How Hospice Keeps Patients Home for the Holidays

While the 2020 holiday season may look a little different given COVID-19, we can all agree that people want to be home with their loved ones if at all possible. As healthcare professionals we know that families value the traditions and memories associated with holiday meals, gift exchanges, and time spent together. The last thing they want is to see a loved one isolated and hospitalized during this time.

Achieving time at home can be particularly difficult when a loved one is suffering from end stage (Class IV Stage D) heart failure. Heart Failure is not a disease, but it is a condition that occurs when the heart is unable to pump enough blood to meet the body’s needs. This makes the heart work harder, which eventually leads to the worsening symptoms of heart failure.

No one wants to refer to end of life care when the holidays are approaching, but this is precisely when hospice can be of the most help! This time of year is for being in the comfort of your own home, surrounded by familiar people and things. Skilled hospice providers recognize that expert care must be available to assist the eligible heart failure patient with a goal of allowing family time at home.

The Christmas Holiday Effect is a Real Phenomenon

A study suggests that while hospitalizations for heart failure decline on the holidays themselves, they rapidly rise after major holidays such as Christmas¹. The “Christmas holiday effect” on mortality has been established in the United States, with spikes in deaths from natural causes at both Christmas and New Year’s Day. Every year, during the holiday season, millions of Americans abruptly change their patterns of traveling, eating, drinking, exercising, working, and vacationing. These large-scale behavioral changes may affect cardiac mortality².

There are a number of reasons for heart failure decompensation and rehospitalization. In end stage heart failure stresses including family gatherings, eating high-salt foods, and increased activities can lead to worsening symptoms. Patient and family measures to decrease the incidence of decompensation include:

1. Making sure medications are filled and taken according to directions,
2. Avoiding stress,
3. Eating low salt diet,
4. Knowing functional and emotional limits, and
5. Being aware of worsening symptoms³

A skilled hospice provider can educate a heart failure patient and their family on these measures. The hospice interdisciplinary group will help patients and families control distressing symptoms so they can spend the holidays in the comfort of their own bed at home, in a loved one’s home, or in an assisted living facility they’ve made their home.

As a healthcare professional, it is important to partner with a hospice that can manage the complex symptoms of end stage heart failure according to the American College of Cardiology / Heart Failure Society of America guidelines^4,5. This includes:

• providing excellent symptom assessment
• guideline HF medications to palliate symptoms
• IV and combination PO diuretics
• IV inotrope management
• ICD deactivation

Ask questions to make sure a hospice provider can manage these complex symptoms to keep your residents or patients home over the holidays and beyond.

Be Aware of Worsening Symptoms

When might a patient with heart failure be ready for hospice?

• Shortness of breath at rest
• Shortness of breath that has become worse especially if it wakes you up
• Cough that is worse or won’t go away
• Nausea or vomiting especially after eating
• Anxiety
• “Racing” or fast heartbeat
• Swelling in neck, abdomen, legs or feet
• Chest, arm, jaw pain
• Extreme weakness or tiredness

How Hospice Keeps Heart Failure Patients Home

Hospice care is for the patient and family. The hospice interdisciplinary works with family members to ensure they are feeling supported throughout the holidays as they cope with the stress and the emotion surrounding a final holiday with someone they love. Combining the stress of the holidays with caring for a seriously-ill loved one, and things can get overwhelming fast.

A high-quality hospice will offer supportive care including chaplains, music therapists, social workers, and volunteers who will communicate with patients and families to address their emotional, psychological, and spiritual needs. They will work with families on their plan for the holiday, so they can make the most of it without adding additional stress. Caring for a loved one facing a terminal illness can be challenging, but it can also be incredibly fulfilling. Effective use of hospice can ensure that the family and facility have the support they need to keep their loved one or resident out of the hospital this holiday season.

References

1. Shah, M., Bhalla, V., Patnaik, S. et al. Heart failure and the holidays. Clin Res Cardiol 105, 865–872 (2016). https://doi.org/10.1007/s00392-016-0995-8
2. Phillips DP, Jarvinen JR, Abramson IS, Phillips RR. Cardiac mortality is higher around Christmas and New Year’s than at any other time the holidays as a risk factor for death. Circulation. 2004;110:3781–3788.
3. https://www.redorbit.com/how-to-manage-heart-failure-during-the-holidays/
4. Yancy CW, Jessup M, Bozkurt B,, et al. 2013 ACC/AHA guideline for the management of heart failure. Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;134:e282-e293.
5. Heart Failure Society of America, Lindenfeld J, Albert NM, et al. HFSA 2010 Comprehensive Heart Failure Practice Guideline. J Card Fail. 2010;16(6):e1-e194.