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VNA of Care New England
VNA of Care New England

Answers to Your Home Health Care and Hospice Questions

My father was recently diagnosed with COPD. What are some things he can do at home to better manage his disease?

This is a great question and one that I am often asked as a respiratory therapist.  There are definitely things that people can do to manage COPD and maintain quality of life.  I addressed things you can do at home and others to consider and/or remember in general about this disease.

  • If you are a smoker, quit smoking now. It is the best thing you can do for your lungs. Be aware of your surroundings and environment.  Exposure to secondhand smoke can significantly worsen COPD, so can chemical fumes and polluted air. 
  • Take medications as directed; it is extremely important not to miss doses.   If you have any doubts or concerns about your medication, talk to your physician, pharmacist, or other health care provider.
  • Since people with COPD tend to be more susceptible to respiratory infections, avoid having contact with people who are sick with colds and flu 
  • Learn and practice diaphragmatic breathing / belly breathing and pursed-lipped breathing.  It is a more natural and efficient way to breath. Your doctor and/or other health care provide you further instruction.
  • Learn to pace your activities.  It's ok to slow down a bit or find ways to lesson your workload.  You might do some chores while sitting down or ask for help with particularly strenuous tasks.
  • Talk to your doctor about starting an exercise program. Working out may be tiring and difficult at first, but don’t give up. Increasing your strength and stamina can go a long way towards increasing your quality of life.
  • Talk to your doctor about getting a flu shot and the pneumonia vaccine. They will help to protect you.
  • Try to eat a balanced diet. Eat several small meals instead of a large one.  If your stomach is very full it can push up on the diaphragm making it harder to breathe.  Make sure you drink plenty of water each day. This will help to thin the mucous.
  • Continue to educate yourself about the disease.  Better understanding = better disease management. There are many resources available through organizations like the American Lung Association (ALA).  Information may also be available through your physician.
  • Support groups can be a great resource when faced with a new diagnosis. Some people find them helpful as a means to get information and to meet others who are living with the same disease. 
  • Depending on the severity of illness, you may be eligible to participate in a pulmonary rehabilitation program that will provide a lot of education as well as get you exercising safely. 

There are many good programs both that are offered in Rhode Island that provide services both as on an out-patient or an in patient basis.   The VNA of Care New England offers Rhode Islands only home -based pulmonary rehab program.

Answered by:  Ellen Perz, RRT Respiratory Therapist and Pulmonary Rehabilitation Coordinator

 I am helping to care for my mother and help with things she needs done. We want her to be able to stay living in her home. Do you have any service that helps with bathing/cleaning/cooking? I am juggling job, my family and trying to help mom.

Here at HealthTouch we understand the complex nature of caring for loved ones and the efforts that go into helping them live at home. While we may want to do everything for them, personally, there comes a time when we may need help. It sounds like you are at that point with your mother.

HealthTouch, an affiliate of the VNA of Care New England, provides a wide range of personal care services, including assistance with getting in and out of bed, bathing, dressing, medication reminders, cooking, shopping, cleaning, laundry, errands and transportation. We also provide companionship services. Care can be arranged for just a few hours a week or 24 hours a day-7 days a week. The type of services and the frequency of them, are dependant on what a person needs.

When you call HealthTouch for assistance, we start by sending a registered nurse to the home. The nurse will conduct a comprehensive assessment of the individual(s) and/or family needs and make recommendations regarding the services that would be beneficial. This initial assessment comes at no cost to you.

Once you make a decision about the services you would like, we schedule a certified nurse assistant to go to the home to start the care. All of our nursing assistants are licensed by the State of Rhode Island and certified in basic life support. The care provided, is based on a plan developed by a registered nurse.

You are not alone in finding it a challenge to manage your own family needs with that of a parent's. HealthTouch can help.

Answered by: Allison DeBlois, Manager of HealthTouch

My husband is scheduled for heart surgery. We have been told his recovery at home will be approx.5-6 weeks. When he comes home, are the nurses able to care for his incision?
Yes, the nurses will follow the instructions of the physician and assess the incision regularly to ensure it is healing properly. Typically a patient who has heart surgery will need a plan of care which focuses on several areas, in addition to the care of the incision. These areas include:

•    Physical strength and endurance 
•    Ability to do daily activities and  gain independence
•    Management of any discomfort or pain
•    Management of medications  
•    Education on post surgery care
•    Diet and nutrition to promote healing 
This type of comprehensive care is provided by a team of clinicians. The team is made up of nurses, physical therapists, occupational therapists and dieticians. A certified home health care agency that provides skilled services will have this kind of team.  Good communication with the treating physicians is also important to managing a patient's care at home. Other things to consider or ask when looking for a qualified home health care agency are:

•   How often does the agency care for heart surgery patients?
•   Does the agency have a special heart program?
•   Does the agency have cardiac specialists who  provide clinical supervision
•   Does the agency provide telehealth monitoring ( special equipment that is placed in the home that allows  daily monitoring of vital signs)
If you have any more questions about home health care, please do not hesitate to contact me at 737-6050.
Answered by:  Karen Beauchesne, Vice President of Clinical Operations

Recently, when my mother was being discharged from a nursing home after a hip replacement the home keep pushing for us to use a certain home care agency.  Can they do that?  What about what we wanted?

Patients always have the right to choose the agency they prefer as their home health care provider. A patient's health care insurance may dictate a provider and the agency's ability to see a patient is another other factor that is taken into consideration when a referral is made.

Some nursing homes may automatically refer to an agency they have a relationship with. However, patients who do not realize they have a choice may not question why they were referred to one agency over another.

If a patient and/or family has a preference for a certain home care agency, it is important to let the nursing home and the physician know as soon as possible so arrangements can be made with that particular agency. Most nursing homes are very good about respecting the patients' preferences.

A facility that insists that a patient use a particular home care agency even after the patient has expressed a preference for another, is acting against that patient's rights. This can be considered a serious offense and reportable to a number of regulatory agencies, including the Department of Health.

I hope this information is of help.

Answered by: Karen Beauchesne, Vice President Clinical Operations 

My husband has beyond stage 4 colon cancer, now in his lungs, lower liver and peritoneal apron, yet he looks and acts remarkably well.  At what point can he be considered for hospice care, while he is currently cared for by Dana Farber?

Very often the decision to consider Hospice care begins with the patient's physician, who may start the discussion based on the response to treatment and prognosis. However, the patient and/ family can also raise the question about whether it is the right time to get Hospice involved.

To be eligible for Hospice, a person has to decide not to pursue curative treatment and have a prognosis of 6 months or less. Your husband may be eligible for hospice care, depending on whether he is receiving chemotherapy or radiation for the treatment of his cancer and how far the disease has progressed.

The VNA of Care New England provides both Hospice and Palliative Care. I would be happy to talk to you and your husband to answer any questions you have about hospice care or the services we provide.  I can be reached at 737-6050 and by email at ctaylor@vnacarenewengland.org.

Answered by:  Cheryl Taylor, RN, BSN Hospice Clinical Nurse Manager 

As my parents age, they seem unwilling to face the difficulties they experienced (financially and otherwise) with their own parents. Any suggestions on how to approach them?
You are not alone when facing the challenges of discussing health and financial needs with a loved one.  Without knowing more about your parents and their history it is hard to know why they may be reluctant to face or talk about their difficulties.
For example, they may be people who have never really been "talkers" and find it difficult to start now, or they may be experiencing a level of anxiety regarding their issues and therefore hesitant or afraid to address them. If they are part of the older generation, they may believe that personal problems are to be managed privately. Sharing or talking about private matters with other people, even family, is something you don't do.
However, there are some things you can do. Here are some suggestions you can try to begin a conversation:

  • Let your parents know that you care about them and that you are concerned about what you see. Describe the changes or the behaviors that have you concerned.
  • If your parents typically do not discuss things openly, express that you know it is not easy to have this kind of conversation with them but you want to help.
  • Ask open ended questions to facilitate a discussion and get more information, “You seem so preoccupied these days, what's on your mind?"  
  • Sometimes starting the conversation with one parent makes it easier to talk with both parents at a later point.
  • Timing can be everything. Look for the right time and opportunity that will work for all of you.

Helping your parents to express their thoughts, concerns or wishes can help put them at ease and lead to conversations about solutions and next steps. Remind your parents that they do not need to face their difficulties alone. There are many resources and supports to help address the challenges they may have

One of those resources is HealthTouch. HealthTouch is private care agency and an affiliate of the VNA of Care New England which provides a number of services including a Geriatric Care Management program.  This program helps to coordinate resources so people can live at home independently. It includes a comprehensive needs assessment and recommendations.  Facilitated family meetings/discussions are often part of the assessment process.

I hope this information is of help as you prepare to talk with your parents. If I can be of further assistance, please contact me at 401-788-2400 or 1-800-640-8434.
Answered by:  Alison DeBlois, Manager of HealthTouch

My dad has stage 4 cancer and is receiving chemo. Is he eligible for hospice? What services are included with hospice?

Your father may be eligible for Hospice, if the chemotherapy he is receiving is not being used to treat or cure the cancer. To be eligible for Hospice a person has to decide to not pursue curative treatment and typically has a prognosis of 6 months or less. If your father is still receiving curative treatment for the cancer, he may not be eligible for Hospice at this time but he could be eligible for Palliative care in the interim.

Hospice care focuses on managing end of life symptoms and meeting the individualized goals of the patient and family to enhance quality of living. Hospice strives to keep patients in their homes surrounded by their loved ones by providing care that addresses the physical, emotional and spiritual needs. The care is provided by a team of specially trained staff, including nurses,  pharmacist, home health aides,  social workers, chaplains, and hospice volunteers.

Palliative Care focuses on symptom management and quality of life while treatment is being pursued.  VNA of Care New England offers both Palliative and Hospice Care Services. Our programs are built on a commitment to quality, respect and compassion.

One of the advantages of the VNA of Care New England’s Palliative and Hospice Programs is continuity of care. The staff who provides palliative care are also part of the team who provide hospice care. Patients who start with palliative care and decide to transition to Hospice Care, find great comfort in knowing the staff they have already established trust and a care partner relationship with, are the same staff who will provide their hospice care going forward. 

I would be happy to talk to you more about the differences between Hospice and Palliative Care and what services your father is eligible for.  I can be reached at 737-6050 and by email at ctaylor@vnacarenewengland.org.

Answered by:  Cheryl Taylor, RN, BSN Hospice Clinical Nurse Manager

 My mom is 78 years old and has been living on her own for the past 9 year.  Everything has been fine until 4 mths ago.  I noticed a couple of bruises and she said she fell - this has happened twice. I'm worried about her falling and hurting herself seriously.  What advice do you have?
It sounds to me that a Home Safety Evaluation by a Physical Therapist would be a good place to start to help identify what has changed over the past 4 months.   This can easily be arranged, by calling us at 737-6050 or by sharing your concern with your mother's physician and asking for a home safety evaluation, provided by the Rehab Team at the VNA of Care New England.  

The Evaluation consists of an assessment of your mother’s strength, balance and overall safety with mobility. In addition it includes a review of her medical history, medications and home environment and provides recommendations for accommodations to keep your Mom safe. Determining the how, when and what of each fall, will provide valuable information to help create a plan of care, specific to your mother's needs.  

In the meantime, you can begin to look at some of the common environmental factors that contribute to falls. For example:

  • Are there scatter rugs that need to be removed? 
  • Are pathways around the home well lit? 
  • Is there a nightlight illuminating the pathway to the bathroom?  
  • Is there clutter than can be removed?

You can also explore the use of Lifeline, a personal emergency response system.  This system can detect when an individual falls and immediately notifies an emergency contact. HealthTouch, our private care affiliate  can help  to arrange this service at 1-800-640-8434.

I applaud you for thinking ahead and trying to prevent future falls as the risk for serious injury will only increase.  I hope you will find this information helpful.

Answered by:  Cheryl Taylor, RN, BSN Hospice Clinical Nurse Manager


How can I volunteer?
VNA of Care New England volunteers are special people who play an important role in our programs . If you are interested in volunteering, you can complete an application online at www.carenewengland.org or contact 401.737.6050.  Some of the volunteer opportunities that exist at this time are:

Hospice Helpers:  Hospice Helpers provide companionship and support to patients and families facing end of life illnesses. Hospice Helpers can be a listener, share a cup of coffee, play cards, read a book out loud or lend a helping hand just by sitting quietly with a patient.  Sometimes just having the quiet understanding that a volunteer brings can be the greatest gift for a patient and their family.  Hospice Helpers are required to complete a 20 hour Hospice volunteer training program . 

Hospice Bereavement Helpers:   Hospice Bereavement Helpers assist with monthly bereavement mailings,  follow up calls to bereaved family members and monthly record-keeping.  Hospice Bereavement Helpers are required to complete a 20 hour Hospice volunteer training program.

Office Volunteers:   Office volunteers provide office and clerical support services  to a variety of  departments and teams throughout the organization, Office Volunteers assist by preparing  informational packets and support materials for mailings, helping with printing and duplication services, filing, and making phone calls.

Does the regular flu shot this year protect you from H1N1?

Yes, this year, the seasonal flu vaccine protects against three influenza viruses that research indicates will be most common during the upcoming season.

The 2010-11 vaccine will protect against 2009 H1N1 and two other influenze viruses (an H3N2 virus and an influenza B virus). About 2 weeks after vaccination, antibodies that provide protection against influenza virus infections develop in the body.

For more information, call the FLU Hotline at 401-681-1102. 

Answered by:  Paula Foster, RN, BS, Flu Expert for the VNA of Care New England




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