For those not familiar with the term, palliative care reduces the amount of suffering or pain from an illness or disease. Often palliative care is administered once the disease can no longer be treated or when treatment of disease(s) will result in additional unwanted health problems or issues. Many recipients of palliative care are in hospice, but they do not have to be.

ManorCare on Rossmoor Parkway in Walnut Creek, CA, is the whole package with good looks and a proven track record to back it up. The facility has a “homey” feel that is atypical of a skilled nursing homes facility, while raising the level for care.

Beyond first impression: Williamsburg Wing, a swanky health home facilites, offers private accomodations with lush appointments. The amenities include swagged drapery, dark wood furnishings in resident’s room and plush carpet. Director of Admissions Carrie Williams says that the environment is good for family members and friends, as well as the residents, noting that the wing is “less hospital-like, less scary,” taking first time visitors by (pleasant) surprise. In the Williamsburg Wing, patients are available, no matter what their health status is, so even those at end of life can spend their remaining days in this cozy, homelike environment. Soft lighting and dark wood furnishings are found throughout the facility. In the main dining room, special touches recall a fine dining atmosphere with white linens and crisply folded napkins, fresh flower arrangements, and a decorative china cabinet. An upright piano and a grand piano add style and elegance.

A family affair: Making a SNF homey goes beyond simple accord. Rossmoor Parkway residents enjoy regular happy hours that welcome family members and caregivers. Williams says that this is essential in showing families that the atmosphere is a friendly and warm one, not just “some sterile environment.” These events help keep families involved and visiting regularly, and assures them that they have made a good choice in finding a home for their beloved ones.

Numbers don’t lie: Another area where this home health facility shines is its rehab department. Take note that an astounding 97.9% of short-term rehab patients are able to handle their care independently upon discharge. Williams credits the success rate on the consistency of care that she says can be found across the board at the chain

This article, which is written by Jill Gilbert, originally appeared as “Grieving Takes its Course” in McKnight’s Long Term Care News June 2008 edition. For this month, we will continue our discussion with Joyce Ebmeier of Tabitha Health Care Services. A 25-year veteran of the nursing home industry, Ebmeier talked about the great social benefits of the Green House and a phenomenon she calls the “Green House Creep,” explaining how the model of senior care is leading to positive change at Tabitha’s 205-bed traditional nursing home, affectionately known as “the mothership.”

Mary’s story

To many, the social benefits of a Green House are undeniable. Living in a smaller community which is operating under its own set of rules makes for a happy household. When Mary, who was one of the first elders to move into the Green House, celebrated her 101st birthday, the staff asked her what she wanted. Ebmeier sounds wistful when she recalls, “Mary and her daughter sitting on the porch enjoying a margarita and a cigarette.” This year, on her birthday, everyone gathers on the porch and had margaritas to honor her memory.

b. Community before business.

It always is painful to lose someone you love, but Ebmeier says in the Green House it is “that intense and more. [Death] impacts the dynamics acutely.” After the first death in the Green House, Tabitha staff acted to fill the spot. The senior care residents and staff of the Green House pushed back, saying they “had not grieved enough yet” they needed more time.

Tabitha’s administration agreed, writing a policy for the Green House, outlining the steps to be taken when an elder died, in order to allow time for everyone to grieve properly. Collaborative change. Tabitha’s administration worked with the community to develop guidelines and a timeframe that worked. Ebmeier describes the policy as “an opportunity to honor that member of the household.” After the initial grieving period, residents and staff members will welcome the newest member to the Green House. The outcome has had a profound effect on the mothership as well. Its staff and residents quickly developed their own policy so that they, too, could grieve for neighbors and friends who had died.

A major fear people have of dying is that they’ll be in pain. Hospice eases that fear by providing palliative care with an emphasis on pain control. The main objective has always been to relieve symptoms that will interfere with one’s quality of life. Hospice manages emotional and spiritual pain in addition to physical pain. By using a combination of counseling, medication and therapy, hospice care has a very high success rate of easing a patient’s pain. Some families worry about their loved ones being so drugged that they are unable to communicate or are unaware of what’s happening. Although this can happen, fortunately, it is rare. Fortunately, hospice nurses are capable of providing strong medications and high dosages that will provide comfort without impairing the patient’s alertness.

Hospice supports the Pain Care Bill of Rights, which actually states that as a person with pain, you have a right to:

Have your report of pain taken seriously and to be treated with dignity and respect by doctors, nurses, pharmacists, and other health care professionals.

Have your pain thoroughly assessed and promptly treated.

Be informed by your health care provider about what may be causing your pain, possible treatments, and the benefits, risks, and cost of each.

Participate actively in decisions about how to manage your pain.

Have your pain reassessed regularly and your treatment adjusted if your pain hasn’t been eased.

Be referred to a pain specialist if your pain persists.

Get clear and prompt answers to your questions, take time to make decisions, and refuse a particular type of treatment if you choose. CCRCs are living communities for seniors. Most have three levels of residence: independent living, assisted living and skilled nursing. Each level of residence is tied to the level of care that the resident requires. The primary concept behind a CCRC is that it offers a wider spectrum of assisted care, so that once a senior moves into the community, he or she will be able to receive the appropriate care as his or her needs change.

Most of us have already heard about the recent news of swine flu, but have you thought about what it means for the seniors in your life, your aging parents or you as a caregiver? Anyone who has an aging parent or relative or a senior in the house, including all certified senior care managers, should be concerned about the recent swine flu pandemic and the potential risks for seniors. This group is at particular risk due to difficulties recovering if exposed. It is very important to ensure that all home health care aides are educated about swine flu Prevention Guidelines as prescribed by the CDC Center for Disease Control(CDC). Obtaining relevant information from all active caregivers, including recent travels and experienced flu symptoms, is a key component of prevention.

There are steps that professional and family caregivers as well as the community at large can take to decrease exposure and combat symptoms of swine flu. The Center for Disease Control is always updating their website, but the current guidelines and information about swine flu for caregivers is as follows: The symptoms for swine flu basically resembles those of the seasonal flu; fever, sore throat, cough, congestion, chills, headache, body aches and fatigue. Some patients also report diarrhea and vomiting. If you have symptoms, see your doctor or visit a community clinic. A doctor or medical provider’s diagnosis is very important and prescription antiviral drugs are most effective when taken within 48 hours of the appearance of the symptoms. If you are ill, avoid travel and do not go to work or school. Wash your hands often with soap and warm water for at least 20 seconds or use alcohol-based cleaners and hand sanitizers. Remember to cover your nose and mouth with a tissue when you cough or sneeze, and then discard the tissue.

Or if necessary, use your upper sleeve; not your hands. If you’re healthy, wash your hands often and avoid ill people. The flu’s incubation period is 24 to 48 hours. Make certain to follow any new developments regarding public health advice, such as avoiding crowds. Develop an emergency plan with the senior care caregivers. Your plan should include maintaining a supply of food, medicines, facemasks, alcohol-based hand rubs and other essentials.

If you are confined to bed, your hospital team (nurse or discharge planner) will assess your ability to move about and position yourself to prevent skin breakdown and for maximum comfort. They will decide whether you need a trapeze to help raise yourself in bed and will examine your ability to transfer in and out of bed, either to an ordinary chair or a wheelchair.

Once you are able to stand up on your own, your hospital team will evaluate your ability to “ambulate” (walk) to the bathroom, and to other parts of the house. If you need help to move about, your home health care team will show your family how to support your weight while you are walking and getting out of bed, so as to avoid injury to either of you. Perhaps you can walk independently with the use of a “walker,” a “three-pointed” or ordinary cane, braces, or other specialized equipment. It is very important that this equipment be the right size and configuration, and that it be adjusted specially for your needs. You must be sure to speak up at any time if your equipment is no longer satisfactory. When using braces, pay particular attention to your skin in the areas where braces fit. Point out any blisters or areas of redness. If you find that your shoulders, arms or legs get very tired during walking, it may be that your appliances, cane or crutches are not in proper adjustment, or that you may need some additional strengthening exercises. Toileting Bowel and bladder elimination should be re-evaluated in light of your home set-up.

Are you able to go to the bathroom on your own without any problems or with the use of aids? Is the toilet situated so that you can safely and easily use it? Equipment may be needed to adapt the height or accessibility of your toilet. A raised toilet seat, arm rests or grab bars can be easily added if needed. If you cannot get to the bathroom, a bedside commode can be provided. Arrangements can be made for privacy and cleanliness. Urinary incontinence is sometimes a problem after certain kinds of strokes or surgical procedures. If your situation requires the use of a catheter of any type, your homecare nurse will show you how to use and care for it. If incontinence products are needed, purchasing those ahead of time is important.

An assessment of your ability to shower or bathe and what safety equipment you may need is important. If sponge baths are preferred, decide whether the bed or bathroom would be more practical and energy-saving. Have the nurse show your family how to bathe you most efficiently, simply, and with the least discomfort. Bed and sponge baths should be comfortable and relaxing.

Transportation can be a major concern, particularly if you will have therapy or doctor appointments. If you have long term care insurance, check to see whether it covers ambulance or alternative transportation. Ask your hospital discharge planner if there are local transportation resources available. Some free transportation is available through the American Cancer Society and other organizations. Home Health Licensed home health agencies are available in most communities and will give skilled services on an intermittent basis. The services of professionals who make up your home health team (e.g., registered nurses, social workers, and physical, occupational, and speech therapists) are prescribed by your physician. Your hospital discharge planner will help arrange for home health services if needed. You can also search for one on our own.