Breaking Down Barriers to End-of-Life Support

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Kristine Crockett, RN, CHPN, Director of Homeland Hospice and Homeland Palliative CareBy Kristine Crockett, RN, CHPN, Director of Homeland Hospice and Homeland Palliative Care. Kristine has been providing compassionate end-of-life care as a hospice nurse for more than 25 years and provides a wealth of knowledge and experience to those she is leading as the director. Kristine is an Army Veteran having served in the military for over nine years as a military police and corrections officer. She enjoys spending time with her family and friends at gatherings and vacations on the lake, as well as helping out her staff and finding ways to support fellow Veterans whenever possible.

Hospice care is a vital resource designed to provide compassionate support to individuals facing life-limiting illnesses. However, despite its benefits, hospice remains significantly underutilized in many communities. This trend raises important questions about why individuals and families may not be accessing this valuable service when they need it most.

One key factor contributing to the underutilization of hospice care is a lack of awareness and understanding. Many people are unfamiliar with hospice and may mistakenly believe that it is only appropriate for individuals in the final days or weeks of life. Hospice care is most effective when accessed earlier in the journey of a life-limiting illness, allowing patients and their families to benefit from comprehensive support, pain management, and emotional care for a longer duration.

Furthermore, cultural and societal attitudes toward death and dying play a significant role in shaping perceptions of hospice care. In some cultures, discussions about death may be considered taboo or uncomfortable, leading individuals to avoid conversations about end-of-life care until it becomes unavoidable. This reluctance to confront mortality can prevent individuals from seeking hospice services until it is too late to fully benefit from them.

Financial concerns also contribute to the underutilization of hospice care. While hospice services are typically covered by Medicare, Medicaid, and most private insurance plans, some individuals may be unaware of their coverage options or may be reluctant to incur additional expenses related to end-of-life care. This financial barrier can prevent individuals from accessing hospice services until their illness has progressed to a point where the benefits of hospice may be limited.

Additionally, healthcare provider attitudes and practices can influence the utilization of hospice care. Some healthcare professionals may be hesitant to broach the topic of hospice with patients and their families, fearing that it may be perceived as giving up hope or admitting defeat. This reluctance to discuss end-of-life care options can delay access to hospice services and limit the ability of patients and their families to make informed decisions about their care.

Addressing the underutilization of hospice care requires a multifaceted approach that involves raising awareness, promoting cultural competence, addressing financial barriers, and improving communication between healthcare providers and patients. Education campaigns aimed at dispelling myths and misconceptions about hospice can help individuals and families understand the benefits of early intervention and comprehensive end-of-life support.

Healthcare providers should receive training on how to initiate conversations about hospice care in a compassionate and sensitive manner, ensuring that patients and their families are fully informed about their options. By addressing these barriers, we can work towards ensuring that all individuals facing life-limiting illnesses have access to the support and care they need to live their final days with dignity and comfort.

National Cancer Institute. Choices for Care When Treatment May Not be an Option

Medicare.gov.Hospice care

Shalev A, Phongtankuel, Kozlov E, Shen MH, Adelmand R, Reid MC. Awareness and misperceptions of hospice and palliative care: A population-based survey study. Am J Hosp Palliative Care. 2018 Mar; 35(3):431-439. Doi:10.1177/1049909117715215

Called to Serve Others: Meet Volunteer Coordinator Tamara Jaroszewski

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Homeland Volunteer Coordinator Tamara JaroszewskiAs a young woman, Tamara Jaroszewski of Harrisburg experienced the profound impact of hospice services when her sister died of breast cancer at age 40. For Tamara, hospice work became a beacon of hope and inspiration. She felt called to help patients during their end-of-life journey. Her call was recently answered when she joined Homeland’s Hospice team as the volunteer coordinator. Homeland Hospice, a nonprofit hospice program, serves communities throughout Central Pennsylvania.

“I proudly do this work in honor of my sister,” Tamara says. “I couldn’t imagine doing anything else.”

Tamara joined Homeland after working as a volunteer coordinator for a large hospice organization that served a sizable region. Her work with Homeland gives Tamara the opportunity to build relationships with patients and their families and the dedicated cadre of hospice volunteers. Homeland’s life-changing work is made possible by volunteers who share their time and compassion with others. From working directly with patients to helping with administrative tasks, volunteers are the lifeblood of the organization.

“I am getting to know our volunteers personally,” Tamara adds. “I am overwhelmed by their kindness and dedication to our work.”

Many volunteers find personal satisfaction from the relationships formed through patient visits. Often, patients think of volunteers as an extension of their family. Tamara helps support these relationships and assists volunteers to ensure they feel supported in their roles. When a volunteer returned to her scheduled patient visits after a reprieve to grieve the death of her father, Tamara was by her side.

“I knew her first visit back could be difficult,” Tamara says. “We approached it as a team.”

While Tamara has been with Homeland for only a few months, she is impressed by the longevity of service and creativity volunteers bring to their work. Many individuals have dedicated years to the organization and continue to raise their hands to take on new and different projects to bring comfort to patients and their families.

Tamara is excited to see more people participate in My Life, My Legacy, which gives hospice patients an opportunity to tell their life story to a volunteer who records the responses and allows the family to add their thoughts and recollections, as well as photographs. The end result is a printed book for the patient to help him/her find peace, and pride in his/her life story. The book also helps families preserve memories after their loved one dies.

“The books are beautifully written,” Tamara adds. “Our volunteers put their heart and souls into these projects and it shows.”

As Tamara grows in her tenure with Homeland, she looks forward to shepherding new projects as they evolve to benefit patients. For her, each day is a new and wonderful opportunity to build on Homeland’s rich history of service.

“You know when you are in the right place,” Tamara says. “I feel I was destined to do this work.”

For more information on volunteer opportunities with Homeland Hospice, call Tamara at (717) 221-7890.

Homeland Palliative Care Enhances Continuum of Support

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patient kissing a child on the cheekA hallmark of a successful organization is its ability to evolve to meet the needs of its community. For more than 156 years, Homeland Center has structured its programming to meet the needs of its patients and their families. In 2022, Homeland started offering palliative care, a new and valuable outreach service, to provide a greater continuum of care for its patients. The addition of palliative care services helps patients with a serious illness have a better quality of life.

Palliative care may be appropriate if a patient suffers from pain, stress or other symptoms due to a serious illness. These diseases may include cancer, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), liver disease, kidney disease, Parkinson’s, amyotrophic lateral sclerosis (ALS), dementia, stroke, HIV/Aids and other serious illnesses. Palliative care is based on the needs of the patient, not on a specific diagnosis, and can be provided along with curative treatment.

The goal of palliative care is to reduce and eliminate symptoms such as pain, fatigue, depression, anxiety, difficulty sleeping, shortness of breath, constipation, nausea, vomiting and loss of appetite.

“Offering palliative care services is another critical line of support we can offer patients,” says Dr. David Wenner, Assistant Medical Director for Homeland Hospice. “This form of care often helps patients avoid emergency room visits due to uncontrolled symptoms and other issues related to the disease.”

Similar to Homeland’s other at-home services, palliative care can be administered any place a patient calls home. The convenience and comfort of receiving care at home has driven the demand for the creation of a palliative care program.

“For patients who are homebound because of a serious illness, this service brings them comfort,” says Hadiza Fox, a registered nurse practitioner at Homeland. “We provide our patients the highest quality of care in their personal space.”

nurse and an elderly woman smiling at each other“Each patient is unique and requires a personalized approach to care,” Dora Butler, a registered nurse practitioner at Homeland, adds. “The Homeland team works together, along with a patient’s other health care providers, to ensure that care is consistent, compassionate and individualized.”

In their roles with Homeland, Hadiza and Dora help patients with palliative care support. They work with each patient to provide a comprehensive evaluation of the patient’s medical condition as well as the needs of the family. They then set goals for the type of care needed to ensure the best quality of life possible.

Hadiza shares an example of when she met with a patient who was homebound and in significant pain. She evaluated the patient’s immediate need for symptom management and contacted the primary physician, pharmacy and insurance company. In one visit, she helped solve the patient’s immediate needs and addressed the ancillary concerns.

“I like to think we are the glue that holds the pieces of care together,” Hadiza says. “It is a privilege to help people when they need it most.”

Palliative care is sometimes mistaken for hospice care; however, they are not the same. Hospice care is provided at the end of life. Palliative care may be provided at any time during a person’s illness and is often offered to patients at the same time they are receiving potentially life-prolonging or curative treatments. Palliative care does not prevent patients from receiving other healthcare services, treatments or procedures.

Palliative care also helps patients and families better understand an illness and assists with complex medical decision-making. Central to palliative care is that a patient’s care team fully understands the patient’s goals and values, so they can make the best care choices possible. Homeland’s Palliative Care team consists of board-certified nurse practitioners, a licensed social worker and a physician medical director.

For more information on Homeland’s Palliative Care program or to request a consultation, call (717) 857-7403.

The Power of Music In the Lives of Hospice Patients

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logo for music and memory“You, my brown eyed girl.” The lyrics of “Brown Eyed Girl,” Van Morrison’s nostalgic and catchy song from 1967, is familiar to many and a portal to another time for others. For anyone growing up in the 1960s, this song and others from this era evoke memories of times with friends and the feeling of freedom that comes with youth.

Music has the power to connect us to memories hidden in the recesses of our brain and ignite energy in our mind and body. Homeland Hospice, a nonprofit hospice program that serves communities throughout Central Pennsylvania, uses a music and memory program to bring patients comfort and peace during their end-of-life journey. Through this program, volunteers work with a patient’s family to create a playlist specific to the patient’s interests.

For Stephanie Douglas of Carlisle, the song “Brown Eyed Girl” has a new meaning after she played the song for a hospice patient. Stephanie has volunteered with Homeland Hospice for several years. A self-described hugger, Stephanie believes human touch relieves stress and restores calm in the body. When “Brown Eyed Girl” was played, the patient’s demeanor changed.

“The tension disappeared from her face,” Stephanie says. “I could feel her lightly squeeze my hand.”

Stephanie’s patient was nonverbal. She conveyed her emotions through facial expressions and the occasional tightening of her hands. Music was a lifeline to connect her to her past. Stephanie’s patient loved musicals and would often sing and dance throughout her home during her younger years.

“We filled the playlist with musicals and her favorite songs,” Stephanie adds. “We even added holiday songs since my visits were close to Christmas.”

The music helped transport the patient’s memory to a time when illness did not exist. The stress in her face and occasional tears were replaced with lifted eyebrows and wide eyes of excitement. In addition to “Brown Eyed Girl,” holiday songs like “Rudolph the Red Nosed Reindeer” and “Up on the Housetop” changed the patient’s demeanor.

“Her face looked peaceful and her eyes grew wide with excitement,” Stephanie says. “I could see her shoulders shimmy ever so slightly.”

Hearing is widely thought to be the last sense to decline during the process of dying, making music the ideal way to connect and ease worries. Music also provides comfort to caregivers.

For Kelly Willenborg of Florida, educating people about the power of music and memory has been her professional life’s work. Kelly is a brain health gerontologist, a researcher who studies the impact of aging. Among her many accomplishments in this field, Kelly launched the Healing Jukebox to bring musical engagement to senior living homes. She also is part of the documentary “Alive Inside: A Story of Music and Memory” and has developed a series of questions to help guide family members when creating a unique playlist. She uses a free Spotify App for ease of use.

Kelly connected with Homeland Hospice several months ago to bring this organized and purposeful approach of music and memory to Homeland.

“Homeland is one of the first hospice organizations to use this program,” Kelly says. “I hope this is the spark to encourage people across the country to try this approach.”

While more music therapists are in need to keep up with the aging Baby Boomer Generation, the music and memory program is an easy and free approach anyone can use to care for their loved one.

For Stephanie, her experience with music and her hospice patient was a powerful lesson she used when caring for her father during his final days earlier this year. Stephanie developed a playlist of her dad’s favorite music including music from the Four Freshman.

“Music took my dad to a place of comfort,” Stephanie says. “The songs helped all of us find peace during a difficult time.”

The power of human connection brought Stephanie to Homeland as a volunteer. The opportunity to make meaningful connections and utilize new services, like music, has given her a volunteer experience like no other.

“I love my time with Homeland,” Stephanie adds. “I am thrilled to add music as another way to connect with patients.”

For more information about Homeland Hospice, call (717) 221-7890.

Homeland Social Workers Make the Puzzle Pieces Fit

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Amanda Williams, Daniqwa BucknerWhat do social workers do? At Homeland, they help families navigate the complexities that are often involved with caregiving.

“The hard work shouldn’t be on the family,” said Homeland social worker Amanda Williams. “They should just be coming to visit their loved ones. They shouldn’t have to worry about the other stuff. The hard work should be on us.”

March is Social Work Month, a time to recognize social workers and their dedication to serving as advocates to those in need. Homeland Center’s social work office is led by Director of Social Services Daniqwa Buckner and her assistant director Amanda. Together, they ensure residents and families feel at home.

Daniqwa joined Homeland in October 2020. She earned her bachelor’s degree in social work from Messiah University and her master’s from Temple University.

Amanda knew from childhood when her parents struggled to find care for her ailing grandmother that she wanted a career in social work. Originally from Souderton, she earned her bachelor’s degree from Elizabethtown College and her master’s from Marywood University.

Daniqwa and Amanda describe social workers as connectors. They meet with residents when they first come to Homeland, whether for a long-term or short-term rehab stay. Navigating the system means linking residents with people and resources inside Homeland — dietitians, therapists, unit managers, and activities. The introductions provide assurance that needs are taken care of and that there’s always someone to turn to.

Amanda is often the social worker helping residents who come to Homeland for short-term rehab stays. When they are discharged, she puts together the puzzle pieces of home health care, therapy and insurance, working longstanding connections with Homeland at Home and other providers in the community to ensure a safe and productive transition.

“Whatever comes next, we want them to have the best quality of life,” said Amanda.

Strong communication skills are essential in social work. Amanda makes it clear to families that she wants to know about a resident’s needs “in the moment” when they can be addressed quickly and efficiently.

Social workers are also detail-oriented multitaskers, attuned to subtle changes and differing needs. At Homeland, they are key team members, reviewing residents’ daily well-being. They work with assistant directors of nursing, admissions, quality assurance and activities, and therapy. Constant communication with unit managers creates a “buddy system” that keeps everything focused.

“There are multiple components to every resident,” said Daniqwa. “There’s no black and white. There are gray areas, so you have to think out of the box and be flexible to make it a full picture.”

Social Work Month, sponsored by the National Association of Social Work, is a time for recognizing the hard work of social workers and their role “beside the families, fighting the battle,” in Daniqwa’s words. They are highly educated professionals who must earn 30 credit hours of continuing education every two years to maintain licensure.

Those credits keep social workers updated on the latest research in elder care. Their knowledge of dementia and behaviors equips them to educate families about changes a loved one may experience.

In one recent case, the wife of a new resident was struggling to understand her husband’s dementia diagnosis. Daniqwa helped guide her through getting to know the new person he had become.

“We helped her understand that it’s not him, it’s the disease,” said Daniqwa. “She told us that the education we provided helped create some ease in her.”

The care social workers provide for the families of Homeland residents and patients brings comfort directly to the residents and patients.

“They’re more relaxed because their family members are relaxed,” said Amanda.

American Heart Month at Homeland: Healthy staff, happy residents

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Employee Wellness Coordinator Roxane E. Hearn, PhD assisting a staff memberWhen Homeland Employee Wellness Coordinator Roxane E. Hearn, PhD sees Homeland Center staff wearing scrubs that have grown baggy from weight loss, it warms her heart.

“You see them moving faster,” she said. “They say they’re not as tired on their shift or feel they have more energy to spend time with family.”

“Dr. Rox,” as she is affectionately known, is a resource for helping to keep Homeland Center and Homeland at Home staff healthy and on their toes. For American Heart Month this February, she offered fun incentives and challenges to protect the hearts that, in turn, protect Homeland’s residents and patients.

A human heart at peak condition keeps the body energized and alert. When the heart pumps blood properly, a person stays focused and avoids fatigue. Shortness of breath makes it hard to push carts of meals or medical supplies through the halls. The body is strong enough to help a resident move around the room or get out for an activity they enjoy, whether listening to a musician or making a craft.

A healthy heart also shows up outside of work, giving staff the motivation and energy to play with children, exercise, and enjoy a favorite hobby. All are essential to the work-life balance that equips Homeland staff to manage life’s daily stressors.

Put it all together, and Homeland keeps its heart-health initiatives beating. Dr. Rox is a National Board-Certified Health and Wellness Coach with a doctorate in health psychology, a certification in functional nutrition counseling, and has recently begun to place strong emphasis on the use of a functional medicine approach to health and wellness in the Homeland employee population. Functional medicine doesn’t replace traditional medicine. Instead, it takes a holistic view that considers the whole person and seeks to identify and address the root causes of health issues, aiming to understand the underlying imbalances or dysfunctions that contribute to symptoms.

“Hearts don’t always send warning signs when they start becoming unhealthy; even when they do, people often ignore them,” Dr. Rox said. “It is imperative to teach employees to listen to their bodies and get their preventative screenings.”

She provides blood pressure screenings and helps staff see signs of approaching danger in all by understanding the medical terms on their lab tests. From there, she recommends steps for improvement. As she likes to say, family predispositions to heart-related conditions, such as high blood pressure and high cholesterol, are no excuse for complacency.

“Genetics may load the gun, but lifestyle and diet pull the trigger,” she said. “With that in mind, you do have some control. You can change the trajectory.”

For American Heart Month, Homeland staff participated in the Commit to Fit Wellness Challenge, a six-week mobile app-based program that helps employees take proactive steps towards healthy lifestyle goals. Participants receive points for tracking physical activity, taking steps, rating their nutrition, and checking their weight routinely. Cash rewards are given through the challenge to support their efforts.

Additionally, Heart Healthy 7-Day Meal Plans approved by a Registered Dietician with the matching grocery list and step-by-step recipes were emailed and posted on the Homeland Employee Wellness Board. The meal plan focused on key nutritional considerations for a healthy heart and recommended meals that were low in sodium and reduced saturated fats and included healthy omega-3 fats, fiber, and plant sterols that block cholesterol absorption in food.

staff members smiling together

“We are now starting to teach the employees how to use food as medicine. We are empowering them to take charge of their health by not just telling them what to do but teaching them and giving them the tools to execute,” said Dr. Rox.

The emphasis on heart and overall health doesn’t end after February. Every quarter brings a new wellness challenge. Webinars zero in on specific health topics, such as fighting inflammation or maximizing digestion. One-to-One health coaching by Dr. Rox provides personalized support for employees by helping them set and achieve their health goals. This support includes tailored guidance on nutrition, exercise, disease management, stress reduction strategies, and overall wellness. Through regular meetings both in person and via a telehealth portal, the employees are provided with accountability, motivation, and education, empowering them to make sustainable lifestyle changes and improve their health outcomes. Lifestyle and diet recommendations are a staple in the Homeland Employee Wellness Program, with constant suggestions to eat right, exercise regularly, quit smoking, limit alcohol, get quality sleep, and manage stress.

“We are giving employees the information and support they need so they can take charge of their health,” said Dr. Rox. “Proactiveness is crucial.”

She recalls a Homeland Hospice nurse who cared for multiple family members and patients. About eight years ago, Dr. Rox helped her quit smoking, change poor eating habits ingrained by long days of driving, and learn “box breathing,” a form of deep breathing known to calm frazzled nerves. Gradually, the nurse lost 50 pounds.

“Lifestyle change is something you’re able to maintain and be flexible with, despite life’s twists, turns, and hurdles,” said Dr. Rox. “Habits can change in 21 days, but the more sustainable change takes longer.”

Creating sustainable changes is key to Homeland’s commitment to health and well-being – for staff and residents.

“When staff are healthy, the environment for the residents is safer, and they receive better-quality service,” said Dr. Rox. “Happy, healthy employees make for happier, and healthier residents.”