This is end of life care which may be provided in your home or at a designated facility such as a hospital or nursing home.

If life expectancy is six months or less  or  curative treatments are no longer working and/or a patient no longer wants them, then choose hospice.  They will not offer cures, but rather comfort items such as medications for pain.  Also see links in my blog about hospice .

Levels of care (1):

routine home care ……...medications, nurse visits, physician consults, spiritual counsel

continuous care………… in the patient’s home, more intense care

general inpatient………...Facility: freestanding; part of a hospital or long term care

respite care……………… up to 5 days of inpatient care to give family members a break

Note that Medicare (2) pays for most hospice care but pays a flat per diem rate regardless of the care needs of the patient.  However, I’d advise you to get the latest hospice info from Medicare since laws change.

Questions to ask:

  1.  Where is the staff located?  You don’t want them to be 50 miles away.
  2. There should be full-time medical director available full-time to make home visits, consult with other physicians, and act as a resource for nurses and one on call 24/7.
  3. Is there a case manager nurse directing your care? There should be the same nurse who visits you every time .  Are their nurses licensed or registered? Registered is preferred.  If they are certified for palliative care (CHPN)  that indicates this hospice cares about quality.  How many patients are assigned per nurse?  If more than 10, care may not be as good.
  4. Do they have home health aides to provide personal care?  How often do they visit and how long do they stay?
  5. Are they accredited?  By whom?
  6. Do they have social workers?
  7. Do they have a chaplain?
  8. Are there volunteers?  Are they there because this hospice dis a good job for one of their loved ones?
  9. How long have they been in business?
  10. Is this a for-profit or not-for-profit agency? This matters because medicare pays a flat rate per patient per day while patient needs vary greatly.  If it’s a for-profit hospice, are they choosing patients with less care needs and/or the potential of longer lives?  Dementia for example may require less service than a terminal cancer patient. See the article for details (3).
  11. Pharmacy - how close is it?  How easy to get medications when you need them? Does the hospice provide you with an emergency medical kit so the patient doesn’t have to wait hours for help if there’s an emergency?
  12. What local facilities do they work with should the patient need care in a facility?
  13. Advantages and disadvantages  of hospice  range from less cost to you to not being allowed to enroll in clinical trials.





(4 )

Five hearing tech announcements that could benefit older adultsPosted: 12 Sep 2016 07:20 AM PDTHearing technology advances -- the hearing aid industry considers changing. It’s a positive when you see disruption of industries that have too tight a lock on the consumer, whether it is in categories of health insurancetelecom carriers or hearing aids.  You spend time with people everywhere you go – those with significant hearing loss but no hearing aids; they have hearing aids, but hate to wear them.  According to a recent NY Times article, two-thirds of adults over 70, but only 15-30% of those wear them – and at $5000 a pair, no wonder. In recent years, personal sound amplification products(PSAPs) that are not classified as hearing aids and thus do not require the audiologist role, though the FDA may change that. Just asking, if the device is called a 'Wearable,' does Silicon Valley find it more worthy of funding?  But anyway. In July, Consumer Reports published an explanatory guide that should be required reading for organizations that serve older adults. It would seem to be the wild west of innovation.  Here is a sampling of five recent product announcements:ReSound. The firm "introduced a new model to the award-winning ReSound LiNX2™ family: the world's only mini behind-the-ear (BTE) model to feature Made for iPhone. In addition, the mini BTE also features telecoil capabilities. ReSound LiNX2 is the world’s first internet-connected hearing aid, connecting to the internet to locate misplaced hearing aids. This new model enhances the award-winning ReSound Smart Hearing portfolio, giving users even more choices to meet individual preferences and hearing loss needs." Learn more at Resound.Oticon. 

"Technological limitations of current hearing aids have led to the use of tunnel directionality: Speech coming from the front is clear, whereas the rest of the sound environment is suppressed. This results in a limited, narrowed and artificial listening experience. With new, groundbreaking technology, Oticon Opn™ is fast and precise enough to analyse and follow the soundscape and differentiate between sounds. Even in complex listening environments, this allows Oticon Opn™ to constantly open up and balance individual sounds to deliver a rich and meaningful soundscape, empowering the brain to choose on which sounds to focus." Learn more at Oticon.

Silicon Valley based startup that "offers an entry-level rechargeable hearing aid (FDA class I medical device) that it sells directly to consumers. Eargo is a near-invisible in-the-canal device offering four volume settings. Developed by a French ENT, it features patented silicone “flexi-fibers” that enable the device to sit comfortably deep in the ear canal while letting air and natural sound flow freely to the eardrum. At $1,980 per pair, the Eargo hearing aids are more expensive than many of the new off-the shelf “hearables” (classified as personal sound amplification products, or PSAPs, by the FDA), but less expensive than the higher end hearing aids fitted by audiologists." Learn more at

 "Cochlear Limited (ASX: COH), the global leader in implantable hearing solutions, announces today it has received U.S. Food and Drug Administration (FDA) approval for its newest innovative hearing loss solution, Kanso. The Kanso Sound Processor provides a distinct new way for cochlear implant users to hear. Unlike most hearing aids and current cochlear implant sound processors that are worn on the ear, Kanso is a small, off-the-ear hearing device  that provides a more discreet hearing solution and delivers the same hearing experience as a behind-the-ear sound processor." Learn more at Cochlear.

 "iHear® Medical announced today the launch of the world’s first online hearing solutions platform. The company begins taking orders today for its flagship invisible iHEARHD® hearing aid, and the iHearTest™, which recently received landmark FDA approval as the first and only home hearing screener. Delivery of iHear products starts July 15, 2016. The company also plans to launch the iHEARMAX™, a mini behind-the-ear hearing device, on August 15, 2016. iHear’s products are currently being offered in the U.S., with plans to introduce them in China and other markets in 2017." Learn more at iHearMedical.