Your Choice in Home Health and Hospice Care

As I meet people in the community in my role as President/CEO for Ramona Visiting Nurse Association and Hospice, it is interesting to learn how few people understand the Medicare Hospice Benefit, and how even fewer understand that they have a “Choice” in selecting their hospice provider.

An analysis completed by United Government Services, LLC, the Medicare Regional Home Health and Hospice Intermediary for California and 8 other western states, demonstrated that this misunderstanding is not peculiar to our community.

A common misperception is that your physician must select the provider of your hospice care. It is important to remember that patients have a CHOICE in the selection of their hospice provider. While there are a number of hospice providers in our community, not all Hospice Providers are alike. The relationship between RVNA & Hospice and Hemet Hospice Volunteers, Inc. (HHVI) is one of the things that set RVNA & Hospice apart from other hospice providers.

This special relationship affords us the ability to provide special needs, education and necessities our patients might not otherwise receive during their hospice care. Some of the ways HHVI assists our patients include: payment for basic necessities (groceries, utility bills, special care products); payment for special needs items (caregiver at home, airline tickets to fulfill a last wish, Christmas gifts for children who have a parent receiving hospice care); free bereavement group services to families in the community; and hosting our annual Happy Hearts Kids Camp for children in the community who have suffered a personal loss.

Another common misperception is that hospice care is only for those persons with a terminal cancer condition. Although hospice care is commonly requested by physicians for their patients with cancer diagnoses, there are many other conditions also appropriate for hospice, and for which Ramona VNA & Hospice provides care.

National data shows that 50.5% of hospice diagnoses are cancer. The top five non-cancer diagnoses that frequently receive hospice care are: end-stage heart disease, dementia, lung disease, end-stage kidney disease and end-stage liver disease. The common thread with each of these diagnoses is that the physicians feel that the patients are unlikely to survive more that 6 months if their disease runs its natural course.

However the 6 month figure is not absolute. Medicare recognizes that predicting life expectancy is very difficult. Many patients enter the program, leave the program and return to the program over the course of their illness. Many people enter hospice in the last few days or weeks of life, rather than earlier in the progression of their disease. As noted in a National Hospice and Palliative Care Organization (NHPCO) study, “There is an inaccurate perception throughout America that receiving hospice care means you have “given up”. Rather, patients or families who choose hospice care live an average of one month longer than similar patients who do not choose hospice care.

Remember, you have a CHOICE when it comes to hospice care. If you or a loved one needs hospice care, please tell your physician you would like Ramona Visiting Nurse Association and Hospice to be your hospice provider. As the premier hospice and home health providers in the valley for the past 25 years, we are proud to continue to provide this important service to our community.

ASK THE DOCTOR - Fiber

Question: “I have been told to add fiber to my diet, but when I go to the drugstore there are so many products to choose from. What are the benefits of fiber, how much fiber do I need and what is the best type of fiber to take?”

The recommended daily intake of fiber is 20-35 grams per day; which is about twice the amount the typical person consumes. Fiber, which is sometimes referred to as “roughage” is the non-digestible part of fruits, vegetables, whole grains, nuts/seeds, and beans which passes through the digestive tract. Diets high in fiber have been shown to reduce the risks of constipation and overeating, lower cholesterol levels, lower blood sugars in diabetics, and decrease the risk of heart disease.

In general there are two primary types of fiber, soluble fiber and insoluble fiber. Soluble fiber readily dissolves in water whereas insoluble fiber doesn’t dissolve well in water. Examples of soluble fiber include beans and fruits as well as the fiber products Benefiber®, Metamucil® and Citrucel®. Examples of insoluble fiber include wheat bran, whole grains, nuts and vegetables. Most experts now agree that taking more fiber is more important than distinguishing between the two types of fiber.

I suggest you try to get the majority of your fiber through eating whole foods. For example try ½ cup Fiber One Cereal (14 grams) at breakfast topped with a banana (3grams). 1 cup of raw carrots (4 grams) and a large apple (4 grams) for lunch. For supper how about adding a spinach salad (3 grams) and a cup of strawberries with whipped cream for desert (4grams). This would total 32 grams of fiber for the day. A simple way to remember fiber content is “5-alive per day,” meaning 5 servings of fruits and vegetables per day should provide around 20 grams of fiber per day.

If you are going to use one of the supplemental fiber products, they each provide about 3 grams of fiber per serving but are not nearly as tasty or full of vitamins and minerals as whole foods. If you select one of the fiber products, beware that they may contain sugar and should be taken with plenty of water. They are all good sources of fiber but vary in side effects such as gas and bloating.

So remember, it actually takes 5 apples a day (20 grams of fiber) to keep the doctor away.