Caring for a loved one.

If you are a caregiver, you may have had training in symptom relief for terminally ill patients. But, many family members now take care of their loved ones at home, and training may come through experience only. If you are one of those latter individuals, spend some time at the library, as many books about caregiving can be found on the book shelves. Also, calls to local hospice organizations or training programs offered by hospitals can help provide information as well.

Some basic information about symptom relief is listed below, and these solutions apply to any person at any age — even if they do not have a terminal illness. These problems may frighten a caregiver at first, but they are common problems, and solutions are available. Remember to rely on a trained hospice worker, a trusted nurse or a doctor for specific directions for your ‘patient’ before you take extreme measures.

Constipation: This is a common problem during the last stages of terminal illness, because the patient may not be physically active. Some solutions include increasing fiber in the diet with foods such as prune juice and bran cereal. Sufficient fluids also help to resolve the problem in many instances. Only give stool softeners or laxatives as a doctor may recommend. He or she may recommend them, as constipation can be a side effect of some medications. The warning sign for severe problems – one that warrants a call to the doctor – is constipation for more than three days or blood in the stool.

Eating and Drinking: Smaller and more frequent meals may resolve the eating problem. Some physical activity, if the patient can tolerate it, also helps stimulate appetite. Fluids are, sometimes, the most important issue. Dehydration can develop rapidly in people who do not drink enough fluids. Use a straw or offer ice chips to suck. Be aware that too many fluids also are dangerous and providing intravenous fluids to a person who is dying may result in respiratory distress. Follow a doctor’s instructions on how much food and fluid is ‘normal’ for your patient’s situation.

Breathing Problems: Breathing problems can occur during the final stage of any illness and may require oxygen. Another way to help open breathing passages is to elevate the head of the patient’s bed or to move the patient to a recliner. A doctor may prescribe small doses of liquid morphine or bronchodilator drugs. Follow orders for these prescriptions carefully. Opening a window on a mild day or running a fan in the patient’s room also can help improve air circulation.

Nausea and Vomiting: This problem may occur as a side effect of some medications or as a result of the disease. Do not force a nauseated person to eat. Use ice chips instead of drinking to help retain body fluids. Overt vomiting is an issue, however, as the patient may not be able to keep down medication. A doctor may order medication in suppository form if the patient continues to be nauseated.

Dry Mouth: A dry mouth can be caused by medication or by the disease or by a lack of fluids. Go by the doctor’s advice on the amount of fluids to provide, and if the patient continues to have dry mouth, contact the doctor. You may need to provide glycerin swabs or artificial saliva for the inside of the mouth and a lit coating of lip balm for dry or cracked lips.

Itching: Dry skin, a new reaction to a laundry product, medications or the disease may cause rashes, dry skin and discomfort. To stop the itching, you can apply a soothing  skin cream (alcohol-free, as alcohol-based products can further dry the skin) or calamine lotion to itchy areas. Cornstarch, baking soda or baby powder may work, too. Use a humidifier during the fall and winter when heat is used to help moisten the air. You may need to experiment if none of this solutions work. Change laundry detergent or avoid dryer sheets to see if those solutions help.

Howard Gleckman, senior research associate at the Urban Institute and moderator of the Genworth 2009 National LTC Symposium, and others look on as paid caregiver Ancil Alexander speaks.

“It’s more dangerous to be a home health aide than it is to be a coal miner.”* Howard Gleckman, senior research associate at the Urban Institute, said that as he described the state of home health care in the U.S. at Genworth Financial’s Fourth Annual Long Term Care Symposium on Monday, September 14, in Washington, D.C.

As aging baby boomers put unprecedented demands on the nation’s long term care resources, Gleckman, who served as moderator of the Symposium, also noted that 80 percent of the long term care giving taking place in the U.S. is done by informal caregivers, often family members or close friends who receive no financial compensation. As most people who require long term care services prefer to be taken care of at home rather than in a nursing or assisted living facility, Gleckman said that it is becoming critical that society acknowledge and address the stresses being placed on caregivers, most of whom have no formal training in providing care.

Genworth Financial’s Long Term Care Symposium is held annually to discuss and evaluate public policy issues surrounding the state of long term care across the nation. As Congress addresses healthcare reform and its many components, this year’s event emphasized the need for a national long term care strategy including funding, education and support for the caregiver. Additionally, the event served to highlight the viability of numerous legislative proposals in support of caregivers aimed at helping to solve the nation’s long term care challenges.

Part of the emotional strain facing many home care givers results from low wages paid for providing such services. According to Genworth’s “A Workforce to Care for our Aging” 2008 white paper, 19% of home care aides and 16% of nursing home aides are compensated at a level insufficient for them to rise above the poverty line. The report adds that the typical working family caregiver loses approximately $110 per day in wages and health benefits due to care giving responsibilities. Suzanne Mintz, co-founder of the National Family Caregivers Association (NFCA) added, “The wellbeing of family caregivers and direct care workers are inextricably tied together. As the wages of the latter go up, it makes it that much harder for family caregivers to purchase the services they need. The solution to this ironic situation is that easing the financial strain on family caregivers must go hand in hand with raising the wages of direct care workers.”

Recognizing the urgent need for a comprehensive national long term care strategy, Representative Charles W. Boustany, Jr., (R-LA) said in his opening remarks that, “We’ve got to do much more with regard to long term care and how it’s provided, how it’s financed.” He noted that “most seniors did not realize that Medicare doesn’t do much in terms of providing for long term care.”

Author and expert on aging Virginia Morris said national education campaigns – like Genworth’s “Let’s Talk” program (www.genworth.com/lets-talk), aimed at providing families with the planning tools necessary to prepare for future long term care obligations – “will be critical in the years ahead.”

To view excerpts from Genworth Financial’s Fourth Annual Long Term Care Symposium, visit http://genworth.edgeboss.net/download/genworth/5700_ltcsymp_akamai.wmv.

* Bureau of Labor Statistics, The injury rate for coal miners is 3.6 per 100 workers. The official rate is 4.1 for home health aides.

Portrait of old woman sitting by a window by Chalmers Butterfield.

Are you seeking expert advice on how to work with an elderly parent? Do you want to find information about your own aging? Many experts, including lawyers, hospice nurses and nursing home advocates, have taken to the Web to offer their advice and knowledge through the following up-to-date blogs. Their information may be what you need to answer your questions about aging, deathcare and eldercare.

The following list of hospice and eldercare blogs are listed in alphabetical order to show readers that we do not favor one blog over another:

1. AARP: Can’t live with out AARP if you are age 50 or older. This site provides advocacy, information, resources and even a game section. It’s more of a portal than a blog, but it’s a raging good resource.
2. About.com Palliative Care: This site is designed for patients, families, and caregivers who are faced with life-threatening illness and are seeking information about palliative care or hospice.
3. Caregiver List: This blog focuses on resources for caregivers for the elderly.
4. Death Care Law Blog: William Stalter focuses his law practice on preneed and death care compliance, serving banks, funeral homes, crematories, and cemeteries.  He has written multiple published articles on the subject of preneed and is a member of The International Cemetery, Cremation Funeral Association.
5. Dethmama Chronicles: This hospice nurse is off the charts – funny, intense, philosophical and nurturing, she provides an insider’s perspective into death care.
6. Eldercare ABC Blog:If it requires a village to raise a child, then what does it take to care for an aging parent? This blog tries to answer that question with a myriad of resources.
7. Eldercare Diary: This site is more of a portal than a blog, but it does contain a blog as well as a forum, articles and resource directory.
8. ElderCare Expert Blog: “Dr. Cheryl” is an owner of a Geriatric Care Management business in Southern California, and she offers information on eldercare advocacy and information for caregivers and for eldercare professionals.
9. GeriPal – A Geriatrics and Palliative Care Blog: This blog is a forum for discourse, recent news and research, and freethinking commentary. They welcome the perspectives of generalists, specialists, gerontologists, palliative care clinicians, and anyone else interested in care of the elderly or palliative care.
10. Hospice Blog: This blog is dedicated to all of the hard working hospice professionals across the nation.
11. Hospice and Caregiving Blog: Sponsored by the Hospice Foundation of America, this blog offers stories and articles about the end-of-life experience.
12. Hospice and Nursing Homes Blog: Frances Parker is a consultant, hospice volunteer and former school principle, and her blog focuses on Parker’s experiences and knowledge about hospice care.
13. Hospice Physician’s Blog: This fellowship-trained and board-certified hospice and palliative medicine physician shares insights into patient experiences from a hospice and palliative care point of view.
14. How We Die: Ok, so this is not a blog – but, it’s a “can’t miss” site that may hold you spellbound. The founders explore how our most personal experiences have shaped what we believe about death and dying, and about the decisions we make for ourselves, for loved ones, or for patients at the end of life. The site welcomes stories from patients, their families, loved ones and friends, and doctors and healthcare professionals.
15. Inside Eldercare: One man’s mission – to educate and inspire readers to make their elder care experience a positive. Ryan is the creator of the “by families, for families” approach to elder care which teaches families how to make elder care a positive experience.
16. Lasting Tribute: This blog celebrates the lives of family, friends and people in the public eye who are no longer with us. It also allows members of the public to leave their own personal messages and upload photos.
17. Medical Futility Blog: Thaddeus Pope tracks judicial, legislative, policy, and academic developments concerning medical futility and the limits on individual autonomy at the end of life.
18. My Better Nursing Home: Dr. Eleanor Barbera frequently lectures on subjects related to psychology, aging, and nursing homes. Read her blog to gain insight into those topics.
19. My Elder Advocate: Jack Halpern has held several key leadership roles during his 30 years in the nursing home industry, and he shares his current perspectives on eldercare with readers.
20. Palliative Care Success: Tim Cousonis is a certified health care executive who has worked for the past 20 years to improve end-of-life care in the U.S.
21. Pallimed: This blog is a hospice and palliative medicine blog that focuses on education about the hospice movement and industry.
22. Risa’s pieces: This blogger is a palliative care provider who writes about his experiences with death and dying individuals.
23. The Good Death: Jessica Knapp is a PhD student and freelance writer who wants to help people better handle all facets of death and dying. Her posts are filled with facts, questions and many links to other resources.
24. The New Old Age: This New York Times’ blog focuses on Baby Boomers who face the challenge of parents who are living longer.
25. The Nursing Home Administrator: Learn more about nursing home matters from Matthew Maupin, who writes about topics ranging from diseases to tech tools.

Volunteer at a Hospice.

Do you care about people, especially those individuals who are terminally ill? This type of care requires a special affinity for understanding and some psychological training. While many social workers and psychologists may be called to caring for hospice patients, others may not have the college degree that seems necessary for this job. You may be surprised to learn that many hospice workers are volunteers who may not have a college degree, and the only requirement is registration for local classes or training at a local hospice program.

For instance, Santa Fe Springs hospice volunteers need to be at least 18 years old and have their own transportation. They should be able to donate at least two hours a week as they provide relief for family members, run errands, help with meals or transportation, read to the patient or write letters, play cards, games or listen to music, and provide companionship. “Some visits are very short, perhaps only 15 to 30 minutes, and others up to the maximum four hours (which is enough to go to the hairdresser, bank, post office and grocery store for the regular caregiver).”

If you want to take this service further with more intensive training, you might seek classes held by hospices or hospitals. In one case, the Marion General Hospital Hospice program in Ohio offers Hospice 101, a one-hour introduction to the rewards of being an active volunteer. Fingerprinting and background checks for interested individuals will begin that evening and classes begin in mid-September.

Concord Regional Visiting Nurse Association in New Hampshire is offering a nine-week Hospice Volunteer Training Session that starts on Wednesday, Sept. 9 from 6-8 p.m. This is an ideal time for those who work to make the classes to learn more about how to offer companionship and support to terminally ill patients and their families.

If you don’t have time now for a long class, shorter classes are available from many hospice centers. In some cases, fingerprinting is necessary to meet regulations and other facilities may have rules for volunteers, such as no heavy lifting. In most all cases, hospices are pleased to obtain new volunteers, especially individuals who care about what they do and can show compassion rather than fear and hope rather than despair for their patients.

If you plan to make nursing a career, some work as a hospice volunteer may help you decide if you’re cut out for a career as a nurse or nurse’s assistant. Although, in most cases, you must be over age 18 to serve as a volunteer, you may be working with individuals who are as young as five or as old as 95. This range of terminally ill patients may wear on you, as each case is different and each one can affect you in different ways. This is another reason why training is important, as classes or work sessions can provide you with the support and knowledge you need to volunteer effectively.

]]> http://www.deathcare.com/2009/the-best-place-for-hospice-training.html/feed 0 http://www.deathcare.com/2009/more-people-know-about-photography-than-hospice-care.html http://www.deathcare.com/2009/more-people-know-about-photography-than-hospice-care.html#comments Sun, 07 Jun 2009 19:05:24 +0000 goinhome http://www.deathcare.com/?p=486 When the photography exhibit “The Art of Caring” opened on May 16 at the New Orleans Museum of Art (NOMA), the National Hospice Foundation was proud to be present as a “Caring Partner” for the section on “Remembering.”

The show captures life’s milestones through the lenses of a diverse group of contemporary photographers, some very well known (such as Annie Leibovitz) and some emerging artists. The exhibit contained seven parts, each depicting an aspect of the physical or emotional process of human life: wellness, caregiving and healing, children and family, aging, love, disaster, and remembrance.

The exhibit’s public opening featured an “Afternoon Focus on Hospice” that was organized by Jamey Boudreaux, executive director of the Louisiana-Mississippi Hospice and Palliative Care Association. This event gave exhibit attendees the opportunity to meet with hospice professionals and learn about community end-of-life care resources, but also provided a visual glimpse into the special care that hospice provides. Images created by children who had experienced the death, and photographs from the Louisiana State Penitentiary Hospice at Angola, which Boudreaux was instrumental in establishing, were shown.

According to NOMA:

In today’s interconnected world, photography is more a part of our everyday lives than ever before. Only a few years ago, bringing a camera with you was a conscious decision and often involved fastidious planning and the transportation of cumbersome equipment that made documentation far from spontaneous. Today, most cell phone users have a camera with them at all times. Taking a photo of anyone, anything and then transmitting it effortlessly via email to one person or many has become second nature. Walking, talking, shooting, and transmitting photos are now virtually synonymous.

Yet, according to the National Hospice Foundation, most Americans don’t know what hospice is and nearly 75 percent don’t know that hospice care can be provided at home. Less than 10 percent know it provides pain relief for the terminally ill, and nearly 80 percent don’t think of it as a choice for end-of-life care, while 90 percent don’t know that Medicare pays for it.

You can use the National Hospice and Palliative Care Organization’s directory to find a hospice near you. You can learn more about how a hospice operates, whether or not you can volunteer or if you want to think about this choice for yourself or for loved ones as a choice for end-of-life care. Later, I’ll show other ways on how to get involved with a local hospice or palliative care organization.

HPA promotes quality care whether a patient is enrolled in a licensed hospice or not, whether residing at home or in a facility. HPA is rare in that it is one of the very few true “watchdog” advocacy groups that truly serves hospice patients, families and caregivers. They are dedicated to promoting the welfare of the hospice patients, their families and/or caregivers. No member of their Board of Directors can be an employee or administrator in any hospice Agency or hospice lobbying groups.

HPA can help you learn about many hospice issues. For instance, did you realize that there are four levels of required services that hospices must provide? The hospice must inform you about all these levels of care when you consider admission to hospice services. If the hospice’s “informed consent” form does not list the following four levels of care, think carefully about whether you want to use their services.

A hospice that provides the following levels of care and lists them clearly in their “informed consent” form is more likely to provide the required services, especially if your request them and remind the hospice that you have this service ‘in writing.’

1. Routine Home Care: Routine home care includes case manager visits, social worker visits, access to a chaplain, counselors, dietitian, therapy and more. Additionally, you have access to 24-hour hospice-registered nurses who can answer your questions. These services are part of the “hospice benefit” reimbursed by Medicare, Medicaid or private insurance.
2. Continuous Nursing Care at Home: If you choose to stay at home for death care, continuous around-the-clock nursing care in your own home is your right if the you (as the patient) or the your loved one is having symptoms which are “out of control.” According to HPA, “This standard of care applies whether you reside in your own home in the community, a foster care home, assisted living facility, apartment or even a nursing home…all of these locations are considered ‘your own home.’” However, the patient cannot be forced into a facility if the patient wants to remain at home.
3. Inpatient Care Level of Services: If your loved one is already residing at home or in a hospice facility and the symptoms become uncontrolled, you can inquire about placing the patient on “In Patient Level of Services” so that he or she can get the special attention required. In some instances, the patient may be temporarily placed in an acute care hospital (transferred from home) if there is no hospice facility.
4. Respite Level of Care: If the family needs a break with taking care of an in-home patient, respite care is there to save the day. The patient, if willing, is temporarily placed in a facility up to five days so that the family can get rest from the seemingly never-ending list of things to do which are part of the patient care routine. After that time, the patient is transferred back home.

If you want to learn more about your hospice rights and even more about deathcare management, be sure to visit the HPA site. Their resources are numerous and helpful to anyone who is considering the ability to die at home.

The following list is filled with sites for patients, but a few are geared toward professional caretakers. We included those sites, as they are filled with information that patients and caregivers might want to know. Additionally, the list below is in no particular order. We don’t advocated one site and its information over another.

1. Hospice is a comprehensive site geared toward educating viewers on death care and hospice and palliative care programs. They focus on the explanation and education of hospice services, help for patients, children and caregivers through articles and links to valuable online information.
2. Hospice Foundation of America exists to help those who cope personally or professionally with terminal illness, death and with the grief process. Hospice Foundation of America meets its mission by conducting programs of professional development, public education and information, research, publications and health policy issues. Their programs for the public assist individual consumers of health care who are coping with issues of caregiving, terminal illness, and grief.
3. The National Hospice and Palliative Care Organization (NHPCO) is the largest nonprofit membership organization representing hospice and palliative care programs and professionals in the United States. The organization is committed to improving end of life care and expanding access to hospice care with the goal of profoundly enhancing quality of life for people dying in America and their loved ones. NHPCO advocates for the terminally ill and their families, develops public and professional educational programs and materials, conducts research and works closely with other organizations that share an interest in death care.
4. The American Hospice Foundation outperforms most charities in America in its efforts to operate in the most fiscally responsible way possible, according to Charity Navigator. Their mission is to improve access to quality hospice care through public education, professional training, and advocacy on behalf of consumers. They also support programs that serve the needs of terminally ill and grieving individuals of all ages.
5. International Association for Hospice & Palliative Care (IAHPC) operates to help increase and optimize the availability of access to hospice and palliative care for patients and families throughout the world. IAHPC focuses on program development, education, information dissemination and policy changes to improve availability of good and adequate care of patients with advanced diseases. They support programs, projects and individuals around the world, especially in developing areas in Africa, Eastern Europe, Asia and Latin America.
6. The Hospice Patients Alliance (HPA) was formed in August of 1998 as a nonprofit charitable organization to serve the general public throughout the United States. It was formed by experienced hospice staff and other health care professionals who saw that hospices were not always complying with the standards of care, and in fact, were in some cases, violating the rights of patients and families and exploiting them for financial gain, or not providing adequate care to control pain or other distressing symptoms during the end of life period. HPA promotes quality hospice services whether a patient is enrolled in a licensed hospice or not, whether residing at home or in a facility. HPA protects the rights of patients, their families and caregivers, the bereaved and staff by providing information about the standards of care governing the health care provided, the services required to be provided by law, standard industry practices and how to obtain the very best hospice care available.
7. Hospice Directory is more than a directory. This site provides information on how to choose a hospice to hospice stories and a caregiver’s corner. They break hospice care centers down into state hospice organizations and Canadian/Provincial hospice organizations to make it easy to find one near you. HospiceDirectory.org is a subsidiary of its founding sponsor, the Hospice Foundation of America (HFA), and it is the most comprehensive and user-friendly hospice directory around.
8. Children’s Hospice International’s ultimate goal is to so ingrain the hospice concept into pediatrics that it isn’t considered a separate specialty, rather, an integral part of health care for children and adolescents. CHI works closely with health care professionals  providing technical assistance, educational materials, and other resources. They also help the families and friends of a child with a life-threatening condition by providing literature specific to families, connecting them to local resources, and offering support.
9. The American Academy of Hospice and Palliative Medicine (AAHPM) is dedicated to expanding access of patients and families to high quality palliative care, and advancing the discipline of Hospice and Palliative Medicine through professional education and training, development of a specialist workforce, support for clinical practice standards, research and public policy. Their core purpose is to improve the care of patients with life- threatening or serious conditions through advancement of hospice and palliative medicine. The Academy is the professional organization for physicians specializing in hospice and palliative medicine. Membership is also open to nurses and other healthcare providers who are committed to improving the quality of life of patients and families facing life-threatening or serious conditions.
10. Help the Hospices is a UK site that supports hospice and palliative care throughout the UK. The site is geared toward all involved in the death care process, including professionals, patients and families. They also support a directory of hospice services available throughout the UK and Ireland and an international directory for palliative care services outside the UK.
11. National Association for Home Care & Hospice is the nation’s largest trade association that represents the interests and concerns fo home care agencies, hospices and home care aide organizations. From professional development to fighting for better regulation, from knowing all angles of federal and state regulations to providing the latest information affecting home care and hospice, NAHC stands ready to serve your needs, enabling you to better serve your patients.

Wald’s work included efforts to bring hospice care to U.S. prisons and she trained inmates as hospice volunteers. The hospice movement, which focuses on providing care for terminally ill patients and their families, now includes more than 3,200 programs nationwide.

Mrs. Wald was a Dean at Yale Nursing School when, in 1963, a friend persuaded her to attend a lecture by Dame Cicely Saunders, a British physician who planned to open the world’s first hospice in Sydenham, south of London. Saunders’ hospice, St. Christopher’s Hospice, opened in 1967, and Mrs. Wald went there to work and learn. After returning, she and several Yale colleagues joined forces to establish the Connecticut hospice.

Wald’s hospice work was based upon the fact that terminally ill patients during that time period were subject to a medical ethic that ignored a patient’s transition from life to death, and her work gained national attention. Hospice care took a substantial leap in credibility when Congress ordered Medicare to begin to pay for the service in 1982.

Philosophy: The cornerstone to hospice care is Elizabeth Kubler Ross’ philosophy about death and dying, grief and grieving. After years of listening to and talking with dying patients, the lessons that evolved shaped today’s treatment for terminally ill patients and for their families.

Treatment: Usually, hospice patients have less than six months to live according to a physician’s diagnosis. These patients have chosen to stop curative treatment and to allow family members to learn how to provide care. Finally, most hospice patients prefer to die in their homes, surrounded by familiarity rather than in a clinical setting.

Financial issues: Although Medicare can pay for hospice care, many people who aren’t listed with Medicare may not be able to pay. And, many hospice organizations are beginning to face losses, as a federal regulation cut Medicare reimbursement rates to hospice programs after October 1, 2008. While many programs do not want to cut services, they may be forced to reduce staff and abilities to serve the dying through this rate cut. State funding, also, may be limited depending upon state financial issues.

Find a hospice: The National Hospice and Palliative Care Organization (NHPCO) can help you or a family member find a hospice near you. Established in 1992, NHPCO is committed to leading global, philanthropic efforts advancing quality, compassionate, end-of-life care for all. Their vision is “a world where individuals and families facing serious illness, death and grief will experience the best that humankind can offer.” Use their form to find a member organization near you, so you and your family members can benefit from their programs.

NHPCO is one organization that can help many people end their lives in dignity, surrounded by loved ones and with special care provided by hospice workers. If the government cannot support hospice care financially, the help needs to come from individuals, people who care about how the transition from life to death is conducted.

Few individuals think about long-term care when healthy, as this subject usually lands at the end of the list of things to do for the day. But, when accidents occur, or when someone is diagnosed with a terminal illness, long-term care often becomes a subject that is addressed. Many times, an attending doctor or a family member will broach the subject, especially when care for an individual becomes overwhelming.

The choice of a long-term care option often depends upon whether the stricken individual carries long-term care insurance (LTCI). Some insurance policies focus specifically on long-term care, while others may subsidize only certain forms of long-term care. In the latter case, it is important to understand the levels of care available:

• Skilled care: This is round-the-clock care designed to treat a medical condition. Often, a treatment plan is established and ordered by a physician and performed by accomplished medical personnel.
• Intermediate Care: Often, a physician will order this type of care as well, and a plan where registered nurses, licensed practical nurses and nurses’ aides carry out the doctor’s orders.
• Custodial Care: This type of care can be carried out by someone who lacks professional medical skills, but who is trained and supervised by a physician or by an organization that specializes in care such as bathing, eating and dressing.

Note that the terms above may be defined differently by Medicare.

An individual can receive long-term care in a nursing home, through a hospice, through home-care options, an adult day-care center or through respite care. Of all these options, the nursing home and hospice care are designed to care for terminally ill patients. With that said, hospice care can be provided in the home. This is especially comforting for those who wish to die in their homes, surrounded by familiar objects and friends and family.

Hospice care is varied, and can include a medical plan designed by a physician or simple care for everyday activities. Home health care often is provided by a visiting or traveling nurse, a therapist or a home health aide. The visit times can range from all-day or all-night care to several visits to the home each week. The visit frequency will depend upon the care required. Once a plan is in place, professionals can help arrange for services, monitor care, and periodically help re-evaluate the plan and make adjustments based upon the client’s personal preferences and needs.

Hospices also treat individuals outside the home in special facilities and even through a local hospital program. Sometimes, family members may need a respite from caring for an elderly or terminally ill family member, and hospices also can provide this service. They may offer temporary care for an individual so family members can take some time off for their own needs.

The individual’s choice of long-term care often depends upon financial and insurance issues, the number of family members who can agree to help provide care, and the options available to the patient. In some cases, the long-term care options are limited; however, some research about long-term care before it is ever needed can open up more possibilities when it’s needed. Some programs, such as the Federal Long Term Care Insurance program (FLTCIP) can help with understanding long-term care and possibilities provided by the U.S. Government.