Every November, we recognize National Hospice and Palliative Care Month helping our community understand how important hospice and palliative care can be before you or a loved one are facing a medical crisis.

Hospice and palliative care combine high-quality medical care with the emotional and spiritual support families need most when facing a serious or terminal illness. Palliative care offers comfort and support earlier in the course of a serious illness. Hospice brings patients and family caregivers high-quality, compassionate care and support when a cure is not possible. Together, palliative care and hospice can help people live each moment of life to the fullest!

As we raise awareness and reflect about hospice and palliative care, here are five useful facts about hospice and palliative care and how they can improve the last stages of life for patients and loved ones.

1. Hospice care and palliative care are not the same.

Palliative care is specialized medical care for those living with a serious illness, such as advanced heart failure, cancer, dementia, chronic liver disease, COPD or severe kidney disease.  Palliative care works to improve quality of life through symptom management and can be provided alongside curative treatments. Quality of life has different meanings to different people. The Freeman palliative care team will discuss what quality of life means to the patient and help the patient sort through different treatment options to find the one that best suits their goals of care. 

Hospice is a program funded through Medicare, and most insurances, for people who have a prognosis that could be less than six months and aggressive life-prolonging treatments are no longer benefiting the patient. The main goal is focused on comfort and quality of life and is achieved through a holistic team approach that includes a registered nurse, nurse aid, social worker, chaplain and volunteers overseen by a physician. Different team members visit throughout the week to ensure the patient’s needs are met, whether they are at home, a nursing facility or hospital. 

2. Medicare covers hospice and might cover palliative care.

Hospice is a Medicare benefit and is covered 100%. Most private insurances and Medicaid programs cover hospice services as well. This includes all team members, medications required for symptom management and equipment. A person must have a prognosis of six months to qualify for hospice, although, some people may live longer and will still qualify for hospice services. 

In-home palliative care services may be categorized as palliative care or home health services.  Coverage is based on individual insurance plans.  Some home health or hospice teams may provide in-home palliative care services for those who are not yet appropriate for hospice. 

Freeman Health System offers an embedded palliative care program within the main hospital and an outpatient clinic. Both the inpatient program and the outpatient clinic file with Medicare, Medicaid and insurances. 

3. Hospice and palliative care are not just for people with cancer.

We often think of cancer patients as the ones in need of hospice and palliative care, but anyone with a chronic condition can benefit from this personalized attention. The goal with each is to improve the quality of life, which in turn, can help maintain or improve those with chronic/debilitating diseases such as dementia, Alzheimer’s, stroke, neurological disorders and end-stage heart, lung or kidney disease.

4. Hospice is for the entire family.

Hospice not only supports the patient but supports the entire family. Family members appreciate having a hospice team available 24 hours a day by phone in case there is a medical emergency. Once the patient passes, the hospice bereavement coordinator follows up with family for support. 

5. Hospice care is offered in the home.

When treatments are no longer effective or causing more harm than good, many patients can return to their daily activities in the comfort of their own home. This way, they can be surrounded by the people and things they love. All equipment and medical supplies brought into the home are covered by the Medicare hospice benefit. Respite services, up to five days a month, are available for caregiver breaks as needed.

Freeman’s highly trained palliative care professionals ensure patients and families find dignity, respect and love during life’s most difficult journey. They encourage patients and their families to complete an advance directive to document and share end of life wishes. The Freeman palliative care team is available to discuss and assist in filling out these documents for those who need assistance. Advance care planning involves talking about the care you would and would not want. 

The Freeman palliative care program assists with pain management, symptom control, psychosocial support and spiritual care to patients and their families at all stages of illnesses. These programs combine the highest level of quality medical care with the emotional and spiritual support that families need most when facing a serious illness or the end of life. For more information regarding Freeman’s palliative care services, call 417.347.4094.

Every October, Freeman celebrates National Physical Therapy Month (NPTM) – a time when we recognize our dedicated Freeman physical therapists (PTs) and physical therapist assistants (PTAs) who help transform people’s lives by restoring and improving their motion.

Movement and exercise are fundamental to leading a healthy and happy life! Freeman PTs and PTAs can identify factors that prevent patients from being as active as possible and find ways to help them overcome obstacles so they can be well, mobile and self-sufficient. Freeman PTs and PTAs play an integral role in helping our patients be healthy and encourage everyone to choose physical therapy in their battles against pain, limited mobility and other ailments. Physical therapy can also help individuals combat future injury and chronic disease.

It’s very rewarding to have the opportunity to make a positive impact in someone’s life,” explained Jeff Borum, Director of Rehabilitation Services at Freeman. “Whether it’s from an accident/injury, chronic condition or a planned procedure, we get to help patients regain their confidence, independence and freedom.”

While focusing on the physical ailments, Freeman therapists help patients with strengthening, balance and endurance and also serve as motivators to tackle the emotional and mental components for long-term success.

“Freeman has passionate physical therapists ready to treat patients in a variety of settings,” said Borum. “From Outpatient/Sports to patients in the hospital and pediatrics to work injury therapy, there are skilled clinicians available to meet our community’s needs!”

National Physical Therapy Month is an important time to raise awareness about the key role PTs and PTAs play in helping people find relief from pain, improve mobility and overall functional ability, and live healthier, more physically able lives. If you feel a physical therapist could benefit you, talk to your primary care provider for a referral. Freeman physical therapist professionals are ready to help you take that next step towards moving and feeling better!

There is a significant gap in emergency behavioral health care in our community. Our community, like many others, has had good options for addressing behavioral health crises. Ozark Center maintains a Crisis Line (800.247.0661) that offers hotline counseling or in-person assessment. Local emergency rooms have always provided behavioral health assessment for urgent matters 24/7. However, people experiencing mental illness often have difficulties accessing timely ambulatory behavioral health care, contributing to an overreliance on emergency departments. Ozark Center Urgent Behavioral Services (UBS) will soon fill this gap, beginning October 1.

As an urgent care for behavioral health issues, UBS is the first and only program of its kind in the area. Behavioral health urgent cares like UBS enable better monitoring of patients and reduce risk of self-harm. The less-rushed environment allows for increased time to gain diagnostic clarity and develop alternatives to hospitalization, potentially avoiding a conventional psychiatric inpatient admission.

While the idea of behavioral health urgent care is trending across the United States, not many are operating yet. This makes Ozark Center a pioneer in the field and allows customization of the program to meet the unique needs of our community.

The environment at UBS is trauma-informed, meaning it emphasizes physical, psychological and emotional safety to help individuals rebuild a sense of control and empowerment. This difference in environment is apparent everywhere you look in our UBS facility – from spacious exam rooms with sofas and recliners to private waiting areas. Throughout the building, you’ll also find comforting color schemes and calming local art.

Additionally, UBS is an integrated medical care facility, so co-occurring physical issues can be addressed in tandem with behavioral health needs. The UBS team includes mental health professionals as well as primary care providers, case managers and certified peer specialists, enabling providers to treat the whole person.

UBS is a great option for those experiencing:

• Increasing levels of depression, anxiety, psychosis and/or sleep disturbance
• Urgent need(s) and unable to access same-day appointment
• Substance use issues
• Running out of psychiatric medication
• Missed behavioral health appointments with providers

Located at 3230 Wisconsin Ave, Suite A, Joplin, MO, UBS will be open 11:00 am – 9:00 pm Monday – Friday and 1:00 pm – 9:00 pm Saturday and Sunday. Learn more about the program at ozarkcenter.com/UBS.

About the author

Vicky Mieseler, MS, BCCP, NCP, has been with Ozark Center since 1984. In that time, she has held the positions of substance use counselor, adult psychologist, crisis coordinator, director of community care, director of family preservation services, director of New Directions, director of crisis services and vice president of clinical services. In 2017, she was promoted to chief administrative officer of Ozark Center. Mieseler has been a licensed psychologist in Missouri since 1993 and a nationally certified psychologist since 1997.

September is Prostate Health Month, also known as Prostate Cancer Awareness Month, a time for a better understanding of the health issues associated with a man’s prostate, prostatitis and prostate cancer. According to the Men’s Health Network, most men don’t know what their prostate is nor what it does. It’s time to empower men with knowledge about the prostate, giving them more personal power over their general health and their prostate health!

WHAT IS THE PROSTATE?

The prostate is a walnut-sized gland that functions in the reproductive system found just under the bladder. It undergoes many changes during the course of a man’s life and generally remains stable until men reach their mid-40’s when, in most men, the prostate begins to enlarge.

THE IMPORTANCE OF PROSTATE SCREENINGS

One of the best ways to beat prostate cancer is to get regular screenings using the prostate-specific antigen (PSA) test. By measuring the amount of PSA in a man's bloodstream, the test helps health professionals discover prostate cancer at earlier stages – giving men a better chance for survival. PSA screenings are especially important for men with a family history of prostate cancer and for African-American men, who have a 60% higher incidence of the disease than Caucasian men.

There are several risk factors associated with prostate cancer, including family history, race and diet, but the most common factor is age. Prostate cancer occurs mainly in older men. About six in ten cases are diagnosed in men aged 65 or older, and it’s rare before age 40. The American Urological Association (AUA) recommends all men obtain a baseline PSA test at age 40. This value can help doctors tailor future screening frequency. For example, men who have an initial PSA of less than 1.0 can generally be reassured and told to return at age 45. With thorough screening and careful management, the vast majority of men with prostate cancer will survive the disease and enjoy a high quality of life after treatment!

LEAD A HEALTHIER LIFE TODAY FOR A BETTER TOMORROW

More than 30 million men suffer from prostate conditions that negatively affect their quality of life. Before men face any kind of prostate health issue, the best plan is to prevent prostate problems from starting by first leading a healthy lifestyle. Men’s daily routine, including exercise and nutrition, has a tremendous impact on their prostate health. Healthy habits to improve men’s general heath can help prevent and lower risk factors for prostate disease and conditions. Some tips include:

• Drinking plenty of water and non-caffeinated green and hibiscus tea, which contain antioxidants.

• Exercise and lose weight. A study published in the Journal of Urology found that overweight men, especially men with a high amount of abdominal fat, have an increased risk of prostate gland enlargement or benign prostatic hyperplasia (BPH). Losing extra weight can help reduce the risk for prostate cancer and relieve prostatitis. Walking, jogging, swimming, tennis and other aerobic exercises can help men maintain a healthy weight. Kegel exercises can also strengthen and train men’s pelvic floor muscles to help control urination.

• Eat more prostate-friendly food, including oily fish high in omega-3 fatty acids, vegetables and foods high in healthy fats like avocados, nuts and olives. Foods that help fight prostate cancer include Asian mushrooms, tomatoes, pomegranate juice and walnuts. Eating less sugar and processed foods is also good guidance.

• Stress negatively affects prostate health. In fact, some men unknowingly tighten their pelvic muscles when stressed. This chronic tightening can create pelvic floor muscle problems and can be one of the causes of chronic prostatitis. Stress can also affect men with BPH. Stress can worsen symptoms such as urinary urgency, frequency and pain.

If men lead healthier lives daily, they can better manage their prostate health. Some things are beyond men’s control, but they can control day-to-day factors that lower their risk and give their bodies the best tools for fighting illness. In the case of chronic prostatitis and chronic pelvic pain syndrome, which is a difficult-to-treat and often-painful inflammatory condition, traditional treatments, such as antibiotics, tend not to work. Fortunately, there are more and better treatment options today than ever before!

About the author

Ashley Southern-Devoe, MSN, APRN, FNP-C, at Freeman Urology Associates, is devoted to providing patients the opportunity to express their concerns and getting their questions answered. The team at Freeman Urology Associates, including Dr. James Frogge, place a high emphasis on patient education to ensure patients have a clear understanding about their particular condition. For more information on the quality services provided at Freeman Urology Associates, please call 417.347.3703.

At least 2.7 million Americans are living with atrial fibrillation (AFib), according to the American Heart Association. AFib, affects the heart’s ability to pump blood normally and causes blood to pool in the left atrial appendage and potentially clot. Some patients are prescribed blood-thinning medications, such as coumadin, to prevent a blood clot, but patients who have a bleed risk are at a higher danger when taking blood thinners.

More than half of Americans experience a traumatic event in their life, according to the National Center for PTSD. These events can include anything from military service to car accidents and from assault to natural disasters. In some cases, it may not even be an event the individual personally experiences – trauma can also come from learning about a loved one’s sudden injury or death, or from witnessing someone else experience a traumatic event.

While it’s normal to have trouble sleeping or feel on edge shortly after a traumatic event, most people will start to feel better in a few weeks or months. Those who develop post-traumatic stress disorder (PTSD), though, see symptoms continue longer than that and interrupt their daily lives.

Symptoms of PTSD can include:

• Flashbacks or nightmares 

Unwelcome memories can pop up at any time, or they may be triggered by something that reminds you of an event. A familiar example is the sound of fireworks bringing back memories of battle for combat veterans.

• Avoiding things that remind of you of the traumatic event

You might try to avoid places or people that remind you of the event or try to stay busy to you can avoid thinking about it.

• Increase in negative thoughts and feelings

You might feel sad or numb; things that you used to enjoy might not interest you anymore. You might also feel guilt or shame about the event, and think about what you might have done to prevent it.

• Feeling on-edge

You may have trouble sleeping or relaxing. You might also feel angry or irritable. These feelings can contribute to behaviors like drinking, using drugs or driving aggressively.

The good news, though, is that PTSD is treatable. Therapy and medication can both help ease PTSD symptoms, giving trauma survivors a better quality of life with fewer problems in their relationship, career and education. Even if you wonder if you are ready for treatment or fear that maybe it’s too late to seek help, it’s still a good idea to call a therapist, like those at Ozark Center.

The truth is it’s never too late to recover from a past psychological wound. And the sooner you reach out for help, the sooner you can start to feel better.

For more information about PTSD services at Ozark Center, call 417.347.7600.

Jacob Hefner, EdS, LPC, is Ozark Center Director of Adult Outpatient Services. He has received specialized training in the fields of substance use disorders, first-episode psychosis and mental health treatment. He has over 12 years’ experience in the mental health field.

Although the birth of a baby is an expected event, the delivery of a baby who needs intensive medical care is often unexpected. Occasionally, obligations at home and work mean families cannot visit the hospital each day to spend time with their new bundle of joy. Understanding the importance of infants being held and comforted, Freeman launched the Neonatal Intensive Care Unit (NICU) Cuddler Program, in November 2019, giving parents the much-needed help when they’re unable to be with their little ones.

For most situations in which a newborn would benefit from human contact, the first choice is the baby’s mother or other family members. In some circumstances, though, the mother is sick or the family needs to tend to other children at home. Maybe the family lives far away, and they can’t be with the baby all the time. In those cases, having an extra pair of cuddly arms may come in handy. “For most parents, having their baby in the neonatal ICU is the most stressful time of their lives. Any parent will attest that no amount of time spent at their child's bedside is long enough,” explained Dr. Rahul Oberoi, Freeman NICU physician. “Due to various reasons, a lot of families are unable to visit their baby even daily. As a medical community, we know the reduced interaction and bonding a neonate experiences while in the NICU can have long-lasting implications. This is where the Cuddler Program can help bridge the gap in order to improve long term brain and developmental outcomes. Feedback thus far from parents has been positive, and the support from the community has been tremendous!”

Some would describe it as the coolest volunteer opportunity ever, providing snuggles, love and developmentally appropriate support under the guidance and direction of the medical staff in the Freeman NICU. “One of the biggest benefits the Cuddler Team provides is the knowledge and satisfaction that we’re helping soothe the youngest of our next generation, at a crucial time when they’re in need of additional comforting,” said Karen Graham, RN, Cuddler Program Coordinator. “We exist to fill the gap when parents or family members are unable to be with their newborn patient. For a Cuddler to have a tiny patient totally relax in their arms, while they’re talking, reading or singing softly to them, is such a joy and a privilege. And it’s truly a team effort! The NICU nurses, physicians, staff and Cuddlers all work together to help these little angels have a positive beginning in life.”

A Cuddler volunteer is a trained adult who’s able to hold and talk to the baby in soothing and stimulating tones and words, sing to the baby in rhymes and favorite lullabies, and console the baby with positive touch and sensitive comfort. The typical role of a volunteer Cuddler is not to replace the baby’s family but to provide additional support. “Several years ago, I learned of NICU Cuddlers in California, and it was my dream to begin a Cuddler Program in my hometown of Joplin when I retired,” said Graham. “While being employed at Freeman, Paula Baker, Freeman President and CEO, Dr. Dennis Estep, Freeman Chief Medical Officer, Children’s Miracle Network Hospitals and Freeman Health System allowed me the opportunity to start the program for our tiniest patients, and we began our first shift on November 6, 2019. The program was made available from funding provided through our Children’s Miracle Network Hospital’s partnership at Freeman.”

Requirements to become a volunteer Cuddler include: interview and selection process, background check, drug screen, physical plus immunizations and flu shots. Program training with the Freeman Cuddler Coordinator, Freeman Volunteer Services Program Manager and NICU nurses includes safety, confidentiality, handwashing protocol and infection prevention and control. The Cuddlers do not feed, change or get up and walk with infants. The popular program is currently full and therefore not accepting applications.

For questions regarding the Freeman Cuddler Program please contact Karen Graham, RN, at 417.347.3922 or kegraham@freemanhealth.com.

In the last decade, the time children spend in active play (i.e. play that does not involve screen time) has decreased. This is problematic because while play may seem like fun and games to adults, it is actually crucial to a child’s development.

All areas of a child’s life improve with increase access to free play. From infancy through adolescence, play improves children’s abilities to handle toxic stress in their lives. The joy of playing, along with the interaction with parents and/or peers, helps manage the body’s stress response.

Play also helps improve children’s social skills and problem-solving skills by providing opportunities to interact, negotiate and develop language skills. Kids who engage more in more free play do better in the classroom, too. The American Academy of Pediatrics reports that children who engaged in active hour for even one hour per day were able to think more creatively and multitask better.

Of course, there are also physical benefits to play. The exercise involved in play promotes core strength and balance, healthy weight and cardiovascular fitness. Just as importantly, it enhances the immune system, decreases depression and increases motor skills.

Parents can help their kids get more playtime by:

• Get the kids outdoors. Enjoy time outside together.
• Put the screens down. Try having a designated place to put the screens when everyone gets home and spend time together rather than on your phones.
• Use low-tech, simple toys. Even a box can be a great toy for a young child. Simple toys like puzzles, blocks and books also increase creativity.
• Get together with family and friends. Adults can relax and watch the kids while the children play together.

For additional ideas about how to integrate more playtime in your child’s life, visit healthychildren.org.