Continuum Care Hospice

04/18/2026

Understanding Feeding Tubes in Hospice

Understanding feeding tubes in hospice care requires a shift from a curative mindset to a comfort-focused approach.

At the end of life, decreased appetite and reduced oral intake are expected physiologic changes as the body gradually slows down. Current evidence demonstrates that in advanced illness,particularly advanced dementia, feeding tubes do not meaningfully improve survival, prevent aspiration, or enhance quality of life. Instead, they may contribute to complications such as infection, fluid overload, gastrointestinal distress, and increased patient discomfort.

Hospice care prioritizes comfort feeding, which involves offering small amounts of food and fluids based on the patient’s preferences and tolerance. This approach preserves dignity, minimizes burden, and aligns with the natural progression of end-of-life physiology.

Providing clear, evidence-based education to families is essential. It helps reduce guilt, correct misconceptions, and supports informed, goal-concordant decision-making during a vulnerable time.

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04/18/2026

Understanding the Comfort Kit in Hospice Care

What’s in a Comfort Kit?

A comfort kit is a standardized set of medications provided at the time of hospice admission or shortly thereafter. These medications are kept in the patient’s home to allow for rapid symptom control without delays associated with pharmacy access. This proactive approach aligns with hospice goals of preventing unnecessary suffering; reducing crisis-driven hospitalizations; supporting patients to remain comfortable in their preferred setting

Most kits include:

*️⃣Morphine/hydromorphone/oxycodone
Relieves pain and eases breathing by reducing the feeling of “air hunger.”

*️⃣ Lorazepam (Ativan)
Calms anxiety and helps with breathing-related distress.

*️⃣ Haloperidol (Haldol)
Helps with confusion, agitation, and restlessness at end of life.

*️⃣ Atropine drops
Reduces noisy breathing caused by fluid buildup.

*️⃣ Acetaminophen suppositories
Used when swallowing is difficult.

*️⃣ Bisacodyl (Dulcolax) suppository
Prevents and treats constipation, especially from opioids.

Important to know that these medications are, carefully dosed and usually only used when needed. They help your loved one feel more at ease, not hasten the dying process.

When to Call Hospice

Call your hospice team if you notice:

✅ Increased pain
✅ Trouble breathing
✅ Restlessness or confusion
✅ Noisy breathing
✅ Difficulty swallowing

You are not expected to manage this alone. The comfort kit is about dignity. It ensures your loved one is cared for with comfort, peace, and respect in their final days.

The Hospice NP
Clarity. Comfort. Compassion.

04/18/2026

Understanding Morphine & Hydromorphone for Dyspnea (Shortness of Breath) in Hospice

What is Dyspnea?

Dyspnea or shortness of breath is the feeling of air hunger, like the body is not getting enough oxygen. It is not just physical. It is processed in the brain and can feel like panic.

How These Medications Work In the Brain?

Morphine and hydromorphone act on opioid (mu) receptors in key areas:

*️⃣Brainstem (medulla) – regulates breathing rhythm.

*️⃣Limbic system – reduces fear and distress.

*️⃣Cerebral cortex – changes perception of breathlessness.

In simple terms, the body may still be working to breathe, the brain no longer feels like it is suffocating.

What does these medications do?

They:

✅Decrease the sensation of air hunger
✅Reduce the brain’s panic response
✅Slow rapid, ineffective breathing
✅Improve breathing comfort
✅Promote relaxation

Evidence-Based Practice

Opioids are considered first-line treatment for refractory dyspnea in hospice and palliative care.

Clinical evidence shows that low-dose opioids reduce breathlessness, improve patient comfort and they do not cause harmful respiratory depression when used appropriately

This is supported by the American Academy of Hospice and Palliative Medicine, the National Comprehensive Cancer Network (NCCN) and the World Health Organization (WHO).

Morphine vs Hydromorphone

Both of these medications work similarly. Hudromorphone however may be used when Morphine is not tolerated, when kidney function is reduced or when smaller , more concentrated doses are needed.

💙 Important to Know

✅ Medications are carefully titrated
✅ Doses are individualized
✅ Patients are closely monitored

What families May Notice

After medication, your loved one may:

*️⃣ Breathe more slowly and comfortably
*️⃣ Appear more relaxed
*️⃣ Have less visible distress

Don’t walk this journey alone.
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03/18/2026

Stay safe in inclement weather…..

03/01/2026

Happy Social Worker Month!!! We are truly fortunate to have the top 2 Social Workers in North East Ohio!!

10/07/2025

Final Gifts by Maggie Callanan and Patricia Kelley is a book I recommend for anyone wanting to better understand what can happen at the end of life. Written by two hospice nurses, it shares stories from the bedsides of dying people and reveals the profound messages, wisdom, and experiences that can arise in those final days. It’s compassionate, practical, and beautifully written — a powerful resource for anyone walking alongside the dying.

09/25/2025

Congrats to the staff at Continuum Care Hospice for having another deficiency free Ohio Department of Health Survey….. !! Back to Back sure feels good
Here’s to 2028!!

09/09/2025

Researchers recently found that “trigger systems” signaling when a patient may need palliative care can boost utilization of those services, as well as

07/29/2025

“Once my clothes and now a bear, hug it tight and know I’m there.”

I love our Hospice Bears ❤️❤️❤️❤️

07/04/2025

06/25/2025

Not long ago, I had a conversation with the daughter of a hospice patient.

She asked, “Why didn’t my mom’s doctor tell us about hospice sooner?”

Her mother was doing Tele-health visits for over a year with her doctors because she was unable to leave her house due to edema from Congestive Heart Failure.

Her mother had been refusing to go to the ER for assessment/ treatment of her symptoms. Four times over the last year this was recommended. Four times she said no. She wanted to be at home. She did not want to return to the ER.

Her disease was advancing and advancing.

Her quality of life was declining and declining.

Finally, the physician referred her to palliative care after more than a year of living like this.

The patient quickly found out that she qualified for hospice care.

She came on to hospice and, within a week, her symptoms were better managed.

Her daughter also now had the support of the hospice nurse, physician, social worker, chaplain, and bath aids. She shared that she feels so much less alone in caring for her mom.

The daughter shared with me, her hospice social worker, “my mom has suffered needlessly for over a year because we didn’t know there was another option.”

We all need to be community educators, making sure everyone knows the options that are available at end of life. We need to keep communicating with medical providers who can begin to refer sooner.

Everyone deserves quality care at end of life.

Learn more about hospice at: hospicefoundation.org or nhpco.org.

06/06/2025

Morphine doesn’t kill people. Pain does.
But in hospice, fear often wins.

Families whisper:
“Won’t it speed things up?”
“Can’t we wait until the very end?”
“I don’t want them to sleep through the goodbye.”

We get it. You’re scared. You love them.
But withholding morphine doesn’t preserve life.
It prolongs suffering.

Here’s the truth:

• The standard starting dose of liquid morphine (Roxanol) is 5mg—roughly equivalent in effect to one tablet of Norco 5/325 (hydrocodone + acetaminophen).
• Sublingual morphine begins working in 15–30 minutes, peaks at ~1 hour, and lasts 2–4 hours.
• When appropriately dosed and titrated, morphine rarely causes respiratory depression—even in frail, terminal patients. In one study of 27,000, the risk was