What Caregivers Can Expect from Hospicare

In poll after poll, Americans consistently say they want to die at home. Hospicare, like all hospices, is set up to help our patients do just that. When patients choose to receive our services, they immediately begin to receive care based on the principles of comfort, dignity and choice. This individualized patient- and family-centered care is most often provided in the comfort of the patient’s own home. Yes, it’s true: our board-certified hospice and palliative physicians and fully credentialed interdisciplinary teams of nurses, aides, chaplains, social workers and counselors make house calls! In addition, we arrange for any needed medical equipment such as special beds, wheelchairs, oxygen tanks and nebulizers to be brought to the home so that the patient can be as comfortable as possible.

Knowing that their loved one can remain at home while being cared for by professionals trained in end-of-life care can often ease the minds of the patient’s family members and friends. But there is another piece to the end-of-life care-giving puzzle that is also extremely important: the primary caregiver. While Hospicare team members will visit patients in their homes, those visits are usually an hour at a time, a few times a week. The main caregiving duties still fall to the patient’s primary caregiver, usually a family member.

We will do all we can to assist the primary caregiver. Our social workers and bereavement counselors are available to help with problems the caregiver may be experiencing, including practical problems as well as feelings of grief or inadequacy that can surface during this stressful time. Our nurses will educate caregivers on care and symptom management, and we have a nurse, on call 24-hours a day, seven days a week, to answer questions that may arise. We can also provide trained volunteers to visit with the patient an hour at a time, freeing up caregivers to have some private time for themselves. Many caregivers find that this assistance is a great support to them both physically and mentally.

Sometimes, however, a patient’s needs become too much for the caretaker to handle at home. When that happens, the Nina K. Miller Hospicare Residence is an option for the patient. At the Residence, we provide intensive around-the-clock care in a homelike setting, which can lift the burden of constant responsibility from the caregiver, providing much-needed relief.

Myths and Truths about Pain and Pain Medicine

by Eric Lessinger, MD

As Medical Director of Hospicare & Palliative Care Services, I spent a considerable amount of time addressing issues related to pain and its treatment. Some people have deeply-held beliefs about pain medication which have little or no basis in reality, but which interfere with their willingness to take the drugs that will provide needed relief.

Myth: One person can judge another person’s pain by observation.

Truth: What people say about their pain is the best way to know how much and what kind of pain they have. Some people with severe acute pain and many people with chronic (constant) pain may not show any signs of pain.

Myth: The use of strong medications for pain can lead to addiction.

Truth: Addiction begins as a psychological phenomenon. It is extremely rare for a person to become addicted to narcotics if the medication is being used to treat pain, and the person was not addicted before.

Myth: People taking narcotic medications can’t function well.

Truth: Moderate to severe pain itself often interferes with psychological and physical function. People getting adequate relief of pain through use of narcotic medication commonly think more clearly and function better physically than they did before taking the medication. Side effects of narcotics commonly do include sedation, nausea, and constipation. However, with chronic use, sedation and nausea almost always resolve, leaving only constipation as a side effect which does require ongoing treatment.

Myth: People taking narcotics become dependent and can never stop.

Truth: If the source of the pain is eliminated, a person can safely taper off. On the other hand, with chronic use, it is true that a person’s physical system can become dependent upon narcotics, meaning that abrupt withdrawal of medication can lead to an uncomfortable withdrawal syndrome. This is very different from psychological addiction, and withdrawal syndrome can easily be avoided by tapering off the medication instead of stopping it abruptly.

Myth: Morphine and other narcotics are useful only for treating pain.

Truth: Narcotics are quite effective in treating shortness of breath. As more and more people with chronic lung disease and chronic congestive heart failure reach a terminal phase of their illness, morphine and other narcotics provide welcome relief from episodic shortness of breath, without worsening the underlying condition.

Myth: Morphine is only used when you are dying, and brings death sooner.

Truth: Morphine (and other narcotic or opioid pain relievers, including codeine, oxycodone, hydrocodone, hydromorphone, fentanyl, and methadone) can be used to treat moderate to severe pain from any cause, when less potent pain relievers such as aspirin, ibuprofen, naproxen, and acetaminophen are not adequate. Morphine is often given to relieve pain in patients who are near death, and in such cases it is just as likely to lengthen life (by allowing the patient to relax and live comfortably) as it is to shorten life (by decreasing alertness and thus decreasing intake of fluids). Generally at that very last stage of life, getting comfortable and staying comfortable to the end become the main goals of the patient, and narcotic medications are very useful in helping the patient meet those goals.

If you have questions about pain and symptom management, talk to your physician or call Hospicare & Palliative Services at 607-272-0212.

Dr. Eric Lessinger was the medical director at Hospicare for 12 years until his retirement in 2014.

It’s an Honor to Volunteer at Hospicare

by Cheryl Jewell

I started volunteering at the Nina K. Miller Hospicare Residence in April 2012.I have learned something special from each individual I have encountered.I have been moved by the look in patients’ eyes when I have held their hands and they are unable to speak. I have sat next to others who were unconscious, or who could no longer speak and were unable to open their eyes. I have put my hand on top of their hand and have felt their heartbeat slow down or their hand twitch slightly as they manage to just barely move a muscle. Just bringing a patient a meal or a beverage is  rewarding because they smile or say thank you, and I know they feel loved.

The work I and other volunteers do helps the Hospicare staff as well. Volunteers help make staff members’ jobs easier so they can concentrate on the professional care they are qualified to give, while we can focus on the volunteer work we’re able to do.

Every minute I have volunteered with Hospicare I have learned more about myself and I’ve learned about the patients I have been with.Some patients have told me about their experiences living though World War II or Vietnam. Many have shared cherished memories of all kinds with me.

It is truly an honor to work with Hospicare and to be involved in a patient’s life during their last days.