Camp Kangaroo campers and counselors, August 2012 in Glenview, Illinois

Losing a loved one to a terminal illness reminds us of our mortality and enables grief. Adults turn to religious or spiritual sayings, Scripture, songs or words to aid in recovery from grief. Children, however, grieve differently as they move forward past new developmental milestones. They must learn how to adjust without having that loved one there.

In early August 2012, Seasons Hospice Foundation unveiled their first day camp for children struggling to deal with grief from loss of a loved one. Camp Kangaroo welcomed children ages 4 to 14 in Chicago, free of charge. Co-sponsored by FGMK, LLC and Seasons Hospice & Palliative Care, the camp hosted two dozen kids from all over Chicagoland as well as funded airfare and hotel stay for attendees and their guardians from out of town.

“We’ve created the program to provide a balance of constant activity and fun,” says Melody Stried, LCSW for Seasons Hospice & Palliative Care. “Every activity has an underlying bereavement piece without being heavyhanded or in their face.”

Russell Hilliard, PhD, LCSW, LCAT, MT-BC, CHRC, the Vice President of Supportive Care Services for Seasons Hospice & Palliative Care, explains further. “Camp Kangaroo is designed to give grieving children an opportunity to learn creative ways to cope with their loss, express their emotions and receive support from their peers and professional counselors. By using music therapy, the arts, professional storytelling and creative play, our campers have fun while working through the grief process.”

Seasons Hospice Foundation is working to expand Camp Kangaroo in 2013 and in years to come, establish the program in communities nationwide where Seasons Hospice & Palliative Care is located.

Appreciation for Our Nation’s Aging Heroes

After serving nine years in the Armed Forces, Joel decided to give back to his fellow Veterans by becoming a We Honor Veterans volunteer with Seasons Hospice & Palliative Care in Dallas-Fort Worth. At a recent Veteran appreciation event, Joel saluted each Veteran patient individually and presented them with certificates of appreciation from the local We Honor Veterans program at Seasons Hospice.

“The looks on the faces of these men and women were priceless. What a sight it was to see Joel salute these Veterans and they salute back,” recalls Jennifer Sobities, Volunteer Coordinator for Seasons Hospice.

According to Jennifer, a Dementia patient who is mostly non-verbal turned to Joel and said, “That is what we need, good guys like you.” This moved a staff member to break down in tears.

A few days after the appreciation celebration, Jennifer was notified that the patients were hugging and kissing their certificates. One patient in particular, who is never emotional (according to the nursing home staff), asked to have the certificate hung on his wall, although he could not see very well. Every day he asks the staff if his certificate is still there and asks for it to be read to him.

A little appreciation goes a long way for our Veteran population, especially those who are aging in place. Have you experienced similar reactions from patients when acknowledging their military service? Tell us in the comments!

Creative Strategies for Self Care

 

Music therapy and other creative-arts therapies rely on the use of an artistic medium and the presence of the therapist. However, music and the other arts can be used therapeutically on an individual basis as well, especially during a grieving period.

Express your down moods with a playlist. Put together a CD or an iPod playlist. You might want to start with melancholy or sad songs reflecting your mood and gradually transition to more uplifting songs. Especially with an iPod, you can have several lists for varied moods or adjust the playlist to fi t your evolving state of mind. Just the process of assembling it actively addresses your grief and helps you progress through it.

Sometimes after losing a loved one, you feel a gap in your life. You suddenly have time. Involve yourself in something new. Learn an instrument. Take an art class. Take a dance or yoga class. This can be a healthy way to refocus some of your energy, releasing your stress and feelings instead of internalizing and recycling them. Physical activity can ground you. Focus on your body. Do yoga or tai chi or just breathing exercises. Get in tune with your body. These can be stabilizing, even spiritual experiences.

If you are a musician, play! An artist, create! A dancer, move! Grief may stifle your normal creativity, but it can also open new avenues of expression. These methods can be used when you are alone to lift you. Or, they may be opportunities to gather in community with other people. What makes art, music, or movement special? h ere is no right or wrong. In grief, you may feel stuck. “I shouldn’t be feeling this way. I should be doing this, or this, now.” Or, “I can’t express my grief. I can’t find the thoughts, the words.” Nonverbal expression, without strict limits or rules, with no need to “come up with the right words,” can help.

ACOs: The Next Generation of HMO Plans?

Health Care Reform has paved a path for the creation of a national voluntary program for accountable care organizations (ACOs).  ACOs look and feel a lot like the health maintenance organizations (HMOs) which were formed in the 1970s; the big difference is that a patient can leave their provider ACO network for services when they wish.

So, what is an ACO? Essentially it is a group of providers responsible for the care of a specific population of patients. The key here is that what have been silo organizations in the delivery of care and the acceptance of payment will now be one entity. This could include hospitals, home health agencies, nursing homes and others. The U.S. government’s definition is “a group of health care providers who give coordinated care, chronic disease management, and thereby improve the quality of care patients get. The organization’s payment is tied to achieving health care quality goals and outcomes that result in cost savings.”

As lawmakers search for ways to reduce the national deficit, Medicare is a prime target.  With baby boomers entering retirement age, the costs of the program for elderly and disabled Americans are expected to soar.

ACOs would make a provider group jointly accountable for the health of their patients, giving them strong incentives to cooperate and save money by avoiding unnecessary test, producers and hospitalizations.  For ACOs to truly work, they have to seamlessly share information.  Those ACOs that save money while also meeting quality targets would keep a portion of the saving as a bonus payment, but some ACOs could also be at risk for losing money.

As a hospice provider, Seasons Hospice & Palliative Care is excluded as being a “legal member” of an ACO.  However, a hospice can play a major role in assisting ACOs to achieve their clinical, satisfaction and financial outcomes which, if achieved, leads to an ACO’s bonus payment.  There are 33 outcome measures which if met and/or exceed lead to the ACO members sharing a bonus payment.  It does not cost an ACO anything (except their time and energy) to collaborate and work with a hospice.

Seasons Hospice & Palliative Care can assist an ACO to meet and exceed an their outcome measure by providing timely care for when a patient/family require it, reduce bonus back or readmissions to the hospital, pain and symptom management and the major focus on the care of heart failure patients.

10 Things Patients Should Know About Their Medications

by Mary Lynn McPherson PharmD, BCPS, CPE

New prescriptions lead to new patient and family routines, and questions often arise about dosage, side effects and the “what if” situations.  Find out what your trusted pharmacy has dispensed to you and how it will affect you in your treatment or palliative efforts.

You can’t go wrong with the Three Ps of medication education: purpose, proper use and potential side effects. Here’s 10 things patients should know about each medication they are taking:

1. What is the name of the medicine and what is it supposed to do?
2. Is this the brand or generic name? Is the generic version available?
3. When do I take the medicine, how much should I take, and for how long?
4. Should I take this medicine on an empty stomach or with food?
5. What should I do if I forget a dose?
6. What foods, drinks, medicines, dietary supplements, or activities should I avoid while taking this medicine?
7. What are the possible side effects, and what do I do if they occur?
8. When should I expect the medicine to begin to work and how will I know if it is working?
9. Will this new prescription work safely with the other prescription and nonprescription medicines I am taking?
10. How should I store this medicine at home?

Read the paperwork that comes with prescriptions and pose questions to your doctor, nurse and pharmacist. The understanding of goals through medication usage can be clarified and will minimize risk for error from the patient, family and clinical team.

Mary Lynn McPherson PharmD, BCPS, CPE is professor and vice chair in the Department of Pharmacy Practice and Science at the University of Maryland School of Pharmacy in Baltimore.  She has maintained a practice in both hospice (local and national) and ambulatory care her entire career. Dr. McPherson teaches extensively in the PharmD curriculum on pain management and end-of-life care, including didactic and experiential content. She also developed one of the first and few palliative care pharmacy residencies in the United States.

Indy 500 Festival Princesses Honor Vets

Memorial Day Weekend is always special in Indianapolis, honoring fallen veterans and hosting the largest one day sporting event in the world, The Indianapolis 500.

In recognition of those who served, Seasons Hospice & Palliative Care coordinated and sponsored the visit of eight Indianapolis 500 Festival Princesses to Richard Roudebush VA Hospital in Indianapolis.

The event was suggested by Princess Emily Schaefer, daughter of Seasons Hospice Chaplain Neil Schaefer who secured the commitment of her fellow Princesses for the visit.

The Princesses met with several veterans who were patients at the hospital, took photographs with them and thanked them for their service. The Princesses also left each Veteran with a small token of appreciation: a small checkered flag to commemorate the 97th running of the Indianapolis 500.

The Physician’s Role in Hospice

When I first started out in hospice (almost 15 years ago), the role of the Medical Director was very clear: show up, sign some papers, keep your mouth shut, and get out of the way. 

Things have changed dramatically: our doctors have spent the last decade taking on an increasingly vital role in driving our models of care.  At many other community-based hospices, the doctors fall under the old model. 

 But at Seasons, our doctors have demonstrated leadership in the following ways:

• Active teaching at team meetings and in the community
• Serving as Executive Director of one of our programs
• Keynote lectures at State Hospice organization events
• Publications in hospice and other journals
• Engaging in local and national research, to improve hospice care across the country
• 24/7 contact availability
• Embracing of new technology
• Working with our staff, facilities, and families to find creative ways to serve extremely complex patients who need us at the end of life
• Getting to the bedside

In 2012 and 2013, our doctors look forward to serving more individuals and families as we launch palliative care in many of our sites.

One of the reasons Seasons has grown so rapidly is our Open Access program.  Our Seasons Physicians process these Open Access requests and are excited to take them on, no matter how challenging.  This often involves calling the patients’ referring doctors, working with large hospital teams, coordinating care with our staff, educating our team members, and speaking with insurance companies to get the right medications covered. 

And in the end, when that Open Access patient goes home on a ventilator and dies comfortably with his/her family at the bedside, our Seasons physician is often there too, holding the patient’s hand. In fact, our Seasons doctors get to the bedside often.  In some programs, over 75 percent of the new patients are seen by a hospice doctor within 14 days! Our required face-to-face visits are also typically made by our Seasons doctors – and many were doing these visits well before the government made this step mandatory.

Our Seasons doctors help each other out often.  They learn from each other, they share insights, and they teach me something new every time we convene, even via conference call.   This spirit of collaboration among our medical staff is uniquely Seasons, and makes me proud to be a part of it.

We sure have come a long way in 15 years.

Balu Natarajan, M.D., Chief Medical Officer, Seasons Hospice & Palliative Care

Board-certified in internal medicine, hospice and palliative care, and sports medicine, Dr. Natarajan has authored book chapters and articles in peer-reviewed journals. He has also lectured across the United States and around the world, including at the Annual Meeting of the American College of Physicians. He won the Scripps Howard National Spelling Bee in 1985.

High Anxiety Over Hospital Readmission Rates

The Hospital Readmissions Reduction Program (HRRP) will move forward in October 2012, changing the Medicare Payment Policy. The Centers for Medicare and Medicaid Services (CMS) will reduce Medicare payments to applicable hospitals based on all admissions, especially higher than expected rates of readmissions.

Over the next several years, we will have a host of data to examine best practices as systems continue to address how to reduce readmissions. Most experts agree that a robust transition care management system coupled with quality community-based partners will succeed.  Dr. Robert Smith, HPCCR Medical Director wrote, “Increased utilization of hospice services can help hospitals and physicians with the challenges of reducing readmissions. When physicians have those most difficult conversations with a patient whose illness is no longer responding to aggressive, disease- specific treatment and a referral for hospice care is made, the patient is less likely to opt for expensive treatments”.

Hospice agencies that utilize industry best practices such as; Accreditation with National agency, ability to take high-acuity cases, specialized disease programs and have response times less than two hours are more apt to admit patients who are at high risk for readmissions.

Many insurance companies are mirroring CMS’s strategy and contracting with newly created Accountable Care Organizations on cost sharing programs.  Rehospitalization oversight and its expected savings appear to be here to stay for all payer sources. Healthcare systems have dramatically reduced Medicare length of stays (over 30% in the last 15 years), reduced the 30 day mortality rate (16%) and have efficiently increased patient transfers to nursing homes (60%).  Rehospitalizations have increased by 18% in the same timeframe, negating much of the cost savings of the shorter length of stay. 

The penalty cap limits are up to 1% of each hospital’s base operating revenues for FY 2013, 2% for FY 2013 and 3% for FY 2014 and subsequent federal fiscal years.  There is debate of how great a financial penalty this will create for hospitals; will the cost of intense medical management system override Medicare penalties?  Data has shown that lower socioeconomic areas experience increased rehospitalizations raising the question of the new model’s fairness.

The statistics that support the HRRP include: two-thirds of Medicare beneficiaries are readmitted or die within one year of readmission; hospitalizations account for 31% of total healthcare expenditures; readmissions contribute significantly; as almost one in five Medicare patients discharged from a hospital are readmitted within 30 days accounting for over 18 billion dollars.

Avoiding Medication Errors

by Mary Lynn McPherson PharmD, BCPS, CPE 

A medication error can occur during any part of the medication use process: prescribing, transcribing, dispensing, administering or monitoring. Specific protocols will guide employees on the medication use process to reduce liability. Here are descriptions of the stages, each extremely important to prevent a medication error in any setting.

Prescribing: Medication errors can occur if patients are prescribed inappropriate medications. Each prescription should be checked to ensure correct selection of drug, dose, route, frequency or indication.

Transcribing: Transcription errors happen when verbal orders are given or transcribed incorrectly. To prevent this, verbal orders can be read back to ensure accurate transmission.

Dispensing: The pharmacy could dispense the wrong drug or amount of medication or create labeling errors. The delivery of medications also crucial.

Administering: If a patient takes an unprescribed medication, takes a medication differently than prescribed or doesn’t take the medication at all, it should be reported.

Monitoring: Not providing the appropriate monitoring is a significant error, especially if patient harm or suspected drug abuse occurs.

Mary Lynn McPherson PharmD, BCPS, CPE is professor and vice chair in the Department of Pharmacy Practice and Science at the University of Maryland School of Pharmacy in Baltimore.  She has maintained a practice in both hospice (local and national) and ambulatory care her entire career. Dr. McPherson teaches extensively in the PharmD curriculum on pain management and end-of-life care, including didactic and experiential content. She also developed one of the first and few palliative care pharmacy residencies in the United States

Helping Families Leave a Legacy

When we think about the word “Legacy,” we typically think in terms of large gifts or of memorable and famous individuals who have left a lasting impact on society. Seasons Hospice & Palliative Care recently rolled out the “Seasons Remembered: Leaving a Legacy Program”.  This innovative program involves our team members helping our patients capture their “Legacy,” leaving their message and memory for ongoing generations to share. 

Some Legacy projects are larger than others, but all undoubtedly leave their mark not only for those receiving the created memory, but also for the patient, staff and volunteers who help complete the work.  Projects have ranged from helping our patients record their favorite memories and stories via hand-written messages or recordings, to creating a timeline of a patient’s favorite music or capturing them singing a favorite song with one of our music therapists. A recent project involved working to compile what might have been a bestselling cookbook, but instead is the multitude of recipes from the family matriarch and some of the captured tales that went along with them; it was then bound and copied for each of her children. 

Often times, Legacy projects can be bittersweet and difficult for a young hospice parent to complete.  But when our staff realizes that by gently nudging a mom to record her voice on a story book for her small children or assisting a father to write out cards for future events in his daughter’s life where he won’t be present, the end result is always seen as a cherished blessing that all are grateful for.  The uncomfortable feelings of staff soon fade as we often have the privilege of seeing the power of these projects carry on long after our patients are gone.  

There is no value that can be placed on one person’s legacy over another. Compare a piece from a famous art collection and a picture that was finger painted by a pediatric hospice patient; both are priceless and certainly irreplaceable, the latter being a one of a kind masterpiece to that child’s parents.  While a Legacy is often thought of when someone is at the end of life, it really should be a project for the living.

Consider your own legacy or perhaps, the legacy your parents or grandparents left you.  How do you want your children, grandchildren, family and friends to remember you?  Will it be the company you built from the ground up and have it successfully passed on or, might it be that you are a talented artist or photographer and have a collection of creative pieces that many will enjoy? 

If you are wondering how you might get started, take a piece of paper. Trace your hand, and on each finger, write a life message or lesson you would like to pass along.  Fold up the piece of paper and tuck it away in a safe place to be found at a later date. Or choose to share it with those closest to you and encourage them to do the same.  Regardless, leaving a legacy for those that follow is what should motivate each of us everyday in the work we do and the lives we touch.