Sunday, February 27, 2011

When I'm 64

I had a chance to see "Rain: A Tribute to the Beatles on Broadway" yesterday afternoon.  In a word - breathtaking.  Seriously.

As I was positioned halfway across the universe... er... balcony, I couldn't actually see the faces of the performers... and that's a very good thing.  From my perch, they looked just like John, Paul, George and Ringo.  And more impressively, they sounded just like them as well.  The costumes, the wigs, the huge screens broadcasting scenes from the 1960s beside and behind the quartet all added to the illusion.  And I, along with the entire audience, was happy to subscribe to it for a few hours on a February afternoon in Boston.  It was the 1960s.  We were the screaming fans in Ed Sullivan's soundstage and Shea Stadium.  And it was the Fab Four right there in front of us.  Breathtaking.

But here's the most impressive part.  There were a lot of kids in the audience.  And the vast majority didn't look as though they would all rather be sitting at a Justin Bieber concert, marking time because mom and dad didn't get a babysitter.  No, these kids were having fun.  And many of them were singing right along: "Shake it up baby..."  "Yesterday, all my troubles seemed so far away..."  "Speaking words of wisdom, let it be..."  The 10 or so year old kid in front of me nailed every last word of "I Am the Walrus", right down to the last goo goo g'joob.  Impressive.

As a child of the '70s, I didn't listen to any music from the '20s or '30s.  But that would have been the parallel situation.

It looks as though the Beatles are going to be safe and sound for another generation or two.  Thank goodness!

Only on a weekend...

This was sent to me by a co-worker.  As impressive as the "hand dancing" is, I found myself more impressed by the deadpan facial expressions and the bizarre backdrop.

Wednesday, February 23, 2011

Discussing End of Life Care

Here's some great... and helpful... information from VNA Hospice Care.  It's geared toward providers, but anyone considering hospice care for a friend or family member can benefit from the information here:

Understand that every discussion surrounding end of life care will be different. Each patient and family will have differing personal, cultural and spiritual concepts and experiences with death and dying. These will be brought to the forefront as you begin your discussion. There is no "one way" to have this conversation.

Don't expect the patient's physician to have done all the "heavy lifting" for you. Recent surveys, done both here and abroad, of physicians likely to provide care for someone who is dying reveal that only about 1/3 of them ever have open, honest and frank discussions with their patients about the fact that they are dying. A full 2/3 of these physicians have expressed discomfort with such conversations as well as a real willingness and need to learn how to do them better.

Before beginning any conversation review your own experiences with death and dying first. Examining your own thoughts, emotions and beliefs about death and dying will give you a focal point to work from and better prepare you for the questions, concerns and fears the patient and family may want to discuss. By understanding and being comfortable with the choices you would make, it will better help you to accept those they may choose to make for themselves.

Pick a time and place when the discussion can be done in a calm and unhurried manner. If your visit is a particularly task oriented one and procedures are your primary focus it may be better to set aside the discussion until you can visit again and have more time to talk and especially, listenAny time a patient or caregiver brings up the topic first is the time to have the discussion.  If you are the one initiating the conversation, include it into your plan of care as a priority as you anticipate the patient's condition declining. It is best not to have the conversation when there is a medical crisis already in play or the family is in turmoil over other issues.

Know about the patient's disease process and its likely progression. As importantly, explore with the patient and family what their understanding of it is. Are their goals of the care you can continue to provide realistic and consistent with what their condition now warrants? Are they in denial or do they understand the severity of the disease and are just having great difficulty in expressing their fears about it?  If key words like "hospice" are likely to be problematic as you "break the ice", suggest rather that they may be interested in learning about another "level of care" from a colleague and friend you work with.

Know a bit about what hospice care can offer in the way of services. You do not have to be an expert in hospice care. Simply getting them to allow you to have hospice come in to provide a consultation for informational purposes will be enough. If you can, try to schedule that consultation for a time when you can be present in the home. You know your patient and family better than we do. Your presence during our first visit may greatly relieve any family anxiety over the consultation and will serve to educate all of us to better collaborate in the future.

Remember that help with initiating these discussions is always available to you 24/7.

Just give us a call and we can talk about what the issues are.


Question of the Month:

What is the single most common expression made by patients who are most likely ready to discuss hospice and palliative care?


"I don't want to go to the hospital any more."

Hospital stays are no vacation. If they were, you could schedule a trip to them via your travel agent and skip the ambulance ride.  We all have said this and no one ever wants to be re-hospitalized but when someone with a chronic, increasingly more debilitating illness says this, the question then becomes, is anyone really listening?


"I'm ready to refer a client for hospice services"

Call ext. 2888 or 781-569-2888 and ask to speak with our Referral Center


"I'm not sure; I need more information and help first"

Call the "Bridge to Hospice Hot-Line" ext. 6888 or 617-886-6888

And request a callback conversation

Nursing... through the years

As we're celebrating our 125th anniversary as America's first home health agency, we thought it would be fun to consider "the nursing look" through the years.  These dolls are on loan from our friends at HealthAlliance Home Health and Hospice.


We're creating a mobile display celebrating 125 great years of caring for the residents of Boston and Eastern Massachusetts.  More to come...

Tuesday, February 15, 2011

Beach walker...


President's budget Good News for home care... but don't take that to the bank just yet!

Most industry experts have been predicting further cuts to Medicare reimbursement for home health care services in 2012.  And most industry executives have been preparing, even if on paper, for the probable effects of those cuts on service offerings, access to care for vulnerable members of the communities they serve and employees.  No wonder all eyes have been on President Obama's budget, which was just released and contains, for the time being, good news.  The proposal contains:

  • $3.7 trillion in new taxes for oil and gas companies (a back door green incentive?) and high income individuals
  • increased spending on education
  • push out the so called "physician fix" which stabilizes Medicare physician payments
  • cuts to a variety of Federal programs and departments
  • new integrity (anti-fraud) programs for Medicare and Medicaid
  • no home health or hospice Medicare cuts

I'm currently attending the Home Care 100 conference and at a panel discussion today, Billy Tauzin, lobbyist and 25 year veteran of the U.S. House of Representatives (Louisiana) was quick to point out that the road ahead is long and that no one should take comfort in this... yet.  The forthcoming Senate and House processes will quite possibly include new proposals to reduce home care reimbursements.

Thursday, February 3, 2011

Health Reform: For or Against? What's your politics?


The Kaiser Family Foundation recently conducted a ten question "pop quiz", asking Americans questions regarding the Health Reform law that passed last year.  The results were quite interesting.  In short, we didn't pass.

There remains a great deal of polarization and confusion regarding the actual law and provisions contained within it.  To say it has been politicized would be a significant understatement.

The pop quiz contained questions regarding specific components of the law and Americans were asked to respond whether each was included or not in the final bill.  For example, participants were asked whether the law contains 'death panels' (government run committees charged with making critical end of life decisions for beneficiaries).  Hint: it does not.

Only 25 percent of respondents got seven of ten correct.  Less than 1 percent got all ten right.  Overall, 65 percent scored five or more answers correct.

Democrats (who mostly support the law) scored all ten right in 32 percent of cases.  In contrast, Republicans scored 18 percent.

Six in ten Americans believe the law creates a government run health plan - it does not.  Over 65 percent believe that all businesses must provide health insurance - smaller businesses, with less than 50 employees, are exempt, however.

Regarding death panels, four in ten believe they are contained in the new law.  Again, they're not.

So, the House has decided to repeal the law (though the Senate did not) and legal challenges have caught fire across the country, particularly among Republican AG states.  The politicization of the law continues, leading to great misunderstanding.  It's part of our U.S. system to debate and politicize and I believe, ultimately, we're better for it.  The unfortunate circumstance, however, is that managing and planning within the health care delivery system can become particularly challenging.  Organizations such as the VNA of Boston are accountable to the patients we serve... who are often the most vulnerable.  And who may be unlikely to care about these politics.

See all results here.