Monday, January 21, 2019 | By Dennis Stoops, PT, Kosciusko Home Care & Hospice

It is common knowledge that as a person ages there is greater risk of falling. In fact, statistics reveal that one-third of seniors fall in their homes at least once a year. Falls are the leading cause of accidental death for those 65+ and once occurring often happen again. A serious fall may result in a traumatic fracture. Quality of life is often compromised from subsequent decreased function. A person may become more fearful, following a fall, resulting in avoidance of previous activity. If decreased activity follows, this results is weakness and reduced mobility, thus enhancing an individual’s fall risk. To understand considerations to reduce fall potential, we must look at intrinsic and extrinsic factors. Intrinsic focuses on the person and extrinsic deals with our environment. Let’s look at both including potential ways to reduce your risk:

Intrinsic Factors:

Age-related changes are inevitable but we can take measures to reduce the effects.

Vision: Have your eyes checked regularly to ensure the best awareness of your surroundings. If you have a known issue such as Glaucoma, Cataract or Macular Degeneration, use of a cane or walker may be appropriate for safety. A University of Michigan study found that visual impairment doubles fall risk for those 65 or older.

Hearing: A John Hopkins study found that hearing can be a contributing factor to falling. Even a minor hearing loss involving study participants was found to increase risk three-fold. Perhaps a reason to reconsider purchasing those hearing aids you have been putting off?

Systemic Changes: As we age there is a natural decline in Central Nervous System function which increases the likelihood of instability. Transmission of nerve information declines. Systemic diseases may arise involving blood flow, affected by blood pressure, diabetes and smoking. Be sure and have an annual physical to assess status and learn possible ways to limit effects. Take prescribed medicine correctly and faithfully. Understand what your medication does and if there are possible side effects that might influence your balance. Remain active by walking and exercising daily. We may be unable to stop natural decline, but we can influence how slippery the slope is!

Extrinsic Factors:

When dealing with our environment, there are many opportunities to limit our exposure to falls by making changes around the home. Here are a few considerations:


-Keep paths cleared and in good shape.

-Enhance lighting along walkways and at entry areas. Solar and/or motion detection lights work well to illuminate possible hazards.

-Review your entry. If steps are present, are they in good shape and not slippery? Would a railing be beneficial if not present? Could a ramp be helpful, particularly if you already use an assistive device?


-Repair or replace torn carpet and linoleum. Use tape or tack down loose edges. Remove throw rugs where you normally transfer/walk or consider non-skid backing to reduce tripping hazard. Keep pathways cleared of clutter.

-Make sure that lighting in the home is sufficient. Night-lights are recommended for evening trips to the bathroom. Consider motion-activated lights that automatically turn off and on themselves.

-If you’re having trouble getting out of chairs, perhaps a change is needed. Height is your friend, making it easier to rise! Consider using risers under a couch and/or a platform base for your recliner. If possible, limit sitting in a chair that swivels, rocks, or is on wheels. Always push off armrests when attempting to stand and return to sitting by safely backing up to the chair and slowly descending while using armrests.

-In the bathroom, several considerations may bolster safety through the use of durable medical equipment (DME). A toilet riser, with or without armrests, can simplify transfers. Use heavy bath rugs that won’t slip. Grab bars can enhance safety getting in and out of a tub/shower. Remember that grab bars are secured into studs. Plastic suction bar devices may provide stability but can fail if too much pressure is involved. Clamp devices secured to the side of a tub can help when stepping over and back. If you are still fearful, consider using a transfer bench that allows you to sit outside the tub and then scoot over into the enclosure for a shower while remaining seated.

-While spending time in the kitchen or laundry, additional measures can also promote stability. Any rug should be non-skid. Have a secure stool if you must reach and if fearful allow someone else to perform the task. When arranging cabinets keep the most used items near counter height with lighter/less used items placed higher, keeping heavier/ bulkier items such as pots/pans/appliances reserved in a lower position.

In closing, falls may affect many of us as we age. It is important to manage not only our bodies but also our environment to reduce exposure. Become or remain pro-active. Report changes in strength, vision, hearing, sensation, blood pressure and mental status to your physician. Take medication if needed as prescribed, and be aware of possible side effects. In needed, address your safety concerns for possible therapy referral to a home care or outpatient Physical Therapist or Occupational Therapist. Remember to stay active and exercise to influence strength and stability.

Hospice–One of Life’s Most Valuable Services

Wednesday, September 12, 2018 | By Max Sherman, KHCH Board of Directors

On June 4 this year in my column entitled “Life’s Final Journey Nothing to Worry About”, I described the process of dying.  In it I quoted the great sixteenth century essayist Michel de Montaigne who was once on the verge of expiring after an accident and found himself gasping for air, and attempting to pound on his chest to breathe.  Fortunately he recovered.  He later reflected that despite the trauma, he began to grow languid while feeling like he was being carried aloft on a magic carpet.  From this he found that learning to die is not necessary.  He noted, “If you don’t know how to die, don’t worry; nature will tell you what to do on the spot, fully and adequately.  She will do the job perfectly for you; don’t bother your head about it.”   Well he was partly correct in that we may know how to die but we generally need somebody else around to help either during the process or thereafter.  Fortunately, we have hospice and while most people die in a hospital, many families choose hospice for end of life care.

The web site for the National Hospice and Palliative Care Organization, states that the term “hospice” can be traced back to medieval times when it referred to a place of shelter and rest for weary or ill travelers on a long journey.  The name was first applied to specialized care for dying patients by physician Dame Cicely Saunders, who began her work with the terminally ill in 1948 and eventually went on to create the first modern hospice–St. Christopher’s Hospital–in a residential suburb of London.  Saunders introduced the idea of specialized care for the dying to the United States during a 1963 visit when she presented a lecture at Yale University.  It was given to medical students, nurses, social workers, and chaplains and discussed the concept of holistic (treating mind and body) hospice care, and included photographs of terminally ill cancer patients and their families, showing the dramatic differences before and after the symptom control care.  Hospice care is designed to give supportive treatment to people in the final phases of a terminal illness and focus on comfort and quality of life, rather than cure.  The goal is to enable patients to be comfortable and free of pain so that they live each day as fully as possible.

According to Heidi Telpner in her book, One Foot in Heaven, hospice affirms life and does not hasten or postpone death.  It highlights quality rather than length of life.  She contends that death can be beautiful, peaceful, humorous, touching, tragic, disturbing and even otherworldly.  Hospice care treats the person rather than the disease and provides family centered care involving the patient and family in making decisions. Care is provided for the patient 24 hours a day, 7 days a week.  Care can be given in a patient’s home, a hospital, nursing home or in a private hospice facility.  Most hospice care in the United States is given at home with a family member or members serving as the main hands-on caregiver.

We are indeed fortunate having local hospice services.  It was started by eight nurses and numerous community leaders 42 years ago and continues today through the passion of a new generation of nurses, medical social workers, therapists, and support staff.  According to their brochure, the group of nurses met at one of the member’s home.  They had no money, no office space and no supplies.  Several community leaders volunteered to serve on their Board of Directors, as advisers and help with donations.  Kosciusko REMC provided the office space.  With the support of the community, the agency flourished.   Today, Kosciusko Home Care and Hospice operates 7 programs: home care, hospice, the Help Center (locally-raised funds defray patient and family expenses), medication and dental assistance, Kid’s Smile Kosciusko, Lifeline and private duty care.  They also partner with REAL Services.  A large portion of its funding comes from the K21 Health Foundation, United Way of Kosciusko County, county support, and local donations.  The agency has grown to include 30 full-time and 20 part time employees.  The Home Care and Hospice staff served 474 patients in 2016, totaling 16,122 visits and 178,000 miles driven by staff to care for patients. There were 111 veterans included among the number of patients.  The Help Center distributed assistance funds and services to 861 Kosciusko County residents through the KCCF Good Samaritan Fund.  The Medical and Dental Assistance provided vouchers for 707 clients for medication, medical supplies, and emergency dental assistance.  All services are provided without regard to race, age, color, religion, sex, disability, national origin or ancestry.  For more information call (574) 372-3401 or visit www.koshomecare.org.


Friday, March 9, 2018 | By Brittany Petersen 

Photo by Carl Raw on Unsplash

The month of March is National Social Work Month, so we thought we would give you a glimpse into their world!

According to Google, social work, by definition, is “work carried out by trained personnel with the aim of alleviating the conditions of those in need of help or welfare.” Makes sense – simple enough. How does that translate into hospice care, though?

How do you alleviate the conditions of those with a diagnosis of 6 months, or less, to live?

How do you alleviate the heartbreak of family members as they watch their loved one sign up for hospice care?

How do you alleviate the nerves of a strong-willed man who has lived through world wars and the Great Depression, who thinks signing up for hospice care means giving up?

You do it with superheroes called Social Workers. We do it with Jeni and Amy.

To best create this picture for you – I’ll do my best to walk you through a day in the life of Jeni and Amy.

If you’re in an office setting, it probably starts the same as yours:

  • Check emails
  • Check voicemails
  • Look over daily calendar
  • File paperwork

Actually, no, before any of this even happens there is a hospice meeting in the back room. Every single morning our hospice team, consisting of our two social workers, a spiritual counselor, the Executive Director, and nurses meet to discuss cases. This ensures that everyone is on the same page with caring for each patient in a way that best serves their need. NOTE: Don’t forget the most important daily task – make sure everyone knows which patients passed away between yesterday at 4:30pm and today. The last thing anyone wants to do is find that out over a routine phone call.

NEXT, the above items happen – and the day begins.

Throughout the day, our social workers stay busy:

  • Scheduling visits with patients
  • Checking in on patients by phone daily to inquire about needs and offer a visit
  • Visiting patients
  • Meeting with hospice families for initial meetings to review paperwork and the concept/philosophy of the program
  • Assisting clients in researching nursing home availability as well as paperwork and admission process
  • Assisting families in creating quality of life goals
  • Assisting with power of attorney paperwork
  • Connecting families to community resources
  • Assessing safety of patients in their home – referring APS in needed
  • Speaking with referrals who are considering hospice care
  • Logging notes
  • Assisting with memorial service
  • Assisting with volunteer training, meetings, and tracking
  • Completing paperwork
  • Attending team meetings
  • Serving on local committees like the Cancer Care Fund Committee

Social workers also have the role of making bereavement checks with family members of patients who have passed away in the last 13 months. Did you know at Kosciusko Home Care & Hospice our team checks in with the family of past patients for 13 months through phone calls and letters? Our social workers are available to help families walk through all of the firsts after a loved-ones death; first birthday, first Christmas, first Thanksgiving, first wedding anniversary, etc., and finally, the first anniversary of their death – hence the 13 months.

That’s a hard role to play day in and day out, but one Jeni and Amy do so well.

Jeni is also our Director of Operations and Director of Hospice. So, on top of her social work duties, she also completes Medicaid paperwork for patients, addresses concerns from patients/families and staff, stays up-to-date on regulation changes, schedules nurses, schedules and facilitates meetings, prepares information for our Medical Director, and makes the initial contact with patients/families and their following doctor. I’m still trying to figure out how she fits all those hats on her head!

I have the pleasure of working right next door to both of our social workers – so I, by default, hear many of their conversations. Let me tell you – they are the most kind, understanding, and caring women. You would not believe the conversations these women have with patients and families, the fires they put out, and the emotions they help people walk through on a daily basis. It takes a special kind of person to deal with both fear and tragedy on a daily basis and still have joy, and still push forward, and still have the emotional capacity and empathy needed to FULLY be present for the next patient.

Let’s not brush over the fact that in the time between all these other tasks they support the Kosciusko Home Care & Hospice team as well! They also bring us more laughter than you could imagine in a hospice agency – and that is essential for everyone to do their jobs well!

We love our social workers and are thankful to have them on our team – we could not do home care and hospice without their talents!


The future of health care is a serious concern for all of us.  There are many unknowns, but our dedicated staff knows one thing for certain – we want our agency to be available in Kosciusko County for the next family who needs our help.  Your generous gift will make that possible.