Introduction In hospice and palliative care, clinicians are trained to recognize many of the classic markers of decline: progressive weight loss, dysphagia, recurrent infections, worsening cognition, increased sleeping, and escalating dependence with activities of daily living. Yet one of the most clinically meaningful and often underrecognized indicators of deterioration is
Introduction: A Familiar Medication, An Uncomfortable Truth In hospice and palliative care, few medication classes are as ubiquitous—or as quietly controversial—as benzodiazepines. Lorazepam, alprazolam, clonazepam, and diazepam are encountered daily across care settings, often prescribed for anxiety, agitation, insomnia, dyspnea, and terminal restlessness. For many patients entering hospice,
A practical, defensible guide for hospice and palliative care clinicians Introduction: The Tension Between “Expected Death” and Legal Duty Hospice and palliative care clinicians are uniquely skilled at recognizing when a patient is approaching the end of life. We think in terms of trajectories—functional decline, symptom burden, nutritional status,
Introduction: “Why Is Mom Suddenly So Weak?” One of the most common—and emotionally difficult—questions asked in hospice care is deceptively simple: “Why is she getting so weak?” Families frequently observe changes that seem to happen all at once. A loved one who was previously able to stand independently
Falls in Older Adults: A Public Health Crisis We Often Underestimate Falls are extraordinarily common among older adults, yet their significance is often underestimated. Approximately one in four adults over the age of 65 experiences a fall each year, making falls the leading cause of injury-related morbidity and mortality
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.