National Nutrition Month

Personalize Your Plate with National Nutrition Month® 2021

This year’s theme of “Personalize Your Plate” emphasizes the importance of understanding there is no ‘one-size-fits-all’ approach to nutrition and health. We are all unique and our approach to healthy living should be, too!

Creating healthy eating habits can be a daunting task, with an overwhelming amount of information thrown at us, the latest eating trends, and buzz-worthy ingredients. However, good nutrition really is all about having a well-rounded diet.

Nutrition Made Simple

Keeping in mind that we all have different nutrition goals which require different approaches, the CDC website provides the following four general tips for working towards a well-rounded diet:

  1. Add healthy fats, such as avocados, nuts, olives
  2. Reduce overall sodium intake – start by reading ingredient labels and recipes to find alternatives to sodium
  3. Increase fiber for digestion
  4. Aim for a variety of colors on your plate during every meal

Test Your Culinary Skills!

National Nutrition Month® is the perfect time to learn new and healthy recipes! With the internet at our fingertips, there are endless resources available to you. Most recipes include the nutrition information at the bottom that will help you to determine if the recipe meets your nutritional needs.

For those of us who just don’t know where to begin, there are meal kit services like ‘Hello Fresh’ and ‘Blue Apron’ that delivers recipes and the necessary ingredients to your home based on your nutritional preferences at a frequency of your choosing. These services can be a great starting point and helpful resource in a busy world where we don’t always have the time to dedicate to planning our meals.

If you are still lost on who to turn to for help, Registered Dietician Nutritionists can assist with developing a customized plan tailored to our unique bodies and nutritional needs.

So let’s use National Nutrition Month® as motivation to put our healthiest foot forward and strive for a well-rounded diet. And remember to Personalize Your Plate!

International Women’s Day

#ChoosetoChallenge

“A challenged world is an alert world. Individually, we are all responsible for our own thoughts and actions – all day, every day. We can all choose to challenge and call out gender bias and inequality. We can all choose to seek out and celebrate women’s achievements. Collectively, we can all help create an inclusive world.” -Unknown

International Women’s Day (IWD) is reserved to recognize the social, economic, cultural, and political achievements of women, as well as to raise awareness about women’s equality, lobby for accelerated gender parity, and fundraise for female-focused charities. Although we are only beginning the third month of 2021, it has already been a big year for women. The Business Insider has compiled a list of the most powerful women in 2021. Just to name a few…

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Kamala Harris was sworn in as the first woman, black, and South Asian Vice President of the United States on January 20th, 2021.
“While I may be the first woman in this office, I will not be the last, because every little girl watching tonight sees that this is a country full of possibilities.” – during her VP-acceptance speech in Nov. 2020

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Kathrin Jansen is the head of vaccine research and development at Pfizer. Beginning in March 2020, she led a team of 650 experts to develop a successful vaccine against COVID-19.

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Sheryl Sandberg is the current Chief Operating Officer of Facebook. Under her administration, Facebook managed to recover $22.1 billion in profits in 2018 after having suffered a $56 million loss previously. She became the first female member of the company’s board of directors in 2012, and in 2014, made the Forbes’ Billionaires list due to her vesting stake in Facebook.

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Shonda Rhimes is an award-winning television writer and producer. She created the ABC drama ‘Grey’s Anatomy’, which currently is the longest-running medical drama on television, in addition to several other very popular shows. 
She is an activist and co-founder of the ‘Times Up’ movement, seeking to promote gender equality in the television and film industry, as well as to lobby for legislation that would penalize companies that tolerate sexual or gender-based harassment.

And Everyday Heroes

These are only a handful of the many incredible women changing the world each and every day. Please find time today to reflect and recognize the everyday heroes that make achievements and contributions to make a world a better place for everyone!

Learn more about International Women’s Day and the 2021 theme ‘Choose to Challenge!’ & view Business Insider’s full list of the most powerful women in 2021.

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Hospice Eligibility Checklist For Emergency Department Staff

By Joelle Y. Jean, FNP

Due to its busy nature, providers in the Emergency Room (ER) may not immediately identify patients for hospice care. Approaching patients or family members about hospice can also be challenging-especially if they have specific questions. This hospice checklist can help guide providers on when they should consider a patient for hospice.

What is hospice?

Hospice is for patients who are at the end of life. Patients can have a terminal illness or declining health from a chronic illness. The hospice team can coordinate care with health care providers to manage and treat patients.

Benefits of hospice

Initiating hospice early in the disease process has many benefits for the patient and family members. Hospice is there to improve the quality of life and provide comfort for patients during their end of life. Benefits of hospice include:

  • Improved physical and psychological symptoms
  • Caregiver relief
  • Reduced hospitalizations
  • Lowered hospitalization costs
  • Reduced hospital deaths

Barriers to initiating hospice

Studies have shown that providers initiate hospice too late- patients die within weeks of entering hospice. There are barriers that cause ER providers to wait or not consider hospice. Some barriers include:

  • Not having the right resources
  • Breakdowns in patient-clinician communication
  • Failing to identify terminal stage of life
  • Geographical and socioeconomic barriers

Head-to-toe hospice checklist

Alzheimer’s disease and dementia

Patients in the late stages of Alzheimer’s disease or dementia are candidates for hospice. At this stage, they start to lose activities of daily living (ADLs) and cannot complete basic functions on their own. These functions include:

  • Bathing
  • Dressing
  • Eating
  • Swallowing

Other signs providers should consider patients with Alzheimer’s disease or dementia for hospice are:

Heart disease

Patients in their late stages of heart failure (HF) are candidates for hospice. Providers should consider hospice if the patient has:

  • Visited the ER two or more times in the past six months
  • A decline in ADLs
  • Severe HF symptoms such as dyspnea, angina, fatigue
  • Not responded to pharmacological and non-pharmacological interventions
  • Ineligible for surgery
  • Weight and muscle loss
  • NYHA class three/four heart failure

Lung disease and lung cancer

Patients with end-stage lung disease and lung cancer are hospice candidates. Providers should consider hospice if the patient:

  • Has frequent ER visits
  • Increased weight loss
  • Increased dyspnea at rest even with oxygen
  • Stage four non-small lung cancer

Liver disease

Patients with end-stage liver disease are candidates for hospice. Liver disease is the 12th leading cause of death in the United States. Patients with liver disease are often overlooked for hospice care. Providers should consider hospice for patients with end-stage liver disease if they are:

  • Ineligible for a liver transplant
  • Increased pain
  • Increased pruritus
  • Increased nausea
  • Depression and anxiety
  • A decline in cognition and weight

Cancers

ER providers can opt for hospice for patients with cancer if treatment is no longer working or there are no other treatment plans. Patients also at the end stage of their cancer can benefit from entering hospice early. Other signs a patient is ready for hospice are if the patient:

  • Has increased weakness
  • Significant weight loss
  • Pain control
  • In bed for most of the day

Sepsis

It’s not always easy to identify patients with sepsis who qualify for hospice. However, some patients meet the criteria. Providers should consider patients with sepsis for hospice if the patient:

  • Has impaired kidney failure
  • Not responding to pharmacological treatment
  • Require mechanical ventilation
  • Injury to the liver
  • Hyperlactemia

Hospice is available to patients who are at the end of their life. They can entire at any stage in their disease process. Initiating hospice early benefits the patient. Studies have shown that hospice improves mood, decreases medical interventions, and enhances the patient’s overall quality of life.

Home Health Care Can Help Seniors With Loneliness and Social Isolation

By: Elizabeth Townsend, RN

People are social beings. With COVID-19 introducing social distancing guidelines and restrictions on visitations, social isolation and loneliness are increasing. A report referenced by JAMA discussed the need for solutions for social isolation and loneliness in older adults. There is significant documentation that social isolation and loneliness are related to a higher rate of major mental and physical illnesses, including:

  • Cardiovascular and cerebrovascular risks
  • More depression and anxiety
  • An increased risk of dementia

According to the National Institute on Aging, people who participate in worthwhile activities with others tend to live longer and have a sense of purpose.

Assessing seniors for isolation and loneliness

COVID-19 has made it difficult for seniors to participate in:

  • Social gatherings
  • Communal dining
  • Exercising in groups
  • Social programs at senior centers
  • Volunteering

Home health clinicians assess patients for social isolation and loneliness. Asking patients about their social needs is important to identify who needs assistance, easing isolation and loneliness. The home health agency provides tools or guidelines with questions for the clinicians to ask. Examples of questions to ask:

  1. Do you feel you have no friends or loved ones?
  2. Are you lonely?
  3. How are you staying active?

5 ways to relieve isolation and loneliness

After assessing and finding that your patient is suffering from social isolation, consult with their caregivers and healthcare team —specifically the agency’s social worker—to find ways to relieve their isolation. Daily Caregiving suggests some ways to help:

  1. Encourage a sense of purpose. Suggest activities such as knitting blankets and caps for newborns at a local hospital, making masks for healthcare workers or family members, or writing letters to their grandchildren to encourage them. Allow the patient to have a responsibility, such as taking care of a plant or dog. This would be giving them a meaningful purpose.
  2. Encourage interaction. Encourage interaction with others via phone, computer, or if in person, socially distant, wearing a mask.
  3. Encourage physical activity. Take Into account the patient’s physical ability. They can do gentle exercises such as walking, stair-climbing, yoga, or group exercises via computer. If they cannot get out of bed or are not able to walk, find appropriate activities. Consult with the physical therapy team who can provide resources for exercises for those with limitations.
  4. Assess the food they are eating. Encourage fiber-rich foods like fruit, vegetables, whole grains, and lean proteins. Consult with community services such as food banks, churches, or meal delivery services.
  5. Show them they are loved. Find ways to show that they are loved and needed. Listen to what they have to say. Encourage family members, if they are in the home also, to hug the patient and talk and listen to them.

Social workers can help seniors with social isolation and loneliness

Social workers can ensure that patients have access to available resources. Local churches may have “shut-in” outreach for those unable to leave their homes. They may provide phone calls, run errands, provide food baskets, and communicate by mail with the seniors. Local library programs have online programs and can arrange to have books available for the patient to check out. The social worker can also refer the patient to transportation programs that take seniors to doctor appointments.

Encourage virtual connections for seniors

Advancing States created a resource to help reduce social isolation and loneliness.

  1. If the patient can use a smartphone, show them how to google Earth National Park Tours so they can “visit” the parks and talk about what they saw with others via telephone or with you when you visit.
  2. Patients can meditate through Journey Meditation.
  3. Put the patient in contact with Well Connected by Covia, who will help them participate in virtual classes, conversations, and activities by phone and computer.

There are helplines for mental and emotional support, which include:

  1. Friendship Line by Institute on Aging- 1(800)971-0016
  2. Happy– a free app that provides emotional support 24/7
  3. National Alliance on Mental Illness Helpline- 1(800)950-6264
  4. Substance Abuse and Mental Health Services Administration National Helpline- 1(800)662-4357

Grief During the Holidays

Grief. It’s a small word with a big effect. At worst it is crippling. At best it is nagging. And holidays seem to magnify the heartache that follows grief, regardless of when the loss took place.

For some, pushing through the holidays and honoring time old traditions can be the perfect way to memorialize a loved one. But for others, creating and celebrating new traditions or skipping the holiday festivities altogether might be easier to bare.

There’s no right or wrong way to grieve during the holidays. Even two people who experienced the same loss will grieve differently. Many factors, such as the relationship to the deceased; the surviving individual’s belief and spirituality; past experiences with loss; and the survivor’s willingness and ability to express their grief can impact each survivor differently.

Regardless of how you choose to celebrate or not celebrate the holidays, the following steps can help you feel more prepared to handle your grief:

  1. Acknowledge that the holidays will be different.
  2. Acknowledge that the holidays will be tough.
  3. Communicate your holiday plans with family and friends so that they will know what to expect.
  4. Recognize that even family and friends within your own grief circle may have different plans for how they wish to spend the holidays. Seek to find common ground, establish your plan should the holidays become too much for either party, or choose to celebrate separately if their plans conflict with your level of comfort.
  5. Seek help from a friend that you trust who can be there for you without offering advice or trying to “fix” your grief.
  6. Say “yes” to help if you need the support.

Our wish for you this holiday season, and always, is that you can find joy amid sorrow as you remember your loved one.

COPD Patients: Doctors Calling For Earlier Hospice Referrals

By: Wilma Peterson, RN

According to the American Lung Association, Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in the United States. Living with the symptoms of COPD, such as difficulty in breathing, can induce stress for both the patient and the family. Due to this, Doctors are beginning to call for earlier hospice referrals for these patients with COPD. If elected early, the benefit of hospice care can assist with symptom management, prevent unnecessary hospitalizations, and help patients achieve a better quality of life.

Patients with advanced COPD are eligible for hospice care, which is fully covered by Medicare, some private insurances, as well as assistance from Veterans Affairs. When hospice care is chosen early, patients have access to the appropriate care and medications, allowing for more restful periods and easier breathing. Identifying these factors early can relieve symptoms such as anxiety, panic, labored breathing, and intractable coughing that are uncontrolled with regular medications and traditional therapies.

Factors to consider when discussing the appropriateness of a hospice referral for a COPD patient include:

  1. The patient has a projected life expectancy of 6 months or less
  2. All therapies, including medications and rehabilitation, have been exhausted
  3. The patient has frequent emergency room visits and hospitalizations due to exacerbation of COPD

At this point, the patient is considered to be in the advanced stages of COPD, and the discussion for hospice and end-of-life care should begin.

Eight benefits of early hospice referral for those with COPD

Electing the hospice benefit early allows for the expertise of a focused team of professionals:

  • Physician
  • Nurses
  • Social worker
  • Chaplain
  • Ancillary services

Hospice services are available 24/7/365. The hospice care team will provide medical, emotional, psychological, and spiritual support to the patient and family. Here are eight benefits of early hospice referral:

  1. Early intervention. The earlier the hospice referral is made, the more time it allows the patient and their family to select the right hospice company and be a part of the care plan.
  2. Managed care. A physician leads the hospice care team and can order the appropriate medications and therapies and cater to an individualized care plan for each patient.
  3. Skilled Nurses. A registered nurse will meet with the patient and family, and can admit the same day. The nurse will also reconcile all medications, put together a plan that focuses on managing symptoms, and provide relief of pain and respiratory distress.
  4. Hospice Aides. Health aides assist with normal daily activities:
  • Washing
  • Grooming
  • Dressing
  • Ambulating safely
  • Other household chores, as needed
  1. Medical Social Worker. A social worker will support patients and families with accessing resources within the community, such as respite care, living arrangement and other services.
  2. Chaplain. Clergy works with the patient and their family to support psychological and spiritual needs, assisting them through the end-of-life, grieving process or any other related needs.
  3. Ancillary services. Other ancillary services like physical therapy and occupational therapy, strengthen muscles to assist with safety and allow for a sense of independence.
  4. Respite Care. Allows time for self-care and rest, which can help with a change in attitude and mindset in caring for your loved one.

Living easier with hospice care

Early hospice referrals means early management of symptoms by:

  • Having the appropriate therapy and staff when needed
  • Avoiding the stress of emergency exacerbations and unnecessary hospital visits
  • Providing a more individualized approach to the patient and caregiver
  • Alleviating stress to allow time for future planning or ability to spend quality time

Don’t wait, make the referral to hospice early. An early hospice referral can provide extra support for both the caregiver and the patient. If you or a loved one is struggling with COPD, consider the benefit of hospice services.

Hospice: Keeping Loved Ones Home for the Holidays

The holidays can be a challenging and bittersweet time for those with a seriously-ill loved one. Electing the hospice benefit may seem like one more item on your to do list, but hospice can ease the burdens of facing a life-limiting illness. If a loved one has unmanageable symptoms, they could end up spending their holiday in the hospital, away from family and friends.

Nurses In Touch helps families manage their loved one’s pain and symptoms so they can spend the holidays in the comfort of home–whether that means in their own home, in a loved one’s home, or in a skilled nursing facility or assisted living facility that they’ve made their home.

Hospice Care in the Comfort of Your Home

Whether your loved one is being cared for at home or in a facility, the additional layer of support that hospice can provide can make all the difference. Hospice care can help manage complex symptoms of pulmonary disease, cancer, dementia, Parkinson’s, heart disease, stroke, liver or kidney disease.

Our interdisciplinary approach, which includes care from a nurse, aide, social worker, chaplain, medical director, and the patient’s primary care physician, is designed to support patients and their families physically, psychologically, and spiritually. With the assistance of this personalized care team and the guidance of the patient’s primary physician, your family can have the support necessary to keep your loved one comfortable and supported without unnecessary hospital visits or doctor appointments.

Nurses In Touch’s team is local and available 24 hours a day, 7 days a week, 365 days a year to provide care for our patients and for admissions.

Hospice can also provide necessary durable medical equipment, such as a hospital bed; medications related to the patient’s primary hospice diagnosis; and incontinence products and nutritional supplements. By utilizing hospice services, families have more time to enjoy the most meaningful moments of the holidays — time spent together with family.

Family & Caregiver Support this Holiday Season

With holidays comes stress, as time runs out to shop, run end-of-year errands, and attend special events. Combine that with caring for a seriously-ill loved one during these unprecedented times, and life can become overwhelming quickly.

Our hospice care extends beyond the patient. Nurses In Touch works closely with family members to assure they have the tools necessary to cope with stress or caregiver burnout surrounding what may be the final holiday with someone they love. In addition to scheduled visits, patients and their families will have access to a dedicated hospice nurse by phone who is available to answer your questions and dispatch a nurse to your home as needed.

Our team of chaplains and social workers collaborate to address patient and family members’ emotional, psychological and spiritual needs. They make certain our patients’ families have a plan for the holidays, so they can make the most of the holidays without piling up additional stress.

Caring for a loved one facing a terminal illness can be demanding, but it can also be incredibly fulfilling. Nurses In Touch can partner with you or your loved one’s facility to ensure everyone – patient and family alike – is supported and cared for this holiday season.

If you have a loved one with a life limiting illness, please contact us to learn more about how Nurses In Touch can help your family this holiday season, because home should be more than a holiday wish!

The Hospice Benefit for Veterans

Care at no cost to Veterans and their families.

Nurses In Touch Hospice collaborates with local VA agencies and programs to raise awareness about the benefit of hospice services for Veterans. As a Veteran, expenses for hospice-related services or enrolled veterans are covered in full.

We Honor Veterans Program

Nurses In Touch Hospice partners with the We Honor Veterans program to give veterans the best care possible. This program provides resources and training to meet the needs of our veteran patients and their families through respectful inquiry, compassionate listening, and grateful acknowledgement so that veterans can have a peaceful end-of-life experience.

VA Hospice Program Benefits

Hospice is a benefit that the VA offers to qualified Veterans who are in the final phase of their lives. This multi-disciplinary team approach helps Veterans live fully until they die. The VA also works very closely with community and home hospice agencies to provide care in the home. The VA hospice benefit includes:

  • Care available wherever you call home
  • No co-pay for hospice care
  • Medical equipment, medication and personal care supplies
  • Personalized pain and symptom management
  • Care coordinated with your doctors
  • Physical, occupational and other therapy services
  • Spiritual care and support
  • Volunteers with military experience (when available)
  • Ongoing grief counseling for patients and family

Veteran-To-Veteran Volunteer Program

Nurses In Touch Hospice’s Veteran-to-Veteran volunteer program pairs Veteran volunteers with hospice patients who are Veterans as well. Veteran volunteers have the ability to develop a unique connection with patients and their families through their common experiences and stories, establishing a strong relational bond.

How can Veteran Volunteers Help?

  • Reminisce or tell life stories
  • Educate and answer questions regarding Veteran benefits
  • Assist in pinning ceremonies, distribute certificates and help with other recognition events
  • Assist in replacing lost medals

Sepsis Awareness Month: Why Our Program Actually Works

By: Portia Wofford

Home health clinicians play an essential role in caring for patients who are:

  1. At risk of developing sepsis
  2. Recovering from sepsis or septic shock

Home health providers are vital in preventing hospital admissions and readmission among sepsis patients. According to the CDC, sepsis is the body’s extreme response to an infection. It is a potentially life-threatening medical emergency.

Many patients receiving home healthcare services have chronic medical conditions and comorbidities that put them at risk for infection, including COVID-19 and sepsis. According to the Global Sepsis Alliance, COVID-19 can cause sepsis. Research suggests that COVID-19 may lead to sepsis due to several reasons, including:

  • Direct viral invasion
  • Presence of a bacterial or viral co-co-infection
  • Age of the patient

According to Homecare Magazine, approximately 80% of people with COVID-19 will have a mild course and recover without hospitalization. The remaining 20% of patients with COVID-19 may develop sepsis and be admitted. Patients with severe illness will need home health care.

A study published in Medical Care by the National Institutes of Health (NIH) suggests that when strategically implemented, home health care can play an essential role in reducing hospital readmissions for patients recovering from sepsis. According to Home Health Care News, the study points out that sepsis survivors who were less likely to return to the hospital if they:

  1. Received a home health visit within 48 hours of hospital discharge
  2. Had at least one additional visit and
  3. Had physician visit within their first week of discharge

According to the findings, these interventions reduced 30-day all-cause readmissions by seven percentage points.

Home health clinicians are trained to monitor patients and identify signs and symptoms of sepsis. Additionally, they can teach patients and their caregivers how to prevent and recognize sepsis. According to research and estimates, rapid diagnosis and treatment could prevent 80% of sepsis deaths.

Home health care can contribute to early detection of sepsis

Early detection is critical. For each hour treatment initiation is delayed after diagnosis, the mortality rate increases 8%. Home health nurses can monitor and educate patients and their caregivers on signs and symptoms to report to include. Additionally, home healthcare agencies can provide screening tools that fill the gaps in identifying at-risk patients during transitions from inpatient to outpatient settings.

Home health provides case management for chronic comorbidities

  1. Some comorbidities like Type 2 Diabetes, chronic heart disease, and dementia were associated with sepsis risk in almost all infection types. Those with other chronic illnesses, cancer, and an impaired immune system are also at increased risk. Monitoring can help reduce risks.
  2. Post-discharge and follow-up visits, including telehealth visits, may provide positive intervention for post sepsis patients.
  3. Nurses can review and coordinate care to adjust medications, evaluate treatments and interventions, and refer for appropriate treatment.

When it comes to serious complications, our sepsis program effectively:

  • Prevents infections that can lead to sepsis
  • Recognizes sepsis symptoms before they become severe
  • Rapidly responds if sepsis symptoms occur by initiating appropriate treatments and referrals
  • Follows-up with care to ensure continued recovery

Nurses In Touch’s sepsis program promotes quality of care and improves outcomes for those at risk for developing or recovering from sepsis.

September is Healthy Aging Month

During Healthy Aging Month, we focus on celebrating the many positive aspects of aging. Here are some tips to incorporate in your daily routine that can lead to a healthier lifestyle, allowing you to live your life to the fullest.

  1. Exercise – Get moving and active on a daily basis!
  2. Socialize – Stay in touch and find safe ways to connect with friends and loved ones!
  3. Stay balanced – Try new methods such as yoga to reduce stress and improve your overall balance!
  4. Rest – It’s important to make sure you are getting a good, quality rest each night.

These are important tips to keep in mind for all ages and stages of life. Not only this month, but from now on, remember to take care of yourself and those who surround you. Healthy aging starts with you and your health decisions.