Archive for February 2016

The Stigma Around Palliative Care and The Truth You Should Know

Posted on Feb 24, 2016

Palliative care focuses on relieving the discomfort and distress associated with serious illnesses. It's recommended by primary physicians in a variety of situations, whether the illness is likely to be fatal or not. Many medical professionals regard palliative care as something that should be a routine part of a patient's care, but patients and their families often balk at the suggestion that they recieve it. This is likely due to the misconception that palliative care is only applicable for those near the end of their lives. But palliative care is not a stage or phase. While it shares many characteristics of hospice care, it's not synonymous with hospice and has some key differences. 

The benefits of palliative care are numerous. Concerns over pain, and other symptoms that may not be part of your regular conversations with a specialist, are part of a typical conversation with doctors and nurses administering palliative care. Additional help can even be supplied from social workers to help coordinate schedules, help organize insurance, or just answer additional questions. Individuals receiving palliative care also typically enjoy a higher quality of life than those receiving standard care. Depression affects fewer palliative care patients, as well. 

Palliative care became an approved medical specialty in 2007, and since then it has become an offered service in more than 70-percent of US hospitals. That number explodes to 90-percent of hospitals with more than 300 beds. 

Because of the belief that palliative care signals the end of a patient's life expectancy, and the stigma associated with the term 'palliative care', some facilities have started referring to it by a euphemistic name, such as "the symptom management service". This helps to take the fear out of palliative care while also being able to administer the beneficial services patients need. 

Those benefits have been proven through a number of studies. One such study, a 2010 randomized trial of 151 lung cancer patients, found that those starting palliative care early in their treatment were less likely to receive aggressive treatments like chemotherapy in their final weeks, but were also found to survive several months longer on average when compared to patients receiving standard treatment. This study also found that, because aggressive treatments were not as prominently used, palliative care patients also enjoyed a much higher quality of life and fewer suffered from depression. 

Similar studies have concluded that palliative care patients are less likely to spend time in intensive care units, have greater satisfaction with care, and higher spiritual well-being. For those with lung disease, palliative care patients also reported greater relief from breathlessness. 

The key in most of the research conducted has been the length of time a patient spends in palliative care. Typically, the longer the time in palliative care, the more beneficial the care can be. A study of patients in their 60s and 70s found that those who stayed in palliative care for at least 90 days were significantly less likely to have late-life hospitalizations, visit the ICU, or ER. 

The reduced hospital visits for most palliative care patients translates into thousand of dollars in savings per patient. That can be attributed to a variety of factors, but namely is due to the pain and symptom management and the increase in quality of life. When patients are comfortable, they're typically less likely to require emergency medical help. 

Despite all of this, only about a third of eligible patients ever begin palliative care. For some, they may not be recommended it by their physician, but many others opt not to explore that option due to misconceptions about what palliative care is, and what it means for their prognosis. And that inappropriate association exists even in the mind of many medical professionals. 

In reality, about 40-percent of palliative care patients experience improvement in health, and either "graduate" to other treatment options, or no longer need treatment at all. 

If you or a loved one are facing a serious illness, call us at Cura-HPC to learn more about palliative care and how it could prove to be beneficial. We can also answer your questions about hospice care, so you can make the best care choices. 

Advance Care Planning: Communicate Your End Of Life Care Wishes

Posted on Feb 18, 2016

Senior couple and medical professional

There are a number of options for end of life care, and a number of considerations to make when deciding which is right for you or your loved one. These decisions are difficult to make, and are made even more difficult when time is a significant factor and treatment is needed right away. That's why advanced care planning is so important. It allows you to make decisions for yourself well ahead of the crucial time when you'll need them. This also lays out a clear plan of care for your loved ones should you be incapable of communicating these wishes when they're needed. This ensures that your end of life care goes how you envision it, rather than being forced into facilities due to timing and circumstances. Here's some good information on advanced care planning that everyone should know. The best time to start planning is right now, before you need to. 

Advance Care Planning Statistics

The California HealthCare Foundation completed a survey in 2012 that found, while many understand that planning for care is important, it's a topic and task that is often ignored. A majority of the participants in the survey rated "making sure family isn't burdened by touch decisions" as "extremely important". However, a similar majority admitted they haven't communicated their end of life wishes to anyone. Only 23-percent of respondents had put anything in writing regarding their care wishes, despite 82-percent believing that it was important to do so. And, only 7-precent had talked to their primary physician, or any other medical professional, about end of life care. It's not an easy conversation to have, but it's an extremely valuable and important one. 

Topics To Discuss

Talking about end of life care with your family and medical professionals can be made easier through some planning of what topics need to be covered. First should be your physical needs and the environment you'd like to be in. Preferences on dying at home versus in a nursing facility or hospital should be clearly expressed. So too should be who you want around in your final days. Family members should know if you'd like their help, or company, so they don't feel in the way when that time comes. Additionally, let them know if you want the help of paid caregivers, or if you'd like to spend time alone or with a spouse. Funeral plans should come next on your list. You'll need to decide between burial or cremation, and organ donation. You'll also want to express any specific wishes you have for the funeral ceremony. There are also legal and financial matters to cover, including preparing your will, assigning co-signers to bank accounts, and guardianship arrangements. Finally, consider any other personal matters that may be important to you during your end of life care. For example, some patients want to experience their favorite hobby one more time, or to take one last trip. For wishes or unfinished business, it's important that your family and physician are aware and able to help you. 

Documents Needed

While communicating your plans is important, you also need to include them in writing in specific documents. This ensures that you're legally protected and that the end of life care you've drawn out is what you receive. Start with a living will. This acts as a blueprint for your medical care and will include specific instructions to follow for certain healthcare circumstances. If you are unconcsious or otherwise unable to communicate, this document will provide guidance for your family and doctors. A Healthcare Proxy is another document you'll need to complete. This is where you'll select your durable power of attorney, or healthcare surrogate, who will be able to make medical decisions for you when you're not able to, and when direction isn't specified in your living will. Rules for notarizing and requirements for witnesses for these documents vary by state, so be sure you investigate these rules before completing these documents. 

At Cura-HPC, we invite families to meet with us for consultation on end of life care options and ask questions about hospice and palliative care. Contact us at (800)797-3839. 

Defining 3 Common Forms of Dementia and Their Symptoms

Posted on Feb 11, 2016

For many, dementia is an all-encompassing term that covers all occurrences of cognitive decline. For those in the medical community, however, there are specific types of dementia that have significant, and sometimes subtle differences. It's important to make the distinction between these different types of dementia because there will be different care recommendations and treatments for each, not to mention different expectations for caregivers and family members. Here are three major types of dementia that account for the majority of diagnoses. 

  • Common symptoms

Before getting to the differences between diagnoses, it's important to understand the commonalities displayed in all dementia types. Memory loss is the most widely known symptom of dementia and is typically the first complaint of patients and their families. In many cases, however, memory loss is confused with other cognitive difficulties. For example, taking longer to process information, shorter attention spans, and difficulties with language can resemble memory loss. These symptoms are often accompanied by confusion around familiar people and places, difficulty with complex tasks orientation issues related to time and place. These cognitive changes are present in all types of dementia, but there are differences within them that help make a specific diagnosis. 

  • Alzheimer's Disease

About 60 to 80 percent of all dementia cases are attributed to Alzheimer's Disease. As of 2015, it was the sixth leading cause of the death in the US. Alzheimer's is slow progressing, and typically the first noticeable symptom is memory loss. Over time, impairment of other cognitive functions becomes more significant. Paranoia is also commonly observed in Alzheimer's patients, as well as accusatory behavior of caregivers and even family members. It's important to specifically diagnose Alzheimer's Disease because it's one of the few forms of dementia that responds to treatment with certain medications. The progression of symptoms has been slowed through the use of acetylcholinesterase inhibitors, Rivastigmine, and a multi-receptor antagonist known as memantine. 

  • Vascular Dementia

Complications relating to blood vessels, most commonly a series of strokes, results in this type of dementia. Historically, Vascular Dementia has been referred to as post-stroke, or post-infarct dementia, but strokes are not the only cause. Lifestyle choices that result in the blockage of vessels can also be to blame, which could include unhealthy diet, lack of exercise, or smoking. Vascular Dementia only accounts for about 10-percent of all dementia cases, but also has the potential for prevention. While memory loss can be a part of Vascular Dementia, it's often other symptoms that present themselves first. This is typically impairment in judgment and reasoning. The treatment and prevention of Vascular Dementia is closely related. Making healthier lifestyle choices has been shown to lower your risk and to slow the rate of cognitive decline. 

  • Lewy Body Dementia

This type of dementia combines cognitive changes with problems with movement, which can include walking and stability or the occurrence of tremors. Visual hallucinations are also typically pary of Lewy Body Dementia. While many are not familiar with Lewy Body Dementia, it is the second most common dementia diagnosis in the US. In addition to the symptoms, patients also exhibit more variation than those with other forms of dementia. Alertness and memory can exhibit significant changes in a short amount of time. Again, it's important to diagnose Lewy Body Dementia to ensure the correct treatments are being administered. When prescribing medications, it's important to know that about half of Lewy Body Dementia patients experience worsening cognitive ability, heavy sedation and the possibility of neuroleptic malignant syndrome when treated with antipsychotics. Lewy Body Dementia is also one of the fastest progressing forms of dementia with an average life expectancy of five years after diagnosis. 

It's important to understand these different forms of dementia if you have a loved one experiencing cognitive decline, or have a history of dementia in your family. Knowing this information can also help to prevent dementia in some cases. 

If you'd like to make plans for your future care, or have a loved one in need of end of life care, contact us at Cura-HPC to learn about our services and the benefits of hospice and palliative care. 

Exploring Common Objections To Starting Hospice Care

Posted on Feb 04, 2016

Hospice nurse and elderly couple

Choosing care options for a loved one with a life-limiting illness is, of course, extremely difficult. Particularly when multiple family members are involved, there are a number of differing opinions and emotions to deal with. When it comes to hospice care specifically, there are two common objections that are mentioned more than any others. Here is a brief explanation and exploration of each. 

  • Not ready for hospice

This argument against starting a patient in hospice care can stem from a medical concern, emotional concern, or a combination of the two. The family may feel that their loved one's prognosis isn't severe enough yet to warrant hospice care. Or, they may not want their loved one to think that the family, or the patient themselves, is giving up. Of course, hospice care isn't about giving up and some education about its benefits can be helpful in this case. There are even studies to point to that suggest that hospice care improves quality of life, reduces the stress on families, and, in some cases, has even prolonged life. There are similar studies that counter objections over the severity of a patient's illness. Most notably, that patients who receive hospice care for longer typically enjoy more benefits from it. Again, education can be key. Hospice care doesn't have to begin when a patient only has days left to live. Instead, it can be used for several months to ensure a patient is able to enjoy a high quality of life for the time they have left. 

  • My loved one will die sooner

This is a related objection and typically stems from the belief that hospice care is akin to giving up. While the treatment plan under hospice care is likely less aggressive than the treatment received in a hospital, research supports hospice's ability to prolong patients' lives in many cases. This can be attributed to a lower stress environment, the management of pain and symptoms, and the comfort of being at home and around family. Rather than abandoning hope when electing to start hospice care, patients are able to redefine goals for treatment and fully embrace their situation. That often means they're able to attend a special event, like a family wedding, or enjoy one last boat ride or enjoyable experience, that otherwise would have been impossible. This approach to end of life care prioritizes the patient's wishes and comfort in order to provide them with days well spent. 

If you'd like to learn more about hospice care, we invite you to contact us at Cura-HPC. Our experienced staff of medical professionals would be happy to help you decide whether hospice and palliative care is right for your loved one, or to help you develop a plan for your own end of life care. Call us at (800)797-3839.