Homeland Hospice: Ensuring quality of life

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For those unfamiliar with hospice, the very mention may give rise to uneasy thoughts about death. But in reality, hospice care is all about creating a quality of life for patients.

While hospice care is called for at the end of life, the focus is about helping patients live to the fullest.

“When people have a life limiting illness, if the physician feels they have six months or less to live and they are not seeking aggressive therapy they can seek hospice care,” says Sue Minarik, director of Homeland Hospice. But many patients don’t enter hospice until much later. “All too often our patient families tell us they wish they would have known about us sooner.”

From ensuring patients are pain-free to helping them enjoy time with family and friends, Homeland Hospice is about quality of life. Care is provided by a committed team that includes nurses; social workers; spiritual and bereavement counselors; and home health aides and volunteers.

Providing care

Each patient is assigned a primary nurse and a primary social worker, Minarik says. Nurses work with physical pain and symptom management and also keep a careful watch on the emotional well-being of the patient and their family.

“The nurse kind of steers the ship, if you will,” Minarik says. “She can make visits on a daily or weekly basis.”

As needed, other members of the Homeland Hospice team are brought in to assist with the range of emotions that patients and families go through. Among the support services offered are grief support groups, memorial services and 13 months of follow-up after the patient’s passing to help families cope with their loss.

The social worker sees the patient once or twice a month and sometimes more often, depending on the needs of the family. Social workers in hospice guide families through health care decisions, end-of-life wishes, insurance matters and accessing local resources.

Homeland Hospice also offers daily home health aide services, an important feature that most hospices do not provide.

“Home health aides are wonderful,” Minarik says. “They can visit as many as seven days a week and spend one and a half to two hours with a patient. They assist with personal care, housekeeping, cooking meals, feeding and help with activities, such as accompanying the patient on walks.”

Going well beyond the minimum

Since 1867, Homeland Center has provided the highest standard of care to residents of Central Pennsylvania, and Homeland Hospice embraces that tradition, providing special services for patients that go well beyond what is typically seen.

“Barry Ramper, Homeland Center’s president and CEO, really believes in quality of care,” Minarik says. “He has told us, “If you need anything for patient care, we’ll get it.””

Through a contract with a company called Pampered Care, patients are treated to haircuts, manicures, perms, hair coloring and other beauty services. Homeland Hospice also has volunteers who provide music and pet therapy and appropriate holistic medicine.

“Obviously the main goal is pain and symptom management,” Minarik says. “But we offer these other services to improve quality of life.”

Homeland Center meets the nutritional needs of residents

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Just like in any family, mealtime at Homeland Center is one of the most anticipated times of the day. The residents look forward to not only another delicious meal, but also to the social aspects of gathering in the dining room with friends, staff, and families.

What does differ slightly is that seniors have unique dietary needs, so Homeland Center’s first goal is to ensure basic nutrition.

“The primary challenges of meeting the nutritional needs of the elderly is ensuring that they eat enough food to prevent weight loss and consume enough fluids to prevent dehydration,” says Yolanda Williams, registered dietitian and director of food services at Homeland Center. Williams and her team work to meet those needs by planning menus in accordance with the Dietary Guidelines for America and Dietary Reference Intakes.

Special challenges

Additional challenges beyond basic nutrition exist as adults age. Many seniors are prescribed therapeutic diets to help manage specific diseases or conditions.

“Carbohydrate controlled diets are recommended for individuals with diabetes, low sodium diets are recommended for individuals with congestive heart failure,” Williams explains. Medications also can require dietary stipulations. And often, needs can change.

To stay on top of changing nutritional needs, Homeland Center’s dietitians complete nutritional assessments for each resident.

Homeland Center seeks balance

“When residents enter a facility, the goal is about quality of life,” Williams says. Mealtimes tend to be an important part of the day for residents, not only nutritionally but socially as well.

The goal is to accommodate their unique preferences as often as possible.

“Something as simple as cinnamon on their applesauce or their choice of ice cream flavor; those small details can make a resident’s day,” she says.

Homeland’s food services team works with the doctors, nurses and families to individualize and liberalize each resident’s diet. Sometimes it takes a little creativity to make everyone happy, but the efforts go a long way in assuring a positive quality of life.

Homeland Center’s strategies to balance nutritional needs and personal preferences include:

  • Nutritional supplements
  • Working with families to address special requests
  • Adjusting medications
  • Evaluating whether the restrictive diet is really necessary

Let them eat cake, or ice cream!

“My philosophy is if you take care of yourself by making healthy lifestyle choices when you’re young, then once you reach 80 and beyond you can sit back and eat all the ice cream you want,” Williams says. “At this point you deserve it!”

Estate planning: Take the first steps, draw up the right documents

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Estate PlanningNo one likes to face the emotional and practical questions of estate planning. And yet, a well-crafted plan with properly prepared documents can create peace of mind today and prevent conflict and confusion later.

Estate planning isn’t a one-size-fits-all proposition, says Vicky Ann Trimmer, an experienced estate attorney with Persun & Heim, P.C., Mechanicsburg.

“What you want is different from the person sitting next to you,” says Trimmer. “Even husbands and wives sometimes have a complete difference of opinion in what they want to do.”

Start with these three steps:

  • Information gathering: Build a list of assets and whose names they’re under. Planning differs depending on whether assets are in one spouse’s name or two. “A lot of times, folks don’t know how things are titled because they haven’t looked at their deed in 50 years,” says Trimmer. Rough values also help in determining whether federal taxes will come into play.
  • Set immediate goals and objectives: Ask how affairs and assets should be handled during your lifetime, especially if you eventually need help paying bills and making decisions. Who are the people you’d trust to assist you, and what are their strengths?
  • Establish goals for assets after death: Who should benefit: children, grandchildren, charities, faith groups? Will they be disbursed immediately or put into trust for later use?

Once the assets are listed and goals set, it’s time to draw up the documents:

  • Financial power of attorney: This document gives selected others the power to write checks, pay bills, and make financial decisions. Individual circumstances dictate the details, such as shared responsibilities among siblings. “We can help be creative to come up with a solution that meets and accomplishes your goals,” says Trimmer.
  • Health care power of attorney: The health care POA confers the power to make health care decisions in case of incapacitation. It can include a living will, also known as advanced care directives, specifying treatment that should be given or withheld.
  • Will: This is the disbursement of assets to heirs and beneficiaries, the legacy that remains. Whether the assets go into trusts for long-term management can depend on the beneficiaries’ circumstances, such as age, disabilities, or money-management capabilities.

Don’t let the tax tail wag the planning dog. Develop the plan first, and then adapt it for tax purposes.
“Tell me what you want, and I will make it happen in the most advantageous way,” says Trimmer. “You can get so hung up on avoiding tax that when you get done, you have a great plan with no tax, but the things that Mom and Dad wanted didn’t happen.”

Keep the documents in a safe deposit box; home safes might not protect against the extreme heat of an electrical fire — and review them every three to five years, especially when life circumstances change.  “The review may be as simple as reading the document” says Trimmer. Many changes can be made easily after a simple talk with the attorney. “If it still does what you want, stick it back in the safe deposit box.”