June, 2017: Knowing When It's Time for Hospice Care

Many people know what hospice care is but they are not sure when the time is right to start hospice for their loved one or themselves. The decision is not always a clear one, especially when patients and family members are caught up in the emotions surrounding end-of-life issues.

In general, people of any age, from infants to the very elderly, are eligible for hospice once a physician certifies that their life expectancy may be six months or less. There are patients who live longer than this anticipated time frame and they may continue to receive the comforting care of hospice as long as a physician documents their eligibility. However, it is not necessarily the physician who refers someone to hospice; family members, friends or clergy may also do so.

Typically, people enter hospice once it is determined that further medical treatment or procedures will not provide a cure and lifesaving measures will not be pursued. When one accepts that recovery is not possible, doors to a new phase of terminal illness open up through hospice care, with its holistic approach to providing quality time for as long as that person has.

It’s time for hospice when the focus is on care, not a cure. Signs of readiness include:

The disease has progressed to the point where no cure is possible, and the patient (and family, in many cases) opts for pain management and comfort over treatment.

Foregoing any further tests or hospitalizations in order to allow the dying process to happen naturally.

Acceptance of one’s condition and a readiness to let go, say goodbye to loved ones and friends, and allow nature to take its course.

Hospice providers (like Center for Hope Hospice) believe that terminally ill patients deserve the comfort and dignity at the end of their lives, as do their loved ones. Hospice serves patients, their families and caregivers at a crucial time of need. Therefore, the answer to “when are we ready for hospice” may be “as early as possible” so that everyone involved can focus on quality of life at the end of life.

Patients who are receiving hospice care are encouraged to partake in activities they’ve enjoyed in the past whenever possible—listening to music, painting a picture, visiting with friends, watching classic movies on TV—even going out if the person is not yet homebound or bedridden. Hospice is all about making the final stage of life as meaningful and comfortable as possible while under professional medical supervision.

At Center for Hope Hospice & Palliative Care, we offer additional support beyond our medical team; these include social workers, bereavement counselors, visiting clergy and volunteers who share their talents with patients and loved ones by offering whatever support is needed. (We even have a special team of canine volunteers who visit our residences and offer lots of unconditional love. You can read all about our furry friends in the latest issue of our newsletter.)

If you are wondering whether it’s time for hospice for your loved one, we’re here to help; please call us at (908) 889-7780 to discuss your needs.

May, 2017: The Role of Nurses in Hospice and Palliative Care

Whether in one of our residences, in the home or at an assisted living or healthcare facility, nurses are an invaluable part of the hospice and palliative care team. Hospice nurses are specially trained in various aspects of hospice care and care management, ensuring that pain and symptoms are controlled and that quality of life is optimized for all concerned.

Nurses trained in the practice of hospice and palliative care nursing have studied: pain and symptom management; end-stage disease processes; psychosocial, spiritual and culturally sensitive care of patients and their families; interdisciplinary collaborative practice; loss and grief issues; patient education and advocacy; bereavement care; ethical and legal considerations; communication skills; and awareness of community resources. 

With National Nurse Appreciation Week upon us (May 6-12), we are acknowledging all the nurses working in hospice and palliative care—and especially those who bring comfort and compassion to our patients in our residences and in the field.  Although nurses’ roles vary across facilities and practices, here are some ways in which hospice and palliative care nurses help anticipate and meet the needs of the patient and family facing terminal illness and bereavement.

Intake/Admission. Often the first hospice staff member to talk to and visit a patient, the intake or admission nurse explains the hospice philosophy to patients and their loved ones and develops a care plan. He or she assesses a patient's need and readiness for hospice and consults with the hospice physician regarding acceptance or admission into hospice care. This healthcare professional may also be the one to perform a complete assessment of the patient, order the medication and equipment the patient will need (based on the physician’s orders), and begin the process of patient and caregiver education with delicacy and compassion.

Case Manager. A case manager hospice nurse is a registered nurse (RN) who assesses and manages a patient's care. We assign one case manager nurse to each patient, which creates a more trusting relationship and allows for continuity of care. These frontline nurses have sharp patient assessment skills and work closely with the hospice physician.

Care Visits. A hospice visit nurse supplements the care provided by the nurse case managers. They may visit patients who have immediate needs when their case managers are not readily available, and may also be responsible for following up on routine care. At the Center for Hope, our nurses are available around the clock, ready to visit patients and families in need at any time, around the clock.

Whether at Father Hudson House or Peggy’s House, in the patient’s home or in a long-term care environment, the Center for Hope Hospice offers attentive, compassionate and sensitive nursing care through all stages of the patient’s journey. If you or your loved one is in need of hospice or palliative care, our nursing staff is ready to attend to your needs.

Frank Brady, the Center’s President, spoke to each of our nurses this week to say thank you.  “Nursing is viewed number one, nationwide, for honest and ethical work.  This does not come easily or by accident.  It comes from each nurse, each day, applying their intelligence, skill and compassion to each patient.  This is an amazing achievement and today, we stop to thank you for bringing this gift to the Center and our patients.”

April 2017: Finding Meaning and Acceptance in the Face of Loss
Holidays, milestones and special occasions are usually a time of togetherness, high spirits, and celebrations with family, friends and co-workers.  However, birthdays, anniversaries, graduations, weddings, and religious and civil holidays can be difficult for those who have recently lost a loved one—or are still very much missing that person, even after many years. For them, these occasions are fraught with triggers for great sadness.

At Center for Hope Hospice, we know that grief comes in stages and that feelings of loss may linger for a very long time. We understand that many people who are bereaved may also feel isolated when it seems everyone else is enjoying parties and family get-togethers. We asked our colleague, Dr. Ronald Wei—a psychiatrist in northern New Jersey—for some insights into finding meaning on these occasions when one is also dealing with loss.

Dr. Wei suggests that acceptance is at the core of coping strategies.

Accept that milestones and holidays are difficult but that there are ways to overcome the challenge.
Dr. Wei says that rather than avoid the approaching occasion, steer right into the emotional storm. “It’s important to mark what has happened rather than hide the fact of this person’s passing. One should stop the dinner or interrupt the slide show of happy times to make a toast in honor of the loved one. This can be very healing and a source of comfort.” 

Avoiding feelings of grief can create another layer of pain. Accepting it and creating ways that honor who you are missing provides a necessary and healthy outlet for grief.

Accept your varied emotions.
Rather than judge what you are feeling—which may be complicated—be easy on yourself and validate your different emotions. You might be feeling anger (at the deceased, God, the universe, the medical establishment, etc.), guilt, or any variety of emotions.  According to Dr. Wei, “Regardless of how contradictory these feelings may seem, validate them and accept them because they are rooted in a deep personal truth. This includes experiencing joy and laughter mixed in with sadness. It’s all OK.”

Accept what you can and cannot do, and make it happen in some manner.
Dr. Wei encourages people who are living with a critically ill relative to think and do the positive now, regardless of how the other person receives it. There won’t be another time to do or say those positive things but there will be a lot of time to regret them if you don’t act on them … and many future moments for that regret to overshadow good times with friends and family.

He cautions against being left with “I should have said …” This includes accepting what is possible and finding ways to modify or re-imagine how to fulfill it.  It can also mean expressing the positive feelings you have for the person now.  “You will never regret the good things you thought about, did or said, but you will regret what you didn’t do for a long time. Go ahead and do it together if it is physically possible and if not, accept what is possible and make it happen in a different form.”

Hand in hand with this are other acceptances around what you can and cannot do. For instance, particularly in the first year of loss, many bereaved develop new holiday observances and traditions, another way to accept they can no longer share the holidays with those who have passed in the same way they had in the past. It is also important to accept that you may not want to take on the tasks you used to do, at least not this time. Be gentle with yourself and don’t be afraid to ask others for help.

Accept that death is part of the life cycle.
Death is a natural part of life and is not something that anyone can escape. Accepting that as you face the loss of a loved one is an important part of the healing process.
We would add one more form of acceptance—accepting support from others during these difficult days.  For more information about our bereavement groups, please call our Bereavement Department at 908.889.7780 or email info@cfhh.org.



November, 2016: Dealing with Grief and the First Thanksgiving … and Beyond
For millions of schoolchildren across the county, the First Thanksgiving is a social studies lesson, a piece of American history studied every year at this time. But for millions of people who’ve lost loved ones recently, the first Thanksgiving may be something more—the start of many painful events from which the deceased will be absent for the first time.

At the Center for Hope Hospice, we have decades of experience helping families work through their bereavement and cope with loss during the holidays and other occasions.  While some people may find our bereavement support services helpful, we’d like to present some ways to help cope with the grief associated with the holidays.

-    Acknowledge that holidays will be difficult and different.
-    Decide if you want to keep, modify or create new holiday traditions.
-    Plan in advance how you want to spend your time and with whom.
-    Acknowledge what you can and cannot do.
-    Acknowledge the loss in the holiday celebration (light a candle, make a toast, etc.)
-    Make others specifically aware of things you want or don’t want to do over the holidays.
-    If you’re having trouble parting with your loved one’s clothing, use the holidays as an opportunity to donate them to a charity.
-    Don’t feel guilty if you need to skip certain holiday events.
-    Identify people who’ll be able to help you and support you through the holidays.
-    Remember that it’s okay to be happy and joyous in your celebrations; know that it doesn’t diminish your love of those lost.

Additional Support 
For some people, support groups (like the ones offered through the Center) are very effective. Guided by trained grief counselors, our support sessions offer solace and solidarity among friends who are going through similar experiences (even if they are experiencing grief differently). These sessions provide a safe environment for people to express or explore their feelings as they work through the many firsts of that first year without their loved one.

Many additional resources and tips are available for those in need. Please call our bereavement department at 908.889.7780 for additional strategies to deal with the holiday season.

For those of you who are approaching your first Thanksgiving, first Christmas, first birthday or other occasion without your loved one, please know that we understand and we are here for you. Our services do not end when your loved one leaves us. To learn more about the Center for Hope Hospice’s spiritual and bereavement services, contact the Center at (908) 889-7780 or info@cfhh.org.

November, 2016: What is Hospice?

Almost every moment of every day, individuals are all faced with choices.  Some are small: what to eat for lunch, what to wear that day, what to watch on tv.  Some are bigger...like starting a family or planning for retirement.  Usually, decisions are based on a simple set of criteria: emotions, previous experiences, outside influences, etc.

Unfortunately, when someone you love is facing a terminal illness, all of that goes out the window.  Every choice takes on a new and special importance…with an entirely new set of criteria that, truth be told, can be confusing and scary when confronted with them for the first time.

The Center for Hope, and our highly trained team of professionals, understands the challenges families face when it comes to a terminal illness.  We’ve built our reputation on a solid foundation of trusted, compassionate hospice care in the community and in our own residences benefiting both the patient and the family.

We realize that many people are only somewhat familiar with the concept of hospice and palliative care.  Most are uncomfortable thinking about end-of-life issues…until presented with them first-hand.  When a loved one is involved, it’s important to understand your options.  Here, we introduce the concepts of hospice and palliative care and urge you to reach out to us should you have more specific questions.

What is hospice?
According to a 2015 report from the National Hospice and Palliative Care Organization, more than 1.6 million Americans receive hospice services each year. That number is increasing in stride with the rise of our aging population.

People choose hospice for a variety of reasons; it’s a dignified alternative to prolonged, impersonal and often uncomfortable medical procedures when recovery may no longer be an option.  Founded on the philosophy that everyone deserves a death unencumbered by stress and pain, hospice helps patients dealing with a terminal illness stay physically, emotionally, and spiritually comfortable so they can focus on the quality of the time they have left.  It also offers comprehensive support to the patient’s families and caregivers during their time of need.

The Center for Hope’s services typically involve a combination of medical care, pain management, emotional support and spiritual counseling, but there’s no single snapshot of what hospice looks like. It can take place in a patient’s home, in residences like Peggy’s House and Father Hudson House (the Center for Hope’s residences), in an institutional hospice facility, nursing home, or wherever a patient may reside.  Because everyone’s end-of-life needs are unique, hospice is a deeply personalized approach, tailored to the individual’s circumstances and wishes.

What is palliative care?
Pain management, known as palliative care, is a foundation of hospice care but not all palliative care patients are in hospice. The difference?  Hospice is for patients dealing with a terminal illness; palliative care is for patients at any stage of illness, terminal or otherwise.

The focus of palliative care is to provide relief from the symptoms and stress of a serious illness. A team of specially trained physicians, nurses, social workers and other practitioners collaborate with the patient’s doctors to create additional support to improve quality of life. Recognizing the stresses that chronic, serious or terminal illness places on loved ones, this support extends to the patient’s family as well.  Palliative care may be offered for people of all ages and at all stages of illness and can be an excellent adjunct to curative treatment.

There are many excellent online resources for those wishing to learn more about hospice and palliative care.

  • The National Hospice and Palliative Care Organization, the largest nonprofit advocacy group in the field, is dedicated to advancing hospice information to terminally ill patients, their families, and the public.
  • The Caregivers Library offers good background on end-of-life issues including hospice and palliative care.
  • Web MD provides a comprehensive overview of hospice and palliative care.
  • Get Palliative Care answers many common questions about this treatment modality.
  • In her touching blog, Life as a Hospice Patient, author and mental health advocate Judi Chamberlin gives an honest, first-hand account about the ups and downs of daily life in hospice.

To find out about the services we offer at the Center for Hope, you are always welcome to visit our beautiful, state-of-the-art residences and speak with our attentive team of hospice professionals. Contact us at (908) 889-7780 or at info@cfhh.org to find out how the Center for Hope Hospice & Palliative Care is the right choice for all the right reasons.