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By Lucette Moramarco
Associate Editor 

There are options for home care of the sick and elderly


Last updated 8/24/2019 at 11:35am

Lucette Moramarco photo

Toni Kisgen, LVN, speaks about healthcare services at the August Woman of Wellness event.

The Woman of Wellness program for August was about the differences in three healthcare options: homecare, palliative care and hospice. The guest speaker was Toni Kisgen, LVN, from Destiny Home Health, Palliative and Hospice Care.

Kisgen said there are three options in paying for these services, Medicare, veterans benefits or health plans whether HMO or PPO.

She gave examples of why people would need each kind of service.

Home health would be needed if a person fractures a hip or has a serious illness and is making progress in getting better.

A home health aide helps homebound patients with bathing, changing sheets and applying lotion. Home health services also include

a home-health nurse, nurse practitioner, physical therapist, occupational therapist and medical social worker who can aid the patient in staying at home and out of a hospital.

A patient would get two or three visits a week for individualized one-on-one assistance and support including management of pain, disease and medication; infection prevention and wound care.

Some patients also need education in eating well and in understanding why they need to take their medication. This help is offered at the beginning of recovery. Besides medical observation and assessment, these services also help maintain communications with the patient's doctor.

If a person is mostly homebound – only going out for church services, short lunches or doctor's appointments, they qualify for home health services. They also have to be under the care of a doctor and have to keep their appointments, Kisgen said.

The service provider needs to be a Medicare-approved agency. Also, Medicare will only cover home health as long as the patient is improving fast enough. It will not cover slow improvement but does cover outpatient therapy and helps patients stay out of the hospital.

Destiny has a special accreditation for palliative care, Kisgen said. For this service, a patient must have a diagnosis of a serious illness like cancer, be undergoing chemotherapy or blood transfusions.

Palliative care allows the patient to seek care to cure a serious illness. A nurse makes sure their medication is working and helps them deal with side effects. This care allows aggressive treatment and care from a home health aide and nurse practitioner as well as the patient's doctor, social worker and pharmacist.

Those who need palliative care include someone with Lou Gehrig's disease or anyone on a vent or trach. Patients can get treatment and remain at home so they are not in and out of the hospital.

Palliative care is appropriate at any age and at any stage of a serious illness including congestive heart failure, stroke, Alzheimer's, kidney or liver disease and cancer.

The battle to extend the patient's life includes help with managing care and symptoms with the goal of improving quality of life for both patient and family.

This kind of care treats pain, depression, shortness of breath, fatigue, constipation, nausea, loss of appetite, difficulty sleeping and anxiety.

The next phase of care is hospice which embraces both the patient and their family, usually after a terminal diagnosis of six months or less. Hospice care involves a team-oriented approach of pain management, emotional and spiritual support tailored to the patient's wishes, Kisgen said.

She gave the history of hospice care which was developed in the early 60s in London.

A woman named Cicely Saunders was a social worker who became a nurse and then a doctor. She created hospice care at a time when dying patients were placed in the back wing of St. Christopher's Hospital with minimum care.

Saunders moved the patients to the front of the hospital and involved social workers, aides and volunteers in their care and they lasted much longer than expected because of it. Saunders started promoting St. Christopher's hospice program which attracted a group of Yale medical students who visited around 1970.

The Yale students returned home and started the first hospice in America in New Haven, Connecticut.

By 1972, the program was saving money and allowing people to stay at home.

Kisgen explained that by 1982 hospice services were benefiting hospitals because it was the height of the AIDS epidemic and people were dying fast.

Because of that, hospice is connected with the dying.

However, "It's an amazing benefit to help us live longer; it's about the quality of life, not quantity," Kisgen said. Patients can live at home as it doesn't matter where they are, hospice is available to them. She recommended people plan for end of life care and decide how they want to die.

Chaplains are also an important part of hospice care, she said. It also provides equipment to make care easier, including beds, lifts, commodes, anything to make them comfortable.

Hospice cares for the patient's family, making sure they are okay and not forgotten. Respite care is offered, moving the patient temporarily to a facility so the caregiver can rest.

Patients get to choose which hospice service they want to use, so they should interview two or three of them. "Make them tell you what

they are going to do for you; it is your right, your entitlement," Kisgen advised.

The patient's doctor has to write an order for hospice, but the patient can choose the hospice first, she said. Also, according to Kisgen, it takes two doctors to verify hospice is appropriate for the patient; the attending physician and the hospice director.

Patients can graduate from hospice if their condition improves; they do not always die. At the center of hospice is the belief that each person has the right to die pain-free and with dignity, and that the family will receive the necessary support to allow them to do so, she said.

Stage 1 of hospice care is planning for one's end of life care.

Stage 2 is spiritual and emotional care while

Stage 3 is help at home and

Stage 4 is inpatient care if needed at hospitals and nursing homes.

Stage 5 is bereavement support for family members and caregivers.

WOW is provided by Fallbrook Regional Health District; the next program will be Sept. 5. An adult education specialist from I Love A Clean San Diego will explain "What zero waste means" at Fallbrook Library.


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