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About Andy Milligan RN, BSN, CHPN

President and CEO of Solaris Hospice.

A Mountaintop View of Hospice

My friend Steve and I, who happens to be the IT Director for Solaris Hospice, love hiking when we have the opportunity. Luckily, we occasionally find ourselves in Colorado where hiking opportunities abound. Our favorite type of hiking tends to be summit hiking. As it sounds, summit hiking involves following a designated trail to the summit of a mountain. Summit hiking is very often a bittersweet journey. Altitude, steep grades, unstable footing, rocky terrain, weather and more can make parts of the ascent downright miserable. But when you reach the summit, something magical happens.

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The obvious joy of reaching the top and gazing out at the amazing view hits first but is by no means the end. As the awe of being on top and all that comes with it settles in, you start to realize that the miserable parts on the way up weren’t so miserable after all. The physical challenge you experienced is no less real but you start to find the appreciation in the ascent itself. The summit is not reached without the difficult journey. You can’t have one without the other. The summit is the goal that keeps you going when it feels like you’re losing a lung, and once reached, the summit is what brings full appreciation of the journey.

Anyone who has worked in hospice care for any amount of time knows it can be physically tiring and emotionally taxing. In many ways, hospice care is like summit hiking. The goal of the hospice caregiver is to help the patient reach the twin peaks of comfort and dignity. This of course involves a journey that includes the unstable footing of disease, the rocky terrain of pain and symptoms and the sometimes stormy weather of family dynamics. It can become difficult to keep pushing for the summit.

This is where you discover that, like summit hiking, hospice care is best done with others. Pushing for a summit alone is much more difficult than doing so with even just one other person. Thankfully, hospice care is delivered in a team setting. Different team members act as guides for the patient and family at different times, and in turn provide support and relief for each other. The joy of reaching the summit with the patient sets in and only then is the true beauty of the journey revealed.

We’d love to hear from other providers and hospice caregivers. How do you and your team support each other?

How can palliative care relieve pain and other symptoms?

Originally posted on helium.com and written by Dr. Pandula Siribaddana. 

What is palliative care?

In the early days, the doctors and medical professionals were striving for the ultimate cure even when the latest scientific evidence indicates the end of no return. Even though this is what is expected of a developing science like medicine, the over ambitious strive for a cure could well be failed with patients undergoing immense hardships for a cure that was not at all realistic. Thus, the quality of life in such patients were almost neglected or in other words ‘masked’ by the over ambitiousness of the health care providers.

In recent times, the health care providers have increasingly recognised the need to improve the quality of life in patients with terminal illnesses and thus came the term ‘palliative care’. The objective of this type of medical care is to alleviate the patient as much as possible from the symptoms of the disease rather than just trying to cure the disease regardless of what the patient will feel. It also tackles the problem of side effects caused by the chemotherapy and other means of treatment by giving counteracting drugs or treatment.

What is hospice?

Hospice is the terminology used in identifying service providers which provides palliative care for patients who are suffering from overwhelming disease conditions which almost certainly lead to fatal outcomes. It can also be used to treat patients who are suffering from exacerbation symptoms of chronic incurable diseases.

The patient care may be provided in an inpatient setting, at home, as respite care or else even as routine visits.

What methods are used in alleviating pain and other symptoms in palliative care?

Out of many symptoms suffered by patient with terminally ill disease conditions such as cancer; pain, nausea, breathing difficulties, weight loss, loss of appetite, incontinence, depression, social withdrawal can be considered as the important symptoms and signs which needs attention. Thus, the palliative care providing team would make sure they advocate the best possible care towards improving the quality of life of such patients. Following are some of the methods that can be used in making palliative are successful.

1. Pain relief : Use of strong Opioid analgesics would be a possible alternative to other pain relief modalities and thus would be more effective.

2. Treating side effects: treatment would be given for nausea, loss of appetite,weight loss, strength building, gastric irritations…etc. Antacids, antiemetic, appetite builders as well as high protein high caloric diets would be useful in this aspect.

3. Reliving social withdrawal : Treating the patient in home setting with caregiver support as well as making the patient to involve in activities of daily living to the extent which he is able to attend would make the patient feel useful as well as happy.

4. Attending to depressive status : providing psychiatric support as well as pampering the patient with tender loving care will facilitate such status improvement and thus the quality of life of the patient.

5. Improving the mental state : Incorporating methods of spiritual uplifting as well as relaxation techniques would facilitate this process and has proved to be very much effective.

Do you have any experience with palliative care or hospice? We’d love to hear your story.

Honoring Our Own

Here at Solaris we have always considered ourselves to be a family. Even our web address carries that message (solarisfamily.com). So today we’d like to honor a very special group of our family that means a lot to us. This week is of course National Nurses’ Week and as the week draws to a close our family put together this special thank you message to all of our amazing nurses. They impact families every day in ways they don’t even realize. Hospice care in particular takes a special kind of nurse and we undoubtedly have some of the best you’ll find anywhere. Thank you to each one of our incredible nurses.

Solaris Family Thank You

Solaris Team Returns From Nepal

Recently, a Solaris team of 7 men returned from the country of Nepal. They spent 9 days hiking through the Himalayas carrying hope in the form of medical care to some of the most remote villages in the area.  They worked among the Tibetan people living in northern Nepal and were only half a mile from the border of Tibet some days. It was a successful trip and Solaris is proud to have been a part of improving the health and education in this remote area of Nepal. A video giving more detail on the trip will be posted soon but for now enjoy these few images from the trip.


Learning The Right Lessons From Hospice

Original article written for Forbes.com by Howard Gleckman.

Health policymakers love the idea of hospice. Yet Medicare seems to be learning exactly the wrong lessons from the success of the program, which provides well-integrated patient-centered comfort care to people with terminal illness. Instead of trying to understand why hospice is growing in popularity, Medicare is instead making it harder to enroll.

As often happens in its regulation of health care, Medicare is focusing on abuses. And make no mistake, those concerns are real when it comes to the $14 billion hospice business. Providers have figured out clever ways to game Medicare, which pays for 84 percent of all hospice care.

But by focusing on fraud, Medicare is missing the bigger point. Hospices are doing something right and they are doing it in a way that patients and their families really like. Instead of trying to make coordinated, comfort-based care fit into the limits of the hospice box, policymakers should be figuring out how to take what hospice does well and expand it through the rest of the health system.

As Melissa Aldridge Carlson and her coauthors put it in a December Health Affairs article, “Hospice is a model of health care consistent with the country’s stated health care reform goals: It is patient centered; it uses a multidisciplinary care team; it is coordinated across settings; it reduces unnecessary hospitalizations; and it saves health care dollars.”

Demand for hospice is booming. We know this because both enrollment and the number of hospices are growing. In 2011, 1.65 million people received hospice care, up 16 percent from 2007, according to the National Hospice and Palliative Care Organization. Nearly 45 percent of all people who died in the U.S. had hospice care (though many for only a few days). From 2007 to 2011, the number of hospices grew from 4500 to 5300, and all that expansion was from for-profit firms.

There is no doubt that some of the popularity of hospice is itself a result of the growth of the providers. Health care is often driven by supply: A new cardiac center opens and suddenly more people need stents. A new hospice opens and, thanks to aggressive marketing, more people get comfort care.

Yet, the market is telling us that hospice is offering a service people want. Remember, patients are usually required to give up standard treatment for their terminal disease in order to enroll. And they can easily drop hospice care and return to curative treatment whenever they want. But relatively few do.

Click here to read the full article. What do you think? Does hospice care have value that could benefit other areas of healthcare?