Blog - Hospice of Southern Illinois

Steroids- the Jack of All Trades in Hospice Care

March 22, 2022

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.

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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

January 18, 2022

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

January 11, 2022

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

December 30, 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!

Celebrated 40 years of serving our patients and their families – Hospice of Southern Illinois is an experienced leader in end-of-life care.
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.
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.
Flag Day Celebration – In June, Clinton County Vietnam Veterans participated in our flag folding ceremony in honor of Flag Day.
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.
First Annual Blood Drive – Hospice of Southern Illinois hosted our first blood drive with over 30 donors.
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.
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.
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.
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.
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.
Golf Tournament in Belleville and Marion – 2021 brought Belleville’s 22^nd and Marion’s 19^th annual golf tournaments. The funds raised from our annual golf tournaments help us care for our patients and further our mission.
Hometown Heroes- We awarded goodies to the Highland EMS and Firefighters who exemplified outstanding service after a fire at Cedarhurst of Highland.
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!
NHDD Airpod Contest – Our podcast hosted a giveaway to promote awareness of National Healthcare Decision Day!
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.
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.
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!
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!
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.
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

Yearly Blog Impact at Hospice of Southern Illinois 2021

In One Word, Hospice of Southern Illinois is a Blessing

September 4, 2020

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.“

[Read more…]

Hospice of Southern Illinois Granted One Special Gift

September 4, 2020

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.

[Read more…]

Social Work Month

March 3, 2020

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

Cardiovascular Medications in Hospice Patients

January 28, 2020

Matthew D. Clark, Pharm.D.

Dr. Matthew Clark PGY2 Pharmacy Resident for Our 4th Year of Our Pharmacy Residency Program — PGY2 Pharmacy Resident

The leading cause of death in the United States is cardiovascular disease. With the rise in the number of tobacco users along with our society’s push for fast food, this statistic should come as no surprise. Cardiovascular diseases can range from heart attack and stroke to congestive heart failure. What commonly accompanies these diseases is hypertension, or high blood pressure. Your body produces a substance called renin which leads to vasoconstriction that ultimately leads to high blood pressure. High blood pressure can also lead to kidney damage. In addition to hypertension, people with cardiovascular issues tend to have high levels of cholesterol. Astonishingly, our bodies contain both good and bad cholesterol. Low-density lipoproteins (bad cholesterol) hang out in our vascular system while our high-density lipoproteins (good cholesterol) work to transport our bad cholesterol to the liver to be metabolized. Build-up of bad cholesterol leads to plaque formation which ultimately leads to stroke. Fatty foods such as hamburgers and pizza can increase levels in bad cholesterol.

Elevated blood pressure and cholesterol ultimately lead to adverse cardiovascular events that can often lead to death. In order to avoid these events, patients are prescribed agents that lower blood pressure and cholesterol. It is common for patients to be on these classes of medications for numerous years. What about patients in hospice who are approaching the end of life? Is it appropriate for these patients to continue strict control on their blood pressure and cholesterol? Indeed, cardiovascular risks are very serious; however, these events are usually the long term effects of uncontrolled blood pressure and cholesterol. Therefore, the need for these medications at the end of life becomes moot. These medications can actually adversely affect the dying patient. For example, tightly controlling a patient’s blood pressure with medications can sharply drop their blood pressure which leads to falls and injury. Additionally, a certain group of cholesterol medications known as “statins” can lead to muscle breakdown and wasting in patients who are bed bound. As a result, these medications are commonly discontinued in hospice patients.

A goal for healthcare providers in hospice is to provide optimal comfort to the patient during the final moments of their life. One way to accomplish this is to minimize the amount of unnecessary medications the patient is taking. As frightening as stopping blood pressure and cholesterol medications may be, patients and families must realize that healthcare professionals, such as pharmacists, weigh the risks versus benefits of discontinuing medications. In this case, the risks of adverse events caused by continuing these medications outweigh the benefits of cardiovascular protection these medications provide for hospice patients. Cardiovascular medications are just one of many medication classes that can benefit hospice patients by being discontinued.

19 Ways We Made An Impact in 2019

December 30, 2019

19 Ways Hospice of Southern Illinois Made an Impact in 2019

Hospice of Southern Illinois is a community-based, not-for-profit, free standing hospice. We give back, connect with people, and build relationships to foster trust and offer excellent end-of-life care when people need us most. We are proud to share 19 ways we made an impact in 2019. We challenge ourselves and our employees, year after year, to stay engaged and continue the tradition of a caring and giving heart! We are looking forward to 2020. While we look to grow and serve more people, always in the forefront is our mission: to enhance the quality of life for individuals and their loved ones touched by a terminal illness.

Served over 43,000 families since 1981 – we are your local, not-for-profit hospice with our roots starting right here in the Metro-East and Southern Illinois.
Celebrated our 38^th year of serving our communities – Hospice of Southern Illinois is an experienced leader in end-of-life care.
Welcomed Matthew Clark, PharmD, as our 4^th PGY2 (post-graduate, year 2) Pain and Palliative Care Pharmacist – Hospice of Southern Illinois’ Pharmacy Residency Program, in collaboration with the SIUE School of Pharmacy, remains the only accredited PGY2 Pain and Palliative Care Pharmacy Residency Program fully funded by a hospice in the United States.
Moved to our new clinical office – located at 333 South Illinois Street, Belleville, IL. The new Belleville Patient Services Location will bring our patient services and administrative teams closer together. Further, the space offers warmth and professionalism. While paving the way for our future growth, it pays tribute to our steadfast, rich history. Altogether, we are proud to showcase it to the residents of the Metro-East.
Reached 5,000 Likes on Facebook – we are your resource for hospice education and news locally. Thank you for your support, stories, likes, comments, shared dedication, compassion and trust for our mission and those we serve!
Marion Honor Flight – Hospice of Southern Illinois’ volunteers served on the Welcome Home Committee for the Veterans Honor Flight Volunteer Group. This group welcomed home 6 flights, actually attending 1 of the 6 Honor Flights. Moreover, 480 Veterans attended these 6 flights. Additionally, about 2,500 community members welcome each flight home at the Veterans Airport of Southern Illinois.
Hosted 15 Virtual Flight of Honor programs – together with community members from Alton, Belleville, Columbia, Millstadt, New Athens, Red Bud, Sparta, Swansea and Waterloo, Hospice of Southern Illinois honored over 200 Veterans. Without a doubt, Veterans and community members alike feel the honor, pride and appreciation when experiencing the typical “honor flight day” without leaving their hometown.
Expanded Pet Therapy Program – our pet therapy program is a complimentary service and an extension of our mission. We focus on finding ways to bring comfort and peace to patients and their loved ones. Pet therapy has the power to offer additional support, while adding joy, companionship, social interaction, and emotional connection to individuals at any stage in their end-of-life journey.
Volunteers donated over 9,000 hours – individuals came together and shared their time and talents with patients, families and employees to support our mission. As a result, volunteers gave back over $244,000 in exchange for their time!
7% of volunteer hours were in direct patient care – Medicare requires a minimum of 5% of volunteer hours in patient care. Our dedicated volunteer teams exceeded this requirement. (Photograph: The Fidget Blankets project comes from Hospice of Southern Illinois’ Volunteer Barb Kunstman. She has been sewing our logo on all of the Butterfly Pillows, clothing covers, medical supply covers, and lap quilts for years. Most importantly, these are given to our patients year after year.)
Presented and hosted over 130 presentations – we offer presentations, education, and resources at minimal or no cost to healthcare professionals, organizations and community groups.
Collaborated with community organizations – Carlyle Lions Club, Greater Belleville Chamber of Commerce’s Healthcare Committee Coat Drive, First Southern Bank + Employees, Highland Area Community Foundation, Kassly Mortuary 3^rd Annual Christmas Food Drive, and Southern Illinois Street Rod Association (SISRA). Thank you to these wonderful organizations for your support year after year!
Music and Memory – In 2019, Hospice of Southern Illinois began the MUSIC & MEMORY® Certification Program. As a result, certification ensures families and their loved ones have access to the therapeutic benefits of music. Additionally, it shows our commitment to person-centered care.
Hospice Month Campaign To Enhance Quality of Life – we launched a National Hospice Month campaign, “Living with Hospice.” As an example, we showcased the moments and memories that matter most between families, friends, and caregivers who are touched by a life-limiting illness throughout their final months and weeks. Those featured in the photographs live each day to the fullest, making all of their days count.
Involved in Salute to Scott – this O’Fallon-Shiloh Chamber celebration welcomes Scott Air Force Base residents, veterans and community members in finding fellowship through a community event. Hospice of Southern Illinois has been volunteering for over 10 years at this celebratory event!
Employees Celebrate Milestone Anniversaries – we are honored and proud to have employees who have a hospice heart and are the very reason we can continue our mission and philosophy. Specifically, they have been growing, changing and caring with us for over 20 years! Thank you, Deborah Hunter, 27 years, Donna Hinant, 23 years, Angela Stoeckel, 22 years, Jane Gazda, 21 years, Deborah Hogg, 21 years, and Pamela Rorie, 20 years. Thank you all your dedication to our organization and those we serve.
Welcomed New Associate Medical Director – Dr. Joseph Jackson, effective June 1, 2019, joined Hospice of Southern Illinois’ Associate Medical Director Team to contribute to and help ensure the highest standard of end-of-life care for our patients and families.
Updated our free phone app – Care | Convenience | Connection, Innovative functions, solutions, and resources to answer your questions and foster engagement at your fingertips.
Skills Lab – our education department has developed a one-of-a-kind skills lab to ensure our nurses have consistent, safe training. Additionally, collaborations with local colleges and universities allow our student interns the access to this distinctive, educational resource.

35th Anniversary Car Raffle Winner

October 14, 2016

Thank you so very much to all those involved in Hospice of Southern Illinois, INC.s 35th Anniversary Car Raffle sponsored by Watermark Auto Group, First Southern Bank, Huck’s General Store, and Simple Solutions Printing Inc. We appreciate your donations and contributions to support our mission! Purchasing a ticket helped so many patients!

Now without further ado… the winner of the BMW was LINDA MARTIN from Marion, Illinois! Congratulations and we hope you enjoy your new BMW!!!