About Kim Lovell, LBSW

L.B.S.W. - Family Services Director

Telemedicine at End of Life – Are We There Yet?

As we close in on the year 2013, it is amazing to look back to the previous years of progress we have made in healthcare technology. Modern science has brought us to a whole new realm of thinking in just one generation. Across the board, we have seen advances in pharmaceuticals, knowledge of disease processes, and inventions of medical tools that I thought I would never live to see. Healthcare always seems to be in a state of change, right? But, what kind of change is acceptable?

This is a brief synopsis of current ideas being brought into the forefront:

Healthcare Finance News, July 26, 2012

Telemedicine and mHealth have the potential to help the healthcare system meet the Institute of Healthcare Improvement’s triple aim to simultaneously increase the quality of care, improve the health of populations and reduce the per capita cost of care.

“A 2011 study by the National Institute for Health Care Reform found that hospital readmissions within a month of discharge have cost over $16 billion each year. Telemedicine can be used to reduce readmissions and other adverse events at a cost that is less than the cost of the problems themselves.”

Telemedicine and mHealth have the potential to help the healthcare system meet the Institute of Healthcare Improvement’s triple aim to simultaneously increase the quality of care, improve the health of populations and reduce the per capita cost of care.

So, what does this have to do with end of life care? Believe it or not, Telemedicine has entered the hospice field. Currently, there are several agencies using this technology for end of life. The University of Kansas Medical Center and Michigan State University launched a bi-state project called “Telehospice: Using Telecommunication Technology for Terminally Ill Patients.” Overall, from the study completed by Pamela Whitten, Gary Doolittle, and Seth Hellmich, of the 51 patient/caregiver interviews completed, felt that telehospice was “an extension of traditional hospice services.” Providing telehospice to traditional hospice care especially to those patients in rural areas offers several benefits:

  1. It could greatly relieve time constraints in travel by the clinicians.
  2. Increase communication between clinician, patient, and caregivers.
  3. After hour’s acute symptom management, video visits offers confirmation if a face to face visit is needed. As well as emotional support to anxious patients and caregivers.
  4. Providing at home triage services, telemedicine appointments, telemonitoring- a form of observation of the patient.
  5.  Reduces unnecessary Emergency Room visits.
  6.  Corporately, telemedicine offers fractional employment. Then in turn, reduces system costs by enabling patients to receive care at a lower price point.

Telehospice. So, are we there yet? Who is to say? It is definitely a debatable point. Traditional hospice was built on the foundation of serving patients with compassion and mercy, meeting with them face to face in their home, alleviating pain, offering spiritual, emotional, and bereavement support. Do we leave this belief system for a new innovative healthcare invention that could leave patients feeling deserted by their providers and not feeling connected to those giving the care? Is this kind of change acceptable? You decide………….

How to Safeguard your Medical Identity

Could identity thieves be using your personal and health insurance information to get medical treatment, prescription drugs or surgery? Could dishonest people working in a medical setting be using your information to submit false bills to insurance companies? Medical identity theft is a twist on traditional identity theft, which happens when someone steals your personal information. Like traditional identity theft, medical ID theft can affect your finances; but it also can take a toll on your health.

The Federal Trade Commission has a link: http://ftc.gov/bcp/edu/pubs/consumer/idtheft/idt10.shtm in protecting America’s Consumer’s against Identity and Medical Identity Theft. Many of you may not know that this is even possible or going on in our world today. We normally hear about bank account security breaches, but could it be possible that someone would want my medical information too?

Here are some ways to know if you have had your medical, personal, or health insurance information breached:

• you get a bill for medical services you didn’t receive;

• a debt collector contacts you about medical debt you don’t owe;

• you order a copy of your credit report and see medical collection notices you don’t recognize;

• you try to make a legitimate insurance claim and your health plan says you’ve reached your limit on benefits; or

• you are denied insurance because your medical records show a condition you don’t have.

It is very important to be aware if your information has been compromised because if a thief uses your identity, your medical records could change- like your blood type, an inaccurate history, test results, diagnosis of an illness- all of which could lead to improper treatment, injury, illness, or worse.

The FTC states that “paying close attention to your medical, insurance, and financial records can help you spot discrepancies and possible fraud.” They recommend several ideas in detecting medical identity theft:

1. Reading your Explanation of Benefits or EOB statement. In doing so, you can make sure the claims paid match the care you received.

2. Order a copy of your credit reports from all three agencies: Equifax, Experian, and TransUnion.

3. Ask for a copy of your medical records for review.

Ways to minimize your risk of theft of your medical information:

1. Verify a source before sharing information. Don’t give out information over the phone unless you know the person you are dealing with.

2. Safeguard your medical and health insurance information. Make sure your records are secure.

3. Treat your trash carefully. Destroy prescription labels on the bottles and packages before you throw them out.

If you are a victim of Medical Identity Theft, here are some steps to take immediately:

1. File a complaint with the Federal Trade Commission online at https://www.ftccomplaintassistant.gov or by phone at 1-877-ID-THEFT (438-4338); TTY: 1-866-653-4261.

2. File a report with your local police, and send copies of the report to your health plan’s fraud department, your health care provider(s), and the three nationwide credit reporting companies. Information on how to file a police report is at www.ftc.gov/idtheft/consumers/defend.html.

3. Exercise your right under HIPAA to correct errors in your medical and billing records. Write to your health plan or provider detailing the information that seems inaccurate. Include copies (keep the originals) of any document that supports your position. In addition to providing your complete name and address, your letter should identify each item in your record that you dispute, state the facts and your reasons for disputing the information, and request that each error be corrected or deleted. You may want to enclose a copy of your medical record with the items in question circled. Send your letter by certified mail, and ask for a “return receipt,” so you can document what the plan or provider received. Keep copies of your dispute letter and enclosures.

Hopefully, with this pertinent information, it will help you be an informed consumer and aware of the need in protecting your medical records.

Spiritual Documentation in Hospice Care

When you chart as a Chaplain, do you view it as an irksome task or rather a meaningful component of care? In 2011, I was able to attend the NHPCO Clinical Team Conference, and there I sat in a class that dealt with this very topic. M. Bernadine Parks, MS, PCC-S, Director of Pathways of Hope was the presenter for this class called “The Devil Isn’t in the Details”.

The quality of charting depends on how you view the task. Is it satisfying and meaningful being able to chart the kind of care you provide your patients? Or is it a “cross to bear?” Problems tend to lie in EMR’s because it lends itself to be too narrowly focused, defines outcomes, not problems, and generic care plans. Ms. Parks also stated that some deficiencies were that the documentation was too vague, irrelevant details and inappropriate remarks about the visit. Some charts include rambling, narratives unrelated to the plan of care, and even relevant details to the plan were uncharted.

So, how can this change? Sometimes we get into a comfortable zone when documenting, so it is good to reevaluate if your notes are effective. As a Chaplain, your notes are vital to the care of the patient and family. It gives a more complete picture of what is truly going on spiritually and emotionally with the patient and their environment. At this point in people’s lives, they focus on what is really important to them, so expressing this in your narrative is crucial.

Here are some helpful guidelines from Ms. Parks to help you as a Chaplain working in hospice care:

1.  Using the acronym F.I.N.D. to help build your assessment

F- Faith- Is a self definition. Is the patient spiritual, religious, curious, or questioning their faith? What are their meanings? What is the patient’s belief system? Do they have any religious or spiritual affiliations, historical or present?

I- Importance of Beliefs- What are the patient’s beliefs about life and illness? What impact does their belief’s have on life choices? What impact does it have on their present circumstances like comfort, distress, hope, guilt, anxiety? What are their personal spiritual or religious practices? Does it bring them a source of peace and comfort? How relevant is it on medical care and how does it impact end of life issues and decision making?

N- Networks- Who is the person close to them that will provide them with emotional and social support? What are the present challenges? What is the history? Who are their sources of spiritual support? Does the patient have faith community involvement? Is there discord, discomfort, or conflict in their faith network?

D- Define- Define the problems. This is your plan of care. What will be the outcomes that define the patient’s problem? What specific interventions are you going to define in your plan? When those problems are solved, there will be new problems, outcomes, and interventions to describe.

Some key Chaplain interventions could be: Praying, discussing, writing a letter, reading, active listening, reframing, normalizing, challenging, exploring, participating, providing information, providing hymn reading, facilitate life review, affirm and validate, process feelings, address guilt, shame, and forgiveness concerns, contacting clergy/faith community, identify spiritual strengths and challenges, identify coping strategies, and exploring concerns regarding the afterlife.

In your narrative, Ms. Parks states always documenting facts that are relevant in the plan of care. Use quotes regarding patient behavior: “Pt…..reports, acknowledges, states, reveals, admits, denies, request, shares, expressed, agrees, reacts, responds, rejects, accepts, insists, fears, believes, questions, hopes…”

Lastly, she states that identifying tasks of who will do what.

1.What will be continued?

2.What will implemented or initiated?

3.What will be discontinued?

a.What actions will the Chaplain take?

b.What will the patient do?

c.What other team members will do related to emerging issues or problems?

d.What will the caregivers/others do?

Devine documentation, as Ms. Parks states, make a dramatic turn-around in the quality of documentation and increase the patient specific care plans linked to the assessment. Once you step out of your box, or your comfort zone of so-so charting, developing good charting habits will become like an old hat.

The Benefits of Rover

Did you know that owning a pet has huge health benefits? Studies have shown that the unconditional love of a pet such as petting and cuddling an animal can reduce anxiety, lower blood pressure and heart rate, and ease depression. In the magazine, Social Work Today, Jennifer Van Pelt, MA, discusses how animals are commonly used in therapy in hospital settings, elder living facilities, and educational settings. Now it is expanding into hospice care. The Delta Society has established standards of practice for animal therapy.

“Animal-assisted programs are just beginning to be understood and offered in hospices,” says Ann R. Howie, LICSW, ACSW, founder of Human-Animal Solutions, LLC, an organization that provides consulting and therapy services based on animal-assisted interactions. According to Maureen Horgan-LICSW, ACSW, who works with her therapy dog at Providence Hospice of Seattle, in hospice settings where social workers have animal partners (usually dogs), the animals help provide socialization and supportive listening for the patients and in some cases, assistance with symptom management. The response has been great.

Because the primary goal of hospice is to provide comfort care, it is ideal for providing comfort to patients who often feel isolated in the hospice setting. “A patient at the end of life can receive comfort from the touch of petting an animal. A patient with dementia can feel positive validation through this touch. Patients who have had animals or love animals find the visits a chance to reconnect to their positive past experiences,” explains Minaxi Patel, MSW, who works with the CarePals Pet Therapy Program at Optimal Hospice Care.

Another benefit is that “when patients have to leave their pet behind, leaves them feeling lonely and depressed” states Stephanie Prince, MSW, also with Optimal Hospice. Howie states how it increases the patient’s quality of life in having pet therapy. The patients make a special connection and then look forward to the visits. Patel also has seen the positive effects of pet therapy with a patient with end-stage Parkinson’s disease who has limited range of motion. “When the therapy dog visits her, she reaches out to pet the dog, her face relaxes, and she smiles. Her range of motion increases to pet the dog, and she receives comfort and pain relief from this simple act,” Patel states.

Comfort of pet therapy dogs as a patient is near death can be soothing and reduce agitation. Howie stated that she was “called by a caregiver when a patient whom I had seen several times was quite agitated and near death. I brought the therapy dog and carefully placed the dog on the patient’s bed. The patient stopped thrashing sat up in bed, and petted the dog for several minutes. Then she opened her eyes and spoke quite clearly, “Thank you for bringing Merlin (the dog’s name).” The patient died a few hours later.

Therapy animals can also be incorporated into grief support therapy, especially for children in hospice care or their siblings, interacting with a therapy dog by giving it commands during play can enable a young patient in hospice to express feelings of grief by providing a sense of control, as well as providing a memorable play time together with other family members. Therapy animals can also be a source of comfort for family members following the death of a patient and be a tool in bereavement counseling.

All of these are wonderful examples of how pet therapy animals can play a positive role in hospice patients and their caregiver’s lives with unexpected outcomes. Sometimes we have to think outside the box to provide that just right extra care needed to make someone’s life more complete. Do you have a pet that is certified in therapy? Solaris Healthcare would love to hear from you!

What are Hospice Patients asking of Chaplains?

Solaris Chaplain Terry Mitchell offers his comments on a recent article by Sam Oliver:

After reading Sam Oliver’s article on “What hospice patients are asking of Chaplains”, I am moved by his observation of what his expectation was and the reality he came to know. Dealing with the dying and their families cannot be learned solely by our education process. It is experienced by our willingness to listen and adapted to the individual needs of a family. To become a friend, when possible and to always be a blessing to those we have been given into our hands.

Full Article:

“Over the years, I have reflected on the needs of the dying and their family members. From working in a Cancer Center for two years to working with Hospice over fifteen years now, I have changed my approach to care a great deal. While doing the work of Hospice Care, it has somehow worked on me as well. I realize that service to others has developed my character and my soul.

I remember leaving Seminary thinking that I was going to “do” ministry. After practicing what I knew for a brief time, I realized that what I knew was not going to get me very far with the patients and families that I serve in the field of palliative care. What I knew from Seminary didn’t matter to those who are dying. This was a big ego loss for myself that I did not anticipate. I soon learned that my ministry would be one of listening to the sacred moments of a person’s life. Sometimes these sacred events meant family, church, hobbies, and much more. Continue reading