One of the most common concerns expressed by families caring for a loved one with dementia is a familiar observation: “Mom was doing fine this morning, but by evening she became confused, anxious, restless, and kept asking the same questions over and over.” This phenomenon, commonly known as sundowning, is
One of the most challenging situations encountered by hospice and palliative care clinicians is the patient who continues to report severe pain despite receiving multiple opioid medications. The natural response is often to increase the opioid dose. Families frequently request stronger medications, patients report persistent pain scores of 8/10
One of the most important responsibilities of the hospice physician is determining whether a patient continues to meet Medicare hospice eligibility at recertification. While reviewing the medical record is essential, the Interdisciplinary Group (IDG) meeting provides something equally valuable: the opportunity to synthesize the lived clinical experience of the entire
As hospice and palliative care clinicians, we spend our careers caring for patients during the final chapter of life. We become intimately familiar with the diseases that ultimately claim our patients—heart failure, dementia, COPD, stroke, cancer, renal failure, and frailty. Yet, every so often we encounter someone who defies
A Practical Guide for Hospice and Palliative Care Providers “Sometimes the best palliative intervention isn’t another medication for symptoms—it’s restoring normal physiology.” Introduction Few problems frustrate hospice and palliative care teams more than the patient who develops “another UTI.” The story is familiar. An 84-year-old
There are few conversations in medicine that evoke more emotion than discussing prognosis, code status, or hospice enrollment. We spend years learning how to disclose devastating diagnoses, navigate goals-of-care discussions, and help families prepare for death. Yet, if you ask many clinicians who care for older adults, patients
Stop Telling Me the Answer. Show Me How You Got There. "The best CTIs don't simply state that a patient is hospice eligible—they demonstrate why." Another quote from beloved and well-respected Hospice Physicians- "think of your CTI as your love letter to CMS.
"Will this help my pain?" It's one of the most common questions I hear from patients and families. Usually, the question isn't really about acupuncture. It's about hope. People living with serious illness are often carrying much more than physical symptoms. There
In palliative care, we often think first about symptom control, emotional support, and guiding patients and families through uncertainty. Yet there’s another piece of the puzzle that can have an enormous impact on quality of life: skeletal muscle. Research has shown that muscle is not just about mobility or
The cerebellum—Latin for “little brain”—may account for only about 10% of the brain’s total volume, yet it contains nearly 80% of all neurons in the brain. Located beneath the occipital lobes at the back of the skull, the cerebellum plays a critical role in coordination, balance, speech,
In palliative and hospice care, our work often hinges on recognizing subtle cognitive changes before they escalate into crises. When most people—clinicians included—think about dementia, they think about memory loss and confusion. While these are hallmark features, they are not always the earliest signs of cognitive decline. One
Agitation is a frequent and distressing symptom in individuals with advanced dementia. It may manifest as restlessness, verbal outbursts, pacing, aggression, or resistance to care. For patients in hospice or palliative care settings, these behaviors can pose significant challenges for caregivers, impact the dignity of the patient, and strain the