• Change in Behavior: increased agitation, decreased activity, decreased oral intake

• Nonverbal Complaints: expression of pain (not in words), moans, groans, grunts, cries, gasps, sighs

• Facial Grimaces/Winces: furrowed brow, narrowed eyes, tightened lips, jaw drop, clenched teeth, distorted expressions

• Bracing: clutching or holding onto side rails, bed, tray table, or affected area during movement

• Restlessness: constant or intermittent shifting of position, rocking, intermittent or constant hand motions, inability to keep still

• Rubbing: massaging affected area

It is important to use verbal reports AND behavior observations when documenting pain.  Be careful not to make assumptions based on medical diagnoses or scores on rating scales.  Too often, clinicians assume that the patient can’t report pain, so the question is never asked.  So, learn to become observant to non-verbal pain indicators.  Cognitively impaired patients communicate their level of pain more than one would think.

Adapted with permission from the Swedish Institute – PERT Program

HEART ‘N HOME OPENS BEND OFFICE

BEND, OR (April 2013) – HEART ‘N HOME HOSPICE & PALLIATIVE CARE, a leading provider of hospice care Oregon and Idaho is opening the Bend, Oregon office located at 920 SW Emkay, Suite 104.  Please join our Open House on April 25th, 4:00-6:00pm. The Bend Chamber of Commerce will also be holding a ribbon cutting for us.   The Bend office will serve Deschutes, Klamath, and Lake counties in Central Oregon.

“We have a wonderful team of local professionals that have worked in the Bend community for more than 20 years. We are very excited about the opportunity to affirm the lives of our patients and families in the region,” says Maggie Arnold-Rabine, RN, BSN and Executive Director.

“Opening the Bend office is important to Heart ‘n Home. We love this area and the people we are serving.  Our team is very passionate about end-of-life care and building meaningful relationships,” said Cindy Lee, RN, CHPN, CHPCN, and CEO/Owner of Heart ‘n Home.

Heart ‘n Home Hospice & Palliative Care affirms life by providing emotional, physical, and spiritual support to our patients and to those who love and care for them.  Heart ‘n Home currently serves 11 counties and employs over 160 people.  For more information about Heart ‘n Home or our services visit www.goHOSPICE.com or stop into the office!

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So let this be a time for us to say it is obvious that what our VOLUNTEERS do for the patients and families of Heart ‘n Home is beyond extraordinary!  Heart ‘n Home has the absolute BEST Volunteers in Idaho, Oregon . . . I would even go as far to say, THE WORLD!

Our Volunteers truly COMPLETE our interdisciplinary team. We would not be whole without their giving hearts and helping hands.

The impact and power of their volunteerism and service to our community is inspiring to others and is an integral piece of our civic leadership.

Words seem so small, but we THANK YOU for your service, loyalty, and commitment to serving with the Heart ‘n Home family!

What can hospice Volunteers do?

• Help Patient Write Life Story/History
• Table Games
• Household Tasks
• Meal Preparation
• Minor Home and Yard Work
• Transportation
• Physician Visits
• Deliver Medications
• Beautician/Barber/Manicurist
• Massage
• Read Books
• Listen to Patient
• Special Projects
• Health Fairs
• Parades
• Community Events
• Assisting with Office Duties and Administrative Service
• And other exciting opportunities…

APPLY to VOLUNTEER NOW!

The National Hospice and Palliative Care Organization applauds this study that adds to a growing body of research demonstrating the value of hospice care both in terms of high quality and cost savings.

Led by Amy S. Kelley, MD, MSHS, from the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mt. Sinai, researchers looked at the most common hospice enrollment periods: 1 to 7 days, 8 to 14 days, 15 to 30 days, and 53 to 105 days. Within all enrollment periods studied, hospice patients had significantly lower rates of hospital and intensive care use, hospital readmissions, and in-hospital death when compared to the matched non-hospice patients.

The study reveals that savings to Medicare are present for both cancer patients and non-cancer patients. Moreover, these savings appear to grow as the period of hospice enrollment lengthens with the observed study period of one to 105 days.

Study authors suggest that investment in the Medicare Hospice Benefit translates into savings overall for the Medicare system. “If 1,000 additional beneficiaries enrolled in hospice 15 to 30 days prior to death, Medicare could save more than $6.4 million,” they note.

Furthermore, the authors write, “In addition, reductions in the use of hospital services at the end of life both contribute to these savings and potentially improve quality of care and patients’ quality of life.”

“We know that hospice care addresses so many critical issues involving quality of care at the end of life and that hospice brings dignity and compassion when they are needed most. This new study reaffirms other reasons why hospice is the best solution for caring for the dying in a way that provides patient-centered care and is cost effective for the Medicare system,” said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization.

This study builds on the valuable work of the 2007 Duke University study by providing further proof that hospice care saves the federal Medicare system money.

Added Schumacher, “For many years, hospice professionals have known through firsthand experience, that the interdisciplinary care they provide to patients and family caregivers coping with life-limiting illness significantly improves quality of life and allows people to focus on living as fully as possible even as life draws to a close. Now the broader healthcare community, regulators and legislators understand more fully the many benefits of hospice care.”

NHPCO reports that more than 44 percent of dying Americans were cared for by hospice in 2011. Among these patients, 84 percent of hospice care was paid for through the Medicare hospice benefit.

“We have an example of a care delivery model that not only scores high in patient and family satisfaction, reduces hospital services, and promotes the dignity of every person cared for but also can be cost effective with regards to federal spending,” Schumacher noted.

Based on the study’s findings, the researchers questioned recent aggressive efforts, including the Office of the Inspector General’s investigation of hospices that enroll patients with late-stage diseases but unpredictable prognoses.

“Our finding suggest these efforts maybe misguided,” write the researchers. “Rather than working to reduce Medicare hospice expenditures and creating a regulatory environment that discourages continued growth in hospice enrollment, CMS should focus on ensuring that patient’s preferences are elicited earlier in the course of their disease and those who want hospice care receive timely referral.”

NHPCO has consistently supported earlier discussions of care options once a person receives a diagnosis of a serious illness.

To learn more about hospice and end-of-life care visit www.goHOSPICE.com

(Press Release, New Research Validates That Hospice Saves Medicare Dollars, March 4, 2013, NHPCO)

The following information is brought to you by our very own Hospice Pharmacist: Trent Jenks, PharmD!

Studies have shown that at least 60% and 90% of patients with advanced heart disease and COPD respectively will report feeling breathless.

First treat the underlying cause that may be disease-specific such as bronchospasms, COPD exacerbations, or edema in congestive heart failure. If still symptomatic, we then turn to the following treatments for dyspnea:

Opioids: Opioids are the mainstay of treatment for dyspnea. The main opioid that is used for dyspnea is morphine usually at 5-10mg PO Q 1-6 hours PRN. Contrary to popular belief, opioids do not improve dyspnea through inhibition of the respiratory drive, rather, opioids improve dyspnea without causing significant deterioration in respiratory function. Exact mechanism is unknown but thought to act on opioid receptors either locally or centrally. Opioids may also decrease anxiety and diminish ventilatory response to hypoxia and hypercapnia. In heart failure, morphine may exert its effect in the treatment of angina by decreasing preload, inotropy, and chronotropy.iv

Anxiolytics: Dyspnea acute or severe may cause severe anxiety and panic. Benzodiazepines are highly effective anxiolytics and can be used safely in combination with opioids to decrease dyspnea. Usually start low and titrate to effect. Longer acting agents are preferred (lorazepam, diazepam) due to possible rebound anxiety that may occur with the shorter acting agents (alprazolam).

Oxygen: Supplemental oxygen for patients with oxygen saturation above 90% is unproven. It may be helpful to improve air circulation such as opening windows or using a fan. If oxygen saturation is <90% consider initial oxygen flow rates of 2-6 L/min.

Dyspnea is a common and distressing symptom in hospice patients. Opioids should be considered as first-line therapy. Oxygen is a useful treatment, but has only been proven in patients with oxygen saturation below 90%. Longer acting benzodiazepines are preferred over shorter acting agents due to a possible rebound anxiety that can occur.

The Heart ‘n Home Cardiac Team can help with:

 Patient/caregiver ability to manage illness at home

• Confidence of patient/caregiver to manage symptoms
• Specific cardiac plan of care that manages symptoms and reduces episodes of crisis
• Reducing emergency room and hospital visits

If you or a loved one needs extra support dealing with end-of-life cardiac disease, contact us at 1-800-HOSPICE or submit a referral for a free, in home visit to get the assistance needed to stay comfortable and in your home.

References:

Dudgeon D. Dyspnea, death rattle, and cough. In Ferrell BA, Coyle N (Eds.). Textbook of palliative nursing (pp. 164-74). New York: Oxford University Press, 2001.
Anderson H, Ward C, Eardley A, et al. The concerns of patients under palliative care and a heart failure clinic are not being met. Palliat Med 2001; 15:279–286.
Levenson JW, McCarthy EP, et al. The last six months of life for patients with congestive heart failure.
J Am Geriatr Soc 2000;48(Suppl):101–109.
Hallenbeck JL. Non-pain symptom management: Dyspnea. In: Hallenbeck JL, ed. Palliative Care Perspectives: Oxford University Press; 2003

FOR IMMEDIATE RELEASE

HOSPICE SPOTLIGHTS BAKER CITY RESIDENT AS A KEY ASSET TO THE COMMUNITY

Baker City resident, Valerie Potter, RN, BSN has accepted the Executive Director position of the Baker City office for Heart ‘n Home Hospice & Palliative Care! Executive Director, Potter is responsible for the overall clinical and clerical management of her respective areas. Potter will help recruit, hire, train, and evaluate new employees working out of the Baker City office; she will be participating in community activities and is always available for the community to use as an end-of-life healthcare resource.

Potter says, “I look forward to working with such a truly dedicated company and outstanding team in Baker City and La Grande. For me, hospice is about being present in a very important time of life. I have had the honor to be with my loved ones and hope to be of service to others during this time.”

“We believe our employees are our most valuable assets.” said Cindy Lee, CEO/Owner of Heart ‘n Home. “We applaud Valerie as she leads her team to success and look forward to supporting her future achievements.”

For more information about career opportunities in hospice visit http://www.gohospice.com/career/jobs/ or call 1-800-HOSPICE (800-467-7423).

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In the United States, the most common type of heart disease is coronary artery disease (CAD), which can lead to a heart attack. You can greatly reduce your risk for CAD through lifestyle changes and in some cases, medication.

If you or a loved one needs extra support and are dealing with end-of-life cardiac disease, please contact Heart ‘n Home today at 1-800-HOSPICE.  We can help with patient/caregiver ability to manage illness at home; confidence of patient/caregiver to manage symptoms; specific cardiac plan of care that manages symptoms and reduces episodes of crisis; and reducing emergency room and hospital visits.

 National Heart Month helps remind us all to be heart healthy in everything we do.

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Thank Church for Coverage of End-of-Life Care!

Another great way to give back to your community is volunteering in hospice!

HEART ‘N HOME HOSPICE & PALLIATIVE CARE Purchased NEWBERRY HOSPICE

LA PINE, OR (December 2012) – HEART ‘N HOME HOSPICE & PALLIATIVE CARE, a leading provider in hospice care, has partnered with Newberry Hospice of La Pine.  Newberry Hospice has successfully served the La Pine and surrounding areas for more than 15 years.  As two family owned and operated providers, we are excited for this new adventure and opportunity to grow and continue to serve our community. 

We are pleased to announce that Jim Smith will continue to be the Executive Director for Newberry Hospice and staff will continue to serve as they have in the past.  This office is one of six Heart ‘n Home locations with over 150 employees in Baker City, OR; Emmett, ID; Caldwell, ID; Meridian, ID; and Fruitland, ID. 

“The partnership between Heart ‘n Home and Newberry is an important step towards providing excellent hospice care in Central Oregon. I love the staff that comes with Newberry and I am excited to work alongside them.  I love the area and all of the great people I have met in these communities,” said Cindy Lee, RN, CHPN, CHPCN, and CEO/Owner of Heart ‘n Home. 

Founded in 2004, Heart ‘n Home has served over 2,900 patients and is recognized as one of the leading providers of hospice services in Idaho and Eastern Oregon.  Our mission is to affirm life by providing emotional, physical, and spiritual support to our patients and to those who love and care for them. Heart ‘n Home has received numerous awards, with the most recent being nationally recognized as the Top 100 Best Places to Work in Healthcare as well as the Better Business Bureau’s Snake River Region recipient of the Integrity Counts Award.  For more information about Heart ‘n Home or Newberry Hospice stop by our office or visit www.goHOSPICE.com.

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• Heart ‘n Home is a company that is built on integrity and a passion to care for our patients and families at a most difficult time of life. You feel the spirit of the work here. Team work, going the extra mile to help, an unsaid goodness of service and caring that I believe for most of our employees will continue on because it’s surpassed the almighty dollar, and what’s in it for me. It has become a culture. If you build it they will come!”
• “A common goal of providing legendary hospice care. We all love what we do. We all love hospice.”
• “Benefit package, team atmosphere, encouragement to grow even if it is not within the company, opportunities for education.”
• “Besides the industry of Hospice which brings so much meaning and purpose to work. The leadership team works hard to bring innovation and solutions to the issues and concerns employees have. The culture of Heart ‘n Home is family oriented and employee first.”
• “Hard work is rewarded. I feel like I make a difference in the work I do and I am a valued employee. I can give my opinion and feel that I am listened to.”
• “Great atmosphere, good pay, great service.”
• “Heart ‘n Home creates an unparalleled workplace where every employee’s needs and wants are catered for in any way possible. They create an air of comfort and understanding I have never seen anywhere else. You really feel like you’re part of a community that is helping others deal with some of life’s biggest trials.”
• “Great communication. Great use of technology. Great training.”
• “I like the flexibility with my schedule.”
• “Instilling trust in their employees that they will get the job done. The company has very high integrity.”
• “They realize that an employee’s family is very important and works with the employee to make sure that they can balance work and family life.”
• “The ‘Team atmosphere’ makes it feel like we are all equal regardless of our positions in the company. The Corporate Team does not act like they are better than anyone else, we are all valuable in the eyes of Heart ‘n Home.”
• “We are a hospice and it is the perfect environment for people with compassion and genuine caring for their fellow man, especially the elderly, to express that compassion. I believe working for hospice is a calling.”
• “The people that we serve, and the services that we offer, along with the training we receive make this a superior job.”