Hospice & Palliative CareCenter is committed to improving excellence in the delivery of palliative, hospice, and end-of-life care.

Continuing Medical Education Offerings
Hospice & Palliative CareCenter’s medical staff services department offers several opportunities for medical professionals to gain a deeper understanding of end-of-life care.

Through a series of conferences, case studies, and other forums, our team of experienced physicians and nurse practitioners, will offer the following opportunities:

CME General Medicine Conference Series in Palliative Medicine
Hospice and palliative care focused training – various topics offered by our staff and guest speakers. The conference series is open to medical staff and other healthcare professionals interested in expanding their knowledge of Hospice and Palliative medicine.

Conferences are offered the 2nd & 4th Friday’s of each month and run from September thru June. Appropriate continuing education credits are awarded to healthcare professionals who attend.

For more, visit http://www.hospicecarecenter.org!

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Is life with a terminal illness hopeless? Not at all. Seriously ill individuals thrive on hope, just like the rest of us. It gives us a sense of purpose.

According to hospice expert Cathleen Fanslow-Brunjes, hope in serious illness typically has four main stages:

- Hope for a cure. “I’m not going to let this stop me.”
-  Hope for treatment. “I think the radiation is really working!”
- Hope for prolongation of life. “I want to go to the family reunion.”
- Hope for a peaceful death. “I’m hoping for no pain in my final days.”

The four stages often align with disease progression. But it’s not uncommon for a person to move back and forth among them.

Knowing the four stages, you can better support your family member in sustaining his or her hope. Listen carefully for comments that indicate hope.

Many families are concerned about “realistic hope.” Find out what your loved one is hoping for and ask the doctor if it is feasible. If so, then all of you can work toward this shared goal.

If the hope is not realistic, it may signal the need for a change in care goals. But it does not mean your loved one must be without hope! Instead, it means you need to talk together with the doctor and come up with a more achievable project or purpose.

Dr. David Casarett, a hospice physician, wrote an insightful book about this topic called “Last Acts.” It specifically looks at the many ways his patients chose to find meaning in their last few months, weeks, and days.

Hope is always available. We just need help knowing how to look for it.

For more, visit http://www.hospicecarecenter.org!

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Some people maintain strong driving skills as they age. But over time, most of us lose physical abilities that are key to safe driving. Indeed, only teens have more accidents per mile than do adults over age 65.

Advanced years alone are not a reason to stop driving, however. Health, fitness, and thinking power, not age, determine a person’s ability.

Following are signs of possible problems:

- Trouble with vision or hearing. Watch for problems seeing lane lines or pedestrians, overlooking stop signs, or judging the speed of oncoming traffic. Other signs include discomfort with glare or driving at night.

- Inability to twist or turn easily. Arthritis and stiff muscles can make it painful to turn and look when needed. This can lead to trouble when backing up, changing lanes, or merging with traffic.

- Medication use. Many medicines can slow thinking and response time. Drugs for depression and anxiety can do this, as can sleeping pills and medicines for heart conditions, colds, and allergies.

- Dementia. At “early” stages, many individuals can still drive safely. Talk to your loved one’s doctor about a driving skills evaluation.

- Two or more recent tickets. Consider tickets a yellow, warning light. Common infractions include poor parking, running a stop sign, or going the wrong way.

- Two or more recent accidents. Parking lot and sideswipe accidents indicate driver error. Poor depth perception also causes seniors to have a very high rate of left turn accidents.

Take regular ride-along outings. Notice your loved one’s skill level and confidence level. Ask for input from friends and neighbors.

It is important to approach this subject with sensitivity. In the meantime, you may want to explore self-assessments your loved one can take privately, at home. These two were created by the American Automobile Association’s Foundation for Traffic Safety.

AAA Roadwise Review (30-minute multimedia screening tool measuring specific mental and physical capabilities)

AAA Drivers 55 Plus: Self-Rating Form (15 multiple choice, text-based questions)

For more, visit http://www.hospicecarecenter.org!

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Are drug costs a worry for your elder family member? This year, new assistance is available for many Medicare Part D participants.

Your family member may qualify for “Extra Help.” This program helps pay for a Medicare prescription plan. It trims monthly premiums and the annual deductible. And it shrinks the co-pay costs for prescriptions. The average annual savings is $3,900.

If your family member didn’t qualify for the program last year, apply again. There are new criteria this year. They make the “extra help” available to more people. Eligibility is based on income and financial resources. Specifically,

• Income must be less than $16,245 per year for an individual or $21,855 for a couple.
• This year, income does NOT include any help received from others for expenses such as rent, utilities, and food.
• Financial resources include bank savings, stocks, and bonds. An individual can have no more than $12,510 in such savings. A couple can have no more than $25,010.
• This year, life insurance policies are not counted.

You can apply online or call Social Security at 800-772-1213. Ask for help with prescription drug plan costs. They will send you the application.

Even without Extra Help, your loved one may get a rebate. The rebate is for individuals who fall into the Medicare Part D coverage gap. This is also called the “donut hole.” This year, everyone reaching the coverage gap will receive a tax-free rebate of $250. No application is necessary. A rebate check will be sent automatically to those who qualify. Next year, a 50% drug discount is planned for people who fall in the donut hole. The discount will apply to brand name drugs covered by the individual’s Part D plan.

Some drug companies offer special assistance programs. Check our prescription assistance page for information.

For more, visit http://www.hospicecarecenter.org!

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Ann Gauthreaux and Jane Smart from Hospice & Palliative CareCenter appear on Triad Today to discuss Palliative Care and the addition to the Kate B. Reynolds Hospice Home.

For more, visit http://www.hospicecarecenter.org!

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What is Palliative Care?

Palliative care is medical care focused on relief of pain, symptoms, and stress of serious illness – whatever the diagnosis. Palliative care is provided simultaneously with all other medical treatments.

How can the Palliative Care team help me and my family?

When you are on the front lines of an illness, you need answers, relief, expertise, and support. Our team of board-certified physicians, nurse practitioners, and licensed counselors makes sure that all your concerns are addressed.

For more, Visit us at: http://hospicecarecenter.org!

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Perhaps you’ve heard of “adult day care.” Although you may be reluctant to consider it for your parent, research shows the benefits are undeniable.

Three basic kinds of adult day programs are offered across the country.

• Adult social programs provide activities, meals, and personal care.
• Dementia-focused programs are like social programs but are geared for individuals with memory loss.
• Adult day health programs provide activities and meals, as well as therapeutic and social work services. They serve individuals with serious medical concerns and/or dementia.

Most programs provide transportation to and from the center. The average cost is $67/day, although you may be eligible for assistance. (If your loved one spends at least 8 hours a day living with you and is financially dependent, you may be eligible for Dependent Care Tax Credits from the IRS.

Day programs create a win:win for you and your parent. Researchers report:

• Reduced stress for family caregivers.
• Increased quality of life for program attendees.
• Fewer dementia-related behavior problems over time.

Concerned that your parent will say “no”? Studies of dementia-focused programs find this is not a common problem. Still, follow these tips for a successful transition:

• Start slowly. Have your loved one attend for a few hours at first, then a full day. Build up to several days a week.
• If your loved one has dementia, new places and faces may cause anxiety or resistance. Stay with them initially to ease their adjustment.
• If your loved one does not have dementia, be sure the program has other non-impaired attendees.
• Discuss your concerns with center staff. They are experienced at helping newcomers fit in.

See our Community Programs page on adult day centers for more details.

For more, Visit us online at: http://hospicecarecenter.org!

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It’s difficult to know what to anticipate when traveling with a frail family member. Here are tips from experienced, disabled travelers to reduce your road-trip stress this summer.

If your travel includes hotel lodging:

• Talk directly with the hotel. Many chains have a centralized reservation system. Get a direct, on-site number instead. Then ask to speak with the head of housekeeping or engineering. With their intimate knowledge of the building, you can ask them to describe the disability features: How wide are the doorways? Does the bathroom have grab bars? And don’t forget to ask about access to the hotel from the street!
• Reserve the room. Confirm that you are guaranteed an “accessible” room. Reconfirm a few days in advance of your arrival. If your room is not available or not accessible, ask to speak with the manager. It is the hotel’s responsibility to find you suitable alternate lodgings.

You might also consider bringing these items. You’ll find them sold online or at medical supply stores.

• A folding ramp. An easy way to eliminate a short flight of stairs.
• Safety items for the bathroom. Consider a lightweight toilet seat extender. For bathing, look for a suction-based grab bar, or folding shower bench and slip-on shower hose. Add nightlights to improve visibility after dark.
• Chair comfort. Bring a lap blanket and special pillows if your family member will be spending a lot of time sitting. Or a small fan to help with cooling. A swivel seat cushion may help a lot with getting in/out of the car.

To help your loved one join in excursions, consider a wheelchair. A wheelchair can preserve your family member’s energy. All transport chairs fold, but some are made for travel and pack easily in a small bag.

For more, Visit us online at: http://hospicecarecenter.org!

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We’re all aware that diet affects health. But did you know that people with COPD (chronic obstructive pulmonary disease) can help themselves breathe better by making simple changes to their eating habits?

What we eat

The food we eat combines with the oxygen we breathe to create energy and carbon dioxide. Our body needs the energy to function. The carbon dioxide is a waste product we need to dispose of. Too much of it is toxic. But having to exhale a lot can be tiring.

• Limit sugar and sugary foods such as candy, cake, and soft drinks. Carbohydrates (sugars and starch) produce more carbon dioxide than fats or proteins. They make more work for the lungs.
• Fats produce the least carbon dioxide. The best fats are polyunsaturated fats such as vegetable oils and soft margarine (look for those labeled “zero trans fat”).
• Protein is necessary to maintain the respiratory muscles. At least two servings a day is recommended: eggs, dried beans, dairy products, and meats.
• Limit foods that produce gas, such as carbonated beverages, dried beans, cauliflower, and broccoli. They cause the stomach to expand which puts pressure on the diaphragm.
• Limit salt. It can cause the body to retain fluid, making it harder to breathe. See our January 2010 article on reducing salt.

The way we eat

• Consider eating four to six small meals a day and minimizing fluid intake at mealtime. It’s harder to breathe when your stomach is full.
• Eat earlier in the day. If energy is generally low by dinnertime, focus on consuming more of the day’s calories in the morning and afternoon.

As always, check with a doctor or dietitian to determine the diet that is right for your loved one. You can search for a registered dietitian near you at www.eatright.org.

For more, Visit us online at: http://hospicecarecenter.org!

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These additional factors play a key role in adequately protecting you and your heirs.

1. Review ownership and beneficiary designations. You can unwittingly limit your power to distribute certain types of property through your will. In the case of a married couple that owns all property in joint tenancy, the will of the first spouse to die may lose its effectiveness.

2. State your health care wishes through a living will. This simple document outlines your preferences about lifesaving medical treatments in certain circumstances such as if you are terminally ill. Combine this with a durable power of attorney for health care to appoint someone to make your medical decisions if you cannot make them yourself.

3. Keep your financial affairs private. Unlike a will, a revocable living trust is not available under public records, and all assets in the trust are handled with the same privacy. Your personal family business is not exposed.

4. Include a trust in your estate plan. If you have substantial financial assets, consider creating a credit shelter trust in your plans. The potential benefits include estate tax-saving opportunities that can help ensure that your heirs will not have to liquidate those assets to pay estate taxes.1

5. Finally, allow yourself peace of mind. Seeking professional advice and looking at all your options can lead to a tax-wise estate plan that meets the needs of your heirs and your favorite charitable organizations, such as Hospice & Palliative CareCenter, giving you the comfort of knowing that your assets will benefit those you leave behind.

Have questions? We can help. Contact Ellen Coble at 336-331-1312 or ellen.coble@hospicecarecenter.org.

1Currently federal estate taxes are repealed for all deaths that occur in the calendar year 2010. In 2011, estate taxes are scheduled to be reinstated for estates worth more than $1 million at rates up to 55 percent. Congress, however, is likely to address reinstating estate taxes before 2011. What the final legislation will look like and when it might become effective is unknown at this point.

For more, Visit us online at: http://hospicecarecenter.org!

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