News and Events

Hospice versus Palliative Care: What’s the Difference?

What’s the difference between hospice and palliative care? For patients and families facing serious illness, this is a common question. Ultimately, the goals of both hospice and palliative care are very similar: to relieve symptoms of a serious illness, provide comfort from pain and improve quality of life for the whole family. Yet how these goals are achieved and when a person is eligible for each type of care can be very different. If you missed the March 15 Lunch & Learn, here is more information on this frequently asked question.

Eligibility

Patients in both hospice and palliative care have similar diagnoses. Frequent illnesses include cancer, chronic obstructive pulmonary disease (COPD), congestive heart failure, kidney disease, liver disease, dementia, stroke and many others.

Yet where you are in the course of your illness makes all the difference in whether you’re eligible for hospice or palliative care. In order to be eligible for hospice, a doctor must certify that, if the illness runs its natural course, death could be expected in six months or fewer. The individual must also not be receiving curative treatment, such as chemotherapy.

On the other hand, palliative care can be used anytime during the course of a serious illness—starting with the diagnosis—and patients can be receiving curative treatment for their illness. See the “On the Road of Life” image below.

Services Provided

One of the biggest differences between hospice and palliative care is what specific services are provided. The hallmark of hospice care is its interdisciplinary, comprehensive approach. The patient and family has a whole team of professionals assisting them on a regular basis, which can include a nurse, hospice aide, the patient’s primary care doctor, hospice doctor, social worker, chaplain, volunteer and grief counselor.

The “Circle of Care” image below demonstrates this hospice team approach. Patients are seen frequently by different members of the team, sometimes multiple times per week, and sometimes 24-7, as at Beacon Place, HPCG’s inpatient hospice home.

Yet palliative care is less comprehensive and more consultative in nature. After the patient’s health care provider requests a palliative care consultation, one of HPCG’s nurse practitioners meets with the patient to assess the symptoms of their serious illness, whether its pain, nausea, coughing, delirium or anxiety. They then recommend medications or therapies to treat those symptoms. The palliative care team also helps the patient and family better understand the illness, review advance directives and make choices for their future health care decisions.

Where They are Similar

Whether a person is receiving hospice or palliative care, HPCG meets patients wherever they call “home”—in private residences, retirement communities or nursing homes. Moreover, both palliative and hospice care are usually covered by Medicare, Medicaid and private insurance, though the way they are billed can differ.

When a Death Changes Everything: Supporting Children Through “Secondary Loss”

For kids and teens, grieving the loss of a loved one can sometimes be further complicated by related changes. The death of a parent or guardian might result in the child moving to a new home or school or even having a new primary caregiver. Some children are strongly impacted by the death of a grandparent or other extended family member if the person played a significant role in their daily life.
Secondary loss is a term that counselors use to describe the changes in a child’s life that result from a loved one’s death. Often, the disruption in daily routines or family traditions can be as painful as the loss of that person. It takes time for anyone to adjust to these kinds of major changes. Below are a few ways that families can support children and teens as they transition to a “new normal.”

Getting Back to a Routine.

When possible, focus on reintroducing consistency and routine to the child’s weekly schedule. Major loss or change can create a feeling of chaos, which sometimes manifests as anxiety or other emotional responses. You can reestablish familiar structures such as mealtime and bedtime routines. In addition, consider adding a reassuring new tradition such as setting aside a day of the week to do something fun together.

Giving Space for all Types of Feelings.

It’s normal for a child or teen to experience sadness, anger, confusion or other strong emotions in response to loss and change. Let them know it’s okay to have a range of emotions or to feel “mixed up” sometimes. You can offer ways to express feelings such as pounding play-doh, engaging in physical activity, painting an image about the changes or writing in a private journal.

Finding Ways to Communicate.

Families may find it challenging to communicate during a time of upheaval and increased stress. Consider initiating a routine family meeting during which children can voice their opinions and settle conflict in a fair way. Older children and teens may prefer to communicate in writing, such as by texting you or leaving a note, instead of talking face-to-face. No matter your method of communication, focus on maintaining connection and finding ways to problem-solve together.

Grief Counseling May Help.

Does your child or teen seem to be struggling with changes related to the death or serious illness of a loved one? Kids Path counselors are available for phone consultations at no cost. Individual grief counseling and age-specific support groups are also available at Kids Path. For more information, call 336.544.5437 and ask to speak with any Kids Path counselor.

Stronger Together: Update on Merge with Alamance-Caswell

As of October 1, 2019, Hospice and Palliative Care of Greensboro and Hospice and Palliative Care of Alamance-Caswell have merged into a single legal entity.

At this time, however, we will continue to operate as Hospice and Palliative Care Center of Alamance-Caswell and Hospice and Palliative Care of Greensboro.

You should not notice any changes in the care and services provided to you or your loved one.

Our merger is a wonderful opportunity for our two mission-driven, not-for-profit organizations to better meet the needs of more than 3,000 hospice patients each year and thousands of others who seek palliative care, Kids Path support, and grief counseling services in multiple North Carolina counties.

In January, we will announce a new name for our organization, and you will notice changes to our logo. Until then, know that we remain committed to keeping our patients and families at the center of our work and connecting them to the best care available.

Click here to read the original announcement about the merger.

Click here to review Frequently Asked Questions about the merger. 

Why Grieving Kids Get “Clingy”

Separation anxiety can be a common response to a significant loss for preschool or elementary-age children. You may find that your child has difficulty letting you out of their sight and may even seem to be in your personal space all the time. We see this most commonly in children whose parent or primary caregiver has died, regardless of whether the loss was expected or sudden.

Many families want to soothe the worries of their “clingy” child but also feel frustrated by trying to meet these increased needs following a loss, at a time that is difficult and stressful for everyone in the family. Here is some guidance about ways to address behaviors related to separation anxiety.

Recognize the Need for Connection.

Let your child know that it makes sense to want reassurance from loved ones when a special person has died. You can reassure your child that they will be taken care of and that even on hard days when big feelings are coming up, you are in this together. When it’s necessary to be apart, you can offer a tangible reminder to help your child feel connected to you—for example, a family photo to keep in their book bag or a special voicemail message they can listen to when feeling anxious.

Provide Sensory Comforts.

Children sometimes have strong emotions without the capacity to verbalize them or self-soothe. You can work together with your child to make a “five senses” list of sensory items that make them feel safe and happy. Some examples include wrapping up in a soft blanket (touch) or using a scented lotion that is relaxing for them (smell).

Keep Things Routine.

Although this may feel like a topsy-turvy time for your family, it’s important to maintain familiar routines, such as bedtime rituals and mealtimes, as much as possible. When this is not possible, try to institute a new routine for the time being so that your child knows what to expect. Some families find it helpful to post a written schedule or calendar in their home as a reminder of what will be coming up next. Be sure to include important family rituals and special time together whenever possible.

Consult a Kids Path Counselor.

Children as young as four years old may be eligible for individual grief counseling at Kids Path. For a no-cost phone consultation about how your young child is coping with death or illness, please call 336.544.5437 and ask to speak with any Kids Path counselor.

My Child Hasn’t Cried — Are They Grieving?

Kids Path counselors often hear from parents or caregivers that their child has not cried after a significant loss. Some families worry that a lack of tears means their child is “bottling up” or repressing emotions in a harmful way.

Often, grief in children and teenagers looks different from what we expect. The range of feelings and behaviors tends to be broader in kids and teens than typical grief in adults.

Here are some of the most common grief responses for children and teens.

Sadness may not look like crying.

Certainly, some children react to a death by crying. Children who don’t cry after the loss of a loved one might express their grief in other ways. They might have less energy than usual or become distracted because of sad thoughts or memories.

Teenagers, perhaps due to feeling self-conscious, might cry in private rather than around family or friends. It is also typical of teens to express their sad feelings in creative ways, such as through writing or music, and to share more detail about emotions with their peers than with family members.

Anger is common after a loss.

One of the most common reactions to loss is anger. Younger children may be able to talk about feeling mad, or their anger may take the form of frustration, impatience or general “acting out.” Teens might also demonstrate angry behaviors or seem irritable. Regardless of how it is expressed, it’s important to let kids and teens know that it is okay and normal to feel angry when someone has died.

Children may worry about others dying.

Some children worry that something might happen to another person in their life. While some kids verbalize these thoughts, others experience anxiety in the form of nightmares or being fearful of separation from family members. It is also common for older children and teens to experience separation anxiety after a significant loss. Some children or teens ask questions about death or seem anxious about minor illnesses and injuries.

Families can support grieving kids and teens.

There are many ways to provide support at home after a loss. Adult family members can model talking about feelings and validate whatever is verbalized by a child or teen. Families can also offer safe and healthy ways to express grief emotions through art, play or movement.

Consult a Kids Path Counselor.

The licensed counselors at Kids Path provide no-cost phone consultations about how to support a grieving child or teen. Call 336.544.5437 and ask to speak with a counselor.

United Way Eliminates Funding for HPCG Counseling Programs

In the United States, the rate of suicide and death by overdose has reached a level not seen since World War II. In fact, for those aged 10 to 34, suicide is the second leading cause of death.

Left in the wake of these heartbreaking statistics are the loved ones who are devastated. Their sorrow is often compounded by stigma, guilt and isolation. They require help navigating the complicated grief associated with traumatic loss.

Thanks to generous community support, Hospice and Palliative Care of Greensboro (HPCG) has been able to respond to this growing need, regularly offering suicide and overdose loss-themed grief support groups. In fact, diverse programs that address challenges like these have been a hallmark of HPCG’s mission.  Whether it’s through these specialty loss groups offered by the Counseling and Education Center or kid-friendly grief counseling offered through its Kids Path program, HPCG’s work has been driven by the needs of this community.

HPCG’s Suicide Loss Support Group made these rocks depicting messages of hope. Donations make groups like this one possible.

The core charitable support that has underwritten these efforts has been the United Way of Greater Greensboro. Unfortunately, after 20 years of partnership, United Way’s support of HPCG has ended. HPCG is no longer considered a Strategic Partner agency and will not receive its annual funding allocation.

While the loss of United Way support seems sudden, it is not completely unanticipated. For several years, United Way has shifted their strategic focus to eradicating poverty—a worthy goal indeed.

United Way leaders assure us that HPCG’s grief support programs remain valuable, especially for families living in poverty. However, with limited resources, the United Way must invest in organizations that more directly influence the cycle of poverty in Greensboro.

Although HPCG’s annual request of $210,735 wasn’t funded, United Way will honor all donor-designations to their fundraising efforts. Therefore, we anticipate a revenue shortfall of about $110,000 for the current fiscal year.

We are committed to making sure services continue uninterrupted. However, we need your help to keep this commitment. Every donation—large or small—will be needed to fill this funding gap.

Please consider making a gift to support our 2019 Annual Campaign:

Make A Gift

The Importance of Peer Support for Grieving Teens

The middle school and high school years are a unique time in life. Teenagers are outgrowing childhood but have not yet fully developed in a social, cognitive or emotional capacity. Because of the developmental challenges faced by teens, they have specific grief needs that are distinct from both child and adult grief.

Grief counselors who work with teens often recommend strengthening their support network. This can include time with not only family, school and faith community, but also time with peers. Teens who have experienced a loss sometimes feel that although family members care about them, it is only other teens who can truly understand how they feel.

Ideally, teens can participate in grief programs that allow them to learn about grief and share experiences among people their own age. These programs normalize grief emotions through expressive activities and provide a chance for teens to mingle with grieving peers in a low-pressure environment.

“I Thought I Was the Only One”

An important part of individual grief counseling for teens is normalizing the emotions and behaviors that can be triggered by loss. However, teens are most likely to believe that other teens go through similar situations when they are able to meet those others and hear their stories for themselves. At a time when teens need peer support the most, they may not know anyone at school or in their community with a similar loss. Teen grief programs offer a chance to bond with other teens who have lost a loved one.

A Safe Place to Talk About Grief

For teens, it often feels important to fit in and seem normal to peers. They may minimize or hide their experience of loss in an effort to avoid having to discuss what happened with people at school or in the community. A grief program designed for teens can provide a safe space for teens to express grief emotions, speak their truth about their experience or simply just be genuine without having to put on a mask of normalcy.

Kids Path counselors design and facilitate programming to meet the unique grief needs of teens in 6th through 12th grade. These include frequent Teen Night events featuring specific activities or speakers, as well as an annual Pathfinders four-week support group with an expressive arts focus.

Kids Path provides grief services for children and teens from age 4 through high school. To learn whether your child or teen may be appropriate for Kids Path programs, call 336.544.5437.

What is Palliative Care?

Learn about this invaluable resource before you need it!

Most adults will suffer from a serious, life-limiting illness in their lifetime. However, despite the prevalence of these illnesses, over 70 percent of the US population knows little to nothing about palliative care services[i].

Palliative care is specialized, holistic care for people living with serious illness. Unlike traditional medical care, palliative care as a philosophy does not aim to cure illness. Instead, it focuses on the patient’s quality of life.

Traditional medical care is hyper-focused on treating an illness. With some illnesses, such as cancer, treatment methods can be uncomfortable, painful or even traumatic. The goal of traditional medicine is, first and foremost, to preserve life, sometimes at the expense of the patient’s comfort.

In contrast, a palliative care team’s focus is quality of life and patient comfort. Palliative care does not seek to treat an illness, but it can be provided in combination with curative treatment. For example, a cancer patient receiving chemotherapy might choose to add palliative care to their treatment plan. The chemotherapy is meant to treat their cancer, while the palliative care is meant to alleviate distressing symptoms from both the cancer and the chemotherapy itself.

The palliative care team assists in improving quality of life by establishing “goals of care.” To do this, they find out what is most important for each individual patient. Perhaps the patient wants to remain mobile for as long as possible, or maybe they want to be able to comfortably sit and watch their favorite TV show. Whatever matters most to each patient’s individual definition of a “good life” will become the driving force behind their palliative care treatment plan.

In addition to nurses and a doctor, the palliative care interdisciplinary team also includes a social worker to help the patient and family cope with emotional or mental distress. The palliative care team can also assist the patient in creating advance directives so that their medical wishes are well-established.

Some people are afraid of palliative care because they associate it with hospice care and death. However, unlike hospice care, an illness does not have to be terminal for a patient to receive palliative care. Anyone suffering from a serious, life-limiting illness may be eligible for palliative care services. Palliative care becomes an option when a patient is diagnosed with a serious illness and can be provided continuously until it is no longer needed or until the patient enters hospice care.

Palliative care can be given anywhere: in the patient’s home, a hospital or an assisted living facility. It is covered by Medicare, Medicaid and most private insurances.
If you or a loved one has been diagnosed with a serious illness, contact Hospice and Palliative Care of Greensboro for more information about palliative care.

[i] Awareness and Misperceptions of Hospice and Palliative Care: A Population-Based Survey Study.
Am J Hosp Palliat Care. 2018 Mar;35(3):431-439. doi: 10.1177/1049909117715215. Epub 2017 Jun 20.

 

Do Very Young Children Feel Grief?

There is a commonly held belief that young children are “too young to grieve” when a loved one dies. However, we now know that preschool-age children, toddlers and even infants all experience grief.

Following is a brief guide to understanding and supporting young children through a grief experience.

Grief in Infants and Toddlers

Babies are affected by changes in household routines. If the person who died was a parent or caregiver, an infant will feel the absence of that familiar person’s voice and touch. Toddlers are likely to resist being apart from family and may develop new “babyish” behaviors or become unusually clingy. Grief in both babies and toddlers can sometimes seem like irritability or anxiety, or they may seem quieter than usual.

Preschoolers and Grief Emotions

 Preschool children are likely to express grief through behavior changes rather than words. They may demonstrate separation anxiety, a need for comfort and reassurance or regression of previously mastered skills such as potty training.

Preschoolers may seem completely unaffected at times, while at other times they may exhibit intense emotion through tantrums or outbursts. Their behavior may seem out of proportion to the immediate circumstances. Some preschoolers and young school-age children may seem worried and ask questions, such as who will take care of them.

How to Support a Young Child After a Loss

Young children tend to experience grief in bursts. It is helpful to expect that a young child’s grief responses may be unpredictable, but also short-lived. The most effective response by caregivers can be simply to maintain the child’s physical safety if needed, offer comforting touch and let the child know it’s okay to have big feelings.

As much as possible, families should try to maintain the structure and routines of the household. Give your child opportunities to express emotions through play, art or physical activities. Some families may choose to read and discuss a picture book about maintaining connection with loved ones after loss, such as “The Invisible String.”

Children’s Grief Counseling at Kids Path

Children as young as 4 years old may be eligible for individual grief counseling at Kids Path. For a no-cost phone consultation about how your young child is coping with death or illness, please call 336.544.5437 and ask to speak with any Kids Path counselor.

A Day in the Life of Amy Johnson, Hospice Nurse

Amy Johnson, a nurse with Hospice and Palliative Care of Greensboro (HPCG), arrives at Whitestone Retirement community at 11 a.m., with nothing but her laptop bag and an ever-present smile. As soon as she enters the lobby, she is excitedly greeted—and often hugged—by every person she passes.

Amy pops her head into the dining room, where dozens of staff and residents are gathered for lunch. She is met by yet another chorus of “AMY!”

Amy makes her way around the dining table, giving a shoulder squeeze and a joyful “How are you feeling?” or “Are you enjoying your lunch?” to every patient she passes.

As Amy walks toward the nurse’s station, she sees a nurse’s aide and pulls her aside: “How is Lorna doing today? Any change?”

The aide replies, “She hasn’t talked or moved much. She seems to be declining quickly.”

Clearly concerned, Amy hurries to her patient’s room. Amy’s normally bubbly mood has quickly turned into gentle concern. “Hi, Miss Lorna. It’s Amy—I’m here to visit you.”

Hymns are playing softly on Lorna’s radio. “Miss Lorna has a very strong faith,” Amy says, arranging some crocheted angels on Lorna’s pillow. “That’s why she always has angels around her.”

Lorna has been Amy’s patient for many months. As they’ve gotten to know each other, Amy has listened to stories of Lorna’s long and full life. She points to a picture on the dresser. “That’s her and her husband on vacation in the mountains.”

In recent weeks, Lorna’s health has declined rapidly. She responds when Amy holds her hand by lightly stirring but otherwise remains in a peaceful-looking sleep.

In the hour that follows, Amy talks to Lorna, holds her hand and gently examines her. More than anything, her focus is on Lorna’s comfort.

“I don’t like the angle of her neck; that doesn’t look comfortable,” Amy mutters. She quickly searches the room for another pillow, gently lifts Lorna’s head while talking softly to her, and props up her neck. “That’s better.”

“Miss Lorna does not like her socks to be too tight on her toes. She likes wiggle room. It’s very important to her; she reminded me every visit for the first few months.” Amy lifts the covers and pulls the toes of Lorna’s socks before re-tucking her blankets. “Your socks are the way you like them, Miss Lorna.”

After saying a quiet goodbye to Lorna, Amy is off to update her chart at the nurse’s station.  An HPCG social worker arrives shortly after, and they work next to each other while catching up on patients.

Amy notices another of her patients relaxing on a recliner nearby, and walks over to check in. “Hi Charles, how are you today?”

Charles lights up at Amy’s presence. “I’m doing OK!” he says softly.

She and Charles talk and laugh together as she seamlessly proceeds through the exam- checking Charles’ blood pressure, examining his skin and listening to his heart and stomach with her stethoscope. “Has your wife been here yet today?” Amy asks.

“Not yet, but she should be here any minute. Maybe you’ll get to see her.” Midway through the exam, Charles complains that his feet are hot. Amy carefully removes his shoes. Soon, Charles begins to get tired and drift off. Amy gently finishes her exam before leaving him to nap. Then, it’s back to finish charting.

Amy’s day as a long term care hospice nurse seems to balance two main things: patient care and meticulous documentation.

But to Amy, nursing duties far exceed blood pressure tests and temperature-taking. Most of her time is spent connecting with her patients, identifying what makes them uncomfortable, and taking immediate action to ease that discomfort. Whether she does this herself or coordinates with facility staff and doctors, Amy seems to leave no loose ends when it comes to the comfort of her patients.

A hospice nurse’s charge isn’t necessarily to heal. After all, hospice patients are dying. Yet whether they’re caring for a patient’s wound or adjusting the toes of their socks, hospice nurses improve the quality of the time their patients have left.

“It’s an honor to connect with my patients and ease their journey into whatever comes next. Losing patients is hard, but the memories and connections I make to each person have given immense joy and beauty to my life. I was called to this job, and I’m grateful every day for the calling.”