Alzheimer’s Disease and Hospice Services
March 20, 2006
Speaker: Joel Fry, MSW, Hospice of Central Iowa, 515 271-1324
Hospice is about taking care of end of life illness. Hospice of Central Iowa serves people in 34 counties in Central Iowa.
The criteria for receiving services from Hospice of Central Iowa are as follows:
1) Generally person is in end-stage of disease process. Usually people are determined to have approximately 6 months of remaining life, though there are persons served who have been with the service for several years.
2) Care can be given in a person’s own home, nursing homes, or in Kavanaugh Houses.
3) Person must be experiencing reduced mobility, unable to do normal work activities, maybe able to dress self but have difficulties with activities of daily living, intake of food and water can still be relatively normal up to a need for total care.
4) Person must meet 2 of the ADL dependence criteria: feeding, ambulation, continence, transfer, bathing or dressing.
5) Person must be able to meet all characteristics of Stage 7 of Functional Assessment Scale.
· note that the loss of the ability to smile for a person with Alzheimer’s Disease is a significant marker.
6) Must have experienced one of several medical conditions in the last 12 months.
· note that significant weight loss of 7 or 8 lbs in a month is a trigger for need for Hospice care, as is medical/family discussion of need for repeated hospitalizations.
7) Co-morbidity with another disease.
· note, if the person’s stage with Alzheimer’s disease doesn’t qualify them for Hospice services, another disease such as cardiovascular disease or diabetes, etc may.
Hospice care is covered by both Medicare and Medicaid. There are no direct charges to the person being served. Services not covered under Medicare or Medicaid (such as massage therapists, acupuncturists, pharmacists, dietitians etc) are covered by donated funds.
Hospice uses an interdisciplinary team approach: mind, body and spirit.
Mind:
1) Social workers assist with determining needs for services and
work with the family in processing the information and expressing their feelings, as well as assisting with resolving issues of logistics and services.
2) Bereavement counselors assist with planning for the ultimate death of the person served and help the family deal with the grief process following the death of their loved one.
3) Complimentary therapists: serve additional psychological needs of the person being served.
4) Volunteers: help by providing someone to talk with and offer an experienced shoulder to the family being served. Volunteers also provide practical assistance for the person being served.
Body:
1) RN: provide medical care and care planning for the person being served’
2) Home Health Aide: provide hands on care, assistance with activities of daily living, personal care, bathing, toileting, linen changing, feeding, etc. Intimate personal care for the person being served
3) Physicians: Hospice works with the person-being-served’s personal physician to assure continuity of care. There are physicians who serve as medical advisors to Hospice.
4) Dietitians: Assist with meal planning to assure appropriate nutrition for the person being served, and ideas and suggestions to assist with swallowing problems, and making food taste better.
5) Pharmacists: Assist with reviewing medications to make sure they are still doing the job they need to do, reduce the number if possible, and improve ease of taking the meds. Works in conjunction with the physician.
6) Massage therapists, acupuncturists, and other alternative medicine practitioners: assist with supplemental therapies to increase patient comfort.
Spirit:
1) Works with local spiritual care, family pastor/priest/rabbi/spiritual leader to help them learn best way to work with family in grieving process.
2) Hospice chaplains: also available to work directly with families and persons being served.
3) Bereavement counseling: will look at what existing support systems you have (spiritual, community, family, hobbies, health) and help supplement them and draw them in for support.
Hospice enjoys working with persons with Alzheimer’s Disease because they get to do the best relationship building with those patients and their families. It is a joy to work with them.
One of the goals of Hospice is to help keep the person being served out of the hospital (which is a strange, confusing and stressful setting), reduce non-essential medical procedures (such as routine lab or blood draws), manage symptoms and pain, chose appropriate medications and medication levels. Ultimately,
Treatment Options = Patient Quality of Life
For more information:
Ethicalwills.com: Good resource for discussion of what you want and don’t want in your own end of life care.
Hospiceofcentraliowa.org: For more information about Hospice care
Alz.org/greateriowa: For more information about Alzheimer’s Association services