What is the Meaning of Palliative Care?

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. 

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.

Seniors and Caregivers: Establish an Emergency Action PlanFor seniors and their caregivers, having a plan in place should an emergency strike can provide some peace of mind in a turbulent world. A crisis, such as illness, trauma, natural disaster, or any other unexpected adverse event, may one day require you to act quickly and decisively.Thinking and adapting can be particularly difficult when you are facing a high-stress situation. This is why disaster experts emphasize the importance of planning and practicing for various types of emergencies.For example, you might decide to run a fire drill in your own home. If your loved one lives in a residential facility, you want to ensure that the facility has suitable procedures in place. In an emergency, their staff members need to be able to provide adequate care for your loved one.If you do not have a disaster plan, its time to start creating one. If you have one, update it yearly and anytime there is a major change in your or your loved ones health care needs.Sharing Information on CaregivingHopefully, you would be able to continue to care for your loved one during and after a crisis. You should still ensure that other trusted individuals know how to care for your loved one, in case you are not with them. The more these helpers know about how to tend to your loved ones needs in emergency situations, the better.Start with writing a document to share with alternate caregivers. Involve the person who needs care as much as possible in this process. That way, you are making your loved one aware and allowing them to contribute. At the same time, it is also a great way to prompt conversations about what they might like to change in their current situation.The document should list your loved ones current needs, impairments, medications, and allergies. Describe what a typical day looks like for them, what provides comfort, and what foods they enjoy or avoid. Include crucial identifying information such as a current photo, date of birth, and Social Security number.A short biography informing providers of your loved ones interests, personality, and background can go a long way, especially if you are often their advocate or need to speak for them. Share this information with other family members, a family lawyer, their care facility, and anyone else who might help during a crisis.If you do not live with or near the person for whom you are creating the plan, think about who can help care for them until family arrives. Check which organizations or neighbors may supply necessities and check in on your loved one daily.In the Event of an EmergencyBe sure to keep any relevant medical information as well as your trusted contacts in an accessible place. Emergency responders, for example, you may look for your In Case of Emergency (ICE) contacts in your smartphone. Medical ID bracelets are essential for first responders as well.In addition, the Centers for Disease Control and Prevention (CDC) offers a Care Plan that you or your caregiver can print and fill out. In it, you can include detailed information on your medical care and emergency contacts. The CDC suggests storing the completed form in a waterproof bag with your insurance cards and photo ID.Consider creating a safety profile with Smart911 if it is available in your area. This free service will provide 911 dispatchers with details about your health needs or disability. In an emergency, this information could aid them in locating or assisting you. You can create profile for loved ones as well.Compile a disaster supplies kit; this may include your medications and any necessary medical supplies for your specific condition. Other items, like N95 masks, matches, and towels can prove useful in an emergency. Visit Ready.gov and the American Red Cross website for lists of recommended items and guides on preparedness.Planning for EvacuationThink ahead about how you would evacuate quickly and safely. Consider where you would go, how you would get there, and what you would need to bring.Does your chosen relocation site have adequate food, water, toiletries, and medication available? In times of emergency, keep in mind that you can check with the pharmacy before leaving, as many will provide early refills. Some major retailers also offer prescription delivery.Your plans should address specific seasons. For example, it may make sense to have summer plans that differ from winter ones, depending on where you live.Often, you or the senior needing care has medical needs requiring equipment, medicine, and attention. If they are not mobile, think about how you would relocate them in an emergency. Consider organizing some medical supplies in a bag or box to grab for a quick exit.Emergency relocation requires addressing the need to move all assistive medical devices and durable medical equipment. Remember batteries and chargers for all necessary devices.Try to avoid the need to evacuate quickly. A proactive early departure will help you stay calm and think more clearly. It may also help prevent potential difficulties like gas shortages and traffic jams.A Crisis Plan for Senior Citizens in a Residential FacilityYour plan for a senior living in a facility will look different than it would for one living in their home. Below are some recommendations to ensure aging loved ones in a facility will stay safe in a disaster:Review the facilitys backup generator, evacuation routes, and other basic precautions.Make sure the facility has your primary and alternative contact information.Request updates from health administration staff regarding changes in your loved ones emotional or physical state.Ask for medical records that document all care they are managing.Communicate frequently with your loved one in any way possible to ensure they are as safe as possible.Take detailed notes because it is easy to overlook or forget important details during times of high stress.Share as much information as possible with your loved one to reassure them that their health and safety are a priority.Start Small and SoonIt may feel overwhelming to consider all the steps involved in crisis planning and put it off until another day. Unfortunately, you never know when disaster might occur, so theres no time to lose.To start, jot down the most critical information and share it with your loved ones. You can always update your plan with more details later. These steps can provide organization, protection, and comfort in times of great uncertainty.This article shared by Ashley Day Special Needs & Elder Law.  Ashley Day can be contacted at 251-277-3377