Hospice of Southern Illinois

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Medical Director Minute: Pruritus- Itching Doesn’t Have to be a Head Scratcher

The International Forum for the Study of Itch defines itching, medically known as “pruritus”, as the unpleasant sensation that provokes an urge to scratch. Conditions specific to the skin, underlying systemic issues, or a combination of both can cause itching. Pruritus is a relatively common and frequently frustrating symptom encountered in end-of-life care.

Medical Information on itch and pruritus

Common Causes

Dermatologic conditions, such as dryness, wetness, or irritation from eczema, psoriasis, or local irritants, most frequently cause localized pruritus. Skin naturally dries as we age, and hydration of the skin is the primary treatment with emollients and moisturizers. Cooling agents, such as Calamine or Menthol, can be helpful with itching also. If local inflammation is present on the skin, topical steroid creams and ointments are a solution to treat the underlying skin condition in many cases.

Metabolic derangements can also be a cause of itching, including liver failure, kidney failure, and hypothyroidism. Liver failure or liver malignancies can produce cholestasis, a condition that impairs the flow of bile from the liver to the small intestine, causing increased bilirubin levels. This typically causes generalized pruritus that can be worse on the palms and soles. Kidney failure produces a build-up of uremia, and uremic pruritus is a common symptom in individuals with renal failure, particularly those on chronic dialysis treatment. This itching is typically generalized and can be continuous or intermittent. Uncontrolled hypothyroidism can also lead to generalized pruritus and overall skin dryness.

Hematologic disorders, including iron deficiency, leukemia, lymphoma, and polycythemia vera can cause itching that is often aquagenic, meaning exacerbated by contact with water. Other solid organ malignancies, such as breast cancer, anal cancer, and prostate cancer, can generate itching around the tumor site, often associated with an overlying rash. Infestations with scabies or lice and yeast infections can cause itching in the area affected. Treatment of the underlying infecting organism is the treatment of choice.

Patients and Pruritus

Patients with HIV infection and AIDS have a higher prevalence of pruritus. Underlying skin infections, reactions to treatment medications, or subsequent viral-induced neuropathy are all causes. The pruritus may be generalized or localized to the area of the skin issue.

A true allergic cause of pruritus can also be present. This can develop due to a medication allergy or contact dermatitis due to an underlying agent. However, some medications can cause itching, not in the setting of a true allergy. In other words, the medication makes you itch, but you are not allergic to it. In a hospice setting, opioid use is usually the culprit. Some antibiotics, aspirin, and anti-inflammatory agents can also produce the same reaction. With opioids, the pruritus is typically generalized and may even cause hives. Persistent opioid-induced pruritus only occurs in 1% of patients, but up to 10% of patients may have transient symptoms.

Psychogenic itching can also be present. A true cause for the itching cannot be determined, but the scratching can become dramatic. In a hospice setting, this is common for patients with dementia.

Solutions

Regardless of the underlying cause, proper education on skin care strategies for all patients with itching is essential. These include hydration and lubrication of the skin, avoiding fragrances and irritants, and maintaining a cool external environment. Topical treatments are an option in the aforementioned situations. Systemic medications used to treat itching typically work quickly, when effective. Thus, if a prescribed anti-itch medication is not helping within a day, it is reasonable to attempt treatment with another class of medication.

Antihistamines, such as Benadryl or Zyrtec, are useful if the itching is due to a true allergic response. A class of anti-nausea medications, 5HT3 antagonists (ex. Zofran), can be helpful for patients with pruritus due to cholestasis, uremia, or opioid use. An older cholesterol-reducing medication, cholestyramine, can be helpful for cholestatic pruritus. Antidepressants, as a class, may be effective for pruritus due to multiple causes. Finally, two medications, typically used to treat neuropathic pain, gabapentin, and pregabalin, have also been found to be effective for multiple types of itching.

In summary, itching may be a common annoyance for many of us from time to time, but when the itching persists and becomes a hindrance to the quality of life, treatment is necessary. It is always best to treat the underlying cause of the pruritus if known. However, when that is not possible, due to end-stage disease, we must find ways to treat the symptom and minimize morbidity. At Hospice of Southern Illinois, our mission is to improve the quality of life for those touched by terminal illness. Sometimes that means something as simple as making the itch go away.

References:

  1. Dalal MD S. Overview of pruritus in palliative care. Uptodate.com. May 10, 2021.
  2. Von Gunten C MD, Kammell MD A, Ferris MD, F. Fast Facts Pruritus. Palliative Care Network of Wisconsin. Aug 2020.

Medical Director Minute: Alternative Routes of Medication Administration

Medication administration on alternate ways to administer medicine.

When we all think about medication administration our mind naturally goes to swallowing a pill or a teaspoon of cough syrup, for example. This route of medication administration is by far the most common and preferred. However, there are often circumstances that prevent the oral use of medications. These can include the inability to swallow, whether due to a decreased level of consciousness or an oral or gastrointestinal lesion, severe nausea and/or vomiting, or bowel obstruction. When these issues arise, prescribers must look to alternative routes of medication administration to meet patients’ needs. We will systematically review several of these options below.

Intravenous & Subcutaneous Administration

The other most familiar route is via intravenous administration. While this is remarkably common in an inpatient setting, hospice use of IVs is less familiar to many. This is a very useful choice when patients have permanent IV access, such as a port or a PICC line. Intravenous administration works for almost all medications used in hospice care. However, a line “hook up” limits patient mobility and freedom. The IV site itself can also be a possible source of infection.

For those patients who do not have permanent intravenous access, medications and fluids can be administered via the subcutaneous route. Administration under the skin has similar results as administering through a vein. However, the infusion is not as fast, and external tubing still limits patient mobility.

If the patient happens to have a pre-existing enteral tube, such as a PEG tube, crushed medication is an alternative option for administration. Crushing or altering extended-release medications is not possible; thus, precluding their use. Enteral tube placement, in and of itself, has surgical risk, and typically the sole purpose of medication administration in the hospice setting is not enough to initiate placement.

Transdermal & Transmucosal Administration

Transdermal patches have become more common due to their ease of use, typical extended duration of action, up to three days for many products, and their painless nature. The medication is systemically absorbed. However, many types of patches require the patient to have an adequate amount of subcutaneous fat under the patch placement area to ensure absorption. Oftentimes, our hospice patients have lost a large amount of weight, and this can be a limiting factor. Some patients may also develop local irritation to the adhesive. Heat exposure, such as heating pads and personal fever, can also increase medication absorption causing untoward effects.

Topical administration differs from transdermal in that these products are typically gels, creams, or ointments. They constitute direct application to the problem area and minimal systemic absorption. In other words, they work where you put them, but absorption into the bloodstream is not efficient. Thus, they have limited usefulness in hospice care.

Some medications can be absorbed via the transmucosal route, such as under the tongue and via the inside of the cheek. A volume of 1ml is the limit on this alternative, due to aspiration risk. However, this method is very simple for families to utilize and can often be used with the same medications that are already present in the home.

Respiratory Route

Many respiratory medications, such as albuterol, require a nebulizer machine to help with wheezing or shortness of breath. However, other categories of medications, such as opioids and diuretics, might be given this way if needed. Their effectiveness can vary from patient to patient.

The intranasal route can have extremely rapid absorption, similar to intravenous administration, but the dose must be 1.5 to 2 times higher than the parenteral dose. Volume, of up to 1 ml, limits this route, and these medications can be quite expensive.

Lastly, the rectal route is a useful method. Oral administration and rectal administration constitute the same dosage with the same effectiveness. This route is simple to utilize, though many patients may find it unpleasant. Patients with either low white blood cell counts or low platelets should avoid rectal administration due to the risk of infection and bleeding risk, respectively.

In summary, oral administration of medication is the most common and most palatable route of medication administration for most patients. However, when that route becomes unavailable, there are multiple other avenues that prescribers and caregivers can pursue to ensure patient comfort and symptom management. At Hospice of Southern Illinois, we are regularly evaluating our patients with our interdisciplinary team to ensure that our care measures are effective for our patients and manageable for their caregivers. We are proud to be your choice as a community not-for-profit hospice provider.

References:

Kestenbaum MD M, Vilches RPh A, Messersmith MS M, Connor PhD S, Fine MD, P, Murphy MD B, Davis M, Muir MD JC. Alternative Routes to Oral Opioid Administration in Palliative Care: A Review and Clinical Summary. Pain Medicine 2014; 15: 1129-1153.

Medical Director Minute: The Role of Antibiotics in End-of-Life Care

Medical article on Antibiotics role in hospice care

In hospice care, our primary goal is to maximize patient comfort while adhering to a patient’s and family’s goals of care. We work to accomplish these goals by employing an interdisciplinary team approach to address all aspects of the patient’s plan of care. Of course, medications are a mainstay of our treatment plan to ensure patient comfort and symptom palliation. A class of medications that can elicit questions on benefit and purpose is certainly antibiotics.

Proper Use of Antibiotics

I would imagine that most of us have been prescribed an antibiotic for some ailment throughout our lives. Over the last ten years, inappropriate antibiotic use has been a focus area for the CDC (Centers for Disease Control) and WHO (World Health Organization). In 2013, both organizations declared antibiotic resistance a national and global threat. In their joint statement, they stated that “Antibiotic use is the most important modifiable driver of antibiotic resistance.” Vast campaigns were employed to educate both prescribers and patients about the risks of inappropriate antibiotic usage. Per Dr. Amesh Adalja, MD, the Infectious Diseases Society of America Spokesperson, “Antibiotics are misused so often because of the belief that these are benign drugs, and that patient satisfaction depends upon being prescribed an antibiotic.”

In a hospice population, our patients are at a higher risk for infection and are at higher risk for more severe infections due to the nature of their underlying illnesses and morbidity. However, our patients are also at higher risk of medication toxicities. Thus, we must balance these two issues based on patient and/or family preference. Hospice-based studies report overall antimicrobial use ranging from 8-37%, and 27% of hospice patients receive at least one antibiotic in the last week of life. At Hospice of Southern Illinois, we strive to focus on “Person-Centered Care”. Hence, we confirm there is evidence to support the treatment, the benefit of treatment outweighs the risks, and the patient and/or family should be involved in the decision-making process.

Are Antibiotics the Right Fit?

When determining if an antibiotic is appropriate in end-of-life care, consider multiple factors. In addition to comfort and symptom goals, we look at estimated prognosis, swallowing function of the patient, and the risk of infection progression and/or recurrence. Regarding antibiotics in hospice care, most of the evidence for symptom benefit exists for urinary tract infections, with a symptom response rate up to 92%. Respiratory illnesses are often viral, and symptom responses can vary from 0-53%. Bloodstream infections, commonly known as sepsis, have the least symptomatic benefit from antibiotics. Also, the administration of antibiotics rarely improves symptoms in the last week of life.

As mentioned above, antibiotics can have side effects, varying from mild to severe and acute to irreversible. These can include nausea, vomiting, loose stools, rash, agitation, secondary yeast infections, electrolyte imbalances, cardiac arrhythmias, seizures, renal toxicity, and anaphylaxis. Equally important, certain antibiotics should also have reduced doses or increased dosing intervals due to declining kidney or liver function. However, this declining function may not always be apparent in a hospice patient as routine laboratory studies are often aborted for patient comfort. There are also multiple possible antibiotic-drug interactions to consider.

The Importance of Collaborative Planning

It is important to involve the patient and the caregiver early in the care-planning process to discuss and document antibiotic preferences. Planned discussions at the time of hospice admissions or care plan meetings should be utilized, as well as any changes in patient condition. When an infection is suspected based on patient symptomatology or diagnosed based on laboratory or imaging studies, health care providers and caregivers should first focus on whether the infection symptoms are impacting the quality of life. If so, we should then default to our patient’s preferences based on prior discussions.

Non-antibiotic symptom management approaches should always be part of the infection plan of care, with or without antibiotics. Furthermore, these techniques support antibiotic stewardship, compliance with organizational recommendations, and patient advocacy. Please reach out to Hospice of Southern Illinois as your preferred end-of-life care provider. Above all, we take pride in our care of our patients and families and our community at large.

References:

  1. Rosenberg JH, Albrecht JS, Fromme EK, et al. Antimicrobial use for symptom management in patients receiving hospice and palliative care: a systematic review. J Palliat Med. 2013: 16(12):1568-1574.
  2. Albrecht JS, McGregor JC, Fromme EK, et al. Nationwide analysis of antibiotic use in hospice care in the final week of life. J Pain Symptom Manage. 2013;46(4):483-490.
  3. Vitetta L, Kenner D, Sail A. Bacterial infections in terminally ill hospice patients. J Pain Symptom Manage. 2000;20(5):326-334.
  4. White P, Kuhlenschmidt H, Vancura B, Navari R. Antimicrobial use in patients with advanced cancer receiving hospice care. J Pain Symptom Manage. 2003;25(5):438-443.
  5. Reinbolt R, Shenk A, White P, Navari R. Symptomatic treatment of infections in patients with advanced cancer receiving hospice care. J Pain Symptom Manage. 2005;30(2):175-182.
  6. Baghban A, Juthani-Mehta M. Antimicrobial use at the end of life. Infect Dis Clin N Am. 2017;31:639-47.
  7. Givens JL, Jones RN, Shaffer ML, Kiely DK, Mitchell SL. Survival and comfort after treatment of pneumonia in advanced dementia patients. Arc Intern Med. 2010:170(13):1102-1107.
  8. Nakagawa S, Toya Y, Okamoto Y, et al. Can anti-infectives drugs improve the infection-related symptoms of patients with cancer during the terminal stages of their lives? J Palliat Med. 2010:13(5):535-540.
  9. Sinert MS, Schmidt MM, Lovell AG, et al. Guidance for safe and appropriate use of antibiotics in hospice using a collaborative decision support tool. J Hosp Pall Nurs. 2020:22(4)1-7.

Steroids- the Jack of All Trades in Hospice Care

By: Kathryn Storm, PharmD PGY2 Pain Management and Palliative Care Pharmacy Resident VA St. Louis Health Care System & Emily Oliver, PharmD PGY2 Hospice and Palliative Care Pharmacy Resident Hospice of Southern Illinois

Pictured: Kathryn Storm, PharmD (left) and Emily Oliver, PharmD (right)

Steroids are commonly prescribed medications. You may know steroids as a drug that treats allergic reactions or bad colds. However, there’s more than meets the eye when it comes to this customary drug. Steroids, such as prednisone, Medrol DosePaks, hydrocortisone, and methylprednisolone, aid in a wide array of non-traditional reasons in end-of-life care.

Uses of Steroids in Hospice & Palliative Care

In palliative care, steroids manage several different symptoms associated with severe diseases during end-of-life care. In palliative and hospice care, they can help treat fatigue, pain, trouble breathing, nausea, vomiting, and poor appetite. 

When terminally ill patients are feeling fatigued, steroids can help boost their energy. This can help our loved ones feel more like themselves. Therefore, increasing their ability to participate in the activities that mean the most to them. This drug also has anti-inflammatory effects, which makes them beneficial in treating certain pain conditions. Used in conjunction with other medications, such as opioids, steroids soothe pain. They can also assist with breathing issues. They work by opening up the airways in the lungs, and the anti-inflammatory properties help prevent inflammation within the lungs; thus, making breathing easier and more comfortable. Regarding nausea and vomiting, steroids are efficacious in controlling and preventing symptoms. They work by decreasing the chemicals in the brain that lead to feelings of nausea.

Lastly, they can assist patients who lose their appetite during end-of-life care. By promoting our body’s hunger signals, patients feel hungry and able to eat.

Side Effects of Steroids

As with all medications, side effects can happen. The most common side effects include weight gain, insomnia, mood changes or swings, changes in blood pressure, higher blood sugars in patients with diabetes, and fluid retention. If used for long periods, they may also increase the risk of infection. 

In summary, given the wide variety of symptoms, they help manage, steroids used to treat severe disease and end-of-life care are beneficial for patients. They are generally well-tolerated and effective medications for patients in the palliative and hospice care setting. Improving the quality of life and making our loved ones more comfortable are some of the many great uses of steroids.

——

Resources: 

1. Cardenas-Mori, J., & Lewis-Ramos, V. (2020). Corticosteroids for common palliative care symptoms #395. Journal of Palliative Medicine, 23(7), 987–989. 

2. Shih, A., & Jackson, K. C. (2007). Role of corticosteroids in Palliative Care. Journal of Pain & Palliative Care Pharmacotherapy, 21(4), 69–76.

Medical Director Minute: Death Certificates Decoded

Medical Information on Death Certificates

Uses of Death Certificates

Death certificates have multiple purposes. They serve as a permanent record of death and typically the deceased’s estate requires them for the burial and settlement. They provide documentation of an opinion regarding the cause, circumstances, and manner of death. Public health purposes are also a common reason behind the distribution of death certificates. These purposes include evaluating the general health of the population, as well as determining the prevalence of medical conditions among certain cohorts of the population. Death certificates provide data to triage medical research needs and help determine the appropriation of resources regarding health service grants.

State statutes govern Death certificates. Certification and completion of the certificate is typically the responsibility of the attending physician, or the physician in charge of the patient’s care, at the time of death. Effective January 1, 2022, in Illinois, an advanced practice registered nurse may complete and sign a death certificate. According to 410 ILCS 535/ Vital Records Act, the completed and signed by the provider within 48 hours after death, except when the death is subject to the coroner’s or medical examiner’s investigation. Also, each death that occurs in Illinois shall be registered by filing a death certificate with the local registrar of the district in which the death occurred, or the body was found, within seven days after such death and before cremation or removal of the body from the State with the same exception for coroner’s or medical examiner’s cases.

Components of the Document

Regarding the medical section of the document itself, there are two components: the cause of death and contributing conditions. The cause of death is based on the medical opinion of the provider. When there is not 100% certainty as to the cause of death, it is appropriate for the provider to document “unknown” or “probable”. The cause of death includes three sections: mechanism, immediate cause, and underlying cause of death. As an example, a patient’s immediate cause of death could be acute respiratory distress syndrome, due to pneumonia, due to COVID-19. Contributing conditions could include diabetes and obesity as both increases the risk of morbidity and mortality from COVID-19.

The National Center for Health Statistics also collects data from death certificates about risk factors. Death certificates inquire as to whether tobacco contributed to the death. In addition, one section asks if the deceased was pregnant within the year or if the death was work-related.

Deaths that fall under the jurisdiction of the medical examiner or coroner vary by region. The statutes and regulations of local health codes publish reporting requirements. As a general rule, reportable deaths include accidents, suicides, homicides, poisoning, drug intoxication, a disease with potential public health threat, deaths resulting from employment, deaths related to medical or surgical complications, suspicious deaths, deaths of individuals in police custody, and unattended deaths.

Thus, what seems like a simple document, has a large reach in terms of public health. To complete the document comprehensively and accurately, it is imperative to have inclusive medical records. At Hospice of Southern Illinois, we strive to complete death certificates for our families timely and accurately.

Hiccups- Not a Laughing Matter

Almost all of us have had a case of hiccups. Typically, they are annoying, embarrassing, and cause us mild frustration. We hold our breath, try eating some peanut butter or ask a friend to scare us. The nuisance passes, and we resume our daily routine. However, this rudimentary body function can impact our quality of life when it becomes chronic. They can disrupt sleep, interfere with conversation and concentration, and even cause pain if they persist long enough.

Where do Hiccups Come From?

Hiccups stem from stimulation of the phrenic and vagus nerves, as well as involvement from the central reflex center in the brainstem. They can have multiple causes, including stress, excitement, cancer, recent heart attack, dilation of the stomach or esophagus, liver problems, kidney problems, central nervous system disease, or medications, such as chemotherapy and steroids. They can also be idiopathic, therefore identifying the underlying cause may help focus treatment. Multiple approaches to hiccup treatment exist, including nonpharmacologic alternatives. However, there is little evidence that any treatment is more beneficial than another.

Treatment Options

Nonpharmacologic treatments include swallowing sugar, gargling with water, biting a lemon, or trying to induce a fright response. One can attempt to interrupt the normal breathing routine by holding one’s breath or hyperventilating. Those with medical knowledge can attempt vagal nerve stimulation via carotid massage or interruption of phrenic nerve transmission by rubbing over the 5th cervical vertebrae.

Multiple medication classes may provide a worthy treatment. These include the older antipsychotics; such as haloperidol and chlorpromazine. Some anticonvulsants may also be effective, including gabapentin, phenytoin, and valproic acid. A muscle relaxant, baclofen, can also be helpful.

For those cases where typical non-pharmacologic methods and multiple pharmacologic therapies fail, more aggressive options do exist. These include the placement of diaphragmatic pacing electrodes or surgical ablation of the nerve reflex arc.

When developing a treatment protocol, it is essential to consider a patient’s prognosis, comorbidities, and potential treatment side effects. Hospice patients tend to, on average, have a shortened prognosis, multiple comorbidities, and can be more sensitive to medication untoward effects. We must also weigh the burden that the hiccups are causing to the patient enjoying their life. Quality of life is always our utmost goal. Hiccups are not one of the most common symptoms we deal with in hospice care, but they can be one of the most distressing and challenging to treat. As always, if you or a loved one are touched by a terminal illness, please reach out to Hospice of Southern Illinois to ease the journey.

21 Ways Hospice of Southern Illinois Made an Impact in 2021

2022 is here! A time to celebrate new beginnings, but don’t forget to be proud of all you accomplished in 2021. In this blog, we are celebrating 21 Ways Hospice of Southern Illinois made an impact in 2021. At Hospice of Southern Illinois, we take pride in serving our communities. Since 1981, we have been a grass-roots, volunteer movement with offices in Belleville and Marion, Illinois. Our mission is to help patients and their loved ones in the end-of-life journey. Since our founding, we continue the tradition of focusing on quality of life, peace, and dignity for the patients in the communities we serve.

We are a free-standing, not-for-profit hospice. Our goal is to be your #1 choice in providing hospice care to your family and friends. Above all, thank you for your support in our 40 years of caring. We look forward to serving our communities in 2022!

  1. Celebrated 40 years of serving our patients and their families – Hospice of Southern Illinois is an experienced leader in end-of-life care.
  2. Served over 44,000 families since 1981 – We are your local, not-for-profit hospice with our roots starting right here in the Metro-East and Southern Illinois.
  3. Donation from Carlyle Lion’s Club- In 2021, Hospice of Southern Illinois was one of the Carlyle Lion’s Club’s three recipients of a donation at their annual planning meeting. These funds helped provide supplies to our patients.
  4. Flag Day Celebration – In June, Clinton County Vietnam Veterans participated in our flag folding ceremony in honor of Flag Day.
  5. Business After Hours– During July of 2021, we hosted the Greater Belleville Chamber of Commerce’s “Business After Hours” event to celebrate our 40th anniversary with our communities. This event had a “Christmas in July” theme! Business After Hours serves as an opportunity for networking and collaboration between our community partners.
  6. First Annual Blood Drive – Hospice of Southern Illinois hosted our first blood drive with over 30 donors.
  7. Dementia Live – Our Marion and Belleville offices began offering Dementia Live, a training simulation dedicated to better understanding patients with Dementia. Therefore, we can inspire our community to better understand the Dementia population.
  8. Volunteer Parade – To replace our Volunteer Luncheon with a more COVID-friendly event, Hospice of Southern Illinois hosted a volunteer drive-thru parade. This event was a way to thank our volunteers. Through our volunteers, Hospice of Southern Illinois is able to bring assistance to our patients, families, and community.
  9. African American Health Fair – Our Marion team attended Shawnee Community College’s health fair. This fair featured topics focused on People of Color and allowed us to educate attendees about our hospice services.
  10. Employee Appreciation Day– You can’t give from an empty cup! At Hospice of Southern Illinois, our priority is keeping our team’s cup full, so they can continue to provide amazing care and support. Our Marion office hosted a food truck, and our Belleville offices provided a box lunch for all staff.
  11. Bringing Life to Hospice featuring Barbara Karnes, RN – American Hospice Pioneer, award-winning nurse, author of Gone From My Sight, and NHPCO Hospice Innovator Award winner Barbara Karnes made a guest appearance on our podcast to share her journey as a hospice provider. She was able to share her unique expertise with our listeners.
  12. Golf Tournament in Belleville and Marion – 2021 brought Belleville’s 22nd and Marion’s 19th annual golf tournaments. The funds raised from our annual golf tournaments help us care for our patients and further our mission.
  13. Hometown Heroes- We awarded goodies to the Highland EMS and Firefighters who exemplified outstanding service after a fire at Cedarhurst of Highland.
  14. Honor Flight in Marion – Our volunteers participated in Southern Illinois Veteran’s Honor Flight #7 at the Veteran’s Airport of Southern Illinois, honoring retired military personnel!
  15. NHDD Airpod Contest – Our podcast hosted a giveaway to promote awareness of National Healthcare Decision Day!
  16. Pet Therapy Program–We welcomed Charlie as Hospice of Southern Illinois’ newest therapy pet. Charlie visits patients in long term care and assisted living facilities to bring joy to patients and families.
  17. Valentines from Students – Hospice of Southern Illinois partnered with area schools to create Valentine’s cards for residents at long-term care and assisted living facilities.
  18. Reuniting Families– A local Mother and Daughter were reunited at Aviston Countryside Manor after 7 months of separation due to COVID-19 protocols. Watch the video on our Facebook page!
  19. Flowers from Women of Hope Women of Hope provided flowers for Hospice of Southern Illinois. As a result, our volunteers were able to make 75 bouquets for patients and families!
  20. Assisted Living Garden– Our Hospice Volunteer department planted a garden for a local assisted living facility.  Collaborating with our facilities on activities to boost resident’s morale. 
  21. Great Place To Work – Last but not least, we are proud to be Great Place to Work Certified for the second year in a row! Much gratitude to our hospice team for their commitment to our organization.
2021 Impact at Hospice of Southern Illinois
year end impact 2021
Yearly Blog Impact at Hospice of Southern Illinois 2021

In One Word, Hospice of Southern Illinois is a Blessing

Simply the Word Blessing

Dear Friend,

      I never thought I would be in hospice care but last December I was given two weeks to live.  I had been in and out of the hospital most every month during 2019 and my body was not tolerating cancer treatment.  When my wife, Louise and I  first met with the nurse from Hospice of Southern Illinois, I politely declined their services.  The nurse was nice and explained everything to me but I wasn’t ready.  I had seven different doctors and I went to several appointments a week.  How could I just stop going to all of them?  You see, I literally thought hospice care meant that you went home, a volunteer came and sat with you and waited for you to die.  Boy, was I wrong.

” If I had to describe my experience with Hospice of Southern Illinois in one word, it would simply be the word blessing.“

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Hospice of Southern Illinois Granted One Special Gift

One Special Gift – A St. Louis Wish

Have you ever reflected on what makes you happy? Maybe there is one activity that would make a difference in your life or provide joy during a solemn time. Everyone has something that touches their heart. Recently in 2019, a new St. Louis attraction, St. Louis Aquarium – Downtown at Union Station, grabbed the attention of one of our patients. Hospice of Southern Illinois’ nurse and the social worker asked how we could fulfill a wish for the Duvall family. 

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Social Work Month

Macy Wierschem - Orange Social Work Intern

As a Master’s level practicum student with a local University, I chose Hospice of Southern Illinois for my final 600-hour practicum. In May, 2020, I will graduate from the University of Missouri-St. Louis with a Master’s Degree in Social Work. Initially, I was worried that working in hospice would be uncomfortable and honestly, dreary. What I experienced though, was respect and dignity. It can be challenging and emotionally draining at times. I witnessed the impact Social Work can have in a hospice setting as a true benefit to patients and families.

The Hospice of Southern Illinois Social Work team plans their schedule to be accommodating and meet patients and families during the point of their day when they can benefit the most from a Social Work visit. This is typically in the late morning and afternoon. The route is planned as a guideline to allow for crisis and triage needs of the patients that may arise during the day or night. My current knowledge base is from a nursing home perspective. Hospice of Southern Illinois works in patient homes, nursing homes, assisted livings, memory care settings, adult group homes, and hospitals.  My practicum has allowed me the opportunity to witness the Social Work team in all these diverse settings. Being able to go into patients’ homes has been so valuable to me. I’ve had to learn safety and etiquette when entering a new patient’s home, and also the technical realities of Social Work outside of an office. Being in the home setting has a different set of demands than being in a facility. The most beneficial component for me when going from different settings is that it allows me time to mentally prepare and decompress on the way to and from each visit.

One of the hardest skills I learned is how to be present and let a family feel their pain and loss. Often I would find myself in situations where I had no idea what to say to a grieving family. In some instances, I am sitting on their couch, in their living room, that has been turned into a patient’s bedroom complete with hospital bed and medical supplies in reach. I cannot imagine the challenges involved in changing your daily life in order to care for your loved one who is terminally ill and now on hospice services. I would be distraught if I had to leave my job and routine to be there for my family member each day at home. I would do it, but that is not anyone’s ideal situation. What can you say to this family?  I said nothing, I didn’t need to. I acknowledged how good of a job they are doing taking care of their family member and was in awe of how much respect and dignity they are providing. 

Overall, working with the Social Workers and the Bereavement Counselors, I was able to experience and witness first-hand the skills and techniques implemented by staff that I know are related to their experience and training. If I still have your attention, I want to use this opportunity to thank Pam Rorie and Lisa Simonin for taking me under their wings and answering all of my questions. Every Tuesday and Friday since August, 2019, they have shared their days with me, either in the office or on the road. I know it takes them longer to complete their documentation and tasks when they take the time to explain the methods and ask my perspective. Their impact on my education does not go unrecognized. Their impact on the community, its most vulnerable population, should not go unnoticed. Thank you to the Social Work team at Hospice of Southern Illinois for the difference you make in the community.

Thank you, Macy Wierschem BSW

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