Managing Pain At Home
- By Douglas Maitland, Harry B. Ray
- Nov 01, 2001
The needs of my 84-year-old mother when she suffered a fractured pelvis became a personal wake-up-call. When pain or comfort needs become personal matters, empathy and understanding increases in a heartbeat. Because a lengthy drive would be required in order for me to oversee the arrangements recommended by the discharge team, the tasks were carried out without a family member present. While I found myself frustrated and feeling helpless, an effective team and home health service completed the task and made my life easier from miles away.
A properly fitted walker, seating for the shower, commode placement and installation of rails became requirements for my mother's return to home- and self-care. Friends and family added small, comfortable touches that played an important part in my mother's recovery. A warm herbal and flaxseed pillow helped reduce deep aching bone pain during the healing process--an adjunct to drug therapy. Attention and visits, a small, lightweight hanging bag for her walker and a versatile portable container for pens, tissue, thank you cards and stamps, quickly became priority items and comforted her during her recovery.
Home health care suppliers are in a critical position to anticipate patient needs and offer advice, assessment and evaluation for patients regarding supplies, solutions and equipment. For many decades patients were obedient, receptive and compliant with directions given by health care professionals. Now, our increasingly educated and Internet-savvy population knows to ask for and find basic health care products if they have not been provided. The onetime compliant, quiet patient, who may have been accustomed to accept care without question, now speaks out about his or her needs. Outspoken, demanding, impatient or difficult patients or family members may be encountered at the home care level if adequate arrangements have not been made or if products do not meet expectations.
The foundation of holistic selling is compassion, empathy and assessment that considers the complete patient.
It also is important to remember that patients who used to spend long weeks within the hospital complexes or health care setting and rarely needed the equipment are now being sent to the home now. Family members need equipment ready for earlier than expected discharge. The key to a smooth transition falls on the home health care industry.
Holistic Approach and Home Health Care
Acute- and long-term needs are being addressed in home care catalogs as well as retail and supply areas. As you serve your customer base, the salesperson is pivotal. Will sales personnel locate a single item the customer came to purchase? Or will the salesperson listen, ask questions and recommend additional products that may make patients daily living easier.
Laurie Cain, purchasing assistant for Care Home Medical of Augusta HealthCare, Va., found that offering retail items that were more of a gift item seemed to appeal to many customers. The customer traffic in her retail area "are often the caregivers, looking for comfort-type products for the family members or patients or they are really buying for their own personal use." Cain said, "These add-on items are placed for easy viewing and have great appeal. The customer service representatives here help customers by suggestively selling items that contribute to comfort or ease of care. We do take the holistic approach as we help our customers and try to consider needs beyond medical equipment." Emphasis on disease and technological interventions in traditional medicine has precipitated the public's desire to seek more holistic approaches and they are anxious to find sources for these products.
The foundation of holistic selling is compassion, empathy and assessment that considers the complete patient. It involves conditions that brings the customer to you rather than simply being sales-oriented. This approach creates a depth that develops into a relationship lasting longer than the single sales receipt. These individuals leave your store satisfied by exquisite customer care. Return visits and word-of-mouth advertising is the least expensive form of advertising you will ever experience and it benefits both parties. Comfort and minimizing pain become the extra personal touches in the retail customer service area.
Emphasis on Pain Management
As pain receives more attention by health care providers, it automatically will affect all components of health care. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) now requires all hospitals, home care agencies, nursing homes, behavioral health facilities, outpatient clinics and health plans to implement ways to assess and manage pain within the years 2000-2001. Dennis O'Leary, MD, president of JCAHO reminds us that "Unrelieved pain has enormous physiological and psychological effects on patients. The Joint Commission believes effective management of pain is a crucial component of good care. Research clearly shows that unrelieved pain can slow recovery, create burdens for patients and their families, and increase the cost of care." The standards will first be scored for compliance in 2001.
Health care services are now required to:
- Recognize the rights of patients to appropriate assessment and management of pain
- Assess the existence and if positive, the intensity of pain in all patients
- Record the results of the assessment in a way that facilitates reassessment and follow-up
- Determine and ensure staff competency in pain assessment and management, and address pain assessment that supports the appropriate prescription or ordering of effective pain medication
- Educate patients and their families about effective pain management
- Address patient needs for symptom management in the discharge process
The management of pain is a vital issue. All 25,000 health plan members who had received care for specific conditions rated the care received for pain-related problems close to the least attended concerns. Grassroot movements such as the American Pain Foundation--www.PainFoundation.org--offers a Bill of Rights to those who live with pain. Pain is considered the fifth vital sign in the care of patients. All follow-ups of hospital stays will include an inquiry about the of the pain status of the patient.
Be aware that you may have more patients feeling comfortable of speaking up about comfort issues. Family input is encouraged within the health care environment, and this will crossover department lines. Home health equipment, supplies and products will provide comfort as patients are taught that pain management is an integral part of treatment.
Holistic home health is an ingredient to add for every level of customer care. In addition to products and equipment, comfort is a component important to both acute- and long-term customers. The customers you serve can be separated into five broad groups.
- Short Term Needs, Acute Needs, Post-Injury
- Chronic Conditions, Increasing Needs
- Ability Needs, Long Term
- Hospice, End of Life Issues, Palliative Care
- Caretakers, Family
Today's in-patient length of stay is shorter than ever. If it has been a few years since you or a family member has been hospitalized, the impact of leaving before you feel you are ready can be a shock. A larger portion of rehabilitation takes place in the home. The period of need is short, but not unimportant. The home setting requires assessment and adjustment to allow for manageable transition upon discharge. Family members look for products and tools to help during this time.
Beyond medication for pain management, is the use of hot and cold therapy. With all the new technology and plethora of tools to treat so many conditions, this is an old favorite that has been somewhat forgotten. Not because it wasn't effective, but more because manufacturers lacked aggressive and creative marketing campaigns. Often the lower cost of the hot and cold therapy could not support the necessary advertising to continue to promote it in heavy advertising.
Warmth can increase blood flow, increase oxygen profusion, enhance transfer of metabolites across the cell membrane, reduce muscle spasm, improve elasticity of connective tissue and help remove toxins, bacteria and other debris through improved cell membrane permeability. Injured tissues require adequate circulation and oxygen for healing and gentle compression and warmth is an excellent way to increase blood flow and tissue perfusion. Gently weighted warm flax packs can be safer and easier to use than electric units or moist heat packs that may deliver less predictable or more intense heat applications.
Ann Zander, manager of Rehab Services at Jefferson Memorial Hospital, works with in-patients, out-patients and home care patients. All levels of patient care require consideration of pain and comfort management outside the therapy session. "We all teach our patients easy post-therapy home care remedies that can be used inexpensively," Zander said. Freezing ice in a Dixie cup is a good remedy for acute pain, a bag of frozen peas, plastic gel products, or handcrafted grain packs work for cold. Wrapping a damp towel warmed carefully in a microwave and placed in a plastic bag or a grain pack can be warmed for pain management and comfort."
The family members of a patient with a chronic condition must learn the newest technology and products offered to address physical needs. "More that one-third of older persons reported being limited by a chronic condition--versus10.3 percent in general population--per the Profile of Older Americans, 1999, Administration on Aging. Patients and families rely on informed resources for improving care in the home. The home environment must be prepared as changes occur. Communication with health team members plays an increasing role in managing this particular group.
Long Term Care and Ability Needs
A patient's ongoing changing level of care may require additional attention and reassessment. Look for times a client remains in one stationary position for long periods of time and repetitive movements. Evaluate ergonomics and relationship to physiology and anatomy. Look at the personality of the person. Be aware of the level of fatigue. Observe muscle tension or chest compression. Watch for abrasions, irritations or inflammation and swelling. Observe for good respiratory potential with posturing, positioning, seating and reclining solutions. Support the lower back. Assess for sacral, coccyx, lumbar, mid-scapular aching, burning or shooting pain that may be related to over-fatigue or strain. Fitting may require additional products to assure comfort. Support and position, not pressure, is important for preventing pain or discomfort.
Achieving the optimal level of functioning, self-care, self-responsibility, independence and quality of life are the goals. Seeking ways to minimize symptoms, impairments and disabilities are key. In addition to physical needs, the emotional support that a supplier can offer with informed access to adequate supplies, proper equipment and attentive assistance is also important.
Hospice and Palliative Care
"Once a patient enters the hospice level, there is slightly more leeway for ordering equipment or supplies that the patient may need," said Lynn Mark, BA, RN, MA, CHPN. Intake nurse at the Hospice Program, SSM Hospice, St Louis, Mo., Mark said, "there are three vital patient issues of importance in Palliative hospice care: energy conservation, safety and comfort."
Research clearly shows that unrelieved pain can slow recovery, create burdens for patients and their families, and increase the cost of care.
Tools that make the environment work at optimum level can enhance the atmosphere of comfort. That is the goal of hospice. "Medical equipment suppliers can make or break this experience. The family is suddenly faced with new circumstances. A move away from the treat, treat and cure environment of the hospital to the home that becomes a mini-hospital is a major adjustment. It becomes a situation of meeting needs to accommodate the physical, emotional and social needs of the family, caregiver and patient. First and foremost on the agenda, is to have all required equipment delivered to the home prior to the patient arriving. This gives the family time to learn about the equipment and create a new home-like environment," Mark said.
We have become more attentive to the difference between curing and caring. The numbers of hospice patients tripled in less than 15 years (1985-1999). Palliative care with a focus on comfort, has received an amazing amount of attention in the past decade. This is due to:
- Increased interest in death and dying issues
- Increased numbers of hospice programs
- Improved recognition of pain and symptom management
- Increased concerns over high cost of end-of life-care
- Increased national focus on pain management
- Attention targeted to the practical needs of patients and their families from an early stage to the final stage of the illness.
Just as important as the patient, the caregiver turns to home health care for solutions for day-to day needs. "The number of informal caregivers (family members or friends) in the United States is estimated at 20 million to 25 million, accounting for 80 percent of care given to the chronically ill and elderly. About seven million caregivers provide or manage care long-distance." reports the National Council on Aging, 1997. Family members frequently have to balance work responsibilities or make arrangements in their limited time off from work or help manage parents' care across several state lines by telephone.
Mark adds, "The fourth critical consideration are the needs of the caregiver who presents their own package of concerns: fatigue, strength, emotional strain, etc. The hospice team looks at the total suffering. Pain is one unit. If all needs are not addressed, then pain can not be relieved. The unit of care in the home is the patient and the caregiver."
Working with the health care team focused on meeting a patient's needs becomes vital. Discharge planning, identifying continuing physical, emotional, symptom management, housekeeping, transportation, social needs and arranging for services to meet them must include the home health industry.
"Many times the patient will confide in our staff about discomfort during our fittings or assessments," said Dayle Sandler, owner of Medical West Healthcare in Clayton, Mo. "They are grateful for caregivers efforts but they may not say as much or complain so not to be seen as ungrateful. The herbal flax pillows are almost a surprise in our retail setting. They appear so unclinical, yet are clinical in nature. It seems that they empower the patient and the caregiver and also offers something positive in response to physical needs. This becomes a part of the fun of selling on a personal level. We offer them in the store and also send information in mailers. The phone orders for these products unseen was impressive and made us aware of how much individuals need products like this."
Follow up is important for every level of care. Patients and caregivers need simplicity so as not to be overwhelmed. Ask about comfort, times of discomfort, pain or misfit. What is the most aggravating issue the patient or caregiver has to deal with? Your phone call of concern helps minimize potential problems or misunderstandings and is a perfect time to suggest products to assist with comfort. The cost of gaining patient and family confidence and loyalty reaps benefits and becomes the best word of mouth advertising you can get.
The increasing number of patients needing home care is changing and growing. Meeting patient and family needs requires technical, empathetic and compassionate holistic assessment that includes pain management and comfort. Home care is an important part of the home health industry and vital in the big picture.
This article originally appeared in the November 2001 issue of HME Business.