"Deep peace of the running wave to you.
Deep peace of the flowing air to you.
Deep peace of the quiet earth to you.
Hospice aide Tiffany Green sits with Dale Bonnett at his home. Green has been traveling to residences and care facilities in Belmont and Harrison Counties for nearly 15 years.
Some patients are comforted by touch. It can lower blood pressure and calm stress. Hospice workers spend their time alleviating pain and worry for patients and family members as they go through the stages of terminal illness.
Esther Vannest, center, is surrounded by caregivers at her care residence in St. Clairsville. From left, Rhonda Senkavich from Amedisys, Cathy Mueller and Martha Bullion from the House of Hearts and Amy Elliott of Amedisys.
Deep peace of the shining stars to you.
Deep peace of the infinite peace to you." - Gaelic Blessing
And the day comes when there is no turning back, no curing. Acceptance of the end of life is the first step on this last plateau, and the grief process can begin.
When a senior's life reaches this point, it is important to have all of the documents that were discussed in the second installment of this series at hand, and have final arrangements in place as well. He or she and the family may benefit from hospice services at this time.
Hospice care keeps the patient comfortable, termed palliative care, so that they may live (and pass away) without pain and as peacefully as possible. People may not realize that hospice care is not only for the final days of a patient's life. Those patients diagnosed with progressive, incurable illnesses such as dementia, Alzheimer's and Parkinson's disease are eligible for hospice services. Hospice will not initiate medical procedures or make recommendations that are attempts to eliminate the illness. That isn't to say that the patient will not improve enough to regain independence or go into remission, but hospice services will stop when that occurs. Patients who qualify for Medicare may receive hospice care at no charge through Medicare Part A.
What hospice provides in the home, care facility, assisted living facility or hospital includes aide services, spiritual counseling, dietary counseling, physical, occupational and/or speech therapy, medical supplies, equipment and medications related to the terminal illness, nursing visits and bereavement services. Rhonda Senkavich, MSW with Amedisys Hospice Care, points out that hospice is also able to link patients and families with community resources like meal services, accompany the patient and family members to difficult doctor visits and teach clients about the illness and its progression and maintaining personal care - services that help keep the patient in the home for as long as possible. Staff members are available 24 hours a day, seven days a week for assistance.
"I've worked in other types of counseling, but this is a blessing," Senkavich added. "I meet the most wonderful families. People ask how we do this. It's not just about the patient's passing, but about the life they lived. I feel blessed to do this."
Additional services may be available depending on the agency and individual cases. They are in contact with the patient's medical personnel to exchange updates in status. Amedisys also hosts support groups in the area that are open to the public.
"We provide emotional counseling, which can include life review and life resolution for both the patient and family," noted Senkavich. "And every year we do a memorial service for the families. People like that."
Hospice support does not stop at the patient's passing. Medicare-certified services provide follow-up calls and check-ins with family members for 13 months after the patient's death, but as the hospice team does enter the picture, the caregiver and family are able to finalize arrangements as necessary and prepare themselves mentally.
If they are not prearranged, funeral and burial plans should be made. In fact, according to Tess Morando, pre-arrangement specialist for Beck-Altmeyer and Bauknecht-Altmeyer Funeral Homes and Crematory, there are good reasons for pre-arranging and prepaying even years in advance. One of the most obvious reasons to plan in advance is making sure the deceased's wishes are carried out, for instance music, type of service, favorite readings or clothes.
"People think that doing this is morbid, and some of the older generation is superstitious about prearranging," says Morando. "The truth is, you may not need a doctor or a lawyer, but at some point you will need these services."
Another reason to set up these arrangements early is that costs increase periodically. In fact, costs have nearly doubled over the past 20 years. By prepaying, the fixed costs of a casket, calling hours, service, transportation, cemetery plots and other components of burial packages and cremations are set. One way to do this is through a burial account set up through an independent company. In one plan, buyers can place a deposit on the desired package and make a monthly minimum payment that works within their budgets. Once the package is paid in full, the price will not increase. There are various plans and companies available, depending on an individual's circumstances and what is offered at the funeral home.
In addition, this type of account is restricted and closed, meaning that it is only accessible for burial charges. It is not considered an asset for Medicaid eligibility determinations, nor can Medicaid take a portion for its expenses.
"What I notice is the sense of relief on the faces of family members when we tell them the arrangements have been set up by the deceased," Morando explained. "It's like a weight has been lifted off their shoulders. People tell us how glad they are that prearrangements are done. It's one less thing for them to think about."
Note that there are expenses (many variable) which are not included in the pre-selected package that will have to be paid at the time of the funeral or time of service. These include, but are not limited to, flowers from the family, certified death certificates, hair and make-up styling for open caskets and a fee for the minister, priest or speaker. These additional costs could add hundreds of dollars to the total. Burial plots are also separate expenses which vary from cemetery to cemetery. Morando noted that many places here provide full service: contacting the clergy, providing the obituaries to the newspapers, ordering family flowers, setting up the time and equipment at the cemetery. She says in other parts of the country, these tasks are left to the family.
Regarding cremations, Morando adds that people may think that they can't have a visitation or service, but the process can be the same, with flowers, visitors, a service and even a drive to the cemetery. The only difference would be that the body is cremated afterwards instead of buried.
Having final arrangements in place early is, again, highly recommended. Even having a burial account will ease some of the stress for remaining family members. Funeral homes will expect to be paid in full at the time of service. Information on burial plot locations and the arrangements should be kept with the other important paperwork such as the Power of Attorney, Living Will, and Will.
While many families tend to use the same funeral homes through generations, different hospice services have come to the aid of this writer, friends and family, and all have received high marks. Most important is the comfort and desires of the patient, but for those who are left, keep in mind they are available to console and support members of the family at a very difficult time.