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Old 08-19-2010, 08:38 PM   #1
Rich66
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Research Shows Patients May Live Longer with Hospice and Palliative Care

http://www.prnewswire.com/news-relea...101075304.html

Quote:
A new study released by the New England Journal of Medicine found that among patients with non-small-cell lung cancer, those who received palliative care lived, on average, almost two months longer than those who received standard care. Researchers also found that the patients receiving palliative care reported a higher quality of life through the final course of their illness.

The goals of palliative care are to improve the quality of a seriously ill person's life and to support that person and their family during and after treatment. Sharing the same philosophy of hospice care which is usually provided in the final months of life, palliative care may be provided at any stage during a serious or life-limiting illness.

Quote:
"There's an inaccurate perception among the American public that hospice means you've given up," said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization. "Those of us who have worked in the field have seen firsthand how hospice and palliative care can improve the quality of and indeed prolong the lives of people receiving care."
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Old 08-19-2010, 08:50 PM   #2
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Re: Research Shows Patients May Live Longer with Hospice and Palliative Care

Trying to digest this, realizing it's from PR wire via NHPCO. Thoughts like..is this a benefit from teh service or an indictment of the ineffectiveness/harshness of many standard treatments. I also see the term palliative care term referring to a service alongside standard care. So I've come to understand that as treating symptoms to make standard care manageable. I could see that making treatment less likely to be delayed or stopped and leading to longer survival and better quality of life.
But my perception of hospice remains more closely aligned with, as the NHPCO guy says "giving up". Seems to be how it worked for my grandmother. When she was having breathing difficuties, they called hospice instead of an ambulance and the meds took a long time to get there and she died.

My Dad is in a nursing care facility and a particularly insensitive nurse there suggested 5 years ago that we elect hospice and not treat Dad for the next UTI. Ya know..kinda left a bad taste in my mouth. I just got done having dinner with him.

But I'm open to other interpretations based on reality. And my apologies if this is rubbing anyone the wrong way. Not intended.
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Old 08-25-2010, 12:19 AM   #3
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Re: Research Shows Patients May Live Longer with Hospice and Palliative Care

I gained strength after reading that article.
We're trying to keep our mom under hospice care, so she'll get necessary medications and treatments. She started receiving care last year. She's insured since we paid her long-term care insurance.
Breast cancer needs extensive treatments and longer stay in nursing facilities, so I suggest everyone to get LTCi to protect your assets and, of course, afford the expensive services. There are many benefits you can get from LTCi, including the long term care insurance inflation protection -- http://www.completelongtermcare.com/...rotection.aspx




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Old 08-25-2010, 01:42 AM   #4
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Re: Research Shows Patients May Live Longer with Hospice and Palliative Care

Be aware of the patient's condition before putting him/her in hospice care.

My late Mother-in-law was put in Hospice care 'twice'. First time she was experiencing confusion (possibly a mini stroke that resolved itself) and the whole family gathered by her bedside. But she 'woke up' and was later moved back to her regular room in the nursing home. Six months later, she was under hospice care again before she passed away in peace. We were told that under hospice care she would actually get more attention and care.

Earlier this year, my Father-in-law was experiencing confusion for several days and could not take in food or use the bathroom. My Sister-in-law was sure that he was going to 'leave us' and went back to her home (four hours away) to get stuff she needed for a funeral. My husband and I took over the care of Father-in-law and soon realized that he'd been suffering from UTI (which typically causes confusion in the elderly) after we had called the EMS. Father-in-law has since been driving and cooking normally at the age of 87.
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Last edited by Jackie07; 09-06-2010 at 12:23 PM..
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Old 09-05-2010, 02:51 PM   #5
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Elderly nursing home residents receive relatively few cancer care services, according to a study published in the Journal of the National Cancer Institute. Few studies have examined cancer treatment and care among elderly patients residing in nursing homes. Yet, as the population ages, more people will move into nursing homes, many of whom will later be diagnosed with cancer. Cancer risk increases as people age.

Nursing home residents (including any cancer patients) are already supposed to be receiving 24/7 care. The hospice service is an additional $130 a day the home receives. Because Medicare does not collect detailed data about the medical treatments a hospice patient receives, there is very little information about what services are actually being provided.

Neglect is the silent killer in nursing homes. By some estimates, malnutrition, dehydration, bedsores and infection - caused by neglect - account for half of nursing home deaths and injuries.

An indication of negligent care for cancer patients at nursing homes involved a woman in Pennsylvania who was put on the chemotherapy drug Nexavar. Its side effects include decreased blood flow to the heart, heart attack and high blood pressure. The woman was supposed to get emergency care immediately if she started to exhibit any signs of the side effects.

The woman reported a dull heavy chest pain and a severe band-like pressure around her head. Her blood pressure (200/123) was far higher than normal. There was no evidence that a physician was contacted about the situation. Later, a physician said she would have sent the woman to a hospital emergency room immediately.

Instead of calling the physician or getting the woman to the emergency room, the nursing home nurse gave the woman her scheduled dose of painkiller. Two hours later, the woman was found face-down in a small puddle of blood.

The home was cited for violating regulations relating to quality of care, management, patient rights, records and more. The home had previously been cited for similar violations.

There would be a much higher level of care given to residents if adequate staffing were provided. But, "for-profit" nursing homes, the desire for profit margins translates into less staffing at nursing homes, less training for the staff that they do have, less food (or a lower quality of food) for the residents, and less management and oversight.

A conflict arises between saving dollars and providing good care. Administrators benefit from the amount of profit generated by the nursing home they manage, usually paid annual bonuses based on bed-count. They must choose between increasing the profit margins of their individual facilities or supplying more support staff for the care of residents.

Even nursing home abuse may occur because of the desire for profit. Caregivers who work in nursing homes are often stretched beyond their ability. They try to do the best job that they can, but the lack of additional support restricts what they can do to help residents.

The for-profits are taking over hospices the same way they have taken over nursing homes. The Kaiser Network noted that hospice care was designed to be delivered mainly by not-for-profit groups with affiliations to religious and community groups, but the June 2008 MedPAC report found that since 2000 mostly for-profit companies and hospices have been providing such care.

ManorCare Health Services operates hospice under their for-profit nursing homes as Heartland Hospice Care. On top of receiving an additional $130 a day for hospice service, above the daily payment they receive providing nursing home care, they take donations to their Heartland Hospice Fund.

For-profit hospices, like for-profit nursing homes are run by corporations the are coldly efficient, according to a leading palliative care specialist. If there is a way to play the system to make a higher profit, they will. As I've said before, nursing home residents are already receiving 24/7 care. The hospice service is an additional $130 a day the home receives.

In their quest for Medicare dollars, for-profit hospices don’t provide all the care that they should in order to fulfill the hospice mission of maximizing patients’ quality of life.

In fact, a 2004 Medical Care study of 2,080 patients enrolled in 422 hospices across the country found that terminally ill patients who receive end-of-life care from for-profit hospice providers receive a full range of services only half the time compared with patients treated by nonprofit hospice organizations.

That’s because for-profit hospices like to keep costs low by skimping on services, particularly so-called “non-core” services like medications and personal care. For example, families of patients receiving care from a for-profit hospice received counseling services, including bereavement counseling, only (45% as often) as those in a nonprofit hospice.

When researchers controlled for differences across patients, sicknesses, and conditions, those at for-profit hospices were only half as likely to get the same support provided at nonprofit hospices. A 2005 follow-up study confirmed that for-profit patients receive a narrower range of services than nonprofit patients.

But it’s not just “non-core” services that for-profit hospices are skimping on. For-profit hospices are only half as likely as nonprofits to provide palliative radiotherapy (RPT), a radiation therapy that has been shown to effectively reduce pain and other symptoms related to tumor growth.

The dearth of for-profit RPT probably has a lot to do with the fact that for-profit hospices take on a smaller share of patients with cancer than do nonprofits—in part because it costs a lot to care for cancer. In addition, it’s much easier to predict how soon cancer patients will die. They rarely stay in a hospice for more than six months.

Indeed, for-profit hospices tend to “cream-skim” patients, both by taking on fewer cancer patients and having a greater share of patients who require a relatively long stay (In this regard, MedPAC’s fears are warranted).

Worse still, according to research from the University of California, Irvine, patients who stay longer at for-profit hospices receive less high-skilled nursing care—such as tracheotomy care, wound care, and suctioning or feeding tubes—because skimping on these services keeps costs down. In sum, research shows that patients stay longer at for-profit hospices, yet receive less personal care, symptoms management and spiritual support during their stay.

This is a pretty good way to make money, and indeed, the largest for-profit hospices are doing very well: a 2005 study in the Journal of Palliative Medicine found that large hospices owned by publicly traded companies generate profit margins nine times higher than those of large nonprofits and three times higher than privately owned for-profit hospices of similar size. In other words the "corporatization" of nursing homes seems to be a major part of the problem.
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Old 09-06-2010, 12:39 PM   #6
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Re: Research Shows Patients May Live Longer with Hospice and Palliative Care

J Palliat Med. 2010 Aug;13(8):957-64.
Long and short hospice stays among nursing home residents at the end of life.

Huskamp HA, Stevenson DG, Grabowski DC, Brennan E, Keating NL.
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA. huskamp@hcp.med.harvard.edu
Abstract

OBJECTIVE: To identify characteristics of nursing homes and residents associated with particularly long or short hospice stays.
DESIGN/SETTING: Observational study using administrative data on resident characteristics and hospice utilization from a large regional hospice linked with publicly available data on nursing home characteristics.
PARTICIPANTS: A total of 13,479 residents who enrolled in hospice during 2001-2008.
MEASUREMENTS: Logistic regression models of the probability of a long (>180 days) or very short ( RESULTS: Nursing home characteristics were not statistically significant predictors of long stays. The probability of a short stay increased with the facility's nurse staffing ratio and decreased with the share of residents covered by Medicaid. Men (relative to women) and blacks (relative to whites) were less likely to have a long stay and more likely to have a short stay, while those 70 years or younger (relative to those 81-90) and residents with Alzheimer's disease/dementia were more likely to have long stays and less likely to have short stays. Fourteen percent of hospice users were discharged before death because they failed to meet Medicare hospice eligibility criteria, and these residents had longer lengths of stay, on average.
CONCLUSION: Few facility characteristics were associated with very long or very short hospice stays. However, high rates of discharge before death that may reflect a less predictable life trajectory of nursing home residents suggests that further evaluation of the hospice benefit for nursing home residents may be needed.

PMID: 20666661 [PubMed - in process]
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http://www.kevinmd.com/blog/2011/06/doctors-letter-patient-newly-diagnosed-cancer.html
http://www.asco.org/ASCOv2/MultiMedi...=114&trackID=2

NICU 4.4 LB
Erythema Nodosum 85
Life-long Central Neurocytoma 4x5x6.5 cm 23 hrs 62090 semi-coma 10 d PT OT ST 30 d
3 Infertility tmts 99 > 3 u. fibroids > Pills
CN 3 GKRS 52301
IDC 1.2 cm Her2 +++ ER 5% R. Lmptmy SLNB+1 71703 6 FEC 33 R Tamoxifen
Recc IIB 2.5 cm Bi-L Mast 61407 2/9 nds PET
6 TCH Cellulitis - Lymphedema - compression sleeve & glove
H w x 4 MUGA 51 D, J 49 M
Diastasis recti
Tamoxifen B. scan
Irrtbl bowel 1'09
Colonoscopy 313
BRCA1 V1247I
hptc hemangioma
Vertigo
GI - > yogurt
hysterectomy/oophorectomy 011410
Exemestane 25 mg tab 102912 ~ 101016 stopped due to r. hip/l.thigh pain after long walk
DEXA 1/13
1-2016 lesions in liver largest 9mm & 1.3 cm onco. says not cancer.
3-11 Appendectomy - visually O.K., a lot of puss. Final path result - not cancer.
Start Vitamin D3 and Calcium supplement (600mg x2)
10-10 Stopped Exemestane due to r. hip/l.thigh pain OKed by Onco 11-08-2016

"I WANT TO BE AN OUTRAGEOUS OLD WOMAN WHO NEVER GETS CALLED AN OLD LADY. I WANT TO GET SHARP EDGED & EARTH COLORED, TILL I FADE AWAY FROM PURE JOY." Irene from Tampa

Advocacy is a passion .. not a pastime - Joe
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Old 09-06-2010, 12:44 PM   #7
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Re: Research Shows Patients May Live Longer with Hospice and Palliative Care

J Am Geriatr Soc. 2010 Jul 14. [Epub ahead of print]
The Growth of Hospice Care in U.S. Nursing Homes.

Miller SC, Lima J, Gozalo PL, Mor V.
Center for Gerontology and Healthcare Research and Department of Community Health, Alpert Medical School, Brown University, Providence, Rhode Island.
Abstract

OBJECTIVES: To inform efforts aimed at reducing Medicare hospice expenditures by describing the longitudinal use of hospice care in nursing homes (NHs) and examining how hospice provider growth is associated with use.
DESIGN: Longitudinal study using NH resident assessment (Minimum Data Set) and Medicare denominator and claims data for 1999 through 2006.
SETTING: NHs in the 50 U.S. states and the District of Columbia.
PARTICIPANTS: Persons dying in U.S. NHs.
MEASUREMENTS: Medicare beneficiaries dying in NHs, receipt of NH hospice, and lengths of hospice stay were identified. The number of hospices providing care in NHs was also identified, and a panel data fixed-effect (within) regression analysis was used to examine how growth in providers affected hospice use.
RESULTS: Between 1999 and 2006, the number of hospices providing care in NHs rose from 1,850 to 2,768, and rates of NH hospice use more than doubled (from 14% to 33%). With this growth came a doubling of mean lengths of stay (from 46 to 93 days) and a 14% increase in the proportion of NH hospice decedents with noncancer diagnoses (69% in 1999 to 83% in 2006). Controlling for time trends, for every 10 new hospice providers within a state, there was an average state increase of 0.58% (95% confidence interval=0.383-0.782) in NH hospice use. Much state variation in NH hospice use and growth was observed.
CONCLUSION: Policy efforts to curb Medicare hospice expenditures (driven in part by provider growth) must consider the potentially negative effect of changes on access for dying (mostly noncancer) NH residents.
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http://www.kevinmd.com/blog/2011/06/doctors-letter-patient-newly-diagnosed-cancer.html
http://www.asco.org/ASCOv2/MultiMedi...=114&trackID=2

NICU 4.4 LB
Erythema Nodosum 85
Life-long Central Neurocytoma 4x5x6.5 cm 23 hrs 62090 semi-coma 10 d PT OT ST 30 d
3 Infertility tmts 99 > 3 u. fibroids > Pills
CN 3 GKRS 52301
IDC 1.2 cm Her2 +++ ER 5% R. Lmptmy SLNB+1 71703 6 FEC 33 R Tamoxifen
Recc IIB 2.5 cm Bi-L Mast 61407 2/9 nds PET
6 TCH Cellulitis - Lymphedema - compression sleeve & glove
H w x 4 MUGA 51 D, J 49 M
Diastasis recti
Tamoxifen B. scan
Irrtbl bowel 1'09
Colonoscopy 313
BRCA1 V1247I
hptc hemangioma
Vertigo
GI - > yogurt
hysterectomy/oophorectomy 011410
Exemestane 25 mg tab 102912 ~ 101016 stopped due to r. hip/l.thigh pain after long walk
DEXA 1/13
1-2016 lesions in liver largest 9mm & 1.3 cm onco. says not cancer.
3-11 Appendectomy - visually O.K., a lot of puss. Final path result - not cancer.
Start Vitamin D3 and Calcium supplement (600mg x2)
10-10 Stopped Exemestane due to r. hip/l.thigh pain OKed by Onco 11-08-2016

"I WANT TO BE AN OUTRAGEOUS OLD WOMAN WHO NEVER GETS CALLED AN OLD LADY. I WANT TO GET SHARP EDGED & EARTH COLORED, TILL I FADE AWAY FROM PURE JOY." Irene from Tampa

Advocacy is a passion .. not a pastime - Joe
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Old 09-06-2010, 12:46 PM   #8
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Re: Research Shows Patients May Live Longer with Hospice and Palliative Care

Nurs Older People. 2010 May;22(4):22-4.
End of life care: a rapid response hospice at home service.

Davis C.
Sue Ryder Care.
Abstract

In line with recommendations in the Department of Health's 2008 End of Life Care Strategy to enable people to die at home, the charity Sue Ryder Care piloted a rapid response hospice at home service in Bedford. The project supported 17 patients to die in their own homes. Evaluation of the project will be shared with the local primary care trust in the hope that it will continue to fund the service. Other community-based models of end of life care that the charity has developed are outlined.

PMID: 20503676 [PubMed - indexed for MEDLINE]
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Jackie07
http://www.kevinmd.com/blog/2011/06/doctors-letter-patient-newly-diagnosed-cancer.html
http://www.asco.org/ASCOv2/MultiMedi...=114&trackID=2

NICU 4.4 LB
Erythema Nodosum 85
Life-long Central Neurocytoma 4x5x6.5 cm 23 hrs 62090 semi-coma 10 d PT OT ST 30 d
3 Infertility tmts 99 > 3 u. fibroids > Pills
CN 3 GKRS 52301
IDC 1.2 cm Her2 +++ ER 5% R. Lmptmy SLNB+1 71703 6 FEC 33 R Tamoxifen
Recc IIB 2.5 cm Bi-L Mast 61407 2/9 nds PET
6 TCH Cellulitis - Lymphedema - compression sleeve & glove
H w x 4 MUGA 51 D, J 49 M
Diastasis recti
Tamoxifen B. scan
Irrtbl bowel 1'09
Colonoscopy 313
BRCA1 V1247I
hptc hemangioma
Vertigo
GI - > yogurt
hysterectomy/oophorectomy 011410
Exemestane 25 mg tab 102912 ~ 101016 stopped due to r. hip/l.thigh pain after long walk
DEXA 1/13
1-2016 lesions in liver largest 9mm & 1.3 cm onco. says not cancer.
3-11 Appendectomy - visually O.K., a lot of puss. Final path result - not cancer.
Start Vitamin D3 and Calcium supplement (600mg x2)
10-10 Stopped Exemestane due to r. hip/l.thigh pain OKed by Onco 11-08-2016

"I WANT TO BE AN OUTRAGEOUS OLD WOMAN WHO NEVER GETS CALLED AN OLD LADY. I WANT TO GET SHARP EDGED & EARTH COLORED, TILL I FADE AWAY FROM PURE JOY." Irene from Tampa

Advocacy is a passion .. not a pastime - Joe
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Old 09-06-2010, 12:49 PM   #9
Jackie07
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Re: Research Shows Patients May Live Longer with Hospice and Palliative Care

J Palliat Med. 2010 May;13(5):573-9.
Vigilant at the end of life: family advocacy in the nursing home.

Shield RR, Wetle T, Teno J, Miller SC, Welch LC.
Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island 02912, USA. renee_shield@brown.edu
Abstract

BACKGROUND: Increasing numbers of Americans die in nursing homes. Little is known about the roles and experiences of family members of persons who die in nursing homes.
METHODS: The authors conducted 54 qualitative telephone interviews of close family or friends of individuals who had spent at least 48 hours in the last month of life in a nursing home. Respondents had earlier participated in a national survey that found 587 of 1578 decedents (37.2%) received end-of-life nursing home care. In qualitative interviews respondents described the last year of life, focusing on the nursing home experience. Interviews were analyzed by a multidisciplinary team to identify key themes of areas of concern.
RESULTS: An important interview theme revealed families often felt the need to advocate for their dying relative because of low expectations or experiences with poor quality nursing home care. They noted staff members who did not fully inform them about what to expect in the dying process. Respondents reported burden and gratification in care they themselves provided, which sometimes entailed collaboration with staff. Interviews also identified ways hospice care impacted families, including helping to relieve family burden.
CONCLUSIONS: End-of-life advocacy takes on increased urgency when those close to the dying resident have concerns about basic care and do not understand the dying course. Enhancing communication, preparing families at the end of life, and better understanding of hospice are likely to increase family trust in nursing home care, improve the care of dying residents, and help reduce family burden.
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Jackie07
http://www.kevinmd.com/blog/2011/06/doctors-letter-patient-newly-diagnosed-cancer.html
http://www.asco.org/ASCOv2/MultiMedi...=114&trackID=2

NICU 4.4 LB
Erythema Nodosum 85
Life-long Central Neurocytoma 4x5x6.5 cm 23 hrs 62090 semi-coma 10 d PT OT ST 30 d
3 Infertility tmts 99 > 3 u. fibroids > Pills
CN 3 GKRS 52301
IDC 1.2 cm Her2 +++ ER 5% R. Lmptmy SLNB+1 71703 6 FEC 33 R Tamoxifen
Recc IIB 2.5 cm Bi-L Mast 61407 2/9 nds PET
6 TCH Cellulitis - Lymphedema - compression sleeve & glove
H w x 4 MUGA 51 D, J 49 M
Diastasis recti
Tamoxifen B. scan
Irrtbl bowel 1'09
Colonoscopy 313
BRCA1 V1247I
hptc hemangioma
Vertigo
GI - > yogurt
hysterectomy/oophorectomy 011410
Exemestane 25 mg tab 102912 ~ 101016 stopped due to r. hip/l.thigh pain after long walk
DEXA 1/13
1-2016 lesions in liver largest 9mm & 1.3 cm onco. says not cancer.
3-11 Appendectomy - visually O.K., a lot of puss. Final path result - not cancer.
Start Vitamin D3 and Calcium supplement (600mg x2)
10-10 Stopped Exemestane due to r. hip/l.thigh pain OKed by Onco 11-08-2016

"I WANT TO BE AN OUTRAGEOUS OLD WOMAN WHO NEVER GETS CALLED AN OLD LADY. I WANT TO GET SHARP EDGED & EARTH COLORED, TILL I FADE AWAY FROM PURE JOY." Irene from Tampa

Advocacy is a passion .. not a pastime - Joe
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