Specialty Programs

Massage Therapy

The First Choice Hospice Team includes licensed massage therapists. They are part of the patient care team and they visit patients to provide gentle massage and/or therapeutic touch. Our massage therapists adjust their approach to the needs of the patient. Rarely is their approach a traditional massage on a table, but it can include light massage and gentle touch of the head, hands, and feet. Patients remain clothed and often stay in bed or in a chair. Massage therapists are sensitive to any contraindications for the hospice patient, whatever the illness or condition involved.

Touch is powerful because tactile experiences are the first sensations which greet us at birth. Our massage therapists are aware of this as they focus on the patient. Massage/therapeutic touch enhances the quality of life, can help relieve pain and tension, can help patients sleep and improve functioning in body systems (for example, helping to relieve constipation or reduce edema).

Massage can also promote calmness and help relieve anxiety. Studies have shown cancer patients receiving massage can show improved immune function, increased range of motion, and reduced reports of depression and anxiety. Hospice massage therapists are a healing presence. They can act as a space-holder, allowing the patient his/her own process and experience, and sometimes serve as an anchor for family members and other caregivers. They do what is called for in the moment to ease any form of discomfort which might be offering a gentle foot massage, holding a hand or helping to turn someone on their side to make breathing easier.

Speech Therapy

Our Speech Language Pathologists (SLP) provide skilled clinical services. They work with patients to improve their quality of life through regaining the ability to eat and swallow, improving cognitive skills for increased independence, and helping to regain communication skills to express wants, needs and ideas. These problems can result from strokes, accidents, disease/illness or developmental delays.

Our SLPs take advantage of being in the home to more effectively assess our patients’ “real-life” functional needs and individualize their treatment. Often times patients with dementia or cognitive impairment respond better to treatment because they’re in a familiar setting – their own home. They also work with family members and other caregivers to provide strategies to facilitate and maintain functional communicative competence. SLPs help patients improve swallowing skills and teach compensatory strategies that help reduce the risk of aspiration pneumonia, and maintain adequate nutrition and hydration. SLPs are also trained in using adaptive speech devices.

Our SLPs are E-stim Certified, a technique in which a small electric current is passed across the skin into the muscles. Stimulation by electrical current tends to facilitate muscle contraction. This activity may create a facilitator environment in which functionally impaired muscle groups may enjoy enhanced rehabilitation when paired with an appropriate and focused functional therapy program.

Psychiatric Nursing Program

Research points to a high prevalence of medical conditions among older people with mental illness. Psychiatric illness often exists in tandem with physical illness, requiring nursing care that is specific to both conditions. Psychiatric nurses have specialized training and experience to address an individual’s physical and medical needs while simultaneously managing their emotional and psychological needs. Our psychiatric nurses are able to quickly gain the patient’s trust, allowing them to form therapeutic relationships. Because our nurse travels to the patient’s place of residence, access issues are minimized.

Our psychiatric nurses are trained to administer a number of assessments.

In addition to the PHQ-2 and the PHQ-9, our nurses can complete the following:

MINI

Mini International Neuropsychiatric Interview—Diagnostic screening tool that assists in determining the mental health diagnosis and subsequent treatment. This tool can also track improvement or decline.

GAD-7

Generalized Anxiety Disorder Assessment— A screening tool and severity measure for general anxiety disorder.

SLUMS

St. Louis University Mental Status Examination—A screening test for Alzheimer’s symptoms. (including early Alzheimer’s).

AIMS

Abnormal Involuntary Movement Scale—Used to detect tardive dyskinesia (TD) in patients receiving neuroleptic medications and to follow severity over time.

SPMSQ

Short Portable Mental Status Questionnaire—Assessment for organic brain deficit in elderly patients.

Ham-A

Hamilton Anxiety Scale—Quantifies the severity of anxiety symptomatology and is often used in psychotropic drug evaluation.

GDS

Geriatric Depression Scale—Screening tool to facilitate assessment of depression in older adults.

CSDD

Cornell Scale for Depression in Dementia—Assessment tool for elderly with dementia using caregiver information, direct observation and patient interview.

BPRS

Brief Psychiatric Rating Scale—Assesses symptoms of individuals who have psychotic disorders, especially schizophrenia.

Additional benefits from partnering with our psychiatric nurses: They’re trained to assist with assessment and diagnosis, assist in developing a patient-centered care plan, and with drug treatment suggestions, Can administer a rating scale to determine severity.

Urinary Incontenance

Urinary Incontinence (UI) has far reaching consequences not only on a person’s physical health, but also on their financial and mental condition. Embarrassment, isolation and depression are common in patients with UI.

UI is also associated with an increased number of falls, urinary tract infections and skin breakdown. At least 10% of people over the age of 65 have UI. It is estimated that at least 50% of nursing home residents have UI. Although women experience incontinence two times more often than men, both men and women can become incontinent as a result of stroke, multiple sclerosis, or other physical problems that are associated with old age.

How Does it Work?

Our Non-Invasive Urinary Incontinence Program provides a comfortable and dignified method of improving a patient’s retention ability by restoring muscle tone and control. With the placement of electrodes outside of the body, urethral closure improves through nerve stimulation and pelvic floor musculature strengthening. This two part program takes place over a four week period and addresses the problems associated with UI such as: urinary tract infections, medications, diet, ease of access, physical activity, etc.

Part 1 of the UI Program includes neurogenic reprogramming within the Autonomic Nervous System. This is used to re-establish the basic spinal loop pattern and its firing timing patterns to reactivate inhibited pathways. Part 2 of the program works on muscle reprogramming within the Somatic Nervous System by using bursts of pulses where each burst contains multiple pulses to activate an increasing number of motor units which allows for the greatest intensity of muscle contraction at the lowest output intensity.

Requirements and Contraindications

Requirements – Patients must be cognitively intact and be able and willing to monitor hydration needs, voiding charts and other assigned tasks and exercises.

Contraindications – Pacemaker, implanted defibrillator, lead wires, severe infection, cancer or current urinary tract infection.

Transitions

The transitions team is here to help our patients and facilities in working towards the best outcome possible. Our Transition Coordinator works with the sub-acute facilities whether it is the hospital, long-term acute care center or skilled nursing facility to help transition their patients to their home or facility.

The goal is to help start the transition from the beginning of the individual’s admission into their sub-acute environment. We can help ensure the transition is as smooth as possible with the correct information and by building the trust of the individuals we provide services to. The transitions coordinator will meet the patient and their family or caregiver to start building the trust and educate them on the services that may be provided to them. The coordinator will attend any care conferences and work with the facility to ensure that we are continuing the progress that has been accomplished in the sub-acute setting. The coordinator will be involved throughout the process to help manage the continuity of care.

End of Life Doula

Today many families have had experience receiving support from a birth doula. Now at First Choice Home Health and Hospice we have an end-of-life doula available to support families through the end-of-life process. Our doula, Nancy Compton, is an Idaho C.N.A. She is also a nationally Certified Hospice and Palliative Nurse Assistant. In addition to training, experience and education, Nancy specializes as an end-of-life doula having successfully worked over 8 years with patients and families. Across the country, there are a number of different names for this work. Some of them are: doula to the dying, soul midwife, transition guide, death doula, death midwife, end-of-life doula or others.

Our end-of-life doula is an integrated member of the hospice care team. She complements the work of the rest of the hospice team by supporting families caring for their loved one by being available to walk step-by-step with the caregiver through the dying and death experience for a serene and peaceful conclusion.

An end-of-life doula is utilized to provide support to the dying person and guidance to their families and friends making sure the patient’s needs are met and the dying process is smooth. Family members and friends find the doula’s presence comforting as they struggle with their distress and grief in the patient’s final hours. An end-of-life doula works with the hospice team and family members to try to ensure no patient dies alone. Often she will sit vigil and will also support the other hospice team members as they prepare the family or caregivers for the patient’s passing.