Health Professional Resources

Resources for Health Professionals

"There are a number of patients who have a hard time coming to terms with their illness, and our culture has the mind-set that we need to fight, fight, fight. There's a time to fight, but it's also my responsibility to tell patients when it's time to focus on living their life as well as possible." - Dan Mulkerin, M.D.

"When I suggest Agrace HospiceCare to my patients they often give a sigh of relief, knowing they will be well taken care of. Agrace HospiceCare gives my patients resources they can't get anywhere else. It's total care of patients and families; it's reassurance that their pain will be managed and that they won't be alone." - Joan Addington-White, M.D.

Agrace HospiceCare is committed to being your best partner and working with you to provide the highest quality end-of-life experience for your patients and their families. Below you will find resources to make your job easier when discussing end-of-life issues. As always, Agrace HospiceCare is happy to assist you in any end-of-life conversations you may have with your patients and their families. Contact us to request our assistance, refer a patient or to ask for additional resources that you may find helpful.

Advance Directive Forms

Power of attorney for healthcare 45.51 Kb
Addendum to the power of attorney for healthcare 33.73 Kb

Hospice Medicare/Medicaid Benefit Manual

The Hospice Medicare/Medicaid Benefit 288.90 Kb

Physician/Clinician Newsletters

Agrace HospiceCare Physician Alert

Nov 2011 Emergency Comfort Medications 2.02 Mb

Aug 2011 End-stage Debility as a Hospice Diagnosis 1.06 Mb

May 2011 Role of Agrace HospiceCare Medical Directors  1.99 Mb

Feb 2011 Hospice Guidelines for COPD Patients  1.21 Mb

Nov 2010 Patients Live Longer With Pallative Care 1.02 Mb

Aug 2010 Agrace HospiceCare Doesn't Require DNR  544.05 Kb

May 2010 Qualifying Cardiac Patients for Hospice  155.97 Kb

Feb 2010 Assessment Tools for Dementia Patients 86.70 Kb

Quality of Life Matters Newsletter

Vol. 11, Issue 2 279.89 Kb Aug/Sept/Oct 2009 Self-Awareness Approach Offered to Protect Physicians from Burnout and Compassion Fatigue Advanced Dementia Patients 2.5 Times More Likely to Have Feeding Tube Placement in Areas with High Rates of End-of-Life Health Care Transitions New Pediatric Standards Aim to Improve Palliative and Hospice Care for Children Physician Aid in Dying: Requests Often Based on Worries about Future Symptoms, Circumstances Chronic Critical Illness: Advance Directives, Appointment of Health Care Proxies Could Ease Burdens for Patients, Families Perception of Physician Abandonment at End of Life Affects Patients’ Sense of Continuity, Closure Latino Patients: Improving Their End-of-Life Experience Through Clear Communication and Cultural Understanding Consensus Guidelines Offered for Identifying SICU Patients in Need of Palliative Care

Vol. 11, Issue 1 640.07 Kb May/June/July 2009 Selecting Palliative or Hospice Care That Is ‘Competent, Compassionate, Coordinated’ Physicians Report High Level of Involvement in Palliative Care Under reporting of Dementia on Death Certificates of Nursing Home Residents Raises Concerns about Accuracy of Mortality Statistics ICU Clinicians Urged to Better Inform Patients/Families about Prognosis Agitation and Delirium at End of Life: Managing the Symptoms Medical School Curricula in Palliative and Hospice Care Found Lacking Symptomatic Burden of Malignant Wounds Beyond DNR/CPR Orders: Using POLST in Hospice

Vol. 10, Issue 4 636.86 Kb Feb/Mar/Apr 2009 Non-Cancer Diagnoses Continue to Outnumber Malignancies in Patients Served by Hospice ‘Waging War’ on Cancer or ‘Waging Peace?’ Physician Prediction of Survival Duration Found Overly Optimistic by Three Months Hospice Reduces Medical Expenditures Hospice Improves Survival Time by 81 Days in CHF Patients Cost Savings of Almost $5000 per Hospital Admission Associated with Palliative Care Consultation High Rate of Hospice Use Found among Older Stroke Patients Who Die Within Thirty Days U.S. Hospitals Implementing Palliative Care Programs at Steady Pace Suicide Rate Twice as High with Cancer

Vol. 10, Issue 3 620.42 Kb Nov/Dec/Jan 2008-2009 End-of-Life Discussions Offer Patients Benefits, Not Distress Oncologists Urged to Help Patients ‘Think Clearly’ about Chemotherapy for Late-Stage Disease End-of-Life Care Choices Linked to Health Literacy, Not Race Medical Students’ Ratings of End-of-Life Care Instruction Have Risen Nationally, Yet ‘Much More Work Needs to Be Done’ AMA Approves Palliative Sedation for Intractable Symptoms at the End of Life Physicians Offered Two Brief Spiritual Assessment Tools Spiritual Assessment Tools for Physicians AMA Approves Palliative Sedation for Intractable Symptoms at the End of Life

Vol. 10, Issue 2 632.85 Kb Aug/Sept/Oct 2008 Pulmonary Diseases and Critical Illnesses: New Clinical Guidelines Endorse Palliative and Hospice Care Top Marks: Families Value the Communication, Support, and Coordination Services of Hospice Sustaining Hope, Delivering Prognosis: An Approach to Exploring Patient Needs Extensive Use of Antibiotics at the End of Life in Patients with Advanced Dementia Raises Concerns Increasingly Late Referral to Palliative Care Found Among Cancer Patients Heart Failure Patients Overestimate Survival Time Improving Care for the End of Life: A Source book for Health Care Managers and Clinicians

Vol. 10, Issue 1 650.65 Kb May/June/July 2008 Advanced Dementia: Physicians Offered Approach to Support Decision Making for Patients New Subspecialty of Hospice and Palliative Medicine Scheduled for First Certification Exam Half of Dying Long-Term Care Residents Have Pain, Dyspnea Advanced Dementia: Physicians Offered Approach to Support Decision Making for Patients Hospice Care Reduces Medicare Costs While Providing Quality Care Uncertain Prognosis in Pediatric Patients: A Signal to Initiate Palliative Care American College of Physicians Clinical Guideline Aims to Improve End-of-Life Care Valid in 40 States, Popular Advance Directive Also Available in a Pediatric Version

Vol. 9, Issue 4 243.18 Kb Feb/Mar/Apr 2008 Number of Veterans Receiving VA-Supported Home Hospice Care Triples Hospice Care Often Chosen for Diseases with High Caregiving Burden Inaugural ‘National Healthcare Decisions Day’ Set for Spring Number of Veterans Receiving VA-Supported Home Hospice Care Triples Diagnosing Death: ‘Communication in the Face of Uncertainty’ Clinicians Offered Step-Wise Approach to Managing Intractable Nausea and Vomiting Palliative Care Yields Lower Costs, Greater Patient Satisfaction Handling Requests for Nondisclosure: Experts Offer a Clinical Approach

Vol. 9, Issue 3 293.67 Kb Nov/Dec/Jan 2007-2008 Hospice Care Still Underutilized and Misunderstood? Alzheimer’s Association Releases Recommendations Specific to End-of-Life Care ALS and Other Fatal, Progressive Neurologic Diseases: Addressing Hospice and Palliative Care Issues Needs-Based Palliative Care Urged for Patients with COPD Hospice Care for Dementia Patients Receives Same High Family Rating as for Cancer and Other Chronic Diseases Clinicians Offered Strategies to Reduce Stress of Surrogate Decision Making POLST: ‘Physician Orders for Life-Sustaining Treatment’ Portable form translates patient wishes into physician orders Palliative Care ‘Case of the Month’

Snapshot Eligibility Cards

Snapshot Eligibility Card
For all diagnosis
front and back 288.01 Kb

Snapshot Eligibility Card
For dementia patients only
front 132.43 Kb
back 144.06 Kb

Journal Articles

Quality of End-of-Life Cancer Care for Medicare Beneficiaries: Regional and Hospital-Specific Analyses

The Dartmouth Institute for Health Policy and Clinical Practice--A Report of the Dartmouth Atlas Project. November 16, 2010
David C. Goodman, MD, MS1, Elliott S. Fisher, MD, MPH1, Chiang-Hua Chang, PhD1, Nancy E. Morden, MD1, Joseph O. Jacobson, MD2, Kimberly Murray, MPP3, Susan Miesfeldt, MD3,4 Editor: Kristen K. Bronner, MA1

Impact of Hospice Disenrollment on Healthcare Use and Medicare Expenditures for Patients With Cancer

Journal of Clinical Oncology, published online on August 30,2010
Stephen R. Connor, PhD, Bruce Pyenson, FSA, MAAA, Kathryn Fitch, RN, MA, MEd, Carol Spence, RN, MS, and Kosuke Iwasaki, FIAJ, MAAA
National Hospice and Palliative Care Organization (S.R.C., C.S.), Alexandria, Virginia; and Milliman, Inc. (B.P., K.F., K.I.), New York, New York, USA

Comparing Hospice and Nonhospice Patient Survival Among Patients Who Die Within a Three-Year Window 188.65 Kb
Journal of Pain and Symptom Management, Vol. 33 No. 3 March 2007
Stephen R. Connor, PhD, Bruce Pyenson, FSA, MAAA, Kathryn Fitch, RN, MA, MEd, Carol Spence, RN, MS, and Kosuke Iwasaki, FIAJ, MAAA
National Hospice and Palliative Care Organization (S.R.C., C.S.), Alexandria, Virginia; and Milliman, Inc. (B.P., K.F., K.I.), New York, New York, USA

What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program? 317.88 Kb
Social Science & Medicine 65 (2007) 1466–1478
Donald H. Taylor Jr, Jan Ostermanna, Courtney H. Van Houtven, James A. Tulsky, Karen Steinhauserc
Terry Sanford Institute of Public Policy, Duke University Durham, Durham, NC, USA
Duke University and Durham Veterans Administration Medical Center, USA
Center for Palliative Care and Department of Medicine, Duke University and VA Medical Centers, USA

Agrace HospiceCare Audio CD's and mp3 files

Dementia at the End of Life

Right click and "save as" to save files to your computer

Track	Title	File
1	Introduction	Track1.mp3 5.10 Mb
2	Defining advanced dementia	Track2.mp3 10.48 Mb
3	Communication	Track3.mp3 1.00 Mb
4	What kinds of communication can a patient with advanced dementia still understand?	Track4.mp3 3.29 Mb
5	How will my mother, who has dementia, express herself when she is dying?	Track5.mp3 2.62 Mb
6	Is it possible to experience reconciliation and closure with my father who has dementia and is dying?	Track6.mp3 2.82 Mb
7	Pain and the Difficult Behaviors Caused by Pain	Track7.mp3 1.64 Mb
8	How can we treat challenging behaviors exhibited by patients with dementia?	Track8.mp3 3.86 Mb
9	The patient seems more restless than before. What's wrong?	Track9.mp3 930.61 Kb
10	What if the patient's restlessness does not have a physical cause?	Track10.mp3 4.28 Mb
11	How do patients with advanced dementia communicate pain?	Track11.mp3 1.63 Mb
12	How is pain treated in patients with advanced dementia?	Track12.mp3 1.51 Mb
13	Can medications be used to control aggressive behavior?	Track13.mp3 2.46 Mb
14	Infections and Antibiotics	Track14.mp3 1.93 Mb
15	Should antibiotics be used for infections such as urinary tract infections?	Track15.mp3 2.30 Mb
16	Should my mother's pneumonia be treated?	Track16.mp3 2.71 Mb
17	Medications	Track17.mp3 1.45 Mb
18	Are there medications that can treat dementia?	Track18.mp3 7.41 Mb
19	Should we stop the medications or should she continue taking them?	Track19.mp3 2.73 Mb
20	Nutrition, Swallowing and Artificial Nutrition	Track20.mp3 1.22 Mb
21	How does advanced dementia affect the patient's nutritional status?	Track21.mp3 1.40 Mb
22	What options do caregivers have if their loved one shows signs of losing their appetite?	Track22.mp3 3.23 Mb
23	What if the patient is having difficulty chewing or swallowing?	Track23.mp3 2.65 Mb
24	My mom often chokes on her food. Is this normal?	Track24.mp3 940.80 Kb
25	What are some other ideas to help make mealtime less stressful?	Track25.mp3 3.04 Mb
26	Does a feeding tube improve quality of life? How might it affect the course of the disease?	Track26.mp3 6.48 Mb
27	Skin Care	Track27.mp3 1.04 Mb
28	My mother's skin seems so fragile. What's happening?	Track28.mp3 1.16 Mb
29	What can be done to prevent pressure sores or other injuries to the skin?	Track29.mp3 1.62 Mb
30	Advance Directives	Track30.mp3 1.87 Mb
31	What if my sister's dementia has progressed and she does not have an advance directive, such as a Living Will or a Power of Attorney for Health Care?	Track31.mp3 2.72 Mb
32	What is activation of the Power of Attorney for Health Care, and when does activation take place?	Track32.mp3 1.53 Mb
33	In my mother's Power of Attorney for Health Care, she has appointed me her primary decision-maker. What are my responsibilities?	Track33.mp3 2.07 Mb
34	How do I ensure my brother's wish not to be resuscitated is honored?	Track34.mp3 2.16 Mb
35	If my wife has DNR status, does that mean her care will be limited?	Track35.mp3 2.47 Mb
36	Hospitalizations and Emergency Room Visits	Track36.mp3 959.16 Kb
37	How may an emergency room visit or hospitalization affect a patient with advanced dementia?	Track37.mp3 2.10 Mb
38	What resources are available in the hospital setting to help address my husband's dementia care needs?	Track38.mp3 2.05 Mb
39	My grandfather need to leave the hospital now, and I cannot provide his care at home. What options are available to me?	Track39.mp3 2.61 Mb
40	If my grandfather has another episode, do I have to take him to the hospital?	Track40.mp3 1.15 Mb
41	Hospice Eligibility and Services	Track41.mp3 1.62 Mb
42	What is hospice care?	Track42.mp3 2.84 Mb
43	Can you be more specific about the kind of support that is provided by Agrace HospiceCare?	Track43.mp3 7.01 Mb
44	How do I know when someone with dementia is eligible for hospice?	Track44.mp3 4.39 Mb
45	Can the patient be eligible for hospice even if she is in early stages of dementia?	Track45.mp3 6.00 Mb
46	Are there grief services available for the caregivers of dementia patients in facilities?	Track46.mp3 1.34 Mb
47	When a patient with Alzheimer's or dementia loses their "personality," what can we do for the family?	Track47.mp3 2.79 Mb
48	Do advanced dementia patients have spiritual needs?	Track48.mp3 3.17 Mb
49	How can we meet the spiritual needs of a patient with advanced dementia?	Track49.mp3 3.85 Mb
50	Conclusion	Track50.mp3 2.00 Mb

Top 50 End of Life Questions

Right click and "save as" to save files to your computer

Track	Title	File
1	Introduction	Track1.mp3 4.93 Mb
2	Why am I so tired?	Track2.mp3 1.19 Mb
3	How much time do I have?	Track3.mp3 7.29 Mb
4	Can I get married?	Track4.mp3 1015.23 Kb
5	What should we tell the rest of the family?	Track5.mp3 2.80 Mb
6	May I die at home?	Track6.mp3 2.92 Mb
7	What is dying like?	Track7.mp3 4.25 Mb
8	Will I die suddenly?	Track8.mp3 2.13 Mb
9	How soon will I die if I stop dialysis?	Track9.mp3 1.58 Mb
10	How did my weak father get out of his bed?	Track10.mp3 1.02 Mb
11	Can she hear us?	Track11.mp3 1.09 Mb
12	Do you have to tell him that he's dying, because I'd rather you didn't?	Track12.mp3 2.21 Mb
13	What is autonomy?	Track13.mp3 808.27 Kb
14	Do we have to follow the advance directive to the letter?	Track14.mp3 1.39 Mb
15	What is capacity or decisional ability?	Track15.mp3 1.05 Mb
16	When and how do you activate the Power of Attorney for Health Care?	Track16.mp3 3.40 Mb
17	Should I be resuscitated if my heart stops or my breathing stops?	Track17.mp3 9.00 Mb
18	Can I refuse futile care for myself or my loved one?	Track18.mp3 5.25 Mb
19	My father doesn't remember that you talked to him yesterday about Mother's dying. Why is that?	Track19.mp3 2.21 Mb
20	Is artificial nutrition something I should consider?	Track20.mp3 2.80 Mb
21	My mother swallows once in a while. Why can't I feed her?	Track21.mp3 1.50 Mb
22	If Mother doesn't eat or drink, why can't you feed her through a vein?	Track22.mp3 2.42 Mb
23	Are intravenous fluids appropriate?	Track23.mp3 2.25 Mb
24	How about feeding tubes - are they appropriate?	Track24.mp3 1.86 Mb
25	Does she feel pain?	Track25.mp3 1.27 Mb
26	Why does Agrace HospiceCare prescribe morphine?	Track26.mp3 4.64 Mb
27	Why don't you just give pain medicine by injection?	Track27.mp3 960.18 Kb
28	Isn't that a lot of morphine?	Track28.mp3 2.16 Mb
29	Is one opiate better than another?	Track29.mp3 1.09 Mb
30	Is methadone safe?	Track30.mp3 2.44 Mb
31	How do you know you are not killing her?	Track31.mp3 1.31 Mb
32	What is palliative sedation?	Track32.mp3 1.91 Mb
33	Should more tests be done?	Track33.mp3 1.44 Mb
34	Should another treatment be pursued?	Track34.mp3 2.68 Mb
35	Should we have more transfusions?	Track35.mp3 1.76 Mb
36	Why don't you treat the gangrene?	Track36.mp3 1.28 Mb
37	Shouldn't the pneumonia be treated?	Track37.mp3 2.19 Mb
38	Should antibiotics be used for infections like pneumonia?	Track38.mp3 1.30 Mb
39	Can you remove the excess fluid in my mom's abdomen?	Track39.mp3 1.59 Mb
40	You said Dad had trouble breathing because of the fluid in his lungs. Can you remove the fluid?	Track40.mp3 1.23 Mb
41	Should the blood thinner he's on be stopped?	Track41.mp3 2.50 Mb
42	Why are you stopping cortisone?	Track42.mp3 1.97 Mb
43	How do you know it is dementia?	Track43.mp3 1.96 Mb
44	Do demented patients have feelings?	Track44.mp3 913.28 Kb
45	Do demented patients have pain?	Track45.mp3 1010.13 Kb
46	Do demented patients know they are dying?	Track46.mp3 759.33 Kb
47	Can you help me die faster?	Track47.mp3 2.07 Mb
48	Isn't that suicide?	Track48.mp3 1.89 Mb
49	Isn't that euthanasia?	Track49.mp3 1.81 Mb
50	How do you know when someone is close to death?	Track50.mp3 3.05 Mb
51	Our father is dying. Why doesn't my brother come to visit him?	Track51.mp3 1.14 Mb
52	Conclusion	Track52.mp3 2.64 Mb

End of Life Issues


Right click and "save as" to save files to your computer

Track	Title	File
1	Introduction	track1.mp3 1.84 Mb
2	Gaining the Confidence of the Patient and the Family	track2.mp3 2.63 Mb
3	Gaining a Family's Confidence	track3.mp3 2.49 Mb
4	Helping Families Make Tough Decisions	track4.mp3 3.71 Mb
5	Addressing Spiritual Matters With the Patient	track5.mp3 1.82 Mb
6	Military Service	track6.mp3 2.56 Mb
7	Addressing Code Status	track7.mp3 4.66 Mb
8	Addressing the Question of "What Dying Is Like?"	track8.mp3 2.25 Mb
9	Why We Use Morphine	track9.mp3 2.41 Mb
10	Nutrition and Hydration of Dying Patients	track10.mp3 5.14 Mb
11	Anticipating the Need for a Mechanical Ventilator in Respiratory Crisis	track11.mp3 3.26 Mb
12	Total Sedation	track12.mp3 3.16 Mb
13	How Does One Know a Patient is Dying	track13.mp3 4.58 Mb
14	Prognostication	track14.mp3 4.10 Mb
15	Suicide and Agrace HospiceCare.	track15.mp3 3.81 Mb
16	Humor in Hospice Care	track16.mp3 3.10 Mb