For more information about the author, click to view their website: VITAS Healthcare
By Dr. Joseph Shega, Chief Medical Officer, VITAS Healthcare
Hospice provides myriad benefits to patients nearing the end of life: improved quality of life, better symptom and pain control, and greater patient and family satisfaction. However, despite increases year over year in the number of beneficiaries who used the Medicare Hospice Benefit, hospice remains underutilized in some patient populations. Two such populations present an opportunity for improvement: inpatients placed on Comfort Measures Only (CMO) and patients of color. Both groups face unique barriers to accessing hospice care.
Most hospice care (more than 98%) occurs in the home, whether a private residence, assisted living community, or nursing home. However, when a hospice patient’s symptoms can no longer be managed at home, they may move to a General Inpatient Care (GIP) setting for a short period of time to manage acute symptoms and pain. Despite being one of the four levels of hospice care required by Medicare-certified hospice organizations, GIP care remains uncommon. According to National Hospice and Palliative Care Organization (NHPCO) data, in fiscal year 2022, GIP comprised only 0.88% of Medicare days of care.1
This need for an enhanced level of care is particularly evident when examining hospitalized patients on Comfort Measures Only (CMO), or comfort care—a population that may widely benefit from being admitted to GIP care to manage their pain and other symptoms before returning home to receive routine hospice care.
A 2023 retrospective cohort study by Kozhevnikov et al. showed that around 22% of studied patients who transitioned to CMO status during their terminal hospital admission received general inpatient hospice care before death.2 CMO decedents who died without GIP during their terminal hospitalization were more likely to die in an ICU, have a lower Rothman Index (i.e., a higher risk of adverse events, clinical deterioration, and worse outcomes), and spend less time with CMO status.2 Further, without hospice care, families do not receive the 13 months of bereavement support that hospice provides after the patient’s death.
Improving access to GIP hospice care among patients on CMO and awareness among care team members will result in more patients being able to benefit from the specialty symptom management, treatment of psychological and spiritual distress, and bereavement support that hospice can provide.
Along with the barriers faced by CMO patients, racial disparities play a significant role in the underutilization of both palliative and hospice care, particularly among minority groups.
A 2024 study by Cid et al. found that minority patients were less likely than White patients to have documented end-of-life care during terminal hospitalizations.3 Using palliative care encounters and do-not-resuscitate (DNR) status as metrics for end-of-life care, the study showed that, compared to White patients, Black patients were 17% less likely to have palliative care encounters and 9% less likely to have DNR status.1
Going beyond this study's metrics, racial disparity can also be seen in hospice utilization. The NHPCO found that among Medicare decedents in 2022, hospice use occurred in 51.6% of White Medicare decedent beneficiaries, but among only 38.3% of Hispanic decedents, 38.1% of Asian-American decedents, 37.4% of Black decedents, and 37.1% of North American Native decedents.1
Improving these metrics may begin with goals-of-care conversations. Initiated by clinicians, these conversations help uncover a patient’s wishes, values, and care preferences. From these discussions, we can help inform patients and their families about their options for end-of-life care, including hospice.
It is our duty as clinicians to have these conversations early and often with our seriously ill patients and their families, so they are well-informed of the care choices available as their disease continues to progress. Healthcare professionals should ask open-ended questions to understand what matters most to patients facing serious illness.
For minority groups, approaching these conversations in a culturally sensitive and respectful manner is paramount. This may include considering language preferences, understanding specific cultural or religious beliefs around illness and death, and involving family members in the decision-making process.
Over the years, hospice awareness and utilization have grown, but it remains underutilized among terminally hospitalized patients on CMO and patients of color. These two unique populations present their own challenges and opportunities regarding access to hospice, highlighting the need for effective goals-of-care conversations to increase hospice awareness and accessibility.
By fostering culturally sensitive conversations that increase awareness of the Medicare Hospice Benefit, we ensure that patients and families from all backgrounds have the option to receive the compassionate, equitable end-of-life care they deserve. These efforts will help bridge disparities and improve the quality of care for countless individuals and their families.
1. National Hospice and Palliative Care Organization. NHPCO Facts and Figures. 2024. Available from: https://www.nhpco.org/hospice-facts-figures [Last accessed: September 11, 2024].
2. Kozhevnikov D, et al. Factors associated with inpatient hospice utilization among hospitalized decedents with comfort measures only status. Journal of Palliative Medicine. 2023;26(8):1048-1055. doi:10.1089/jpm.2022.0460
3. Cid M, et al. Disparities in end‐of‐life care for minoritized racial and ethnic patients during terminal hospitalizations in New York State. Journal of the American Geriatrics Society. Published online July 10, 2024. doi:10.1111/jgs.19046
Moving to a new home is an exciting adventure, but for your furry friend, it can be a stressful experience. Pets thrive on routine and familiar surroundings, so a sudden change can trigger anxiety. But with a little planning and the right support, you can help your pet feel safe, secure, and comfortable during the moving process.At Bluestar Move Management, we understand that every move is unique, and were here to help make the transition smoother for both you and your pets. Here are some strategies to ensure your four-legged family members feel right at home in your new space.1. Plan Ahead for Your Pet's Health and SafetyBefore you begin packing up your home in SWFL, take a few crucial steps to ensure your pets health and safety during the move:Schedule a Vet Visit: Ensure your pet is healthy and up-to-date on their vaccinations before the move. If youre relocating to a new area, ask your vet for recommendations for local clinics and get a copy of your pets medical records.Update Microchip & ID Tags: If youre moving to a new address, dont forget to update your pets microchip and ID tags with your new contact information. This ensures theyll be safe in case they get lost during the transition.2. Stick to a RoutineRoutine is key to your pets comfort. During the moving process, try to maintain their usual schedule as much as possible. Feed them at the same time, keep walks on track, and continue giving them plenty of love and attention. Familiarity helps reduce anxiety and keeps your pet feeling secure, even in the midst of change.3. Create a Safe Space During the MoveOn moving days, things can get chaotic, especially in the busy neighborhoods of SWFL. With movers coming in and out, its easy for your pet to become overwhelmed. To keep your pet calm and prevent them from getting lost or stressed, set up a quiet, secure room where they can relax.Make sure the room includes your pets bed, toys, water, and some familiar scents. If youre traveling with your pet, whether within SWFL or beyond, bring a comfortable carrier or harness to ensure their safety during the trip.4. Take It Slow in the New HomeOnce you arrive at your new home in SWFL, its important to introduce your pet to their new environment gradually. Start by setting them up in one room with their bedding and toys to create a comforting, familiar space. Let them explore other areas of the house at their own pace.Introducing your pet slowly to the new environment will help them adjust more quickly and feel less overwhelmed. The familiar smells and objects they recognize will help them settle in faster.5. Trust Bluestar Move Management for a Stress-Free ExperienceWith the right preparation, your pet can adjust to their new home in SWFL without too much stress. Bluestar Move Management is here to provide the support and expertise you need for a seamless move. We handle all the detailsfrom packing to unpacking and setting up your new spaceso you can focus on what really matters: your pets comfort and your own peace of mind.Moving with pets doesnt have to be stressful. Let Bluestar Move Management take care of the heavy lifting while you enjoy a smooth, easy transition to your new home.Ready for a stress-free move with pets? Contact Bluestar Move Management today at 239-387-1147, and well help you every step of the way!
How To Stay Healthy and Happy All SeasonWinter can be a challenging season for seniors, requiring extra attention to health and well-being. Even in the warmer climates of Florida, seniors can still benefit from adopting essential wellness practices to boost their physical and mental health. Looking for some ideas for staying healthy this winter? Here are easy winter wellness tips to help you or your loved ones thrive during the cooler months, focusing on staying active, eating healthy meals, boosting immunity, and maintaining mental well-being.1. Stay Physically Active Indoors or Out!Maintaining physical activity is crucial for overall health and managing stress, especially this time of year when outdoor activities may be limited due to cold weather. When the temperature is agreeable and sidewalks are free of ice or snow, walking is a great way to get exercise and fresh air. Prefer to stay indoors? Low-impact exercises, such as chair yoga, stretching or indoor walking, are excellent ways to stay active without straining joints. These gentle routines can help improve:FlexibilityStrengthBalanceConsider joining community classes, a local gym or following online workout sessions specifically designed for seniors to ensure a safe and effective exercise routine.2. Boost Immunity With a Balanced DietEnjoy nutritious, comforting winter foods. Warm meals can bring comfort and nourishment during the winter months. Consider preparing hearty soups, stews, and casseroles that incorporate seasonal vegetables rich in vitamins and minerals, including:SquashCarrotsSweet potatoesThese meals not only warm the body but also provide essential nutrients needed for optimal health. Experimenting with new recipes can also add excitement to your winter dining experience.A well-balanced diet plays a vital role in supporting the immune system, particularly during winter. Incorporating foods rich in vitamins and minerals can help fend off seasonal illnesses. Focus on including vitamin C-rich foods, such as:Citrus fruitsLeafy greensBell peppersEmphasizing whole grains, lean proteins, and plenty of vegetables can keep your body energized and healthy throughout the season.3. Stay HydratedHydration is just as important during the winter as it is in the summer, though many people forget to drink enough water in cooler weather. Seniors are especially at risk of dehydration, so its vital to maintain regular fluid intake. Aim for at least 68 glasses of water a day, and remember that herbal teas, soups, and water-rich fruits like oranges and melons can also contribute to hydration. Staying hydrated helps support energy levels, improves digestion, and keeps skin healthy during the drier months.4. Dress Warmly and Prevent FallsEven in warmer climates, seniors should dress appropriately for cooler temperatures. Wearing layers allows for easy adjustments to temperature changes throughout the day. Proper footwear is also essential; non-slip shoes can significantly reduce the risk of falls, especially on potentially slippery surfaces. Taking proactive measures to enhance home safetysuch as installing grab bars in bathrooms or using slip-resistant rugscan further help prevent accidents during the winter months.5. Stay Mentally EngagedThe winter months, with their shorter days, can sometimes lead to feelings of isolation or the winter blues, particularly if you find yourself spending more time indoors. Staying mentally engaged is critical for emotional well-being. Activities like reading, puzzles or the creative arts can keep your mind sharp and stimulated. Equally important is maintaining social connections. Engaging with family, friends or community groups can uplift your spirits and combat loneliness. Consider participating in local events or joining clubs to foster new friendships and connections.6. Reduce the Spread of GermsWinter is cold and flu season, so reducing the spread of germs is key to staying healthy. Washing your hands frequently, using hand sanitizer, and regularly disinfecting surfaces can help prevent illness. An effective means of preventing the spread of viruses can be as easy as not touching your eyes, nose or mouth. Seniors should also avoid crowded areas during peak flu season and consider getting a flu vaccine to protect themselves. Encouraging social interaction is important for mental well-being, but its wise to limit exposure to anyone showing symptoms of illness and maintain proper hygiene practices. If you do become ill, remember to cover your mouth when you cough or sneeze.7. Get Plenty of RestRest and recovery are essential for overall health, especially during winter when your body may be working harder to fight off germs. Seniors should aim for 79 hours of sleep each night to support immune function and cognitive health. Establishing a relaxing nighttime routine, such as reading or listening to calming music, can help you unwind, improve sleep quality and maintain a regular sleep schedule. Prioritizing rest also boosts mood and energy, helping to combat winter fatigue.Prioritize Your Wellness All Year LongStaying healthy and happy during the winter months is achievable with intentional actions. By incorporating these wellness tips for staying healthy into your routine, you can enhance your physical and mental well-being throughout the season.For seniors looking for comprehensive support in maintaining their health and wellness, communities like The Terraces at Bonita Springs, a luxury Life Plan Community in Bonita Springs, Florida, offer year-round wellness programs, nutritious dining options, and a variety of social activities designed to foster a fulfilling lifestyle. Embrace the season with confidence, knowing small changes can lead to significant improvements in your overall well-being.Prioritize your wellnessand happinessall year long at The Terraces. Call 239-208-6963 or contact us online to schedule a personalized visit and experience our brand of living well.
By Phara Lafortune-Morame, LCSW, MCAP, EMDR cert., QS.There are many reasons that significant moments are often celebrated with a drink. But during the holidays, otherwise-celebratory toasts can be triggers for people who struggle with substance use disorder, including seniors.Some families and cultures have holiday traditions that lean heavily on alcohol consumption. Family recipes for festive cocktails and toasts before dinners reinforce the idea that consumption is part of connecting with loved ones and embracing the holiday spirit.The Distilled Spirits Council of the United States notes that a quarter of the $49-billion-a-year distilled spirits industrys profits come from the month between Thanksgiving and the New Year. Another study notes that the average American drinks 27% more during the holiday season compared to the rest of the year.As a result, the stress and anxiety associated with the holiday season can result in increased consumption or return to drug and alcohol use for those currently in recovery, particularly for older residents, who tend to suffer from depression more during the holidays. Many studies note that nearly half of individuals recovering will return to use during the holiday season.The prevalence of substances in celebrations often mixes badly with the elevated depression and stress the holidays can bring. Expectations for creating and experiencing holiday joy are at the center of potential substance use triggers. When mixed with emotional turmoil, financial stress, loneliness, grief, nostalgia, and dysfunctional and complex family relationships, this can create a desire to seek temporary escape from overwhelming feelings through substances. For those aged 65 and older, alcohol misuse is the most frequently reported substance of use.The use of alcohol in older adults negatively impacts brain structure and function and can lead to declines in cognitive function and memory, particularly for adults over the age of 65. In addition, the bodys ability to break down alcohol decreases with age, resulting in increased risk for accidents and falls, fractures and car accidents. For anyone in recovery from substance use disorder, or concerned about increased consumption through the holidays, it is important to plan.Here are strategies for staying sober: Be aware of people, places or situations that can trigger consumption, and do what you can to minimize these exposures. Keep (and bring, if necessary) a nonalcoholic drink in your hand to resist temptation and discourage others from offering an alcoholic drink. Set realistic expectations. Stress is common for nearly everyone during the holidays, and spontaneous, imperfect moments are often the most memorable and special moments. Take care of yourself. Proper nutrition, exercise and meditation do wonders for your well-being. If you feel well physically, you will be stronger emotionally. Set boundaries, and let people know where you need support in resisting temptations. Have a plan on how to navigate, and more importantly exit social gatherings (For example, do not be dependent on someone else for transportation, so you can leave if needed). Be aware that returning to use a substance after a period of abstinence can happen AFTER the holidays, where we can justify returning to use by feeling entitled to drink or use drugs for having made it through the holidays. Sometimes, we manage better during a crisis than afterward.. Seek professional help and support.Sometimes, substance misuse is difficult to recognize in older adults, and few treatment programs are designed to meet their needs. However, the Primary Care Addiction Treatment (PCAT) program for adults at Healthcare Network follows a supportive, compassionate and nonjudgmental approach to encourage healing and lessen negative effects. The program treats every patient with respect and dignity, using empathetic language to reduce stigma and foster a supportive environment.Healthcare Network also offers medication for addiction treatment (MAT) for opioid use disorder, alcohol use disorder, and other substances within a primary care setting. Comprehensive care includes medication treatment along with behavioral therapy and counseling services to provide a whole-care approach to treating substance use disorders and support recovery.In addition, our primary care programs for the whole family include integrated mental and behavioral health care to address some of the mental health challenges that are sometimes at the root of substance use disorders.Help is available through the holidays and beyond. Supportive treatment can be the gift of a lifetime for you and your loved ones. About the Author By Phara Lafortune-Morame is associate clinical director of behavioral health at Healthcare Network. To learn more about substance use and behavioral and mental health support available Healthcare Network, visit healthcareswfl.org or call 239.658.3000.
Hospice Care in Southwest Florida: Collier, Lee, Glades, and Hendry countyThe VITAS Healthcare team visits patients wherever they call home, including but not limited to: private homes, senior living communities, and long term care facilities in Southwest Florida. We have offices located in Collier and Lee County and an Inpatient Unit in Naples. Coming soon, VITAS Inpatient Unit in Lee County.VITAS provides 24/7 support whenever our patients and families need it.At VITAS, we prioritize our patients and their families above all else. By concentrating on enhancing quality of life, managing symptoms and pain effectively, and minimizing 911 calls and hospital readmissions, we ensure our patients' comfort and well-being. VITAS distinguishes itself from traditional hospice providers through a personalized approach to care planning, transparent medication management, and a comprehensive range of specialized modalities tailored to meet diverse patient needs. These include physical therapy, occupational therapy, speech therapy, respiratory therapy, wound care, palliative oncology therapy, palliative dialysis, and more.Office Locations:Fort Myers VITAS Hospice Office12751 Westlinks Dr. Fort Myers, 33913 Vitas Inpatient Unit at Solaris Healthcare Imperial900 Imperial Golf Course Blvd. Naples, 34110 Naples VITAS Hospice Office4980 N Tamiami Trail, Suite 102, Naples 34103Our Care ServicesAt VITAS we care for patients with an interdisciplinary team comprising a nurse, physician, aide, social worker and chaplain. Our teams design personalized care plans to ensure comfort, dignity and quality of life. Hospice Care at Home Condition-Specific Care 24/7 Telecare Intensive Comfort Care Veterans Care Inpatient Hospice Care Music Therapy Paw Pals Pet Visits Grief and Bereavement Support
Hospice Care in Southwest Florida: Collier, Lee, Glades, and Hendry countyThe VITAS Healthcare team visits patients wherever they call home, including but not limited to: private homes, senior living communities, and long term care facilities in Southwest Florida. We have offices located in Collier and Lee County and an Inpatient Unit in Naples. Coming soon, VITAS Inpatient Unit in Lee County.VITAS provides 24/7 support whenever our patients and families need it.At VITAS, we prioritize our patients and their families above all else. By concentrating on enhancing quality of life, managing symptoms and pain effectively, and minimizing 911 calls and hospital readmissions, we ensure our patients' comfort and well-being. VITAS distinguishes itself from traditional hospice providers through a personalized approach to care planning, transparent medication management, and a comprehensive range of specialized modalities tailored to meet diverse patient needs. These include physical therapy, occupational therapy, speech therapy, respiratory therapy, wound care, palliative oncology therapy, palliative dialysis, and more.Office Locations:Fort Myers VITAS Hospice Office12751 Westlinks Dr. Fort Myers, 33913 Vitas Inpatient Unit at Solaris Healthcare Imperial900 Imperial Golf Course Blvd. Naples, 34110 Naples VITAS Hospice Office4980 N Tamiami Trail, Suite 102, Naples 34103Our Care ServicesAt VITAS we care for patients with an interdisciplinary team comprising a nurse, physician, aide, social worker and chaplain. Our teams design personalized care plans to ensure comfort, dignity and quality of life. Hospice Care at Home Condition-Specific Care 24/7 Telecare Intensive Comfort Care Veterans Care Inpatient Hospice Care Music Therapy Paw Pals Pet Visits Grief and Bereavement Support
Hospice Care in Southwest Florida: Collier, Lee, Glades, and Hendry countyThe VITAS Healthcare team visits patients wherever they call home, including but not limited to: private homes, senior living communities, and long term care facilities in Southwest Florida. We have offices located in Collier and Lee County and an Inpatient Unit in Naples. Coming soon, VITAS Inpatient Unit in Lee County.VITAS provides 24/7 support whenever our patients and families need it.At VITAS, we prioritize our patients and their families above all else. By concentrating on enhancing quality of life, managing symptoms and pain effectively, and minimizing 911 calls and hospital readmissions, we ensure our patients' comfort and well-being. VITAS distinguishes itself from traditional hospice providers through a personalized approach to care planning, transparent medication management, and a comprehensive range of specialized modalities tailored to meet diverse patient needs. These include physical therapy, occupational therapy, speech therapy, respiratory therapy, wound care, palliative oncology therapy, palliative dialysis, and more. Office Locations:Fort Myers VITAS Hospice Office12751 Westlinks Dr. Fort Myers, 33913 Vitas Inpatient Unit at Solaris Healthcare Imperial900 Imperial Golf Course Blvd. Naples, 34110 Naples VITAS Hospice Office4980 N. Tamiami Trail, Suite 102, Naples 34103 Our Care ServicesAt VITAS we care for patients with an interdisciplinary team comprising a nurse, physician, aide, social worker and chaplain. Our teams design personalized care plans to ensure comfort, dignity and quality of life. Hospice Care at Home Condition-Specific Care 24/7 Telecare Intensive Comfort Care Veterans Care Inpatient Hospice Care Music Therapy Paw Pals Pet Visits Grief and Bereavement Support