Lyme Disease Support Group

Almost everyone is excited about going home after being in the hospital, skilled nursing center, or rehabilitation facility.

You should probably be able to go home once you are able to do the following:

•Get into and out of a chair or bed without much help

•Know how to walk around with your cane, crutches, or walker

•Walk between your bedroom, bathroom, kitchen

•Go up and down any stairs that you will need to use

Help You May Need

Going home from the hospital or facility does not mean you no longer need medical care. You may need help:

•Performing simple prescribed exercises

•Changing wound dressings

•Giving medicines, fluids, or feedings through catheters that have been placed into your veins

•Learning to monitor your blood pressure, your weight, or your heart rate

•Managing urine catheters and wounds

•Taking your medicines correctly

Also, you may still need help taking care of yourself at home. Common needs include help with:

•Moving in and out of beds, baths, or cars

•Dressing and grooming

•Emotional support

•Changing bed linens, washing and ironing laundry, and cleaning

•Purchasing, preparing, and serving meals

•Obtaining household supplies or running errands

•Helping with personal care, such as bathing, dressing, or grooming

Family Members or Friends

While you may have family members or friends around to help, it is important to make sure there will be enough help to ensure you have a quick and safe recovery.

Family and friends must be able to do all of the tasks and provide all of the help you need.

If not, you can talk to the hospital social worker or discharge nurse about getting help in your home. Sometimes, they will arrange for someone to come to the home and determine what help you may need.

Types of Homecare

Besides family members and friends, many different types of home care providers can come into your home to help with movement and exercises, wound care, and daily living.

Home health care nurses can help manage problems with your wound, other medical problems, and any medications that you may be taking.

Physical and occupational therapists can make sure your home is set up so that it will be easy and safe to move around and take care of yourself. They may also help with exercises when you first get home.

You will need a referral from your doctor in order to have home health care nurses, physical therapists, and occupational therapists visit your home. Your insurance will often pay for these visits if you have a referral. However, you should still make sure it is covered beforehand.

Other types of assistance are available for tasks or issues that do not require the clinical expertise of nurses and therapists.

Names of some of these professionals include: Home Health Aide (HHA), Certified Nursing Assistant (CNA), Caregiver, Direct Support Person, and Personal Care Attendant. Sometimes, insurance may pay for these also.

Update Date: 5/11/2012

Updated by:

C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, and

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine.

Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

Browse the Encyclopedia.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services.

Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies.

Links to other sites are provided for information only -- they do not constitute endorsements of those other sites.

Copyright 1997-2012, A.D.A.M., Inc. Duplication for commercial use must be authorized in writing by ADAM Health Solutions.

http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/ 000434.htm

Scant background checks of aides often leave frail elderly vulnerable, researchers say

Thursday, July 12, 2012

THURSDAY, July 12 (HealthDay News) --

Many home aides who care for the elderly in the United States have no training and don't undergo stringent background checks or drug tests, a new study finds.

In some cases, the caregivers get no supervision from the agencies that hire and place them. Most agencies questioned said they recruit aides from advertisements, including Internet sites such as Craigslist, and some agencies appear to lie about their employees' screening or education, the researchers found.

"There are good caregivers and good agencies, but consumers need to understand that there are questions that you need to ask," said study lead author Dr. Lee Lindquist, an associate professor at Northwestern University's Feinberg School of Medicine. "You need to be discerning about whom you hire."

Her study looked at the qualifications of caregivers who visit the homes of the elderly to assist with daily activities such as dressing and meal preparation. "These are not nurses," Lindquist said. "These are caregivers, private duty attendants. They don't need any medical training."

They may be expected to help with nutrition assistance, housekeeping, and scheduling medical appointments. But legally, these often low-paid workers can't administer medicine, although they can remind their clients to take their pills, she said.

Without adequate quality control measures, the frail elderly may be vulnerable to abuse, fraud or neglect, experts say.

For the study, researchers posing as consumers hiring caregivers questioned 180 caregiver agencies in Illinois, California, Florida, Colorado, Arizona, Wisconsin and Indiana -- states with large populations of elderly residents.

The study is published in the July 13 issue of the Journal of American Geriatrics Society.

Slightly more than half -- 56 percent -- of the agencies said they performed federal background checks and about one-third tested workers for drugs. Training ranged from nothing to seven days; in some cases, there was no supervision by the agency.

Two-thirds of the agencies said caregivers could assist in financial transactions, such as bill-paying.

Some agencies appeared to lie about their screening system. One agency said it relied on an assessment called the "National Scantron Test for Inappropriate Behaviors," while another mentioned "Assessment of Certification of Christian Morality."

Those don't seem to exist, the researchers said.

Although laws vary by state, the caregiver agencies don't tend to be regulated, Lindquist said, whereas nursing homes, whose services can be funded by Medicare, are regulated.

According to background information in the study, the typical aide is a recent female immigrant, earning $7.25 an hour on average or, for live-in help, $5.44 an hour.

Beth Kallmyer, vice president of constituent services at the Alzheimer's Association, agreed with Lindquist that consumers need to ask plenty of questions when seeking elder care.

It's also a good idea to pay surprise visits when the caregivers are working. "Drop in and see how it's going," she said. "These unannounced visits are a really good way to help people feel comfortable about what's going on."

The study authors also recommend asking caregiver agencies the following questions:

•How do you recruit caregivers, and what are your hiring requirements?

•What screenings are performed before you hire a caregiver? Criminal background check? Federal or state? Drugs?

•Do the aides have CPR (cardiopulmonary resuscitation) certification or any health-related training?

•Are the caregivers insured and bonded through your agency?

•What skills are expected of the caregiver you send to the home?

Examples: lifting and transfers, homemaking skills, personal care skills (bathing, dressing, toileting), and training in behavioral management. •

How do you assess the caregiver's capabilities?

•What is your policy regarding substitute caregivers if a regular caregiver cannot provide the contracted services?

•If you're dissatisfied with a particular caregiver, can he or she be replaced "without cause"?

•Does the agency provide a supervisor to evaluate the quality of home care on a regular basis? How often?

•Does supervision occur over the telephone, through progress reports, or in person at the home of the older adult?[/quote]

SOURCES:

Lee A. Lindquist, M.D., M.P.H., associate professor of medicine, Feinberg School of Medicine, Northwestern University, Evanston, Ill.;

Beth Kallmyer, M.S.W., vice president of Constituent Services, Alzheimer's Association, Chicago; July 13, 2012, Journal of American Geriatrics Society

http://www.nlm.nih.gov/medlineplus/news/ fullstory_127174.html

Copyright (c) 2012 HealthDay. All rights reserved.

Returning home from a hospital stay can result in unexpected allenges for many seniors.

Finding themselves back at home after a hospital stay, many older adults struggle to manage their medications and make followup doctor’s appointments as well as obtain the physical assistance and inhome support they may require, at least on a temporary basis.

As a result, many older adults do not successfully make the transition home well and end up returning to the hospital.

In fact, one in five Medicare patients are readmitted to a hospital within 30 days after discharge. Studies have shown that nearly half of the readmissions are linked to social problems and lack of access to community resources.

You can help ensure that you or your loved one makes a successful transition home from the hospital if you start planning for your hospital visit before you are admitted for a planned procedure or for unexpected visits to start planning for discharge the day of admission.

Planning goes a long way to help patients address the questions that arise during the discharge process and make a safe and smooth return home.

Where

member’s home? A rehab facility? Will you need help getting to followup doctor’s appointments? To the pharmacy? Will you need help with meal preparation? Bathing?

Who will assist you? Your family member? A home health aide? How long will you need assistance? will you go? Your own home?

A family

This guide is meant to help stimulate thinking about the answers to these and other questions. It is intended for older adults and their family and friends who will help them transition successfully from a hospital back home.

You can learn about transitioning home and more from the United Hospital Fund’s Next Step in Care (www.nextstepincare.org).

Additionally, you can learn about community resources that may be of assistance with your transition home from your local Area Agency on Aging.

The Eldercare Locator (www.eldercare.gov) can direct you to an agency in your area.

If you have a planned admission, and you know that you will be staying in the hospital for at least one night for an elective (nonemergency) surgery, tests or special procedures, planning takes several steps.

What do you need to do before you are admitted? What do you need to bring? You will likely get a packet of preadmission papers.

Ask for this packet if the hospital does not offer it.

The packet will have basic information about:

EMERGENCY! Not all trips to the hospital are planned. If you do not have enough time to plan and must go straight to the Emergency Room, be sure to bring any medications you are taking and health insurance information. It is a good idea to have an Emergency Room kit similar to thehospital kit.

PREHOSPITAL

■Tests you need before admission

■Where to go on the day of admission and what time to arrive

■Hospital policies, such as visiting hours

■Information about payment

How long will I be in the hospital?

HOSPITAL TEAM – Maintain regular communication with your “hospital team” – this group can include doctors, nurses, social workers, your caregiver(s) and other health professionals at the hospital.

If your primary care provider is not part of your hospital team,make sure that someone on the team or a family member is communicating with him or her.

Hospital Kit

Leading up to your hospital admission, you

should create a kit to take to the hospital.

Here are some items to include:

■ Insurance information and identification

card

■ List of your doctors, with contact

information

■ Emergency contact numbers

■ Test reports, lab results and copies of

recent Xrays

■ Names and dosages of all your

medications. Besides prescription drugs,

be sure to include vitamins, herbals,

laxatives and other overthecounter

products. You can use a “Medication

Management Form” to assist you.

■ List of any allergies

■ Health Care Proxy and Advance

Directives. You should prepare these

papers whether or not you are going to

the hospital, but if you have not done

this, the hospital can give you

information.

■ Other items to bring: eyeglasses,

dentures, hearing aids and toiletries.

■ DO NOT bring jewelry, money or other

valuable items!

POSTHOSPITAL

Hospital stays are often very short. As soon as a doctor says you are “medically stable,” the hospital will want to discharge you.

Depending on the condition, patients often transition from the hospital to home or to a shortterm rehabilitation program in a nursing home.

This section focuses on important considerations when you are heading home from the hospital or a rehab program.

Make sure you or your family caregiver talks to a discharge planner, someone at the hospital who helps plan a smooth transition home.

There are a lot of details to work out and the sooner you start the better. Here are some important issues to keep in mind:

Your Home

Make sure to order all the needed equipment and supplies. A member of your hospital team can help you with this task. If you are eligible for home care agency services, find out what the agency provides and what you must get on your own. Here are some good questions to ask:

■Will I need a hospital bed, shower chair, commode, oxygen supply or other equipment? If so, where do I get these items?

■What supplies do I need? This may be diapers, disposable gloves and skin care items. Where do I get these?

■Will my insurance pay for the equipment and supplies?

What type of care will I need when I return home?

Additionally, your home should be comfortable and safe, and a good place for care. Ask the hospital team if you need to do anything special to get ready. This might be to:

■Make room for a hospital bed or other large equipment

■Move out items that can cause falls, such as area rugs and electric cords (a good idea in any event)

■Create a comfortable space for a family member or friend who might be staying with you for a few days

■Find a place for important information, such as a bulletin board, notebook or a drawer

Health Care Tasks

You and/or a caregiver will likely do certain tasks as part of your care. What will you be able to do by yourself? What will you need help with?

It is important that you and/or your caregiver know how to do these tasks safely and properly. You and any caregivers you might have should try to learn as much as possible while you are still in the hospital.

You can do this by watching hospital staff as they do these tasks and asking them to watch as you try these tasks yourself.

Sometimes, hospitalas they do these tasks and asking them to watch as you try these tasks yourself.

Sometimes, hospital staff will not teach these tasks until the day you leave the hospital.This may not be a good time to learn if you feel rushed or overwhelmed.

Learn what you can and ask who to call if you have questions at home. You might be told to call someone from the hospital, a home care nurse or other health care professional.

If you are a caregiver, speak up if you are afraid of doing certain tasks (such as wound care) or cannot help with personal hygiene (like bathing or changing adult diapers).

The hospital team needs to know what tasks you can and cannot do so they can help you plan for any needed help.

Medication Management

It is important to be taking the right medications, at the right time and in theright amount. Here are some questions to ask that can help you do this job well:

■What new medications will I take? How long will I take them?

■Should these medications be taken with meals? At certain times each day?

■Do they have any side effects?

■Can new medications be taken with those I was taking prior to being admitted?

■Are any new medications listed in the “Medication Management Form,” along with other prescriptions, overthecounter medications, vitamins and herbal supplements?

■Do I get these medications from my pharmacy or the hospital?

■Will my insurance pay for these medications? If not, are there generic alternatives?

■For more useful tips, read the Eldercare Locator guide, “Managing Your Medicines.”

FOOD —Ask if there are certain foods you can or cannot eat.This might include specific foods such as milk or meat, or general types of food, such as very soft food or liquids. If you need special foods, try to buy them ahead of time when it is easier to shop.

Know Who to Call and What to Do

You may have a lot of questions during the first few days at home. Make sure you have phone numbers for people on the hospital team, as well as any home care agency involved with your care and a listing of community services you may need.

Make sure you know what to do for your care. This includes knowing:

■

Are there any symptoms that you must report right away, such as fever, intense pain, or shortness of breath? If you notice these symptoms, who do you call and what should you do?

■

Are there limits or restrictions on what your can do? For example, you might not be able to drive, take a bath, lift heavy things or walk up or down stairs.

■

Is it safe to be alone? How often should I ask a family member or friend to check in?

Community Resources

Many communities have resources that can help you and your caregiver, such as:

help with transportation for medical appointments, homedelivered meals, medication management assistance, chore services, inhome support services, as well as caregiver support and respite (time away from caregiving)

To find out about the local resources in your community, contact your local Area Agency on Aging, you can get connected with them by calling the Eldercare Locator at 800.677.1116 or visit www.eldercare.gov.

FOR CAREGIVERS

If you are a caregiver, bringing your family member home can be overwhelming. There are so many things to do and remember. Having a good plan is the first step. Try to focus on what must be done immediately.

The rest can wait. Be honest about your limitations, whether they relate to your own health, your job or other responsibilities.

The Next Step in Care guide “What Do INeed as a Family Caregiver?” is a good basis for a selfassessment of your needs. Ask other family members, friends and community agencies for assistance.

USEFUL RESOURCES

Eldercare Locator offers a variety of brochures with information for older adults and caregivers. Visit www.eldercare.gov (Resources tab) to view the “Managing Your Medicines” brochure mentioned in this publication, and more.

Next Step in Care offers many resources for patients and caregivers. Visit www.nextstepincare.org (For Caregivers section) to view the “Medication Management Form” and “What Do INeed as a Family Caregiver” guide mentioned in this publication, and more.

800.677.1116

www.eldercare.gov www.facebook.com/eldercarelocator

The Eldercare Locator is the first step to finding resources for older adults in any U.S. community and a free national service funded by a grant from the U.S. Administration on Aging (AoA).

The Eldercare Locator is administered by the National Association of Area Agencies on Aging (n4a).

www.nextstepincare.org

The United Hospital Fund’s Next Step in Care website has guides for family caregivers on many aspects of transitions, including medication management, discharge checklists, hospice and palliative care, and many others.

The guides are free and available in English, Spanish, Chinese, and Russian.

This publication was supported, in part, by a grant, No. 90AM3206, from the Administration on Aging, U.S. Department of Health and Human Services.

Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions.

Therefore, points of view or opinions do not necessarily represent official Administration on Aging policy.

http://www.eldercare.gov/Eldercare.NET/Public/Resources/ Brochures/docs/HospitaltoHome.pdf

Post edited by: Bettyg, at: 08/27/2012 09:03 PM

you are most welcome; NOT MINE, but when i find good things, i copy/paste them here for all to learn from.

glad you found benefit in this wonderful article.

lots of things to learn on this board. feel free to use the SEARCH feature now in center of top.

type in some specific words or a short question and then add IN LYME BOARD to all searches, click search.

go past ads, read summaries; if it's what you want, click on link to read full post and all replies.

you have to add in lyme board to ALL searches since there are now aroudn 850 OTHER MED. boards here!!

hugs/prayers,

bettyg

is your friend you are discussing from ALASKA or what state?

every state/county have their own home care services. where i live, i know i have at least 12 different companies/orgs who offer some type of care! i'm lucky!!

http://www.mdjunction.com/forums/lyme-disease-support- forums/medicine-treatments/2188386-guideline-nixes-tens-for- chronic-low-BACK-PAIN

BACK LOW PaIN

http://www.mdjunction.com/forums/lyme-disease-support- forums/medicine-treatments/3292587-use-of-mri-before- backpain-injections

http://www.mdjunction.com/forums/lyme-disease-support- forums/medicine-treatments/1669940-chronic-PAIN-ongoing- articles

PAIN ONGOING ARTICLES

http://www.mdjunction.com/forums/lyme-disease-support- forums/medicine-treatments/3824740-palliative-care-fear-and- anxiety#3824740

PALLIATIVE CARE FOR INCURABLE DISEASES .. FEAR AND ANXIETY

logging off, my families xmas gathering is this afternoon.

hugs/prayers, glad you found us.

bettyg

Basic Facts & Information

Role of Health Care Professionals in Home Care

Your physician is the leader of an interdisciplinary healthcare team that may include

nurses,

therapists (such as: speech, physical, occupational, and respiratory),

social workers,

personal care aides,

home medical equipment suppliers, and most importantly,

informal caregivers (eg, family members).

Although all team members are important, the physician is legally responsible for determining the older person’s health care needs.

Physicians also develop, certify, and recertify the plan of care.

House Call Services

Current regulations allow physicians, nurse practitioners, and physician assistants to provide house call services.

House calls can add to the healthcare provider’s knowledge of the circumstances and home setting of the older person, and may allow them to see and address problems that cannot be seen during an office visit.

For example, there may be barriers (such as, cluttered hallways and no railings) that prevent the older person from functioning as well as he or she could.

A home visit may also reveal caregiver burnout, elder abuse, or the use of medications that may get in the way of management or treatment of the disease.

House calls also help older adults who may have difficulty getting around outside of the home because they do not have to travel to see the healthcare team.

Is Home Care Right for You?

Home care is especially useful for patients who have one or more of the following characteristics:

•mobility problems that make transportation to the office difficult

•disruptive behaviors

•terminal illnesses

•multiple medical, psychiatric, and social problems

•either not responding to therapy or responding inconsistently.

Home care and house calls are needed for some patients for a limited amount of time, but others require house visits on an ongoing basis.

To qualify for Medicare home care benefits, a person must prove their homebound status.

Whether you qualify for benefits or not depends on if the person fits the following description:

1.The person should be home nearly all the time. He or she is allowed to be away from home for reasons other than medical treatment [b]up to three times per month.

An exception is if the person is out of the house for only short periods of time.

2.Leaving home must require considerable effort on the part of the patient, the caregiver, or both.

Examples are people who are bed-bound or who have severely impaired mobility. [/b]

For more details, take a look at the Centers for Medicaid and Medicare Services’ booklet on Medicare and Home Health Care.

Limitations of Home care

Most older adults prefer to remain in their own home. However, situations and conditions may come up that make care in an institution or facility more appropriate.

For example, caregivers may not be available to adequately address the needs of the older person.

Similarly, caregiver burnout and stress may prevent continued safe care for the older person in the home.

Some serious medical situations that require frequent testing, breathing treatments, or intravenous medications also may make care in an institution a better choice than home care.

In some cases, the home setting itself may be a barrier to continuing home care.

Unsafe neighborhoods, household troubles from alcohol or drug use, and not enough room for equipment or environmental modifications may make home care a poor or risky option.

Finally, home care is not always the least expensive choice, and out-of-pocket costs may make ongoing home care unaffordable.

Insurance coverage is more likely to cover care that is given in a nursing facility or other institutional setting.

Home Assessment & Modification

Homebound patients often have health problems or disabilities in one or more areas of their health and functioning.

Comprehensive geriatric assessment is particularly valuable in this situation.

A comprehensive assessment can be used to establish the initial level of health and functioning, monitor the course of illness, and evaluate effects of treatments.

Also, assessment in the home has some important advantages over office-based assessment.

Advantages of Home Assessment

The healthcare professional can see how the patient functions in their actual home environment.

This helps the healthcare professional determine if the home is safe and appropriate for the patient’s particular abilities and disabilities, or if changes need to be made.

For example, the health care provider can assess the practical aspects of performing activities of daily living (ADLs) such as bathing or dressing.

The healthcare professional can also evaluate the caregiver’s abilities to address the needs of the older person.

The caregiver’s needs for counseling, training, support, and education can also be identified and addressed.

There are two types of changes (modifications) that can be made to ensure that the home is safer for the older adult.

•Environmental modifications can be recommended to improve function.

For example, a hand-held shower, a shower seat, bathtub grab-bars, or a bedside commode might improve the patient’s quality of life and ability to function.

Barriers to wheelchairs and walkers (such as,door sills) can be identified and removed.

Chair lifts and outdoor ramps can be recommended to help patients manage stairs.

The assessment might also include an occupational therapy consultation.

This can be useful in identifying other personal care and assistive devices for performing ADLs and housekeeping chores.

A number of home safety checklists are also available to help with home assessment.

•Assistive Technology to improve home safety can also be considered.

These include necklace or wrist radio devices to call for help.

There are also emergency response systems that require a person to push a button by a specified time each day to avoid triggering an emergency response or checkup phone call.

Healthcare professionals are finding that portable or mobile testing technology (home diagnostics), including x-rays and electrocardiograms (ECGs), are available in most areas.

Hand-held laboratory devices are also becoming more common.

These home diagnostics allow for a much more comprehensive medical evaluation to be done in the home.

http://www.healthinaging.org/aging-and-health-a-to-z/topic: home-care/

Last Updated: March 2012

Posted: March 2012

© 2013 Health in Aging. All rights reserved.

By Mayo Clinic staff

Original Article: http://www.mayoclinic.com/health/hospice-care/HQ00860

Hospice care: Comforting the terminally ill

Hospice care might be an option if you or a loved one has a terminal illness. Understand how hospice care works and how to select a program.

By Mayo Clinic staff

If you or a loved one has a terminal illness and you've exhausted all treatment options, you might consider hospice care.

Find out how hospice care works and how it can provide comfort and support to you or your loved one, as well as your family and friends.

What is hospice care?

Hospice care is for people who are nearing the end of life.

Hospice care services are provided by a team of health care professionals who maximize comfort for a terminally ill person by reducing pain and addressing physical, psychological, social and spiritual needs.

To help families, hospice care also provides counseling, respite care and practical support.

Unlike other medical care, the focus of hospice care isn't to cure the underlying disease. The goal of hospice care is to support the highest quality of life possible for whatever time remains.

Who can benefit from hospice care?

Hospice care is for a terminally ill person who's expected to have six months or less to live. This doesn't mean that hospice care will be provided only for six months, however.

Hospice care can be provided as long as the person's doctor and hospice care team certify that the condition remains life-limiting.

Hospice care isn't just for people who have cancer.

Many people who receive hospice care have cancer, while others have heart disease, dementia, kidney failure or chronic obstructive pulmonary disease.

Hospice care has been shown to make people who have incurable illnesses feel better and live longer.

Enrolling in hospice care early might help you or your loved one develop a strong relationship with the hospice staff, who can help with preparation for end-of-life needs.

Where is hospice care provided?

Most hospice care is provided at home — with a family member typically serving as the primary caregiver.

However, hospice care is also available at hospitals, nursing homes, assisted living facilities and dedicated hospice facilities.

Keep in mind that no matter where hospice care is provided, sometimes it's necessary to be admitted to a hospital.

For instance, if a symptom can't be adequately managed by the hospice care team in a home setting, a hospital stay might be needed.

Who's involved in hospice care?

If you're not receiving hospice care at a dedicated facility, members of the hospice staff will make regular visits to your home or other setting to provide care and other services.

Hospice staff is on call 24 hours a day, seven days a week. A hospice care team typically includes:

•Doctors. A primary care doctor and a hospice doctor or medical director will oversee your or your loved one's care.

•Nurses. Nurses will come to your or your loved one's home or other setting to provide care. Nurses also are responsible for coordination of the hospice care team.

•Home health aides. Home health aides can provide extra support for routine care, such as dressing, bathing and eating.

•Spiritual counselors. Chaplains, priests, lay ministers or other spiritual counselors can provide spiritual care and guidance for the entire family.

•Social workers. Social workers provide counseling and support. They can also provide referrals to other support systems.

•Pharmacists. Pharmacists provide medication oversight and suggestions regarding the most effective ways to relieve symptoms.

•Volunteers. Trained hospice volunteers offer a variety of services depending on your needs, from providing company or respite for caregivers to helping with transportation or other practical needs.

•Other professionals. Speech, physical and occupational therapists can provide therapy, if needed.

•Bereavement counselors. Trained bereavement counselors offer support and guidance after the death of a loved one in hospice.

How is hospice care financed?

Medicare, Medicaid, the Department of Veterans Affairs and private insurance might pay for hospice care.

While each hospice program has its own policy regarding payment for care, services are often offered based on need rather than the ability to pay. Be sure to ask about payment options before choosing a hospice program.

How do I select a hospice program?

To find out about hospice programs, talk to doctors, nurses, social workers or counselors, or contact your local or state office on aging. Consider asking friends or neighbors for advice.

The National Hospice and Palliative Care Organization also offers an online provider directory.

To evaluate a hospice program, ask questions about the services offered. For example:

•Is the hospice program Medicare-certified? Is the program reviewed and licensed by the state or certified in some other way? Is the hospice program accredited by The Joint Commission?

•Who makes up the hospice care team, and how are they trained or screened? Is the hospice medical director board certified in hospice and palliative care medicine?

•Is the hospice program not for profit or for profit?

•Does the hospice program have a dedicated pharmacist to help adjust medications?

•What services are offered to a terminally ill person? How are pain and other symptoms managed?

•How are hospice care services provided after hours?

•How long does it take to get accepted into the hospice care program?

•What services are offered to the family? What respite services are available for the caregiver or caregivers? What bereavement services are available?

•Are volunteer services available?

•If circumstances change, can services be provided in different settings? Does the hospice have contracts with local nursing homes? Is residential hospice available?

•Are hospice costs covered by insurance or other sources, such as Medicare?

Remember, hospice stresses care over cure. The goal is to provide comfort during the final months and days of life.

HQ00860 Feb. 2, 2013

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Home care organizations all across the country are working to make health care safe. As the patient, you can make your care safer by

being an active, involved and informed member of your health care team.

The “Speak Up” program is sponsored by The Joint Commission. They agree that patients should be involved in their own health care.

These efforts to increase patient awareness and involvement are also

supported by the Centers for Medicare & Medicaid Services.

This program gives simple advice on how you can make health care a good experience. Research shows that patients who take part in decisions about their own health care are more likely to get better faster. To help prevent health care mistakes, patients are urged to “Speak Up.”

SpeakUPTM

To prevent health care errors, patients are urged to...

SpeakUPTM Help Prevent Errors in Your Care Home

http://www.jointcommission.org/assets/1/18/speakup_hc.pdf