Front Range Hospice Blog

Thoughts on Mother's Day 2011

Pam Ware — Tue, 31 May 2011 22:00:00 GMT

Below is an email that was written to the staff at Front Range Hospice by Kate Aiello, a hospice liaison for Front Range Hospice. Front Range Hospice was deeply honored to have taken care of Kate's mother. All patient/family names have been changed to protect the identity of the patient.

Three years ago on Mother's Day, I celebrated with my mom for the last time. She had just recently become a patient of Front Range Hospice and beginning her end of life journey in their loving supportive hands with me by her side. It was a most blessed Mother's Day that is forever imprinted on my heart as are the nearly eight months that followed.

Yesterday I received another blessing, most unexpectedly. I had an opportunity to show up for another family as a liaison for the company that showed up for mine: on Mother's Day. The wife of our patient would have otherwise spent the majority of that day alone and afraid of what was happening to the love of her life and to her world as she knew it. Trying to care for a man she could not bend down to lift, and who no longer recognized her as his wife.

Instead, we hugged, we cried, we laughed and we got through a very overwhelming situation where everything turned out okay. The wife thinks, as do most families, that hospice workers, especially the nurses, are very rare individuals as they have in her words "the hardest job there is". But I took issue with her on this point and recognized her for the cross she has to bear in carinig for her spouse and best friend as he is slowly unable to recognize her anymore.

"Sure", I shared, "YOU have the hardest job there is. I know because I watched it with my dad - his heart literally breaking as my mom no longer associated him with the man she married and had adored since the age of four. There is nothing harder than losing the one you love to any diagnosis, but dementia makes you feel even more helpless in the loss, doesn't it?"

"Oh, you DO understand," she said. "Thank you for being here."

That thank you, that moment we shared, that entire morning, has left another imprint on my heart that I will be forever grateful for. And it is through the blessing of being able to pay if forward with this amazingly heart driven company that my Mother's Day was again complete.

Thanks to each of you who have committed to giving a little more of yourself than most others are willing to. My dad used to always tell me that "showing up is what really matters - just show up."

Thanks Dad. Thanks Pam. Thanks Front Range Hospice.

Kate Aiello

Hospice Liaison

CAPITOL HILL DAY, April 6, 2011

Pam Ware — Thu, 14 Apr 2011 18:00:00 GMT

While attending the National Hospice and Palliative Care Organization's (NHPCO) yearly Leadership conference in Maryland during the week of April 4th, I had the privilege of participating in their annual "Hill Day". All participants were briefed by NHPCO so we created one voice. I was one of several people from Colorado that went to speak to the Health Legislative Aides for Sen. Udall, Sen. Bennet, and Rep. Polis. We were well received and it was a mutually informative day. Below is the message that was delivered.

PRESERVE AND PROTECT THE MEDICARE HOSPICE BENEFIT

Support the HELP Hospice Act

Action Requested:We are deeply concerned about the effect further modifications to the Medicare hospice benefit will have on quality patient care and access to these valuable services. The hospice community asks that the 112th Congress support the Hospice Evaluation and Legitimate Payment (HELP) Act, legislation to (1) require the Secretary to establish a payment reform demonstration program to test and evaluate any prospective payment revisions to hospice, (2) increase hospice survey frequency to every 3 years, and (3) amend the new face-to-face encounter requirement to reflect operational realities for hospice programs, and the needs of the patients and families they serve. The HELP Hospice Act has been introduced by Senators Wyden and Roberts (S.772), and efforts for a House companion bill are underway.

1. Sensible Hospice Payment Reform

The ACA included a MedPAC recommendation to transfer hospice payment authority from Congress to the Secretary of Health and Human Services. MedPAC also recommended, and the ACA statute required, the Secretary to collect and analyze extensive data prior to implementing a new payment system for hospice, on or after fiscal year 2014. Noting a lack of reliable, comprehensive data upon which to base a new payment methodology,

The hospice community calls upon Congress to direct the Secretary to pilot any new payment methodology first through a two-year, 15-site demonstration program. This approach would help to overcome the current lack of reliable, comprehensive data upon which HHS can rely to evaluate schemes to be tested across a representative sample of the hospice community to assess their impact on beneficiary access to hospice services.

COST: $3 million for the 2012-2021 budget forecast periods(6).

2. More Frequent Hospice Surveys

An HHS Office of the Inspector General (OIG) report found that the current certification system for hospice was not providing sufficient oversight relative to other Medicare providers. OIG noted that "the frequency of hospice certification is far different from the certification frequencies required by nursing homes, hospitals, and home health agencies" and recommended regulatory or statutory changes to increase certification frequency. According to the report, the majority of hospices were surveyed within 6 to 8 years (depending upon available resources), while almost 15 percent averaged 3 years past due.

The hospice community urges Congress to institute a 3-year survey frequency requirement.This recommendation is consistent with the survey industry standard for hospices set forth by accrediting organizations, such as the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO).

COST: No cost under OMB score keep guideline 14(7).

3. Hospice Face-to-Face Encounter Adjustments.

The ACA included the MedPAC recommendation to require a hospice physician or nurse practitioner to have a face-to-face encounter with a hospice patient upon election of the Medicare hospice benefit, before the end of 180-day recertification period and again for each 60-day recertification after that date. The hospice community supports the intent of the face-to-face encounter requirement and is working hard to be in compliance, even as the requirement stretches hospice physician and nurse practitioner resources.

The hospice community is asking that Clinical Nurse Specialists and Physician Assistances also be allowed to conduct the face-to-face encounter, and that hospice programs be afforded 7 days after the initial election of services to fulfill the requirement. The current limits on who can conduct the face-to-face encounter and the tight timelines specified in the rule for compliance do not reflect the operational constraints of hospice programs, especially for small and rural hospices. Hospices may be forced to turn down certain patients seeking to elect hospice if they feel they will not be able to comply with the present timeline required to conduct the initial face-to-face encounter requirement.

COST: No cost associated with modifications to the face-to-face encounter requirement.

The National Hospice and Palliative Care Organization (NHPCO) is the largest nonprofit membership organization representing hospice and palliative care programs and professionals in the United States. The organization is committed to improving end of life care and expanding access to hospice care with the goal of profoundly enhancing quality of life for people dying in America and their loved ones.

I urge each of you who are supporters of hospice care to contact your Senators and Representatives in Washington, DC. It is crucial that our voice be heard.

6-All cost estimates in this document are based on a Moran Company assessment of budgetary implications of the hospice proposal, available upon request.

7-OIG Report: http//oig.hhs.gov/oei/reports/eoi-06-05-00260.pdf

8-OMB Circular A-11: "No increase in receipts or decrease in direct spending will be scored as a result of provisions of a law that provides direct spending for administrative or program management activities"

Times Call Special Edition of 100 Personalities

Pam Ware — Thu, 31 Mar 2011 19:26:00 GMT

PAM WARE

Age: 57

Years in Weld County: Almost five; opened Front Range Hospice in June 2006 in Old Downtown Erie.

Occupation: Founder and CEO of Front Range Hospice. I have been in end-of-life care for 30 years and hospice for eight of those years. I am now the owner and administrator of Front Range Hospice, one of the very few Joint Commission accredited hospices in the state.

Have you always been interested in community service and helping those in need? I started volunteering in my church (helped my mom set up for dinners) before I was school age. That community involvement continutes today: I volunteer at my church, First Christian United Church of Christ in Longmont, and the Erie Chamber of Commerce. Front Range Hospice participates in community events in Erie, and we are beginning to support the Fort Collins Chamber.

What have you learned about people when spending time with them in their final days? When our patients are alert and aware for their final days, it is a true blessing. Most of them reach an incredible peace. They are able to reassure their families that all will be well, they love them and will always love them. The families are able to respond likewise. When our patients are not alert, the incredible care offered by the hospice staff puts the families at ease as they wait for their loved one to transition. It is a gift to be part of this stage in any family's life.

Who was one of your most memorable patients? The most memorable patient I have worked with was a young father who had a 3-year-old son. As he moved into the acceptance stage of his dying process, he wanted to make sure his son never doubted the love of his father. He created letters to his son for key times, like his first day of school, first date, high school and college graduation, marriage and birth of his first child. He also arranged for one of his friends to be the Easter Bunny, Tooth Fairy and Santa Claus as long as the son held these magical beliefs. It was a remarkable journey that all who cared for him were changed by.

What does your family think of the work you do? The work I do is life changing and can be stressful. I am blessed to have a partner and friends who support me, stand by me and at times work hard to be a wonderful escape. They, too, have been changed by this journey that I am on, as they are not able to deny their own mortality and work hard to get the most out of every day.

Hospice Profit Status is Not a Reflection of Quality

tara haught — Fri, 04 Feb 2011 22:33:00 GMT

Front Range Hospice has chosen to publish the following press release by the National Hospice and Palliative Care Organization in response to a recent article published in the Journal of American Medical Association. We will soon post key questions that you should ask your prospective hospice provider to determine which one will provide the quality and service that you or your loved one needs and deserves.

(Alexandreia, Va) - The February 2 issue of the Journal of the American Association includes an article, "Association of Hospice Agency Profit Status, With Patient Diagnosis, Location of Care, and Length of Stay." The National Hospice and Palliative Care Organization wants to stress that this JAMA article doesn't provide any correlation between the profit status of a hospice program and the quality of care provided.

NHPCO is concerned that people looking at this study may overlook the critical importance of quality measures when discussing the provision of hospice care in the US.

"Ultimatley, the most important measure or consideration is the quality of care provided to patients at the bedside," said J. Donald Schumacher, president and CEO of NHPCO. "Detailed analysis of data submitted by hospices as part of NHPCO's comprehensive survey, the Family Evaluation of Hospice Care, shows no difference in family caregivers' evaluation of the quality of care based on a hospice program's profit status.

For many years NHPCO has been encouraging hospices to care for a full range of patients in the last months of life including non-cancer patients, such as those with dementia. Many hospices, including newer hospices that are for-profit, have worked to address the needs of such populations, including those who reside in nursing homes.

"The study authors seem to conclude that such patients are 'lower skill' - the implication being that their care needs are minimal. This reflects a fundamental misunderstanding of the important unmet needs for persons dying from dementia. A person dying from dementia may still experience pain," remarked noted researcher Joan Teno, MD, MS, of Brown University and a member of the NHPCO board.

"Furthermore, pain is a huge public health problem in nursing homes where one in four Americans will die," Teno added.

A 2009 article published in the New England Journal of Medicine provides evidence of some of the burdensome interventions that persons dying from dementia receive.

Hospice care brings skilled expertise to patients and families in all care settings to address their unmet needs.

"Hospice organizations providing care to dementia patients and those living in nursing homes are meeting a very important need in this country and to infer that the primary motivation is financial does a disservice to the dedicated hospice staff caring for these people," Schumacher remarked.

"Availability of good care at the end of life is the right of all American," Schumacher added. "The JAMA article also reminds us that for-profit providers are making more inroads in care for African-Americans and Latinos, communities that have been undeserved in the past."

It is NHPCO's position that research should move the entire industry forward by analyzing which hospice interventions enhance the quality of care provided and which demonstrates the efficiency of hospice care in all settings and for all hospice patient populations. Furthermore, NHPCO calls for all providers, regardless of profit status, to meet and exceed NHPCO's Standards of Practice for Hospice Programs, participate in its Quality Partners initiative, and fully comply with all hospcie regulations.

Hospice began as a volunteer-driven, grassroots movement which has evolved to become a vital component of the healthcare system. The industry now includes a mix of nonprofit, for-profit and governmental entitites similar to other healthcare sectors in the US. Together, the diverse hospice provider community is committed to caring for all individuals facing the challenging journey at life's end.

Decisions...Decisions...Decisions

Pam Ware — Tue, 25 Jan 2011 16:57:00 GMT

Every day we are confronted with countless numbers of choices. Each one must be considered and decisions must be made. Should it be corn flakes or bran? Maybe fruit today? Should I wear the blue shirt or the white one? Is this a good time to apply for that new position at work? Can I afford that new car or should I wait? So it goes...choices, big and small, and frequently some decisions are put off only to be reconsidered, yet again, tomorrow.

In most situations, we insist on making our own decisions and choices. As children, we attempted to make choices even if we knew our parents were the final decision-makers. As young adults, we considred choices and made decisions about college, our first job, moving away from home, getting married...Even now, choice and decision-making occupy much of our daily routine.

Life is, indeed, all about the choices we make. Interestingly, however, one of the most important of life's decisions is often made for us...leaving us with little or no opportunity for choice. Choices at the end of life are, all too often, deferred to others...especially when it comes to making choices regarding our medical options, including hospice.

It's safe to say that most people would probably choose not to need a hospice program at all. But the choice of having or not having a life-limiting illness is seldom in our power. When we are confronted with a decision about hospice, many will defer to tohers who are all too willing to make the decision for us. Unfortunately, their choices are often based not on our wishes or goals but on their own preferences and conveniences, no matter how well-intentioned they may be.

Perhaps we're more comfortable letting someone else make the decision because it seems less "real" that way? Or, maybe we feel less vulnerable when we don't have to make the decision for ourselves. However, the choice of how we wish to live out our lives can only be ours. So, too, is the choice of which hospice we want to help us meet our life goals and to protect our vulnerability while facing life's final reality - only ours.

We make many choices during our lifetime. Shouldn't we also have choice when it comes to the end of life? If hospice becomes the most appropriate medical option for us, we must make our own choices.

And if we choose hospice, finding the right hospice requires us to make informed decisions using, at the very least, the same sensible approach we would when deciding to take a new job or buy a new car. To make an informed decision, it's important to compare hospice programs and services that are available to us. We must decide for ourselves which hospice is best suited to care for us and help us achieve our goals at the end of our lives.

If you are facing a life-limiting situation and need help in identifying your options and making decisions about your care, please contact Front Range Hospice for assistance. Or visit www.frontrangehospice.com or call us at 303-957-3101 or 970-776-8080.

Ten Facts about Hospice Care You may not Know

Pam Ware — Thu, 13 Jan 2011 22:38:00 GMT

Some people mistakenly think hospice care is just about dying...that hospice is the place you call when there's nothing more that can be done. Nothing could be further from the truth. Hospice helps patients and families focus on living.

Hospice care brings comfort, dignity, and peace to help people with a life-limiting illness live every moment of life to the fullest. It also reaches out to provide support for the family and friends who love and care for them.

Last year, 1.56 million dying Americans were served by the nation's hospice providers. Yet, there are some important facts about hospice that people don't know. And this may be keeping people from getting the best care possible, when they need it most.

Hospice is not a place; it's high-quality medical care that helps the patient and family caregivers focus on comfort and quality of life.
Hospice is paid for by Medicare, Mediciad, most insurance plans, HMO's, and managed care plans. Fear of costs should never prevent a person from accessing hospice care.
Hospice serves anyone with a life-limiting illness, regardless of age or type of illness.
Hospice serves people of all backgrounds and traditions; the core values of hospice - allowing the patient to be with family, including spiritual and emotional support, treting pain - cut across all cultures.
Research has shown that the majority of Americans would prefer to be at home at the end of life's journey - hospice makes this possible for most people.
Hospice serves people living in nursiing homes and assisted living facilities.
Hospice patients and families can receive care for six months or longer.
A person may keep hsi or her referring physician involved while receiving hospice care.
Hospice offers grief and bereavement services to family members and the community.
To get the most out of what hospice offers, it's better to have care for more than just a few days.

If this information about hospice surprises you, take the time to findout more. The best time to learn about hospice is before someone in your family is facing a healthcare crisis.

For more information, contact Front Range Hospice, or visit www.frontrangehospice.com or call us at 303-957-3101 or 970-776-8080.

**This information is provided by National Hospice and Palliative Care Organization and Front Range Hospice.

Custodial Care versus Skilled Care

Pam Ware — Fri, 13 Aug 2010 21:00:00 GMT

Many people are confused about the difference between custodial care and skilled care as it relates to Medicare coverage. In general, Medicare never pays for custodial care if it is the only kind of care you need. Medicare is a health insurance plan not a long term care plan. Medicare pays for skilled care. So what is the difference?

Medicare defines custodial care as non skilled personal care, such as help with activies of daily living like bathing, dressing, eating, getting in or out of a bed or chair, moving around, and using the bathroom. It also includes care that most people do themselves such as taking medications, taking care of a colostomy or catheter, or testing for glucose levels. Custodial care is often given in a nursing home and is paid for by the individual or Medicaid Long Term Care. Again, it is not covered by Medicare.

Medicare does cover skilled care for a short time. This is usually done by home health or in a rehabilitation unit of a nursing facility. This care is provided by registered nurses, physical or occupational therapists, speech-language pathologists, and dieticians. If you are using this benefit in a rehabilitation center, you must have had a qualifying hospital stay. Your hospital discharge planner or the Admissions person in the rehabilitation center can let you know if you qualify for this benefit. It is important to remember that the Medicare benefit is short term. It will pay the cost of room and board in addition to the above therapies. The maximum benefit is 100 days and includes co-pay. You are not guaranteed 100 days of coverage. You must continue to meet the criteria which is based on showing continual progress. If you are utilizing this benefit through a home health agency, you must also qualify. The care you need is rehabilitative in nature, requires the skill of one of the above professionals, is short term in nature, and intermittent. You must be certified by your physician as being home bound. Home health is not long term care.

Long term care is paid for through a long term care policy, Medicaid, or your personal funds. It is recommended that you seek professional counsel about various ways to fund your long term care needs prior to you ever needing to use this type of care. Waiting until you need it makes the process much harder.

For further information please see the Medicare.gov websites for either Home Health or Skilled Nursing Facility Care.

Patient's Right to Choose Health Care Providers

Pam Ware — Fri, 23 Jul 2010 21:00:00 GMT

The following is a summary of comments sent to all National Hospice and Palliative Care members by Elizabeth Hogue, Esq. Ms. Hogue is considered a leading attorney in the hospice arena and provides tremendous guidance to hospices that are focused on "doing the right thing in an ever changing marketplace." Patients, families, and other post acute care service providers struggle with patient choice, or the lack there of. Ms. Hogue's comments are a good reminder of Medicare and non-waiver choice, or the often lack of it. Ms. Hogue's comments are a good reminder of Medicare and non-waiver Medicaid patient's right to choose their providers. The following is a portion of this recent article:

"Physicians are currently required to abide by a patient's right to freedom of choice of providers."

There are two sources of this right that apply to physicians:

All patients have a common law right, based upon court decisions, to control the care provided to them, including who renders it. Thus, when patients voluntarily express preferences for certain providers, their choices must be honored regardless of payor source or type of care.
Federal statues of the Medicare and Medicaid Programs guarantee Medicare beneficiaries and Medicaid recipients the right to freedom of choice of providers (Medicaid recipients may have waived this right if they participate in waiver programs). Consequently, when Medicare patients and non-waiver Medicaid patients voluntarily express preferences for providers, these choices must be honored.

If patients voluntarily express preferences or choose providers other than those ordered by their attending physicians, then a patients choice "trumps" physicians orders and must be honored.

Ambulance Transports on the Day of Hospice Admission

Pam Ware — Mon, 12 Jul 2010 20:30:00 GMT

The following information was summarized by National Hospice and Palliative Care Association (NHPCO) and distributed to all its members in Feb. 2010. We are placing this on our blog as a resource for discharge planners and families. This is an area of continued confusion. To our families we recommend that if you feel your loved needs an ambulance transport home from a hospital that you work closely with the discharge planner to avoid a “surprise” bill after the fact. Front Range Hospice is grateful for NHPCO’s efforts in helping us educate the general public on this topic.

Summary at a Glance:

In addition to CR 6778 proving clarification about payment of ambulance transports on the effective date of hospice election, CMS has also updated Medicare Benefit Policy Manual (CMS Pub. 100-02) with additional information. CMS has defined the circumstances when the hospice provider is responsible for the cost of ambulance transport.

Hospice responsible:

Ambulance transports of a hospice patient, which are related to the terminal diagnosis and which occur after the effective date of election, are the responsibility of the hospice.

Hospice not responsible:

Ambulance transports which occur on the effective date of the hospice election (i.e., the date of admission), but prior to the initial assessment and prior to the plan of care’s development. (Per the S & C 09-19, Advance Copy-Hospice Program Interpretive Guidance Version 1.1, the initial assessment must be conducted in the location where hospice services will be provided, and the plan of care is developed from that initial assessment and from the comprehensive assessment.)

Implementation date: For claims submitted on or after July 6, 2010

NHPCO comments:

NHPCO received multiple questions from hospice providers in the past year about coverage for ambulance transport and we took your concerns to CMS. We are very pleased that CMS has clarified in writing the circumstances of when a hospice provider is responsible for transport coverage.

Members may direct any inquiries to regulatory@nhpco.org.

Are all hospices the same?

Pam Ware — Tue, 04 May 2010 13:00:00 GMT

Yes and No. All hospices must abide by regulations issued by the Center for Medicare and Medicaid Services (CMS). These regulations are referred to as the Conditions of Participation (COPS). A significant overhaul of the Hospice COPS occurred in December of 2008. Each hospice must also abide by the regulations that are issued by their State Health Department.

Each hospice is free to set their program up in a manner that they believe meets these regulations. The regulations are not a clear description of how the programs will be run but the regulations do describe the necessary services. For instance, some hospices use electronic documentation and some use paper. Some hospices have low patient staff ratios and some require their staff to carry higher caseloads. Some hospices use local pharmacies to provide medications and some use mail order pharmacies.

The other distinctive differences are some hospices are choosing to seek accreditation through the Joint Commission. In order to obtain a Joint Commission accreditation, the hospice must agree to provide care at a higher level than the federal and state regulations. The Joint Commission is a voluntary program that healthcare organizations can choose to participate in. In the hospice world, this provides the patient and the family a high level of confidence in the care being provided. State health departments are under increasingly higher scrutiny and have to use their dwindling resources in mandated ways. In Colorado, the State Health Department is mandated to survey nursing homes and home health agencies but they are not mandated to survey hospices unless there is a significant complaint. As a result, some hospices have not been surveyed in many years. For the few hospices in Colorado that are Joint Commission Accredited, they have an onsite survey every three years and they are required to perform a complete agency survey themselves on the years between. The oversight is extensive and focused on patient safety.

When shopping for a hospice for you or your loved one, you might want to inquire about when they were last surveyed. Was this survey a complaint survey or in the case of Joint Commission agencies one that they have voluntarily agreed to participate in as a way to give you that extra level of confidence in the care being provided. These survey results are open to the public. So the answer to the question are all hospices the same, remains yes and no. For your own peace of mind, ask the tough questions. Choice in providers is your right. I encourage you to exercise that right.

Is Hospice a Place Where One Goes to Die?

Pam Ware — Mon, 19 Apr 2010 13:00:00 GMT

No. Many people are under the misconception that when they sign up for hospice care they or their loved one will "go to hospice". Hospice is a term that reflects the type of care not the place this will be done. Most hospice care is delivered in the home of the patient. This "home" might be a residential home or apartment, a senior living community, an assisted living facility, or a nursing home.

Almost 10 years ago, the Robert Woods Johnson Foundation released its findings about Dying in America. This report has lead to significant improvement and availability of hospice care. One of their findings was the of those surveyed, 70% of all Americans surveyed preferred to die at home yet only 25% died at home.

Under hospice care, the goals are individualized to each patient and will focus on pain and symptom control. Hospice will work to manage current symptoms and be prepared to manage anticipated symptoms as the terminal disease takes its natural progression. The hospice team, especially the nurse and the medical director, are trained in understanding the natural disease progression and work proactively to keep the patient comfortable. Medications, education and support are primary tools of the hospice team as they prepare the patient and the family for what lies ahead. This is done in a manner that is sensitive and respectful to the needs of the patient and the family.

Inpatient units are available for patients whose symptoms have become out of control and cannot be managed in the home environment. With highly skilled nurses, hospice physicians and pharmasists, this has become an increasingly smaller percentage of all hospice care provided. Routine hospice care, hospice care which is delivered in the home environment, makes up the vast majority of all hospice care provided.

My mom is in a nursing home. Why are they recommending hospice care?

Pam Ware — Mon, 12 Apr 2010 13:00:00 GMT

Nursing homes specialize in rehabilitation and long term care. Although many residents eventually die in nursing homes, the staff is not focused on hospice/palliative care. When nursing homes work with the hospice staff, the best of both groups will be providing care to your mom.

The nursing home will continue to provide her day to day care. They will provide meals, activities, medication administration, and assistance with personal care. Medicare regulations are very clear that hospice care is in addition to, not in lieu of, the services already provided by the nursing home. The hospice will provide a hospice nurse case manager available 24/7 to assess your mom and work with her physician to gain and maintain symptom management. They will provide and pay for all medications needed to keep her comfortable. A certified nurse's aide will provide additional assistance with her personal care needs and will be able to spend more time with your mom to pay attention to the small things that make such a difference. The hospice will also provide a social worker and a chaplain to assist both you and your mom in making certain her affairs are in order and you are prepared emotionally and spiritually for her death. Volunteers are also available to spend time with your mom either alone and doing things like taking her outside to smell fresh air or attending activities in the facility.

Your nursing home is advocating for your mom to get the best care possible at the end of her life. They are asking you to allow them to bring in the expertise of hospice to assist them in keeping her comfortable and allowing her to have a death with dignity in the environment that has become her home.