Friday, January 17, 2020

General Description of the Community Essay

Target area being assessed by the author is hospice service in Sioux Falls and surrounding areas provided by Avera Mckennan. Hospice care is end-of-life care provided by health professionals and volunteers Hospice care provides medical services, emotional support, and spiritual resources for people who are in the last stages of terminal illness. Although most hospice patients are cancer patients, hospice accepts anyone regardless of age and type of disease. The goal of hospice treatment is to keep patient comfortable and improve quality of life. Hospice care tries to manage symptoms so that patient’s last days may be spent with dignity, surrounded by his/her loved ones. Hospice care is family-centered: the patient and family are both included in the care plan and emotional, spiritual and practical support is provided depending on the patients wishes and families needs. Hospice is not so much a place, as it is a philosophy of care with a family-centered approach that considers the patient and family to be the unit of care (Lattanzi-Licht et al. , 1998). Avera Mckennan Hospice Services are the main focus of author. Avera McKennan’s Home Hospice and Palliative Care program office is located in the Dougherty Hospice House. Through this program, they provide hospice services in a variety environments: hospice care in the home setting, hospice care in an assisted living facility, hospice care in a skilled nursing facility and also, in Dougherty Hospice House. The Dougherty Hospice House is a unique sixteen bed hospice facility located on the Prince of Peace campus. This place provides a home like setting with specious rooms for patient and sleeping accommodations for family members. It also has a meditation room, wireless internet, beautiful meditative garden, large dining and family room for families to gather, and library. Dougherty Hospice House and its surrounding property are tobacco free environments. About 80% of all hospice care is provided in private homes, nursing homes, independent and assisted living facilities (Caffrey, C. et al. , 2011). If hospice care provided in patient’s home, a family member will look after their loved one much of the time. Someone form hospice team will usually visit patient once or twice a week assessing a patient and addressing current health issues. Avera McKennan Hospice team consist of 25 people including nurses, social workers, spiritual advisors/chaplains, nursing assistants, trained volunteers, pharmacist and medical director. In case of emergency home hospice patient can call the 24-hour hospice number for advice. A nurse usually can come to patient’s house at any time of the day or night or give an advise over the phone. Based on the patient’s circumstances and stage of care, a hospice interdisciplinary team (IDT) may provide variety of services. Registered nurses assist patient with management of discomfort, pain and side effects of previous treatment ( nausea from chemotherapy). Also nurses help educate both patient and family about what is happening. The nurse is a link connecting patient, family and physician. Home health aids provide extra support for personal care such as bathing, shaving, dressing and eating. Trained hospice volunteers offer assistance with everyday tasks such as shopping, babysitting, and carpooling. They are being available to listen to the patients and families and offer compassionate support. Primary doctor approves plan of care for hospice patient and works with hospice team. A hospice medical director who has expertise in symptom management and end-of-life care is available to the attending physician, patient and family, and hospice team as a great resource and consultant. Chaplains, priests, or other spiritual counselors help patient and family explore the meaning of the death, and perform religious ceremony specific to the patient. Respite care can be provided by inpatient hospice to give family a break from stress of care giving in up to 5-day periods. This service recognizes the need for caregivers to have time away from caretaking roles (Ingleton, Payne, Nolan, & Carey, 2003;Lattanzi-Licht e. l. , 1998). Terms such as caregiver burden (Chwalisz & Kisler, 1995), caretaker role fatigue, spousal burnout, and role engulfment refer to an imbalance between the physical and mental resources needed to give care and those available within the family unit (Reese & Sontag, 2001). Regularly scheduled family conferences most often led by the hospice nurse or social worker allow patient and family members share feelings, talk about what to expect, what is needed, and learn about process of dying. The interdisciplinary team coordinates Avera McKennan Hospice services and supervises al care 7 days a week, 24 hours a day. The team is making sure that current information is shared among all the services involved in patients care. Official Community Government (form of government). For-profit and nonprofit hospices have the same regulations. They must comply with State low and Code of Federal Regulations governing hospice care. For-profit hospices grow more than six times faster than nonprofit hospices. Profit sometimes risks compromising the quality of care patients receive. Nonprofit hospices provide hospice services to anyone including persons who do not have health insurance coverage and cannot afford to pay for care. In this case, nonprofit hospice can provide services to person free of charge as part of its charitable mission because nonprofit status of the hospice requires it to offer charitable services and they are dedicated to the mission of caring those in need. Main purpose of for-profit hospices is to make money and pay dividends to their stockholders. They have no obligation to provide services to anyone who does not have Medicare, Medicaid or private insurance coverage. However, both type of hospices are trying to make money, but when they compete for patients, they must provide better care. Avera’s Home hospice services are covered 100% under Medicare and some Medicaid plans, but inpatient care at the Dougherty Hospice House involve some financial expense. Social workers offer patients and their families help with payment options and never turn away a patient for inability to pay for the service. Medicare is the primary payer for hospice services covering 77% of all hospice expenses. The rest is paid for by Medicaid (4%), private insurance (12%) or other sources (7%). Compare to hospital and skilled nursing facilities, hospice is considered a cost-effective service. Hospice charges per day are much lower than hospitals and skilled nursing facilities. Hospice care is covered in full by most insurance. Medicare and Medicaid provide a special Hospice Benefit. This benefit provides 100% coverage for visit by staff, medications related to the hospice illness, durable medical equipment in the home, and supplies for skin care, incontinence management, dressings, etc. Hospice care covered under Medicare includes both inpatient care when needed, and home care services. The focus of hospice is on care, emphasizing help the person to make the most of each day by providing comfort and pain relief. Most private insurance companies include hospice care as a benefit. Patient and family can hire hospice providers and pay for their services out of pocket. If patient has a limited financial resources, non-profit hospices provide services without charge as part of charitable mission. Any patient who enters hospice must be evaluated at the time of admission to the hospice program. Hospice dietitians assist the patient in reaching the best nutritional goals, depending on the current state of the patient’s condition. Common problems for hospice patients are nausea and vomiting. These can be controlled with anti-emetics in some cases, while for some patient s change of diet is sufficient. Educating patient and family about the changes occurring in the patient’s body is imperative. During the course of illness, patient experience changes to some extend in their food intake. It is common for the hospital patient to reduce oral intake of food and fluids as the disease progresses. In general, there is metabolism alterations occur in patient’s body with a terminal illness. Furthermore, there comes a time when the body begins to break cells down instead of building them up. At this point, the body is no longer takes nutrients in. Sometimes patients are forced to take food by family members; in this case the body may refuse through vomiting or diarrhea. A hospice dietitian will explain when this point is reached. However, addressing to stop oral intake before this point is reached is not appropriate. Ongoing assessment of hospice patient nutritional needs will help to determine if there is any appetite change or ability to take the food in and keep it. Based on a study of the non-hospice end-of-life experience of 3,357 seriously ill patients who died reported 40% were in severe pain prior to their death, and 25% experienced moderate to great anxiety of depression before they died (Lynn, 1997). However, hospice is a compassionate way to deliver health care and supportive services. Despite the low South Dakota’s death rate compare the national death rate, the two leading causes of death are heart disease and cancer, accounted for half of South Dakota deaths. Healthy lifestyle changes are critical in reducing deaths due to cancer and heart disease. These modifications can be accomplished by reducing tobacco use, increasing physical activity, and developing healthy eating habits. Minorities in South Dakota include African American, Asian, and Hispanic populations. In general, language barriers, transportation, finances, and lack of insurance were found to be the issues encountered by minorities in seeking adequate health care. Furthermore, end of life care is not reach minority population and remains as a national issue. The majority of hospice patient care is provided in the place patient calls â€Å"home†. In addition to private residences, this includes nursing homes and assisted living facilities. As the health care becomes better, the population lives longer. Nursing home patients benefit from hospice services as much as people living in their homes. According to studies, nursing home residents enrolled in hospice were less likely to be hospitalized in the final 30 days of their life (24% vs. 44%) (Miller, 2001). They were more likely to be assessed for pain, were twice as likely to receive pain management within clinical guidelines (Miller, 2004). Large percentage of elderly people receives home hospice service. Many homes need some modifications for the hospice services to be provided. For example, a bedroom may need to be relocated to a main level of the house for those who have difficulties claiming stairs. There is widening of the hallways may be required to accommodate a wheelchair access. Because of the growing number of people who wish to stay and receive care at home, general contractors are available to assess remodeling needs. A number of programs and sources provide reduced rates, loans, or free services with home modifications.

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