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Graduating from hospice

By Ron King, D.Min., LMFT

There are several ways to be discharged from hospice.  Each carries its own difficulty and relief.

Look for the positive aspects of completion when hospice care comes to an end for your loved one and your family.  It is easy to become overwhelmed with the losses when hospice stops. The losses are real and can’t be denied.  But they come in the presence of new opportunities perspectives on living. Read more

Hospice patient’s caregiver as advocate

By Barbara L’Amoreaux

Pam and Steve are a couple who are part of our hospice service. We never use identifying information about our clients in Caring with Confidence, but this case is a bit different, and Pam and Steve are their real names, and this is their real story.

Steve was diagnosed with ALS five years ago. It’s a devastating diagnosis, but they take it one day at a time with grace and good humor. That doesn’t mean it’s an easy road; ALS progressively fatal disease, and more than 90 percent of ALS patients die within 5 years of diagnosis.
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The connection between mental status and swallowing-challenges for the hospice caregiver

By Maggie Vescovich, SLP

“She chews and chews and chews-then spits out the food!”

“I make him his favorite foods, but he just holds them in his mouth.  Eventually, with a lot of reminders, he swallows. It can take an hour, or more, for him to finish a meal.”

“It’s almost like he has forgotten how to swallow.”

“She’ll have a great appetite one day, then not eat or drink much the next day.”

These are common complaints I hear from caregivers when their loved ones are experiencing difficulty swallowing due to a change or worsening mental status, or decreased cognition.

What’s the connection?  Put simply, swallowing is not automatic until the food or liquid get to the very back of the throat, and the swallow reflex is triggered.  Up to that time, from when the forkful of food is placed between the lips and the swallow reflex is triggered—each of us gets to determine what we do with it when it’s in our mouths.  For those with decreased cognition, the act of eating can become complicated, and a tug of war between caregivers and their loved ones. Read more

Summing it all up: writing an obituary

Few of us ever consider that we might have to write someone’s obituary, or that someone will one day write ours.

When the day comes, and you are the designate writer, where do you start? I wrote an overly long obituary last fall for my father, but I really felt like it took that many words to summarize a complicated, intelligent, modest man who lived 88 years on this earth. And yes, it cost a fortune to run the obituary in the local paper (who knew you had to pay for this?), but even if we hadn’t published the obituary, the resulting essay was worthy of saving, and sharing. Read more

Communicating with the hospice patient with dementia

By Erin Bouquet, Hospice Volunteer

Have you had a personal experience with dementia?

Most have, whether it be with a family member, a friend, or a patient. Those of us who have had multiple experiences understand that every situation is different, and each person’s dementia is unique.

A recent patient experience challenged me to think outside of the box in order to communicate with someone that had Alzheimer’s disease. Read more

A brief history of hospice

By Jean Francis, Hospice Volunteer Coordinator

This year marks 40 years of hospice care in America, an anniversary we should all take pride in celebrating. Hospice comes from the Latin word “hospes” which means hospitality. The first hospices date back to the Middle Ages with volunteers at convents and monasteries providing shelter and food to wayward travelers. Travel by foot and horseback over rudimentary roads was treacherous during these times and these early hospices were similar to hostels. Read more

The moralities of comfort and cure at end of life

By Ron King, D.Min., LMFT

Hospice care requires a choice between seeking comfort care or seeking a cure for a disease.

When choosing comfort care, we honor the dignity and right of patients and families to choose.  Comfort care may also honor the body’s natural illness/healing process and process of dying.

When we choose aggressive cure, we honor the possibility of longer life.  Cure may also honor advances in medical technology and the ability of physicians to assist in finding a remedy. Read more

Honoring veterans at end of life: understanding goes a long way

By Cookie Dickerson, RN

Last night I caught a rerun of JAG, the 80s television series about lawyers representing members of the US Navy. Last night’s case centered on a Vietnam veteran who, after several stressful life events including divorce and separation from his kids, began having flashbacks to his experience in ‘Nam. This was after more than several decades of promotions and exemplary professional performance.

Yes, it’s a story, but it reminds us that experiences of war sometimes come back to veterans at the end of life. Read more

Aromatherapy in end-of-life care

By Valerie Hartman, RN, CMT, CR, Complementary Therapy Nurse

A month ago the Caring with Confidence team got together for a brainstorming session over lunch.  We reviewed past blog posts, discussed topics of interest to hospice caregivers for the upcoming year.  To date, the most popular Caring with Confidence blog post was written on The Use of Biblical Essential Oils in Hospice.

Aromatherapy is gaining ground as a complementary healthcare approach and it is a natural solution to easing mild symptoms, as well as promoting comfort and dignity in hospice caregiving.

What is Aromatherapy?

Aromatherapy is the use of expressed plant oils for human and animal health benefits.  Read more

Selfless service: Honoring the hospice patient’s wishes

By Lauri Weiss, CRNP

Seva, or selfless service, is a traditional yogic concept. The Sanskrit word seva comes from the root siv or sev, meaning to serve or to honor. One of the reasons I work as a Hospice/Palliative Care Nurse Practitioner is because I believe hospice offers an opportunity to serve and honor patients. I know many of the people I work with feel the same way.

A recent patient experience made me take a closer look at what it really means to honor and serve selflessly. I am often asked to visit patients for symptom management consults. A few weeks ago, I was asked to visit a patient, Charlie, who was having severe pain. After speaking with Charlie, getting a history of the illness and doing a physical assessment, I made several recommendations for pain management interventions.

I later found that Charlie refused all of my recommendations. Read more