Being disqualified from anything can be lousy. Being disqualified from hospice, however, can result in many mixed emotions. But yes, it can happen. However, understanding the role of hospice can help clarify issues of no longer qualifying for hospice care. 

Hospice is Not About Giving Up

When many people hear “hospice care,” they immediately assume that someone and their doctors have given up hope. This misconception has led to many attempting to stray as far away from hospice as possible. Hospice is not simply preparing for death (something everyone should be doing regardless of their health condition) but is, instead, a style of care designed for those not expected to survive severe health conditions for the next six months. 

Sure, this care is not generally aimed at curative treatment, but that, by no means, should brand it as “giving up hope.” Where hospice differs from curative treatment is that it aims to increase the patient’s quality of life over recovery from the particular ailment — whose treatment can significantly decrease their quality of life, even when a cure is unlikely. 

Some People “Graduate” Hospice

Most people enter into hospice care when a doctor determines that they are unlikely to survive their condition for another six months. This time span was largely developed by health insurance companies and Medicare to determine coverage spans, though it is useful by the medical establishment as well. 

So, what happens if someone lives longer than six months while in hospice care? If this occurs, the patient is usually reevaluated to determine their continued eligibility for hospice care. Many may have their hospice care stay extended by as much as another six months. Others, however, may “graduate” hospice — being no longer eligible for hospice care either due to a health improvement or because the patient has chosen to discontinue hospice care — either to continue to seek curative treatment or be admitted to another style of care facility, such as a nursing home and the like. 

Conclusion

Is it possible to “graduate” hospice care? Yes. While this is the case, this is not the goal of hospice care and does not necessarily mean that the patient will recover or will even experience a better quality of life outside of hospice care. Many graduations are temporary and the patient may ultimately return to hospice care at a later time due to the same condition. Leaving hospice care — either through “graduation,” “live discharge,” or disqualification simply means that hospice care does not best fit the patient’s current condition or desires. 

Hospice & Palliative Care to the Greater Tulsa, OK Area

Cura HPC Hospice & Palliative Care is honored to serve the Tulsa, OK area with the most professional and nurturing services available. You’re invited to learn more about Cura HPC Hospice & Palliative Care today.

For the very fortunate, end-of-life care can be managed by a loving family member. For many, their spouse may have already passed away or will not be up to the task due to age or state of their own health. In these instances, it’s common for another family member to step in and assist. However, what happens if no biological family members are available to make medical decisions for a hospice patient? Can a dear friend step in? The answer to this question can be very complicated. 

The Second Choice Scenario - Planning For a Lack of Next-of-Kin

We’d all like to believe that when the time comes to make important decisions about our end-of-life care, that our spouses or children will be there. Even if this isn’t the case, we like to believe that we’ll be able to select a good friend who can make decisions on our behalf. However, a deteriorating health condition that may result in the need for hospice care may outpace our ability to make such decisions if a next-of-kin is unavailable. For this reason, every person needs to establish a chain-of-command of decision-makers regarding their care. Such decisions can be made while setting an Advance Directive, Living Will, or even writing out one’s final wishes. This chain of command should extend far beyond one’s own biological family. All responsibilities should be confirmed with those involved to ensure they understand and consent to such duties. 

Why Making Health Wishes Legally Binding is Important

Though scribbling out one’s last wishes on a piece of paper, it is important that these wishes are backed with legal authority. Why? The Health Insurance Portability and Accountability Act (HIPAA), the primary legal act protecting patients’ medical privacy in the United States, protects the disclosure of private health information of patients against outside sources. This means that even family members may not be able to access a loved one’s medical information without the proper release documents. When time is of the essence and making decisions about another’s care can’t wait, it is advantageous for those intended decision-makers to have the necessary medical clearance. 

It’s crucial to have a legal professional or medical organization assist you in providing medical release forms for the intended decision-makers. Keep all release forms in a safe and convenient location along with other vital documents.

Conclusion

So, can a close friend manage someone’s medical care? If the proper planning is done ahead of time — absolutely. If, however, arrangements are delayed until the patient can no longer consent to said medical release, the chances being possible might be unlikely. This is why it is crucial to make arrangements in advance with a legal professional with knowledge of HIPAA requirements. 

Hospice & Palliative Care to the Greater Tulsa, OK Area

Cura HPC Hospice & Palliative Care is honored to serve the Tulsa, OK area with the most professional and nurturing services available. You’re invited to learn more about Cura HPC Hospice & Palliative Care today.

Dementia is one of the most complicated conditions one can experience. Not only are there various types and degrees of dementia, but there are many conditions that appear as dementia, though they aren’t. For this reason, a clear diagnosis is crucial for treating these conditions and managing symptoms. In this piece, we’re going to look at the types of doctors most likely to diagnose dementia and how they come to their diagnostic conclusions. 

1. Your Loved One’s Primary Care Physician

A primary care physician is a gateway to additional care for most individuals — and those displaying symptoms of dementia are no exception. Though a primary care physician may not specialize in neurological conditions, they can still diagnose many conditions that may present themselves as dementia. For example, a primary care physician may be able to diagnose hearing and vision problems that can cause confusion that resembles dementia. PCPs may also be able to run blood tests to identify other conditions or spot adverse reactions to medications or even allergic reactions. While a PCP can do quite a bit, it is very rare that a dementia patient’s care will be limited to the care of a primary care physician.

When a primary care physician deems it necessary, they will likely refer your loved one to a neurologist.   

2. A Neurologist

The most common specialist responsible for diagnosing and prescribing care for dementia will be a neurologist. As specialists in the brain and cognitive function, a neurologist will delve much deeper than a primary care physician for a more accurate diagnosis. A neurologist may conduct physical examinations, run blood work, or conduct scans of the brain. These cognitive specialists may prescribe certain medications to treat conditions and the like. 

If a neurologist is unable to accurately diagnose a particular type or degree of dementia, they may refer the patient to the care of a neuropsychologist. 

3. A Neuropsychologist

Combining the expertise of a neurologist and a psychologist, a neuropsychologist specializes in diagnosing and treating psychological issues rooted in neurological disfunction. They often perform in-depth investigations into the type and degree of dementia by conducting interviews, asking patients to draw objects or symbols, repeat specific statements, and the like. Many of the tests utilized by neuropsychologists are not widely publicized in order to maintain the tests’ integrity and keep diagnoses accurate.  

The process of diagnosis can be immensely confusing for patients and stressful for loved ones, but with the right specialists, your loved one can receive the professional and compassionate care they deserve. 

Hospice & Palliative Care to the Greater Tulsa Area

For the professional and caring hospice and palliative care in the Greater Tulsa area, look no further than the experience caregivers from Cura HPC Hospice & Palliative Care.

The following is a personal account of someone who is not an employee of Cura HPC. A few details have been changed or omitted to respect the privacy of those involved, but the rest is true.

The last time I had seen Don, he was beaming with more than happiness and strength—he seemed downright victorious. 

“Man, am I glad to see you!” I said as I gave him a bear hug around his now-scrawny frame. I didn’t mention that it was because Don had been battling cancer for months and had just been told that the brutal treatments had been successful. 

Though months of treatments had resulted in him now being half of his original size, he hadn’t been a skinny fella before the diagnosis, so he carried his new frame well. In the dimly-lit downtown lounge, he, my brother, Don’s military-pilot son, and I shared drinks and caught up after almost a year apart. Though we weren’t necessarily toasting to Don’s victory over his cancer, it definitely hung in the air like a delicious aroma. 

I still have a picture of the four of us together, taken by a kind stranger whom my brother had asked to snap a picture. A mere selfie wouldn’t do. 

Don isn’t a family member, but he might as well be. He’s my brother’s ex-father-in-law — which makes him my...friend? Despite this, my brother and I share an affinity for Don that we don’t have with many biological relatives. He’s larger than life, so to speak. He’s always been the life of the party and the someone you can call when you’re in a jam. Everyone he knows has a Don story — and he’s quick to tell you what actually happened...though his version isn’t any less hilarious or crazy — he would just tell it as though the events were no big deal. Classic Don. 

Months after that night at the downtown watering hole, the pandemic hit, and everything went into lockdown. I didn’t hear from Don because I hadn’t really heard from anyone. Before the pandemic, I had opted out of social media in lieu of personal interactions and was beginning to regret it a bit. One night, the topic of Don came up with my parents—the few people within my germ circle who were also on social media. 

“Man, I miss Don. How’s he doing?” I said with a smile. 

Both of my parents’ faces drooped and they looked at each other, so as to say, “oh, yeah...he doesn’t know.” 

“His cancer came back. That’s about all we know,” my mom said. 

The rest of my evening was fairly deflated and thoughts of Don swirled. 

A few weeks went by. While working in my home office, my brother called. 

“Don is in hospice.” 

My heart sank and my feet started to physically tingle with shock. After a bit of silence, my brother asked if I was still on the line. I was, I just had to take a bit of time to regroup. Don, whom I’d always seen as the pinnacle of strength, bulletproof, and always ready with a snarky comment, was now dying. This new reality left me shaken and disoriented. 

“I’m coming to town this weekend to see Don while I still can,” my brother said. 

Over the next few days, I wrestled with myself whether or not I would accompany my brother. 

I should see him. No, I shouldn’t. He probably doesn’t even want visitors. No, he’s Don — of course, he wants visitors. No, I don’t want to remember him that way. Ah, what do I do…

I tried to justify not visiting Don by telling myself that he likely wouldn’t even recognize me in a mask, or that he’d be too weak for visitors, or something else—anything to hide the truth: I was terrified that seeing this version of him — Dying Don — would shatter my image of the Don I knew and cherished. I didn’t end up visiting him with my brother in that instance due to sheer logistics, but that didn’t remove the option of visiting him from the table. 

In an odd twist of fate, we all received this news around the same weekend that was Don’s birthday — likely his last birthday. Pandemic precautions meant no usual party, but Don’s sons arranged a drive-by birthday celebration. I felt better about this — I’d get a little bit of closure out of actually going to see him...without actually visiting with him. My version of Don could remain intact. 

Before the drive-by party, my parents drove over to my house. We all decorated our cars with birthday greetings. Posters held firmly to the sides and fronts of our cars with masking tape read sayings like “Wild Man Don!” with a cartoon portrayal of him in his prized Jeep and other greetings covered our cars. We met up with a good dozen or more cars covered in signs and balloons with mask-wearing friends and family of Don. 

As we approached Don’s house, his sons had pushed him outside in his wheelchair to his porch and wrapped him like a burrito in a blanket, topped with a stocking cap. As the parade honking of cars made their way past Don’s house, they would slow to a near stop to wave and proclaim their birthday wishes. Don, though obviously very weak, cold, and thinner than I’d ever seen him, was grinning from ear to ear. 

Our car was up next. I briefly stopped my car with myself, my wife, and our sleeping toddler son in front of Don’s house and stopped to honk and wave. As I waved and yelled out happy birthday wishes, I noticed Don’s eyes squint to try and make out who this person was. Soon after squinting, his eyes shot open wider than I’d ever seen them in life with a smile that revealed every tooth in his mouth. 

“KENNY!” he exclaimed—not only my name but my nickname only reserved for family and the closest of friends. Most people knew me as simply as Ken. His ecstatic face almost made me think he was about to throw off his oversized blanket and run over to the driver’s side window of my door and hug me through the window.
 

“Wow...Kenny!” he said, eyes returning to their normal size with a sleepy grin. He settled back in his wheelchair as I let the next car approach. 

As the cars pulled down the street, we soon realized that this was a dead-end and that we’d have to pull back around and pass Don’s house again. Some cars went by and then on their way. Others pulled over. I followed my parent’s lead and pulled in behind them. Many of Don’s family members got out of their cars and began to gather in his front yard — all spaced out and wearing masks — to sing happy birthday to Don. Others sang from their cars on the streets. I thought I would be among these people until Don made a special request. 

“I want to see Amir” - my sleeping toddler in the back seat. Not about to deny the request of a dying man on his birthday, I gathered the snoozing Amir from his car seat. Donning a mask and 30-pounds of snoring toddler, I walked up to Don’s stoop — staying around a dozen feet away. 

Don’s face softened with a smile as though he was listening to a favorite song as he gazed upon Amir’s sleeping face — a face he’d not seen in over a year or longer. Don’s eyes then lifted from Amir’s eyes to my own — falling upon them like a warm hug from four yards away. 

“Man, am I glad to see you,” he said to me with a gentle smile, repeating the words I’d said to him that victorious night in that dimly-lit downtown bar.

“I’m glad to see you, too.” 

The Don I knew was still there. The Don I know will always be there, and nothing will ever change that.

Author's note: Don passed away just a few weeks after this piece was written. May his memory be a blessing to us all. 

Hospice & Palliative Care to the Greater Tulsa Area

For the professional and caring hospice and palliative care in the Greater Tulsa area, look no further than the experience caregivers from Cura HPC Hospice & Palliative Care.

Most people try not to think about death and dying as much as possible. And this logic is understood—the uncertainty and finality of death can range from unsettling to paralyzing. While this is true, there’s actually a wing of ancient philosophy that teaches the opposite—that there are immense benefits to remembering that, one day, you will die. And it’s enjoying a resurgence in popularity. 

Memento Mori: Remember, You Are Mortal

One of the primary meditations of the ancient philosophy of Stoicism is a concept called “memento mori” — which roughly translates in Latin as, “remember that you are mortal.” 

If you heard this uttered by someone at a party, you’d likely think, “who invited this guy?” However, when the case for constantly reminding yourself that you’re going to die is given a bit more depth and context, billions of people for thousands of years have used this meditation in profoundly positive ways—often compelling them to do accomplish feats they otherwise would not have. 

Ancient Death vs. Modern Death

Even just a few hundred years ago, the average person’s relationship with death was starkly different than it is today. In the past, most people had some kind of personal and possibly even frequent encounter with the evidence of death—whether through war, workplace hazards, or disease that is now prevented simply by washing one’s hands. Today, unless one works in the medical field or the mortuary services, most likely rarely encounter death. Gone are the days of helping prepare a loved one’s body for an in-home wake. Those duties have been largely sterilized and delegated to the professionals. 

And with the outsourcing of these lifecycle duties, most people rarely look death directly in the face. Due to this lack of familiarity with death, the very idea that they will die makes them shiver with fear. Others, however, are using the concept of “memento mori” to fuel their lives. 

Why Meditate On Death?

It sounds so counterintuitive to want to focus on your own mortality. However, for many, meditating on their own mortality is often a helpful reminder to live. 

“Reminder to live? How could I forget?” 

Though many don’t feel like they need a reminder to live, the concept has been used to remind countless individuals throughout history and into today that their lives are often shorter than they think—using this motivation for meaningful action. Some use the symbolism “memento mori” not only as a reminder of death, but also to stop wasting time dreading the future, agonizing over the past, procrastinating in the pursuit of their goals, or holding grudges against others. 

Memento Mori Tops the Country Music Charts

If “memento mori” still sounds fairly bleak, perhaps it can be best understood in the lyrics of a chart-topping country music song by Tim McGraw that exposed more to the positive side of “memento mori” than any work of art in modern history: 

“I asked him

‘When it sank in

That this might really be the real end

How's it hit you

When you get that kind of news?

Man, what'd you do?’

He said

‘I went skydiving

I went Rocky Mountain climbing

I went 2.7 seconds on a bull named Fumanchu

And I loved deeper

And I spoke sweeter

And I gave forgiveness I'd been denying’

And he said

‘Someday I hope you get the chance

To live like you were dying.’”

The purpose of “memento mori” is not to carry a dark cloud above one’s head, but to compel one to lead a rich life of purpose, perspective, and deeper relationships. 

“You could leave life right now. Let that determine what you do and say and think.” 

- Marcus Aurelius

Roman Emperor and Stoic Philosopher

Hospice & Palliative Care in Tulsa, OK

Cura HPC Hospice & Palliative Care is honored to serve the families of Oklahoma with the same compassionate and professional care we would (and do) provide for our own families. 

Learn more about Cura HPC today.