A physical therapist’s perspective

By Fran Moore, PT

When people ask me what I do in homecare, they are often surprised to learn that many of the patients I work with are hospice patients. The first response I often hear is, “It seems that a hospice patient could not tolerate physical therapy.” Patients and caregivers often confuse physical therapy with physical training. And, while it’s true that physical therapists provide “physical training” with some patient populations, the role of the physical therapist with the hospice patient and his caregivers is very different than it is with traditional rehab patients.

Who needs this? Causes of nausea and vomiting in hospice patients

By Lauri Weiss, CRNP

Linda was a young hospice patient—just 54. She had battled cancer and agreed, with her family and physicians, that further treatment wasn’t going to prolong her life in any meaningful way. So, she was surprised when she experienced ongoing nausea, even after ending her chemotherapy treatments. Her family, already wrung out by her treatment regimen and their own emotions, thought this would be a period in which Linda would be more comfortable. They were tired, she was tired, and everyone just wanted the nausea to end.

When someone is already weak, nausea and vomiting just seem to add insult to injury—discomfort and stress and make a hard situation harder for both the hospice patient and the caregiver.

What does a speech therapist do in hospice care?

By Terri Durkin, SLP and Maggie Vescovich, SLP

It may seem like every time you turn around you are welcoming another member of the hospice team to your home. The nurse, home health aide, and social worker may have been expected. But a speech therapist?

An uncomfortable subject: constipation in hospice patients

By Lorraine Thayer

Throughout our lives we have learned what is considered polite conversation. We try to avoid topics that are indelicate or may be offensive to others. Generally, discussions around body functions, especially elimination are difficult even between a patient and their health care provider.  This conversation becomes especially important as a patient nears the end of their life when comfort is the central goal for our loved one. Constipation is a frequent problem for patients nearing end of life.

Comfort for hospice patients with skin wounds

By Lauri Weiss, RN

This is part three of a series on skincare for hospice patients by nurse Lauri Weiss.

The last time I posted on Caring with Confidence, I talked about causes of skin breakdown in advanced illness that respond to preventive strategies. However, even with the best possible care, we are not always able to prevent skin breakdown. So, today I will talk about treatments that promote comfort and dignity when, in spite of our best preventive efforts, people develop wounds.

Caregivers can help prevent skin breakdown for people in hospice

By Lauri Weiss, CRNP

Hospice-palliative care nurse practitioner Lauri Weiss presents a three part series on skin care for hospice patients. In her last post, Lauri talked about how physical changes from advanced illness can alter skin function at end of life.

Skin can become fragile for hospice patients. As a caregiver, there are things you can do to prevent skin breakdown for people with advanced illness. Pressure, moisture, and trauma can all cause skin breakdown, so setting goals of reducing or minimizing undue pressure, assisting with mobility and keeping skin clean and moisturized can make a big difference.

Skin failure for hospice patients—can you prevent it?

By Lauri Weiss, CRNP

Lauri Weiss is a Certified Registered Nurse Practitioner (CRNP) with Holy Redeemer Hospice in Pennsylvania. She is also a certified Wound, Ostomy, Continence Nurse (WOCN). In her role with Holy Redeemer Hospice, Lauri provides expert consultation regarding pain and symptom management in addition to providing assessment and recommendations regarding wound care and other complex issues that our patients may experience.

This is part one of a three part series on skin care.

People with advanced illness are at increased risk for skin failure. The skin is the largest organ in our body, and just like our other organs, its function can be altered in severely ill people. As a hospice/palliative care nurse practitioner and wound specialist, I often speak with patients and families about how the normal functions of the skin are altered in people with advanced illness, common causes of skin breakdown at end of life, strategies for preventing skin breakdown and treatments that promote dignity when skin breakdown occurs.

How do physical changes from advanced illness alter skin function at end of life?  Any one of these issues could compromise skin:

Ensuring your loved one’s safety while in hospice care

By Terre Mirsch

Last week I attended a national Safety Summit, where thousands of healthcare workers gathered to share stories and ideas of how to improve patient safety–whether  care is delivered in a hospital, outpatient setting, long-term care, home care, or in hospice. Significant measures have been taken in healthcare settings across the country to reduce the incidence of errors and patient harm. Healthcare workers must be diligent all day, every day in practicing safety behaviors that prevent human error. Some of the practices that you may have observed include proper patient identification as well as frequent hand hygiene.

As caregivers, there are measures that you can take that will assist healthcare providers in safely caring for your loved one, and that will reduce the chance that you will make a mistake when caring for your loved one.

Knowing what to expect during the dying process

By Terre Mirsch 

Last week we talked about how to be with the dying and the discomfort that we sometimes feel when we shift our focus from one of “doing for” to one of “being with.” Lack of understanding regarding what to expect during the dying process often leads to fear and anxiety—both of which may get in the way of our ability to be fully present with our loved one. While death can occur suddenly, those with progressive illness typically experience the dying process as a series of predictable changes that occur gradually over time, as the body slowly begins to shut down. Early changes may be so discreet that they are often missed by family or even medical professionals.

What’s up with falling down? Reducing the risk of falls for your loved one on hospice

By Terre Mirsch

I remember Jean, an elderly woman living alone with a fierce spirit of independence that was not to be reckoned with. I, and the rest of the hospice team, worried about her day and night. Despite our counsel and concerns, Jean was determined to remain in her home even with the inherent safety risks, including the risk of falls that accompanied her illness and poor home support system. Thankfully, with the support of hospice and safety interventions designed to reduce safety hazards, Jean was able to die peacefully, comfortably, and safely in her home.