Although these individuals can’t control or thwart these behaviors, they can cause a good deal of frustration and stress for their caregivers. The most important thing that you can do as a caregiver is something you must first do for yourself. You must come to the understanding that any actions or words of aggression that stem from an Alzheimer’s patient cannot be taken personally. Behavior troubles such as aggression, distrust, or wandering are caused by chemical reactions and damage to the brain, and they are not necessarily something that your patient can control or prevent. So, remember this when persons with Alzheimer’s do or say stuff that can be interpreted as insensitive.

Things to Consider with Agitated Patients and What you Can Do

1. An underlying issue such as pain, thirst, hunger, or an infection that has gone undiagnosed often causes agitation. You’ll want to try and discover the cause, and then take appropriate actions. If you suspect pain or infection, you will need to notify the head nurse or attending physician.
2. Boredom is a common culprit of seniors acting out – after all, they often feel lonely. If the patient is physically able, you may want to get them involved in an activity, or even talk them for a walk or wheelchair them around the premises to help them feel better.
3. Don’t be surprised if patients act out occasionally, and this behavior is not limited to Alzheimer’s patients. Many of the most perceptive CNAs have learned to provide their patients with ample positive attention while they are calm, which helps avoid the entire scenario of them crying out for attention.

Some Tips to Calm Patients with Dementia Related to Alzheimer’s

• Soothing music, soft toys, favorite personal items, and a gentle touch can be helpful.
• Distraction can be highly effective and is far more effective than attempts at reasoning.
• Ask closed questions as opposed to open-ended ones that leave the patient struggling for answers.
• Reminisce with the patient and help them focus on positive experiences of their life
• Therapeutic activities like mild exercise, art, and interacting with other patients can be quite helpful to lift a patient’s spirits and distract them temporarily from their troubles.

Dealing with these patients is not always easy, and it can be downright disheartening to witness patients falling into states of dementia or developing Alzheimer’s disease. However, it is a part of the job, and with time and experience, you’ll learn which approaches work best with individual patients.

Specific examples of elder speak include:

• Using a simplistic vocabulary and grammar
• Shortening your sentences as if they cannot understand the concept
• Slowing down your speech
• Elevating pitch or tone
• Overuse of terms of endearment
• Collective pronouns – “Are we ready for our dinner?”
• Tagging Questions – “You’re ready for a bath now?”

Certainly, there are situations that are the exception, and if you have a patient that is hard of hearing, suffering from dementia, or other situations, using elder speak to some extent may be necessary. These instances call for you to use your better judgment on a case-by-case basis. Be forewarned, that if your charge is not one of these special cases, they are very likely to resist any and all assistance from you. After all, who likes to be approached in such a condescending manner when they can fully hear and understand what you are saying? More specifics about this topic can be explored in our article concerning the Emotional IQ of a CNA.

Taking an Alternative Approach

In lieu of the elder speak approach with your senior patients, even when they are suffer from dementia or other problems, there are more effective approaches you can utilize. Psychological studies of elderly patients and their interactions with caregivers exhibit that things roll much smoother when a more traditional method of communication is used. Specialists in the field recommend that caregivers:

• Speak in a normal tone
• Use normal words
• Attempt reorientation
• Use distractions
• Provide positive feedback
• Use Memory Aids

Keeping this concept in mind, it’s crucial that you take an emotional inventory of sorts, in efforts to discover if you really have what it takes to be a certified nurse aide. These five areas of emotional competency may not be intrinsic to your nature – however, most of them can be learned and mastered with practice and experience.

Self-Awareness and Regard for Others

If you have the ability to recognize your feelings accurately, you probably can safely say that you have a high emotional IQ. Understanding what you are feeling when dealing with a complicated situation on the job will help you better deal with the patient in many aspects. Essentially, recognition of your emotions is the first step in adequately masking your displeasure of feelings of hurt when an uncooperative patient gives you problems. Many experienced CNA’s are able to handle these circumstances in the same fashion as they deal with children: patience and a straight face.

This leads to the second element of the equation – how are your reactions and responses making the patient feel. Do you have the ability to look beyond your emotions to ultimately realize the affect on your charge? If you feel as though you are not so skilled in the emotional IQ department, don’t panic! There are plenty of resources available to help you learn how to master your emotions, and time on the job may well prove to be the best teacher.

Mood Management – Yours and Others

Part of possessing high emotional intelligence involves controlling your impulses and dealing with any uprising anger constructively, whether the discontent be yours or the patient’s. As with any job, expressing negative emotions can be a firing offense, so the ability to control them is instrumental to maintaining a good standing with your employer – not to mention relations with the patients.

According to many experienced CNA’s, they have had experiences where they fully believed that they were masking their anger, only to receive a reprimand from their supervisor later on. Even though they were keeping a straight face, the patient’s seem to have the ability to tell through very subtle cues about their displeasure. This is not surprising so much, is it? Just because a person is ill or elderly, it doesn’t mean that they are not astute enough to see through a thin veil put out to attempt masking your anger. Even the best CNA’s have to work on their ability to manage their moods successfully, which means they don’t have to hide their feelings whatsoever.

Motivation

What really motivates you and pushes you to achieve your best work? If it’s financial gain, you might not be looking into the right career. Although CNA salary is quite good, it certainly will not make you wealthy in the finance department. This particular job is one that you really need to like on some intrinsic level and truly enjoy. Certainly, no job is a trip to Disneyworld, but if you do not genuinely care about the well being of the patients, this is no arena for you to enter. Before heading to work every day, a CNA needs to possess the ability to work towards the goal of having a successful, productive day with a positive attitude.

Empathy

This is one that you either have or you don’t. Do you truly feel sad when friends and family are having problems? Can you realistically say that you care about the well-being of others? Then you’ve got what it takes to work in the medical profession as a CNA, HHA, or hospice and palliative caregiver. For example, if you have a grouchy or reluctant patient, you might have the natural inclination to see beyond their anger and irritation, and have an understanding of the reasons behind their irritation. Things such as loneliness, despair, and fear often fuel client hostility. Being able to put yourself in another person’s shoes will help you easily manage many of the other aspects of emotional intelligence.

Managing Relationships

Employment as a CNA is all about relationships – with patients, their families, and your co-workers and supervisors. These relationships will often test your ability to resolve conflicts, as well as your ability to cooperate with the members of the clinical team. Working well with others is the only way to ensure that every patient receives the care and dignity they deserve, after all, it’s their troubles or situation that is ultimately paying your salary.

Can You Do It?

As you can see, there is much more involved in being a successful CNA beyond performing task-associated duties, and it takes more than two working hands to be considered competent within this rewarding field. The more in touch you are with your emotional competency, the better your job performance and satisfaction will be. You’ll be able to communicate more effectively, boast a higher level of productivity, and manage changes more efficiently. Again, if you don’t have all of these skills mastered, don’t be discouraged! You will learn in time, as long as you have the willingness to try, you might find it easier to reach a higher emotional IQ than you think with the right experience.

One misconception that students seeking CNA certification often have, is that working with seniors will be dull and messy, and they dismiss the idea early on of pursing a career specializing in gerontology CNA work. Surprisingly, you might find yourself outmatched by some of the seniors within care facilities today. Unlike the good old days, the most recent generation of seniors is relatively independent, strong-willed, and some are downright energetic. Because of the wide range of facilities that exist solely with intent on creating a safe, comfortable environment for like minded retirees, there are several distinct options within the genre for consideration.

Continuing Care Retirement Communities, or CCRC’s

This is one of the more opulent and sought after places to land a CNA gig, as these facilities are distinct from nursing homes and other types of care in significant ways. Residents living in a CCRC, typically have their own private apartments, and they perform most of the upkeep themselves. When working in this environment, you will assist the community’s dwellers as much or as little as they require.

Many of these facilities feature lavish amenities such as tennis courts, movie rooms, and fitness centers, so part of your job might be to set up or oversee these types of activities. Other shifts can be rather exciting if you are in charge of taking the CCRC’s patrons on excursions or entertainment ventures. However, depending on what areas of the community you are assigned to, you may find yourself doing more paperwork, oversight, and vital sign checks than anything else some days. Those who live in a continuing care retirement community are often paying hefty out of pocket fees to live there, which means that the employees tend to receive higher wages. You can see why these jobs are highly desirable for the ambitious CNA.

Convalescent Homes

These facilities can provide either long term or short-term residency for seniors. In addition to housing for geriatric patients, many convalescent homes today are used as a rehabilitation center for those who need additional medical assistance while fully recovering from an illness or incident. For example, a patient that doesn’t require hospitalization is released, but has no one to care for them at home. The complexities of Medicare, Medicaid, and insurance policies have forced individuals to make tough choices concerning their medical care.

Fortunately, many seniors in this situation can take respite at a convalescent center until they are fully recovered, and still receive some sort of coverage benefits. Convalescent homes offer complete care, rehabilitation sessions, occupational therapy, and much more to their temporary and full time residents. This particular sort of senior care facility offers good pay for CNAs, and the environment can best be describes as cross between a hospital and a nursing home. Your job duties will most resemble the work required of a nursing assistant employed in a CCRC.

Traditional Nursing Homes

Nursing homes are the most common place of employment for CNA’s, and over time, these institutions have evolved tremendously. Certainly, you are no stranger to all the headlines concerning abuse of the elderly that occasionally occurs in nursing homes– however, stringent regulations and highly enforced laws and regulations have helped tremendously in lessening the occurrence of these situations. These regulations are directly responsible for many of the hoops you jump through when enrolling for your CNA classes, such as the background checks and fingerprint ID cards.

Working in a nursing home generally entails performing many of the most basic CNA tasks, as some of these facilities house seniors that are not quite as active as their peers. Activities and outings for these patients are somewhat limited, and they tend to require a higher level of attentiveness from nursing aide staff members. Be prepared to deal with issues such as Alzheimer’s, dementia, and even downright crankiness. Not all residents are happy to be there, and may be resistant to your help. Many people end up in nursing facilities because they are all alone and have little or no family nearby. Also, financial issues may be a large contributing factor to their choice to reside in a nursing home, as the alternatives mentioned above tend to cost more, and may often be denied by insurance and Medicare contributions.

As you can see, each workplace has its own merits and potential drawbacks, yet each of them provides a secure place to work and often a set schedule, which is convenient for those with families or school commitments. Whether you plan to be a CNA for life, or plan to achieve further certifications and status levels within the medical field, these senior care facilities can offer you a world of experience that will prove useful in your pursuits.

Types of Tasks Within Each Setting

Generally, the tasks you will be required to perform will be the same – tending to grooming, hygiene, and taking and recording vitals. Unlike in a nursing home, where there are orderlies and janitorial employees, HHA’s and hospice care CNA’s will often perform light housekeeping duties and may be asked to run certain errands for the family. Whether you are employed privately or through a home health care service will be the deciding factor. Working privately has its benefits, especially concerning the level of pay, but you may be expected to perform these additional chores including cooking and assisting with young children.

Naturally, you will need to be more independent when working in a patient’s residence either privately or through a service, and keeping any necessary supplies on hand at the home is an additional task you will deal with. As a home health care CNA, you will likely get to know the patient and their family quite well, at least more so as compared to brief encounters with relatives in a nursing home. Let’s face it, not everyone is exactly a charmer, and some families can be downright disagreeable. Often, this is due to stress caused by their loved one’s illness, but sometimes, you may encounter truly unpleasant people. This is more likely to occur in hospice or when working for an agency, as you don’t get to choose who your patients are.

Number of Patients

This is probably one of the biggest differences for obvious reasons. In home care, you will work with one patient for extended periods, often up to 8 hours, depending on the patient’s status. You may finish your duties quickly, and be left with not much to do beside taking vitals and checking on the patient. If none of your patients is on full-time watch, you may have several specific patients to attend to each day, and they will usually be the same patients, so you know what to expect.

In a nursing home, you may be assigned an entire wing of patients to work solo, or in partnership with a team of nursing assistants. Every senior care facility operates differently. Patient assignments may work on a rotating basis, while others prefer to keep patients with familiar caregivers. This is something you may want to ask about when interviewing for a job at a facility. Not only does it show that really know what you’re facing, but also that you are interested in the job’s specifications – eagerness is always a bonus with interviewers.

Office Politics and Team Work

If you don’t like to get involved in this all too common practice, working within a facility may not be right for you. Nursing homes and senior care institutions require you to work closely with a team of caregivers, so if you enjoy that scene and the sense of camaraderie it can provide, go for it. Many CNA’s prefer to have an organized structure as opposed to driving around town and being responsible for transporting supplies for patients. Those who prefer to do their own thing and work independently are perfectly oriented for home health care positions. The most successful home heath aides are highly motivated, enjoy getting to know their charges, and have no problem getting their work done without constant oversight.

Gaining Valuable Experience

Regardless of which type of working environment you prefer, you will likely learn quite a few new skills very quickly on the job. If you plan to pursue higher levels of nursing in the future, either one of these types of employment will prove invaluable because each experience is unique. You’ll quickly discover which is just right for you as you progress in your training and experience as a certified nurse aide, and both of these options will provide you with a world of opportunities and a good CNA salary.

CNA Functions in Hospitals

Because hospitals feature a variety of departments, there are CNA positions within the emergency room, intensive care, progressive, care, and other areas of the institution that handle less severe patient cases. You will still work under the direction of an LPN or RN and will provide patient care based upon their individual care plan. Each patient’s care plan will provide you with all of the info you need to know to do your job including:

• Date and reason for admission
• Vital sign schedule and readings
• Patient-specific notes for care and feeding requirements
• Details of their condition and treatment plan
• Medications they are taking
• List of doctors and nurses overseeing patient status

After handling each patient and again at the end of the day, your patient notes will be turned in to a nurse, and these are often used to help determine the future course of the patient’s treatment to help them recover and return home quickly. You’re an integral part of the team! Many CNA’s enjoy working in hospitals because they have the chance to work in a number of departments, thus, keeping the job fresh and exciting. Additionally, if you are planning to explore pursuing and LPN or RN title in the future, this experience is invaluable because you get to explore the many facets of hospital care.

Expectations for each Hospital Shift

At the beginning of each shift, you’ll be informed of the room numbers that you will be handling for the day, and you will go on rounds with the CNA that you are relieving. This allows you the chance to get a heads up concerning the patient’s condition and help you be prepared for your tasks ahead. After meeting with the nurse in charge and receiving the medical reports for each patient you are assigned, your shift officially begins.

The level of care you give will depend on the department you work within. Emergency room CNAs will primarily deal with accumulating intake information, taking vitals, answering patient call for assistance, and help them use the bathroom facilities. As patients are discharged or moved to a room, you may also be responsible for sterilizing the room and restocking any supplies that were used. Working in the main care wing with stabilized patients is a bit different. You’ll be handling those duties, in addition to many of the other aspects of the work that you learned in your CNA training and certification classes such as feeding, grooming, and so forth. However, how much help each patient actually needs will vary depending upon his or her physical condition. You may actually only need to set up the hygiene items they need, or you might need to perform the entire routine for them. At the end of each shift, you will complete your paperwork, take the incoming replacement on rounds with you, and then checkout with the charge nurse before clocking out.

Time Frames, Workload, and Pay

Hospital CNA often enjoy very stable, set hours each week, while those in nursing homes or working as home health aides may experience a varied schedule. The extensive staff at a hospital can often cover for employees when they need to miss a shift unexpectedly, but smaller facilities may not have the staff capacity to do so. This means that your hours and shifts could change suddenly when a coworker cannot fulfill their duties.

As a hospital employee, you have the opportunity to work full time and may be offered rotating weekend and holiday schedules. Because of the nationwide shortage of CNAs, overtime is very possible within the hospital setting, as they tend to have the budget to cover the additional pay. In addition to these benefits, a hospital CNA salary tends to be higher than jobs within senior care facilities, and there may even be opportunities for bonuses.

As you can see, working in a hospital setting is the perfect choice you if you’re seeking stable hours that allow you to concentrate on school, tend to your family, or whatever else your life entails. It’s also ideal for those who don’t mind having a different set of patients each day. Hospital turnaround is rather quick these days, so you will not have the chance to forge personal bonds with patients as those who work in care facilities or in residential settings. If these benefits sound good, and the drawbacks seem inconsequential, then becoming a hospital CNA may be the answer for you.

Requirements for CHPNA Testing

Because of the prerequisites in place to qualify for testing, it is important for you to secure a place in the workforce that will allow you to gain experience in hospice or palliative care. You will need to work in a hospice care situation directly under the supervision of a registered nurse for a minimum of 2000 hours before you can apply for CHPNA testing. This experience is deemed necessary by the accrediting board, and without this practice, one may find that they experience difficulty passing the examination. Therefore, you will need to submit documentation that you have achieved these hours, as well as complete an application for testing. Fees average between $130 and $180 depending on whether or not you choose to become a member of the HPNA prior to testing. Testing locations are widely available, and most states boast sites within their major cities and highly populated metropolitan areas.

The Certified Hospice and Palliative Nursing Assistant Exam

The CHPNA examination consists of 110 multiple-choice questions that have been created by individuals with expertise within the field of hospice nursing, and you will have three hours to complete the test. These questions are relevant and appropriate to test your knowledge within the field. This type of examination is geared towards ensuring that your two years of experience has taught you all you should know to be successful in the field. Unlike your CNA training, there will be no practicum skills tested, only the written exam. One of the best parts about becoming a CHPNA is that you do not have to take any additional coursework in order to get your certification, as you will learn most of these tasks within your CNA training classes. If you are interested in seeing some of the types of questions that are on the exam, visit the HPNA website.

Why Get CHPNA Certified?

The benefits of certification are numerous, and as an individual pursuing CNA certification, you surely understand the reasoning behind employers showing a preference for hiring the best caregivers in the industry. Getting certified not only reassures employers that you will do a good job in caring for their patients, but the patients you care for have a sense of relief knowing that you are qualified. Naturally, you should receive a higher pay after certification, even if you stay working at the same facility where you earned your qualifying hours for testing. Your work in hospice can be rewarding in more than just a financial sense, as you will likely find your job to fulfill your intrinsic need to do something special with your life, and CHPNAs certainly fit that description.

Now considered a healthcare revolution, hospice services allow those in need of care to have more choices concerning their healthcare, and pain and isolation are no longer necessarily part of the journey. The field of hospice has had a drastic impact concerning shaping the careers of those in the medical field, including CNAs, who can become certified in hospice and palliative care without taking additional coursework. Now that hospice is clearly here to stay, healthcare consumers and employers are constantly seeking out those with certification as a sign of clinical excellence within this unique field. Before you delve into this rewarding career, lets clear up one of the most commonly misunderstood notions within the field – the difference between hospice and palliative care.

Palliative Care

This type of care is quite similar to hospice care; however, unlike hospice services, palliative care can be implemented at any time during a life-threatening illness. Commonly, you will encounter cancer patients, heart patients, those with liver failure, or patients with any other serious illness that can negatively affect their quality of life. Palliative care is distinctly different from hospice services in the aspect that it does not preclude the use of aggressive treatment of the illness. The primary goal when under palliative care is to ease symptomatic side effects that result from both the illness and any prescribed treatments, such as chemotherapy.

Patients in palliative care receive all the same benefits of hospice patients including social services, full medical staff assistants, and counseling services. Patients can receive their treatment anywhere they choose, and the earlier one signs on for the care after diagnosis the better. This allows the patient and family to clarify and goals of the treatment, whether it is successful or not, to ensure that everyone’s wishes are accurately followed. The results of this care go one of three directions: Either the patient recovers fully, requires palliative care for an extended period, or treatments ultimately fail, and the patient will typically go into the hospice care stage.

Hospice Care

Once hospice care steps in, the patient and their family has likely made the decision that further medical treatment is futile. The goal at this point switches into purely ensuring a patient’s quality of life during their journey’s end. This type of care is designed to minimize the pain and suffering of those with a terminal illness, rather than to cure the illness. Like palliative care, treatment can be provided at home, in hospice facilities, hospitals, nursing homes, and other skilled long-term care institutions. One of the founding principles of hospice care is the conviction that all individuals have the right to depart this life pain-free and with the utmost dignity, while their friends and family are close by. As with palliative care, a hospice team including doctors, nurses, CNAs, social workers, and chaplains closely work with the patient and their families during this trying time.

The team works together to help relieve the patients suffering and to ensure they are as comfortable as possible, as well as to aid with the spiritual and emotional aspects of dying. All necessary supplies can be brought into the home if they choose, and typically, a hospice certified CNA steps in to aid the families in learning how to properly care for their loved one within the home environment. Many hospice patients tend to have fluctuating days, which can often become too much for the home caregivers to handle, and CNAs and nurses may be on 24 hour watch shifts as the end nears.

Making a Difference as a Hospice CNA

As you can see, palliative care is simply one form of hospice, but is reserved for those that still have hope of finding a cure. However, when treatments are unsuccessful, and hope for a longer life is no longer expected, hospice care’s end-of-life experts step in and help maximize the lifespan the patient has remaining. Embarking on a career as a certified hospice and palliative CNA is tremendously challenging, yet highly rewarding on a personal level. You will know you made a difference for these patients and their families with your assistance, compassion, and dedication to your work. Check out our article concerning How to Become a Hospice CNA to see how easy it is to get into this career after receiving your CNA certification.

Working in hospice care can be a rewarding yet challenging position, and it takes a exceptional kind of person to succeed within this workforce. However, for those who do, they know that they are truly an integral part of something special. Hospice is primarily designed to serve people that are nearing the end of their life, whether through old age, terminal illness, or a chronic condition. Naturally, these patients will have special needs, and hospice care is designed to help enhance these individuals remaining time through support, pain management, and other services. As a hospice worker with CNA certification, you will be an important part of each patient’s hospice experience, and possibly one of the most involved participants. After all, it is the CNA who regularly attends to patient’s grooming, feeding, and other essential duties for those under hospice care.

Choosing a Work Setting: Personal Homes or Care Facilities

The primary focus of hospice is to focus on keeping patients as contented as possible, which is why services will be available in a patient’s home, an assisting living facility, nursing home, or hospital. Patients with families will often choose to remain in their home, while others will choose a facility to not be a burden on their loved ones. Realistically, an overseeing physician for each patient’s case will ultimately make a recommendation, but the final choice is typically left up to the patient or his or her guardian.

Many hospice care providers will offer their nurses and nurse aides the opportunity to choose whether they prefer to work within the primary care establishment or in a patient’s home. Naturally, your access to reliable transportation and possessing a good driving record will be essential to work in the home setting. Depending on the size of your city and the span of the hospice care’s servicing area, expect to do a good bit of driving if you choose to work in private homes. As a CNA, expect the working conditions to vary between providing care for patients at home vs. facility care, so see our in-depth article discussing the differences.

Working with Hospice Staff to Foster Patient Comfort

A dedicated team of caregivers is assigned to handle each hospice care patient’s case. There will be a primary medical physician, and typically, a team of two on-call nurses that will be your contacts in case of emergency, and they are whom you will report patient’s changes in status to when necessary. You will be required to work closely with these medical providers to ensure that the patient is properly medicated and being properly cared for by family members if they are receiving home care. A social worker and chaplain is often assigned to help families and patients deal with the inevitable passage of life, so be prepared to process requests and information provided to you by them, as well.

However, there will often be several different people with CNA certification assisting to a particular patient’s needs. You may only see a certain patient once during the course of their time under the care of hospice, or you might be assigned to regularly care for them. Every situation is different, and your scheduling will be highly dependent upon your choice of work settings. Because of the constant shift in nurses aides, keeping good notes is essential to performing your work duties. Documenting the procedures you perform, the medications the patient is taking, and their personal and physical demeanor is important to keep all of these staff members on the same page, so to speak. You will find that you heavily rely on the notes of previous staff to keep you informed, and the benefits of keeping paperwork current are obvious.

Is Becoming a Hospice CNA Right for You?

Naturally, in this position, you will be performing the duties you learned in your CNA training classes, but hospice care often serves up a few additional challenges. For this reason, many states and certain facilities prefer to hire nurse aides that have undergone specific enhancement training for hospice care. Working as a hospice CNA is ideal for those with a good deal of compassion for the well-being of others, and it certainly takes a lot of patience, especially when dealing with those very close to death. Emotionally, this work can be trying, as you must understand that inevitably, your patients will pass away. It is not uncommon for nurse aides to become emotionally attached to their patients, and you need to be prepared to cope with grief yourself as you help patients and families do the same. Those up for the challenges of hospice will find themselves the recipient of personal rewards, as well as a higher CNA salary.

Routine Home Care

Routine home care is the most basic level of care one can receive under the hospice benefit; however, patients that reside in a nursing home facility can also be considered under this category, as that is their home. During the course of this type of care, there-

 are a number of things that occur involving all parts of the interdisciplinary team, and many of the procedures are carried by out by hospice and palliative CNA team members. A registered nurse will typically visit the residents between one and three times per week based on each patient’s needs, but can occur more often as necessary.

Physicians rarely make house calls to patients, as they have generally already met with the patient prior to their enrollment in hospice care; however, nurses stay in constant contact with the overseeing physician concerning the patient’s status. Counseling and social work services are dispatched as needed to the patient’s home or care facility to address pastoral, bereavement, and financial services.

Continuous Home Care

As a hospice CNA, many tasks will ultimately fall upon your shoulders, as you will encounter patients more often than they will encounter any other medical caregiver, especially within the home. Expect to visit patients at least two to three times per week to assist with grooming, bed linen changes, and light housekeeping in addition documenting the patient’s status concerning pain, medication availability, and emotional standing. You will also behelping family members and patients become familiar with any medical equipment ordered, and you may need to show them how it operates after delivery to the home. You will also need to ensure that all equipment works during your visits, and take special care with vital equipment such as oxygen tanks, nebulizers, and other essentials that contribute to patient comfort. Home care does have its challenges, but it also gives you a chance to bond with patients and families on a level that other medical providers do not have the opportunity to.

When a patient develops emotional or physical symptoms that are not easy to manage under routine care, the next option is continuous home care. Some examples of the symptoms that call for continuous care are increased levels in pain, new symptoms, breathing problems, nausea and vomiting, emotional troubles, or a breakdown within the primary caregiver support system. This level of hospice provides additional care within the patient’s home environment, and the need for this care is reevaluated every 24 hours. Depending on the status of the charge, nurses or CNAs will remain in the residence with the patient for a minimum of 8 hours per day up to round the clock care. Because CNAs cannot administer medications, you would likely be filling in during the hours when a family member or nurse authorized to administer medication is not available. Of course, this depends on whether the patient is in a private home or a nursing home. When working a case requiring continuous care you will need to bring a lunch to work and something to occupy the down hours such as a book, puzzle, or personal project.

General Inpatient Care

Some patients have symptoms so severe that inpatient care is the most reasonable solution for both the charge and the caregivers. Inpatient care is anexcellent way to ensure that the patient has continuous access to a full medical staff armed to handle any problem that may arise at any time. Essentially, the approach to caring for the patient will not differ from any other level of hospice care, as only the patient’s location is changed. Facilities that offer inpatient hospice services include:

• Hospitals – Space may be leased to hospice providers where patients can receive both the benefits of a full medical facility under the supplemetal assistance of the hospice provider’s staff.

• Free Standing Facilities – These are owned and operated by the hospice company and staffed by medical providers under the employ of the institution.

• Long Term Care Facilities – Similar to the agreement made with hospitals, hospice providers may lease space and provide care to their own charges within this environment.

Respite Care

This particular level of care is actually designed to be more for families that care for the patient on a continuous basis within the home than for the actual patient. Caring for an ill person at home is a 24 hour a day job, and families can grow weary over time, especially if their loved one has been ill for an extended period. Respite care is a temporary placement of the patient into inpatient care to allow the family a much needed break, or respite. These services are limited to five consecutive days, and then the patient is discharged back to their home.