:Routine Home CareThis is the most common type of hospice care. The full team conducts intermittent visits wherever the patient calls home, providing a comfortable and familiar environment.Respite CareRespite care is available when caregivers need a break. Patients are admitted to a long-term care facility or other inpatient facility with 24-hour nursing available. The patient can stay in the facility for up to five days/five nights and returns to routine level of care on day 6. The hospice team coordinates the plan of care and can arrange transport patients to and from the facility as needed.Continuous Home CareThis level of care is for short-term urgent healthcare needs or symptom crises that can still be feasibly addressed at home. The hospice team provides at least eight hours of continuous care within a 24-hour period. When symptoms are controlled, the patient returns back to routine care.General Inpatient CareIf pain and symptoms related to the patients terminal illness can no longer be controlled at home, the patient may be appropriate for General Inpatient (GIP) care. The hospice team facilitates the patients transfer to a hospital, long-term care facility or hospice inpatient unit and will continue coordinating the plan of care. Patients will return home to routine home care once pain and symptoms are managed.How to Get Started with Hospice Care If youre ready to start talking about hospice care with your family, Amedisys is here to support you through every stage. Contact Amedisys Hospice in Mobile, Alabama at 251-343-0989 for more information.

Ensuring Safety in Hospice Care: A Commitment to ExcellenceThe importance of safety in the workplace for healthcare providers cannot be overstated. As we approach OSHAs Safe and Sound Week in August, it is an opportune moment to highlight the critical measures we undertake to ensure a safe work environment for our staff and patients. This communication aims to inform our referral sources about our safety protocols and provide valuable tips that medical professionals may find beneficial for maintaining safety in their workplaces.Our Commitment to SafetyIn hospice care, where the environment can be unpredictable and emotionally charged, maintaining rigorous safety standards is paramount. Our commitment to safety is evidenced by our comprehensive safety programs, continuous staff training, and adherence to OSHA guidelines. According to the Bureau of Labor Statistics (2023), healthcare workers face a higher rate of workplace injuries than workers in most other sectors, with nearly 5.5 injuries per 100 full-time workers annually. This statistic underscores the importance of our ongoing efforts to mitigate risks and promote a culture of safety.Staff Training and EducationOngoing Training: All our staff undergo regular training sessions that cover the latest safety protocols, emergency procedures, and the proper use of personal protective equipment (PPE). Research has shown that continuous education significantly reduces the incidence of workplace injuries (Smith et al., 2022).Ergonomic InterventionsProper Lifting Techniques: Back injuries are a common concern in healthcare settings. We emphasize training on proper lifting techniques and the use of mechanical lifts when necessary to prevent musculoskeletal injuries (Anderson et al., 2020).Infection Control MeasuresStrict Hygiene Protocols: Adherence to stringent hygiene protocols, including regular handwashing, use of sanitizers, and appropriate use of PPE, is mandatory. These measures are crucial in preventing the spread of infections among staff and patients (CDC, 2022).Mental Health SupportCounseling Services: Recognizing the emotional toll that hospice work can take, we offer counseling services to support our staffs mental health. Studies have indicated that mental health support reduces burnout and improves job satisfaction among healthcare workers (Jones et al., 2021).Safety Tips for Medical ProfessionalsWhile our safety protocols are robust, there are additional tips that medical professionals may find useful in enhancing their safety at work:Use Technology WiselyTelehealth Services: Where appropriate, leverage telehealth services to reduce the need for physical interactions, thereby minimizing exposure to infectious diseases.Stay InformedContinuing Education: Keep abreast of the latest safety guidelines and best practices through continuing education programs. This knowledge is vital for adapting to new challenges and improving workplace safety.Promote a Safety CultureOpen Communication: Foster an environment where staff feel comfortable reporting safety concerns without fear of retribution. An open communication culture is essential for identifying and addressing potential hazards promptly (Davis et al., 2019).Personal Protective Equipment (PPE)Proper Use and Disposal: Ensure the correct use and disposal of PPE. Improper handling can negate the benefits and increase the risk of contamination.Safety in the workplace is a fundamental aspect of providing high-quality hospice care. By implementing rigorous safety measures and continuously educating our staff, we strive to create a secure environment for both our employees and patients. We encourage our referral sources to adopt similar practices to enhance safety within their own organizations. Together, we can build a safer healthcare system for everyone.  Call us today to learn more!ReferencesAnderson, J., Williams, M., & Smith, T. (2020). Ergonomic interventions in healthcare: A review of the evidence. Journal of Occupational Health, 62(4), 311-319. https://doi.org/10.1002/joh.22023Centers for Disease Control and Prevention (CDC). (2022). Infection control in healthcare settings. Retrieved from https://www.cdc.gov/infectioncontrol/index.htmlDavis, K., Turner, M., & Wrenn, G. (2019). Promoting a culture of safety in healthcare. Healthcare Management Review, 44(2), 123-135. https://doi.org/10.1097/HMR.0000000000000199Jones, A., Phillips, R., & Brown, L. (2021). Mental health support for healthcare workers: A systematic review. Journal of Occupational and Environmental Medicine, 63(1), 54-62. https://doi.org/10.1097/JOM.0000000000002025Smith, R., Johnson, P., & Martinez, S. (2022). The impact of continuous education on workplace safety in healthcare. American Journal of Industrial Medicine, 65(3), 233-245. https://doi.org/10.1002/ajim.23394U.S. Bureau of Labor Statistics. (2023). Occupational injuries and illnesses among healthcare workers. Retrieved from https://www.bls.gov/iif/