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Posts tagged ‘hospice’

It’s that Time Again

Don’t be fooled by her beauty. The CDC shared this visual representation of the flu virus.

It seems like every week or so we are learning of a new way to get very sick and, well, die.  It’s not always pleasant to read the news but, even in the wake of all these new viruses, there are some old ones that command respect.

The one that immediately comes to mind is the Flu.  It is boring in comparison to Monkeypox and it doesn’t kill as many people as Covid but really, how important is it to you that your virus is interesting?  Do you care how many other people are dying when you are on life support?  

Last year, the flu wasn’t as much of a threat as it has been (and will be)..  Everyone stayed home and wore masks.  Smart people did not hang out in crowded places and N95s became available.  Jeff Bezos and delivery companies made a ton of money but I don’t begrudge them considering the alternative would have been a higher risk of contracting Covid.

Compare last year’s isolation to this year.  School’s are well populated judging by the long lines of traffic when school lets out.  People are going out again to shop and eat and visit.  The President has erroneously declared an end to the Covid Pandemic and the CDC has revoked its advice that people in healthcare facilities should wear masks.  Please note that the CDC did not prohibit masks in healthcare facilities although the department of motor vehicles might take exception if you don’t remove your mask when you take a picture when you renew your license.

So the flu is a real threat this year.  If you have never had a case of the flu, consider yourself lucky.  Death is an attractive alternative when fevers reach 104 and every muscle in your body aches.  Furthermore, the flu is contagious before symptoms appear.  That means you can go out to several family homes and give them the gift of flu before you even know you have it.  

When a nurse is out with the flu, it isn’t for a day or two.  There are no badges of honor for going to work sick with the flu.  All of the uninfected nurses have to pick up the slack (and overtime).  And flu season peaks in winter when it already takes extra time to visit patients.  Roads may be icy and the holidays and end of year tasks cause everyone to get behind.

And that’s what the flu is like for us.  Imagine the patients!

In the 2019 – 2020 flu season, the last year for which data was collected, 38M people were sick with the flu resulting in 400,000 hospitalizations and 22,000 people died from the flu or flu related complications.  The virus that causes the flu is quite adaptable and mutates often to get around immunity.  Because of the ever changing nature of the influenza virus, the flu statistics vary each year.  

The vaccine is mostly free but even if you pay out of pocket, it is cheap.  If you are an agency that doesn’t pay for your employees to get flu shots, I want you to remember this when you’re writing those overtime checks. There is no charge to Medicare patients and that includes those receiving hospice care.  Home Health and Hospice can bill Medicare although many agencies choose not to bill.  You may also administer the flu vaccine to spouses and other Medicare recipients who live in the house.  For billing purposes, there is no physician order needed.  Get an order anyway.  

With one exception, the flu vaccine is unable to cause the flu.  The exception is the nasal inhaler vaccine which does contain minute quantities of the live virus so there is a similarly small chance that it could give the flu to the recipient.  All other vaccines do not contain live virus particles. Because it takes a while for the vaccine to offer full protection, it is possible to get the flu in the week or so after the vaccine which is a good reason to get your flu shots early.  And it is possible to contract the flu after being vaccinated but these cases do not cause as many hospitalizations and deaths.

Finally, the CDC has a boatload of resource materials that you can use as teaching guides or even wallpaper.  Midway down the CDC Resource page are infographics and fact sheets.  The CDC receives billions in funding.  Make use of it. You don’t want to be known as the nurse or therapist who wasted billions of dollars and current CDC information will support any complaints about you or your agency.  

If misery could be contained in buckets, each case of the flu would fill ten or so home depot buckets.  Think about that and prevent some misery. 

It seems like every week or so we are learning of a new way to get very sick and, well, die.  It’s not always pleasant to read the news but, even in the wake of all these new viruses, there are some old ones that command respect.

The one that immediately comes to mind is the Flu.  It is boring in comparison to Monkeypox and it doesn’t kill as many people as Covid but really, how important is it to you that your virus is interesting?  Do you care how many other people are dying when you are on life support?  

Last year, the flu wasn’t as much of a threat as it has been (and will be)..  Everyone stayed home and wore masks.  Smart people did not hang out in crowded places and N95s became available.  Jeff Bezos and delivery companies made a ton of money but I don’t begrudge them considering the alternative would have been a higher risk of contracting Covid.

Compare last year’s isolation to this year.  School’s are well populated judging by the long lines of traffic when school lets out.  People are going out again to shop and eat and visit.  The President has erroneously declared an end to the Covid Pandemic and the CDC has revoked its advice that people in healthcare facilities should wear masks.  Please note that the CDC did not prohibit masks in healthcare facilities although the department of motor vehicles might take exception if you don’t remove your mask when you take a picture when you renew your license.

So the flu is a real threat this year.  If you have never had a case of the flu, consider yourself lucky.  Death is an attractive alternative when fevers reach 104 and every muscle in your body aches.  Furthermore, the flu is contagious before symptoms appear.  That means you can go out to several family homes and give them the gift of flu before you even know you have it.  

When a nurse is out with the flu, it isn’t for a day or two.  There are no badges of honor for going to work sick with the flu.  All of the uninfected nurses have to pick up the slack (and overtime).  And flu season peaks in winter when it already takes extra time to visit patients.  Roads may be icy and the holidays and end of year tasks cause everyone to get behind.


And that’s what the flu is like for us.  Imagine the patients!

In the 2019 – 2020 flu season, the last year for which data was collected, 38M people were sick with the flu.  The flu caused 400,000 hospitalizations and 22,000 people died from the flu or flu related complications.  The virus that causes the flu is quite adaptable and mutates often to get around immunity.  Because of the ever changing nature of the influenza virus, the flu statistics vary each year.  

The side effects of the vaccine are generally mild unless the recipient of the vaccine is allergic to eggs. For the majority of people any mild side effects can be treated with tylenol or ibuprofen.  It is mostly free but even if you pay out of pocket, it is cheap.  There is no charge to Medicare patients and that includes those receiving hospice care.  Home Health can bill Medicare although many agencies choose not to bill.  You may also administer the flu vaccine to spouses and other Medicare recipients who live in the house.  For billing purposes, there is no physician order needed.  Get an order anyway.  

With one exception, the flu vaccine is unable to cause the flu.  The exception is the nasal inhaler vaccine which does contain minute quantities of the live virus so there is a similarly small chance that it could give the flu to the recipient.  Because it takes a while for the vaccine to offer full protection, it is possible to get the flu in the week or so after the vaccine which is a good reason to get your flu shots early.  And it is possible to contract the flu after being vaccinated but these cases do not cause as many hospitalizations and deaths.

Finally, the CDC has a boatload of resource materials that you can use as teaching guides or even wallpaper.  Midway down the CDC Resource page are infographics and fact sheets.  The CDC receives billions in funding.  Make use of it. It would be a shame to waste billions of dollars and current CDC information will support any complaints about you or your agency.  

If misery could be contained in buckets, each case of the flu would fill ten or so home depot buckets.  Think about that and prevent some misery. 

It seems like every week or so we are learning of a new way to get very sick and, well, die.  It’s not always pleasant to read the news but, even in the wake of all these new viruses, there are some old ones that command respect.

The one that immediately comes to mind is the Flu.  It is boring in comparison to Monkeypox and it doesn’t kill as many people as Covid but really, how important is it to you that your virus is interesting?  Do you care how many other people are dying when you are on life support?  

Last year, the flu wasn’t as much of a threat as it has been (and will be)..  Everyone stayed home and wore masks.  Smart people did not hang out in crowded places and N95s became available.  Jeff Bezos and delivery companies made a ton of money but I don’t begrudge them considering the alternative would have been a higher risk of contracting Covid.

Compare last year’s isolation to this year.  School’s are well populated judging by the long lines of traffic when school lets out.  People are going out again to shop and eat and visit.  The President has erroneously declared an end to the Covid Pandemic and the CDC has revoked its advice that people in healthcare facilities should wear masks.  Please note that the CDC did not prohibit masks in healthcare facilities although the department of motor vehicles might take exception if you don’t remove your mask when you take a picture when you renew your license.

So the flu is a real threat this year.  If you have never had a case of the flu, consider yourself lucky.  Death is an attractive alternative when fevers reach 104 and every muscle in your body aches.  Furthermore, the flu is contagious before symptoms appear.  That means you can go out to several family homes and give them the gift of flu before you even know you have it.  

When a nurse is out with the flu, it isn’t for a day or two.  There are no badges of honor for going to work sick with the flu.  All of the uninfected nurses have to pick up the slack (and overtime).  And flu season peaks in winter when it already takes extra time to visit patients.  Roads may be icy and the holidays and end of year tasks cause everyone to get behind.


And that’s what the flu is like for us.  Imagine the patients!

In the 2019 – 2020 flu season, the last year for which data was collected, 38M people were sick with the flu.  The flu caused 400,000 hospitalizations and 22,000 people died from the flu or flu related complications.  The virus that causes the flu is quite adaptable and mutates often to get around immunity.  Because of the ever changing nature of the influenza virus, the flu statistics vary each year.  

The side effects of the vaccine are generally mild unless the recipient of the vaccine is allergic to eggs. For the majority of people any mild side effects can be treated with tylenol or ibuprofen.  It is mostly free but even if you pay out of pocket, it is cheap.  There is no charge to Medicare patients and that includes those receiving hospice care.  Home Health can bill Medicare although many agencies choose not to bill.  You may also administer the flu vaccine to spouses and other Medicare recipients who live in the house.  For billing purposes, there is no physician order needed.  Get an order anyway.  

With one exception, the flu vaccine is unable to cause the flu.  The exception is the nasal inhaler vaccine which does contain minute quantities of the live virus so there is a similarly small chance that it could give the flu to the recipient.  Because it takes a while for the vaccine to offer full protection, it is possible to get the flu in the week or so after the vaccine which is a good reason to get your flu shots early.  And it is possible to contract the flu after being vaccinated but these cases do not cause as many hospitalizations and deaths.

Finally, the CDC has a boatload of resource materials that you can use as teaching guides or even wallpaper.  Midway down the CDC Resource page are infographics and fact sheets.  The CDC receives billions in funding.  Make use of it. It would be a shame to waste billions of dollars and current CDC information will support any complaints about you or your agency.  

If misery could be contained in buckets, each case of the flu would fill ten or so home depot buckets.  Think about that and prevent some misery. 

A Long Summer

There are a lot of jokes about 2020 not being such a good year. For me, it is the year that I lost my mother at the tender age of 89 just weeks before her 90th birthday. To be honest, my math skills led me to believe she was 90 and on her way to her 91st birthday. Oh well.

Throughout this long summer while hanging out with Mama, I realized that we were living through history. Like the 1918 Spanish Flu, the Covid pandemic is an event that will continue to influence history for decades. I knew I should be writing about it but honestly, is there anything left to write? Maybe.

I lived through one aspect of Covid that isn’t getting as much attention as the number of cases and the mortality rate. My mother was ill since February and it had nothing to do with Covid. How she was treated and if she was treated had everything to do with Covid. In the end, I wonder if Covid will totally transform our healthcare industry.

My mother, always social, had very few visitors in the months prior to her death. I did not encourage visitors and when people asked if they could visit, I usually refused. I had two parents and my Dad, with Dementia, simply can’t remember to wear a mask correctly. It was uncomfortable for him and also, Mama. Covid would have been a death sentence for either of them. Even after it became clear that my mother was terminal, I would not have wished a Covid death on her. And who would have cared for her and my Dad if my son or I became sick?

Hiring help was similarly difficult. We got very lucky when an aide who is otherwise unemployed became available. She is sitting out the semester in college due to the pandemic and we are learning from the news that she may have made the very best decision. Agency help would have meant an aide that possibly went to different homes and it would be unfair to limit someone’s ability to work. Covid has changed the economic status of many Americans.

At times, I received a lot of encouragement to send Mama to the hospital. Each time her condition exacerbated, I called the local ERs and learned that nobody was allowed to stay with her in the Emergency room and if admitted, only one person who tested negative for Covid could stay with her. This person was not interchangeable. That meant my Dad who would forget rules about leaving the room would not be able to visit and either me or my son would not be able to see her.

Chances are we would have dropped her off at the ER like so much dry cleaning that got lost and we would have never seen her again. I could not do that and I had her written power of attorney for healthcare so it did not happen.

But there were friends and relatives who made life easier. I have a cousin who is a physician who visited. His approach to Mom’s care was like mine – as long as something was not painful or invasive, Mama got it. No extensive treatment or ‘heroics’ (as she called them) were attempted. If Mama were around or if she is reading this blog post, she would tell me to add to it that there is nothing heroic about shoving a tube down the throat of a senior octogenarian simply to prolong a heartbeat. And Mama is always right.

A cousin who is a nurse along with her daughter provided the very best palliative care – chocolate peanut butter cookies from the Snoop Dogg and Martha Stewart collaboration cookbook aptly named From Crook to Cook.

Another local cousin dropped off meals. It was gourmet meals on wheels. Like kids playing a joke on neighbors, the doorbell would ring and nobody would be at the door but when I would look down, there was dinner. There are no words to express how grateful we were for the care packages.

Cards were also delightful especially to mother. The beauty of cards is that they can be set aside when appropriate and read repeatedly when someone is awake.

I tell you all of this because unless a treatment is found for Covid very soon, everyone will have a friend or relative with Covid or another illness that prevents visits. You can still let them know that you care. Snoop, Martha and Cousin Tillie would want you to find a way to bring chocolate comfort.

Still, I would have hired help earlier had it not been for Covid. I would have maybe, just maybe, taken Mom to the hospital when she first had a GI bleed just to see if the problem was easily correctable. I would have had hospice come in earlier. As it was, I had access to a hospice client who gives excellent care and they were on call for me whether they knew it or not. Thanks Audubon.

Humana saved a ton of money on my mother without changing the outcome of her illness. I realize this a luxury because not everyone can take a break from life to provide total care to an elderly patient but I wonder how many people are not accessing healthcare because of the pandemic. Are outcomes in general significantly changed?

But that’s just my story of how Mama saw a return on investment on my nursing school tuition.

Covid has affected every aspect of our lives from how we work and shop to how we educate our children, socialize and even experience illnesses. Politics has played an inappropriate role in determining our response to Covid.

I hope you’re keeping some sort of record. 102 years after the Spanish Flu, it is the personal accounts of the patients and the healthcare workers, and even the San Francisco Anti-Mask league of 1919 that tell the story of the Spanish flu. Some numbers are just too high to comprehend.

If you are keeping some sort of record, please consider sharing all or part of it with us. You can email me here.

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Work Place Violence (and free CE’s)

workplaceviolence_bannerI must say that everyone is pretty good about conducting a home safety assessment. Throw rugs are removed, lights are bright and shiny and and much of the work done by therapists is to reach the goal of the patient being able to safely navigate in the home environment. Geaux, Team!

We’re missing something. What about employee safety in the work environment? Everyday home health and hospice nurses, aides, MSW’s and social workers go into homes where they are separated from the agency and out of view of anyone who might help them. All but the most serious incidents are overlooked.

In addition to the injuries that happen regularly such as sprains, abrasions and other musculoskeletal injuries due to moving patients, these are routinely addressed in orientation and annual inservices. A risk of workplace violence also exists and recent research shows it is more prevalent than you may think.

Homecare workers (n = 1,214) reported past-year incidents of verbal aggression (50.3% of respondents), workplace aggression (26.9%), workplace violence (23.6%), sexual harassment (25.7%), and sexual aggression (12.8%). Exposure was associated with greater stress (p < .001), depression (p < .001), sleep problems (p < .001), and burnout (p < .001). Confidence in addressing workplace aggression buffered homecare workers against negative work and health outcomes.1

The CDC along with NIOSH has published an online Continuing Education course addressing workplace violence for healthcare workers. It is not specific to visiting nurses but does offer useful advice. It also offers 2.4 continuing education credit but if you want the credit, read the ‘instructions for credit on the first page. It is provided at no cost and includes short video clips, written text and discussion questions.

In taking this course, I learned that when adhering to the strict definitions of Workplace Violence, many homecare workers have experience with verbal and physical aggression. We also under report workplace violence and ‘forgive’ our patients. It may be a fact of life that nurses eat their young but it doesn’t have to be and agencies should not tolerate bullying of their employees. Regardless of the kind of workplace violence that takes place, visiting staff may suffer stress, depression, insomnia and burnout as noted in the study cited above. Without support from management, the agency’s morale will deteriorate to the point where nothing gets done.

If you know of any other resources to reduce the risk of workplace violence in the workplace, please share in the comments. Our workplace includes most zip codes in the country and all types of people. Reducing the risk of violence and supporting visiting workers can go a long way to making sure you’re agency doesn’t lose its best employees to burnout.

  1.  Hanson, G. C., Perrin, N. A., Moss, H., Laharnar, N., & Glass, N. (2015). Workplace violence against homecare workers and its relationship with workers health outcomes: a cross-sectional study. BMC Public Health, 15, 11. http://doi.org/10.1186/s12889-014-1340-7

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