Are you interested in becoming a legal nurse? Patricia Coonan will tell you what you need to know to transition into this rewarding profession. August 10, 2pm pacific on blogtalkradio.com/kindethics

Are you no longer able to be a nurse due to latex allergies, a back injury or are you just looking for something with more flexibility.  You may want to consider becoming a legal nurse consultant and putting all of your knowledge and compassion into helping others in a new way.  Patricia Coonan will be answering your questions regarding how to transition into the rewarding career of legal nurse consulting. Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics.

Patricia been a RN for 24 years and Legal Nurse since 1997. She works for the Beasley Firm as an In-House Consultant and Legal Assistant. If you are being sued, she is the person that would go through the medical records to see what happened and if you have deviated from the Standards, Protocols and Industry Practices and if you may be negligent.

Patricia has also created a training program for those nurses interested in going into the legal field. If you are interested, you can find her products on eBay under Prrn12 or at www.legalnurseprrn12.com or at pc-rn@comcast.net.

You can follow her on Twitter: pcRN or reach her at pc-rn@comcast.net.

For legal help, The Beasley Firm website is http://www.beasleyfirm.com and their offices are as follows:
The Beasley Building
1125 Walnut Street
Philadelphia, PA 19107
Phone (215) 592-1000
Fax (215) 592-8360
3000 Atrium Way
Suite 258
Mount Laurel, NJ 08054
Phone (856) 273-6966
Fax (856) 273-6913
Have a kind and respectful day.

When A Stranger Decides If You Should Live Or Die

There are so many things that happen behind the scenes in healthcare when it comes to dying. One of the hardest things for me to witness is when a patient has no one to speak for them at the end. We call this person the unrepresented patient or the unbefriended person. This is a person without any friends or family who can make sure they have a good death. So what happens to them? In some cases, a public conservator or guardian is appointed to make their decisions for them. This is a stranger making decisions for another stranger. There is nothing personal or meaningful in this process. The other thing that happens, if there isn’t a guardian available, is a group of people at the hospital will make the decision for this person. Sometimes we call this an advocate team and or a moral community. This group usually consists of a doctor, nurse, social worker, chaplain, members of the ethics committee and community members. As a group they will make the decision whether this person should live or die. Unfortunately this decision is based on very little information about who this person is or what would is important to them in their life. It is usually a medical decision instead of a human decision. Not that the advocate team doesn’t try to make it personal.

Let me tell you about one such patient who had this group of strangers make his decisions for him. This was an 83-year-old gentleman who had been living in a nursing home for the past 12 years. At the nursing home, he was able to eat and walk around, but he had severe dementia and could not communicate with the staff. In the 12 years he had been living there, nobody ever visited, nobody ever called and nobody sent him a letter. He had become invisible. The staff cared about him and took good care of him but they were not family. Just before I met this man, he had a massive stroke which left him paralyzed, in a coma, unable to eat or drink and dying. The social workers at the hospital did everything they could to try to find somebody who knew this man but nobody could be found. I live in Los Angeles and we don’t have enough people who are willing to be a public conservator or guardian. So now we use advocate teams to help make decisions for those who are completely alone and silenced by their disease.

I came into the hospital that day and I went to the patient’s bedside because I refuse to make a decision for somebody that I haven’t met or tried to connect with. I knew this person wasn’t going to be able to communicate back to me, but as I sat at his bedside, I held his hand and connected with the human inside this body in the bed. The only noise in the room was the sound of the machines breathing for him. His body was a shell and it seemed like he was already gone. I sat with him and talked to him and told him that I would try to do right by him. I cried a few tears as I realized he was already gone. These are the difficult moments in my job.

I went to the meeting and heard what the doctors had to say and listened to what the social worker had discovered about this man. This was a man who was dying and there was nothing we could do to change it. We asked all the questions we could think of about his medical condition and if there was any hope. We were told there was not. I then asked the social worker about who this person had been at the nursing home. Had he enjoyed his meals? Had he enjoyed interacting with others? What had brought him joy even in his limited condition? He had been living a life with small pleasures and not too much suffering. But now, he couldn’t feel anything. He couldn’t enjoy eating a cupcake, watching something on TV or going to the sing-along in the activity room.

In the advocate team meeting, we all have to agree on what we think we should do. In this team meeting, we decided that there was no way he was going to be able to return to enjoy any part of his life. He was dying and there was no turning back. Our team agreed that he should be made comfortable and be allowed to die a natural death. This included being taken off the ventilator and being allowed to die.

I wasn’t going to tell you his name because he had become invisible to the world. But I have changed my mind because he wasn’t invisible to me. His name was James and I was part of his life and his death.

These are really difficult decisions. These are decisions that should not be made by strangers. But people in hospitals all over the nation are having their life and death decisions made by committee. This is not how it’s supposed to be. People shouldn’t be dying alone and they shouldn’t be living for 12 years without one person visiting them.

Sometimes it’s hard to do the work I do. Sometimes it breaks my heart. But I have the courage to walk into the darkness with people. Whether it’s the family who is grieving at the bedside, the patient who is afraid of what is happening to their body or the health care professional who can’t bear to participate in one more death. I walk with people on this journey and ease their way.

Have a kind and respectful day.

“Medical Futility and a Legal Update From Across the Nation” Interview with Thaddeus Pope J.D, of the MedicalFutility.blogspot.com. August 4th, 10am, pacific. Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics.

I am honored to be interviewing the legal expert on futility, Thaddeus Pope J.D, regarding the issue of medical futility. You may not have heard much about this issue but you are going to be hearing a lot about it in the upcoming debate on healthcare reform. Every time President Obama says that we have to stop paying for treatments that will not work, he is talking about medical futility. Or when the politicians discuss using our healthcare dollars wisely, they are talking about medical futility. In healthcare, the number one problem being brought to bioethics committees is dealing with requests for treatments that are medically inappropriate or will not work. I encourage you to listen to this interview because when you or your loved one is in the hospital, this issue will be playing a factor in your treatment decisions. And even more importantly, this issue will be shaping the healthcare plan that is being proposed. Please let me know where you stand on this issue and feel free to call in with your questions.

“Medical Futility and a Legal Update from across the nation” interview with Thaddeus Pope J.D, of the MedicalFutility.blogspot.com and www.thaddeuspope.com. Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics.

Thaddeus Pope is an Associate Professor of Law and member of the Health Law Institute at Widener University School of Law. He came to Widener in 2007, after teaching at the University of Memphis since 2005. Before entering academia, he worked seven years for Arnold & Porter LLP (in Los Angeles and Washington, DC), and clerked for the U.S. Court of Appeals for the Seventh Circuit. He earned both my J.D. and Ph.D. (in philosophy & bioethics) from Georgetown University.

His current research focuses on:
Medical Futility and other legal obstacles to good end-of-life care
Internal Dispute Resolution mechanisms in healthcare, particularly ethics committees
Tort Law, particularly consent and the assumption of risk doctrine
Public Health Law, particularly the legitimacy of restricting voluntary self-regarding conduct
Normative Jurisprudence, particularly the justifiability of hard paternalism

He teaches the following courses:
Health Law I (Patient Care & Liability), End-of-Life Decisions Law, Health Law II (Finance & Regulation), Bioethics, Torts, Public Health Law, Business Organizations, Health Law Thesis

You can get copies of the articles he has written at:
www.thaddeuspope.com
http://works.bepress.com/thaddeus_pope/
http://papers.ssrn.com/sol3/cf_dev/AbsByAuth.cfm?per_id=180178

For more information about Thaddeus Pope go to: http://thaddeuspope.com/images/Pope_Bio_1p_-_futility_.pdf

“The Compassion Fatigue Project” Interview with Patricia Smith, August 3rd, at 9AM pacific. Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics.

“The Compassion Fatigue Project” Interview with Patricia Smith, August 3rd, at 9AM pacific. Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics.

Patricia Smith, founder of the Compassion Fatigue Awareness Project,
has published To Weep For A Stranger: Compassion Fatigue In
Caregiving. Along with in-depth explanations of compassion fatigue and
its symptoms and causes, the paperback features the following
comprehensive chapters:

Chapter 1: When Caring Too Much Hurts
Chapter 2: What Is Compassion Fatigue?
Chapter 3: Burdens Of The Chosen
Chapter 4: The Decision To Heal
Chapter 5: Standards Of Self-Care
Chapter 6: To Family Caregivers
Chapter 7: To Those Entering The Helping Professions
Chapter 8: When the Workplace Suffers
Chapter 9: To Weep For A Stranger

To order direct from the Createspace website for only $15, visit:

http://www.createspace.com/3393286

Workbooks:
Healthy Caregiving: A Guide to Recognizing and Managing Compassion Fatigue Level 1 –
Presenter’s Guide www.createspace.com/3363699

Healthy Caregiving: A Guide to Recognizing and Managing Compassion Fatigue Level 1 –
Student Guide www.createspace.com/3363698

CF Marketplace: http://www.cafepress.com/CFMarketplace

To Weep for a Stranger: Compassion Fatigue in Caregiving
www.createspace.com/3393286 (available 7/14/09

Have a kind and respectful day.

“Changing your Nursing Home Culture and Environment.” Part 2 of Interview with Frances Shani Parker, author of “Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes” on July 31st, 12pm PST.

Changing your Nursing Home Culture and Environment.” Part 2 of Interview with Frances Shani Parker, author of “Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes” on July 31st, 12pm PST.

Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics. To listen to Part 1: http://tinyurl.com/rdsf58

An award-winning writer, consultant, and former school principal, Frances shares insights and experiences about her years of hospice volunteering in Detroit nursing homes. Using stories, poems, and general information, she has written a groundbreaking book that is an inclusive and literal guide for becoming dead the right way. Topics include hospice, caregiving, dementia, death, bereavement, and strategies for improving eldercare and nursing homes. While universal perspectives are presented, the often missing views of people of color and residents in urban nursing homes are examined.

Frances’ background as an educator and her upbringing in New Orleans, LA add interesting layers to her problem solving in nursing homes and to her descriptive storytelling. She uses her writing and public speaking skills to advocate for senior citizens and promote conversations empowering others to have dignified death journeys. Her favorite anonymous quote is “If you think one person can’t make a difference, you haven’t been to bed with a mosquito.” Visit Frances in cyberspace at www.francesshaniparker.com and at her blog titled “Hospice and Nursing Homes http://hospiceandnursinghomes.blogspot.com

Video Poem: Reflections of a Hospice Volunteer (Hospice, Nursing Homes, Eldercare) 3:25 mins.

http://www.youtube.com/watch?v=LeBl5QtlPxg

Video Poem: “Pieces of Our Minds” (Dementia, Alzheimer’s Disease, Hospice, Nursing Homes) 2:24 mins.

http://www.youtube.com/watch?v=LgRoKDUEOUk

(Search under FrancesShaniParker on youtube.com.)

Have a kind and respectful day.

Moral Distress Part 2. When patients make bad decisions.

In the first part, we looked at one type of nurse’s moral distress. We focused on the stress we feel when we witness things that we know are wrong but feel helpless to do anything about it. Or perhaps we have tried to do something but nobody will listen. Today I want to talk about a different kind of moral distress.

This distress is also felt by healthcare professional but it is different because you can’t do anything about it. This moral distress is when a patient is making a decision that you don’t agree with. Patients are allowed, by law, to make their own decisions, including the decision to stop or refuse treatments even when they know they will die because of this decision. Patients have the right to do this because it is their body, not ours. We have to accept it as healthcare professionals but that doesn’t mean that we have to like it. These kinds of situations create terrible moral distress. Imagine having to stand by and watch someone die, when you know there is something you could do to stop it. You would feel helpless and frustrated and angry. These are normal reactions and this is what our healthcare professionals feel when they have to watch us make bad decisions.

If you are the patient, you need to understand that when you show up at the doctor’s office or at the hospital, the doctors and nurses think you are there because you want them to do something for you. Makes sense. But when you show up and then refuse what they have to offer, they will feel helpless and frustrated with you. You are entitled to make your own decisions but please understand that you are making it harder on the healthcare team. They are caring human beings. In no way am I saying you have to do the treatments because of their moral distress, just understand that the people taking care of you will feel the distress. Ultimately, the healthcare professional will have to find a way to live with themselves when you leave their office or after you die.

If you are the healthcare professional in this situation, one way you can manage your distress is to ask the patient more questions about why they are choosing what they are choosing. When you find out their story, you may be surprised by what you hear. Many times I have found myself agreeing with the patient’s decision after I hear the why. Yes, I wouldn’t make the same decision for myself, but it makes sense for them based on their values and beliefs. You can ask the patient if they are willing to reconsider but do not ask them to try to force them to change their mind. They do not have to justify themselves to you. If they don’t want to talk about it or reconsider, please respect this decision. Another technique I use in this situation is I ask them why they are saying no, in a non-threatening or demanding manner. When I do, I may discover that they have some misunderstanding about the treatment, the situation or the side effects. In having a compassionate discussion, oftentimes I can discover what is really worrying them and help them reconsider.

The last way I can offer for you to make peace with this kind of moral distress is to think about it as if you were the patient. Wouldn’t you want the choice and the right to make your own medical decisions? Would you want me to try to impose my values on you even though we might not be from the same culture or religion? You would want me to respect you. And I would. People have the right to make the wrong decisions. (except in pediatrics) This is the gift and the curse of autonomy. I am not saying it will be easy. Coping with this type of moral distress is our special obligation as healthcare professionals.

Part 1 https://kindethics.com/2009/06/nurses-moral-distress/
Have a kind and respectful day.

“Saving you Money on your Prescription Medications.” Interview with MrMedsaver, Jacob Milbradt, PharmD on July 23rd, 10AM pacific.

Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics.

If you’re struggling to afford your medication, MrMedSaver.com can help. On average, we’re able to show our clients how to save about 70% on their prescriptions. Here’s what R. Michael Dowden from Farmersville, OH, a recent MrMedSaver.com client, said about his Rx Savings Report:
“I can see already, the biggest benefit is putting information into the hands of the consumer. On some of these, I thought I already had the answers to what was the lowest cost and still effective medicine. Now I have alternatives that I can discuss with my doctor(s).”
Imagine if your mechanic selected which car you would purchase. Not having a firm grasp of fluctuating automobile prices, imagine if he chose your new vehicle without even taking cost into consideration. Instead, what if he based his decision solely on performance, looks, and amenities, and chose a brand new Mercedes? Would you stand for this? Of course not . . . that would be preposterous. Yet this scenario is the norm for the pharmaceutical industry.
Usually, the person who selects your medications (your doctor) has no idea what you’ll have to pay for them. The pharmaceutical industry changes at such a rapid pace that doctors simply can’t keep track of drug prices or developments like new generic availability. In fact, one of the key sources of drug information for doctors is drug company sales reps. These salesmen are highly trained at pushing doctors away from cost-effective generic medications, and toward the expensive brand-name drugs they are promoting. The design of the entire pharmaceutical industry is flawed, forcing you to pay much more than needed for your medications . . . and there’s no one to look out for you.
Now, with the help of Mr. MedSaver, that’s all about to change. Our company specializes in providing an independent assessment of your medication costs, ending with a report demonstrating numerous tactics you can employ to drastically reduce the amount you spend on prescription drugs. Think of us as the Kelley Blue Book for the pharmaceutical industry.
Mr. MedSaver was founded by Jacob Milbradt, PharmD, a pharmacist from Kansas who grew sick and tired of seeing his patients pay too much for their prescriptions. After daily encounters with people who couldn’t afford their prescriptions or who had to make difficult decisions, such as groceries vs. medication, Dr. Milbradt knew he had to do something that would make a real difference. After a large amount of research, he developed Prescription Cost Management—a revolutionary series of techniques that can be used to cut prescription drug costs to a mere fraction of what most people pay.
Now, these techniques have been taken to the next level—Personalized Prescription Cost Management. At Mr. MedSaver, we don’t have inflexible computer programs with “one-size-fits-all” recommendations. Instead we’ll provide you with a detailed analysis of your medications that is personally completed by a pharmacist and is 100% customized to exactly fit your unique needs.
We know how difficult it can be to afford your medications. We also realize how it often seems that there’s no one available to offer any real help. Well, not anymore. At Mr. MedSaver.com, we offer real results. Guaranteed. And remember, you can trust Mr. MedSaver for completely unbiased advice:
• We aren’t an internet pharmacy: The sole motivation of internet pharmacies is to make as much money as possible by profiting off your prescriptions. Because of this, saving you money isn’t a high priority for these companies.
• We don’t offer prescription “discount” cards: Prescription “discount” cards seldom actually offer much of a discount. In fact, most companies actually turn around and sell the data they collect whenever you fill your prescriptions!
• We will NEVER charge you to enroll in a FREE assistance program: Most websites that offer to enroll you in patient assistance programs won’t tell you that these programs are ENTIRELY FREE. Furthermore, these companies aren’t truly interested in saving you as much money as possible. Instead, they focus on continually milking your wallet every month with enrollment fees.
• We aren’t employed by your pharmacy: We don’t work for your pharmacy, and as a result our first allegiance is to you—NOT the company that sells you prescriptions.
• We are 100% independent: The big drug companies hate us, but you’re going to love us. That’s because we tell it exactly how it is. We have no financial ties to any pharmaceutical manufacturers. Also, we’ll never try to steer you toward pharmacies that have paid us to do this.

Have a kind and respectful day.

My dad would say that, “Dying is difficult because we have never done it before.” But we don’t need to be afraid because our bodies know how to die.

My dad would have told you that, “Dying is difficult because we have never done it before.” But we don’t need to be afraid because our bodies know how to die.

A few hours before my dad died, a couple of his friends stopped by to say their goodbyes. His friend Mary asked me, “What do you think your dad would be saying right now?” I said, “He would probably say that dying is difficult, because we haven’t done it before.” The reason I told her this was because he used to say the same thing about aging. “Getting older is difficult because we haven’t done it before.” How true both of these statements are because anything that is unknown to us can be scary. If we had done it before, we would know that it isn’t as bad as we thought it might be. We might realize that there can be profound lessons in aging and in dying. We might be at more peace during the dying process because we would know that our bodies know how to die. What do I mean by this? The act of dying is sometimes referred to as the labor of death. It is actually rather similar to the labor of birth, though hopefully a lot less painful. Let me explain.

When you were about to be born, your mother didn’t have to say to her uterus, “Please contract now and began to push the baby out.” Or, “Cervix, please dilate so the baby can come out.” Your mother’s body knew what to do and the labor of birth happened naturally. The labor of death is similar to the labor of birth because your body knows what to do. As you begin to near the end of your life you may begin to sleep more and to become less interested in the world around you. You may not have the strength to the things you used to do. As death gets nearer, you will begin to sleep even more and to eat even less. You’re just not hungry anymore and that is normal and all right. Your body knows that it’s time to shut down and that it doesn’t need extra food to keep it going.

Your body goes through predictable and peaceful changes as death approaches. Your skin will get cooler and your breathing patterns will change back and forth from fast to slow to barely there. You may get a fever. There are many other symptoms that you might also experience. You probably won’t be communicating at all at this point. But you can still hear and feel your family. Your loved ones should still talk to you as if you are there and hold your hand, give you a massage or climb into bed to embrace you. If you would like music to be played, then play their favorite songs.
They should do whatever they think you might like to comfort and support you.

It’s great if you have a hospice team in place to support you through this process. They can educate both you and your loved ones about what to expect at each stage along the way. Not everybody dies the same way but there are predictable patterns about what to expect. You don’t need to be afraid. You knew how to be born and you know how to die.

There is more information available on the Hospice Foundation of America website at www.hospicefoundation.org

Have a kind and respectful day.

“The Advanced Planning and Compassionate Care Act of 2009” Interview with Richard Handy from the WeCareHospice.com on July 29st, 10AM pacific, on blogtalkradio.com/kindethics

“The Advanced Planning and Compassionate Care Act of 2009” Interview with Richard Handy from the WeCareHospice.com on July 29st, 10AM pacific. Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics.

Find out more and then contact your United States Senator.

Here is a sample letter that Richard Handy provides with the necessary information:

I read with great interest “The Advanced Planning and Compassionate Care Act of 2009”, and while I feel it is an excellent piece of legislation, I also think there is one more item that should be considered.

As I am sure you are aware, for hospice agencies, Medicare has a cost containment strategy often referred to as the 80/20 Rule. According to this regulation, hospice patients must receive 80% of their care at home and no more than 20% at an inpatient hospice facility.

In general, any hospice patient whose care is so complex or demanding that the family can no longer continue to provide home care has two choices. The most expensive option is to go to the hospital emergency room and receive treatment and in most cases be admitted. This often involves very expensive time in the hospital’s ICU.

For example, if a hospice patient, diagnosed with COPD with major complications and co-morbidities is admitted to Singing River Hospital in Jackson County, MS, he will spend and average of 9.45 days with an average final charge of $43,222. This is fairly typical for other hospice diagnoses, CHF,CAD, HIV, ALZ, ALS, CVA, etc.

(2)
An option that achieves a positive outcome for the patient and is more economical is short term placement in an Inpatient Hospice Facility. Patients admitted for inpatient care are reviewed by the interdisciplinary team weekly. Therefore, an estimated average stay would be 14 21 days at an average daily rate of $542.50 or a total charge of $7395 to 11,392.50. This represents a significant savings of between $31,829 to 35,627. This savings is representative of a single exacerbation of the illness. Most patients repeat this process several times during the course of their illness.

Some of the patients inpatient hospice provides care for are those with:
• Bleeding—active or potential
• Sepsis
• Seizures
• Uncontrolled pain
• Any uncontrolled symptoms
• Imminent death under specific conditions
• Acute cardiac symptoms—myocardial infarction, arrhythmias

The primary difference between Inpatient Hospice and the Hospital is the skilled nursing and medical management of the patient. In hospice, the focus is on palliation of symptoms, with attention given to the family, and the psychosocial and spiritual support is provided that is so badly needed.

However, because of the Medicare 80/20 Rule, Most hospice agencies that provide inpatient care face the danger of excessive financial risk if they continue to provide care to all of the patients that require this type of service. These are patients without family support, some with very complicated needs, who require extended inpatient hospice stays, some with complicated morbidity and some who live in an environment that make it difficult to provide services.

(3)
I am asking you to help us help them by amending “The Advanced Planning and Compassionate Care Act of 2009” to include amending Title XVIII of the Social Security Act to remove the 20 percent inpatient limitation under the Medicare Program on the proportional hospice care certain hospice programs may provide. This would free agencies to accept all of the patients referred to their facilities without worrying about financial risk.

If you have any questions or would like to discuss how we can improve patient outcomes while reducing costs, please do not hesitate to call, 228-474-2030 (office) 228-990-5281 (cell) or email: rfhandy@wecarehospice.com

What is the difference between palliative care, comfort care and hospice care?

Dear Viki,

I’m kind of confused because I don’t understand the difference between hospice care, palliative care and comfort care. Is there a difference between these and if so, why do each of the doctors say different things? What are they trying to tell me?

Great question. I think sometimes even doctors and nurses get confused by these different words to describe pain management and end-of-life care. The words do mean different things but many times they are used to describe the same thing, the support your loved one will get during the dying process. In practice, doctors may be saying the same things even though they are using different terms. Let me try to explain.

Let’s start with palliative care. This is the most misused term because it describes both pain management when you’re healthy and the support you receive during the dying process. Palliative care is the global word to describe all of the care that is related to relieving suffering. Let me say it in a different way. To palliate means to relieve or lessen without curing, to mitigate or to alleviate. So sometimes the patient may go to a palliative care specialist, even though they’re not dying, to help them get their pain under control or to alleviate their physical symptoms. They’re not dying, they are just asking for good pain management. It frustrates palliative care specialists when people think that all they do is take care of the dying. This isn’t true. They take care of the suffering of all patients. And one group of these patients happens to be the dying.

Hospice care is for people in the dying process. A patient can get palliative care without dying but you can’t get hospice without being a dying patient. There are also different kinds of hospices, both volunteer hospices and medical hospices. I volunteer at a volunteer hospice and we provide respite care and support for the patient and family. We are like a good friend who stops by to help out. A medical hospice will provide volunteers as well as visits from nurses, doctors, social workers, chaplains and nursing aids as well as providing the patient at no cost, symptom management medications, medical equipment and oxygen etc.

Hospice care can also be found in different locations. It doesn’t always happen in the patient’s home. It can also be found in an outpatient hospice, an inpatient designated bed in the hospital, in a skilled nursing facility, a board and care or assisted living facility. Your location shouldn’t determine your eligibility for hospice, although there are a few facilities who are not accredited to have hospice patients in their facility.

Now let’s talk about comfort care. This is a word that is most often used inside of a hospital. At some point, the doctor may come in and talk to the patient or the loved one about putting the patient on comfort care. Here is what they’re trying to say. They are saying that, at this point they have nothing else they can do to cure your loved one’s disease. But what they can offer you is to keep them comfortable and to help them have a good death. It may not mean that your loved one is dying immediately but that the aggressive treatments that they have been trying are not working to get them better. And now they want to focus on relieving the suffering and keeping your loved one comfortable. They are not abandoning the patient but they are changing the focus from curing to caring.

Now maybe you’re saying to yourself, isn’t the relieving of suffering like palliative care? Isn’t comfort care, palliative care? This is where it gets confusing again. Remember that palliative care is for both when someone is fighting their disease and when a person is in the dying process. In reality, the patient should be getting palliative care throughout their medical treatment experience. But sometimes palliative care is brought in very late and only as part of the comfort care (dying) plan. So you will want to speak up and ask for good palliative support while your loved one is healing and later on when they are dying. Patients should not be suffering or be in pain. Doctors now know how to take care of these symptoms, but if your doctor doesn’t or won’t help, then ask for a referral to someone who does. But be careful because some doctors will think you mean palliative care as in dying support. Make sure you explain what you are asking for, recovery support or dying support.

So, back to your question: If the doctor in the hospital says comfort care, they mean dying care. If they say palliative care in the hospital, they probably mean dying but they might just mean suffering care. You will need to clarify this with them. If they say hospice, then that means you will probably be discharged from the hospital to go home to die.

If a doctor wants to make the patient comfort care in the hospital, the patient can probably go home on hospice or perhaps to a facility that can handle their medical situation with hospice support. If your loved one wants to die at home, you need to advocate for them and say, “They would like to go home on hospice.” You need to speak up about where and how your loved one would like to die. They are entitled to a good death and so are you.

Have a kind and respectful day.

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