Providing compassionate in-home and out-patient care in Plymouth, NH

Pemi-Baker Community Health Improving the Lives of Parkinson’s Patients

(Plymouth)– Physical therapists at Pemi-Baker Community Health (PBCH) are movement experts who improve quality of life through hands-on care, patient education, and prescribed movement.  For almost a year, PBCH’s LSVT BIG specialist, Kaity Schwartzer, PT, DPT has been helping those experiencing the symptoms of Parkinson’s disease achieve amazing results, giving them renewed hope. For National Parkinson’s Awareness month, Pemi-Baker Community Health hopes to raise awareness of what can be done NOW if you are experiencing symptoms.

While you’ve likely heard of Parkinson’s disease (PD), many people don’t know exactly what the condition is or how it manifests itself. The condition can occur when there is a loss of brain cells that produce a chemical called dopamine. The four common symptoms are: tremors, limb and trunk stiffness, the slowing down of movement and weak balance or coordination.  About 500,000 people in the U.S. have Parkinson’s disease, with about 50,000 people being diagnosed each year, according to the National Institute of Neurological Disorders and Stroke.

Since PD symptoms increase over time, as they become worse, patients can have trouble with simple tasks such as getting in and out of bed or the bathtub— or even walking and talking. People with PD may also experience “freezing,” where they have extreme difficulty starting to walk again after having stopped, or difficulty stopping walking once started. This may lead to falls in the home and when out in the community. Pemi-Baker Community Health can help.

LSVT BIG

LVST BIG therapy was developed specifically for people with Parkinson’s disease and other neurological conditions. Treatments target whole body movements for activities of daily living. LSVT programs are administered by specially-trained therapists, in an intensive manner — four times per week for four weeks — and are tailored to each patient.

Therapists ask patients to move in BIG or amplified ways, whether they’re walking, buttoning shirts and pants, getting keys or change out of pockets, or writing. These lead to smoother, larger, safer movements and improved quality of life.

Today, there are over 16,000+ physical and occupational therapists trained and certified in LSVT BIG in 42 countries around the world. Here at Pemi-Baker Community Health, Kaity Schwartzer, PT, DPT is certified to administer this technique. Treatments delivered by LSVT-certified clinicians consist of the following:

  • Four LSVT-BIG sessions a week, for four consecutive weeks
  • Sessions are individual one-hour treatment sessions
  • Daily homework practice (all 30 days of the month)
  • Daily carryover assignments (all 30 days of the month)

LSVT therapy benefits

Schwartzer says LSVT BIG patients typically notice improvements in walking, getting in and out of chairs, and rolling in bed as well as overall flexibility, balance, strength and endurance. Because the program is specific to individual patients and their needs, results are based on personal goals.

As for whom it can help, Schwartzer says, “the people with Parkinson’s disease who benefit the most from LSVT BIG therapy are those with minimal to moderate symptoms but as the protocol is customizable, anyone with PD at any stage of the disease may benefit.” Schwartzer can see people who have severe PD, even those who cannot walk or stand well, as all exercises can be modified to be laying down in bed if needed. The program requires cognitive effort to change habits and reprogram the brain to make bigger, more efficient movements, so patients who have little to no cognitive problems are the most successful.

Cynthia Mathews, a LSVT BIG participant, was hoping to slow the progression of her disease and was surprised how quickly she noticed changes. “Prior to BIG program participation, my neurologist was always encouraging me to, ‘Stand up straight’, and ‘Pick up your feet’ while walking, but I saw no way to do this without thinking about what I was doing with my arms, legs, and spine every single second.  It just sounded impossible.  However, after only two weeks participation in LSVT BIG, I noted that I had regained the ability to walk with good posture and no shuffling of my feet with virtually no conscious effort whatsoever.  My husband has commented on my ‘new’ normal walk.  That has made me feel good, and has helped to maximize my motivation” said Mathews.

Assistance at Pemi-Baker Community Health

Pemi-Baker Community Health currently offers LSVT BIG therapy at their location on Boulder Point Drive in Plymouth, NH.  Prospective patients need to obtain a referral from their physician specifying LSVT BIG and Pemi-Baker Community Health.  The LSVT BIG program falls under the same health insurance coverage as typical physical therapy, check with your insurance provider for your specific policy coverages.

Learning About Caring For Dementia

When I first came on to Hospice work, my supervisor encouraged me to maintain ongoing self-study about various topics relevant to the work.  One day, I pulled a book from the shelf in our office.  An observant co-worker noticed and commented that I had grabbed “the Bible for caring for dementia.” The book is THE 36-HOUR DAY:  A Family Guide to Caring for People Who Have Alzheimer Disease, Other Dementias, and Memory Loss.  The title itself, as does the book, pulls no punches.  Providing ongoing care for a person with dementia is time-consuming, emotionally demanding, stressful, and exhausting, so that one’s days feel like they are longer than they are and packed with too much to do and remember.

The task can also be loving and rewarding, especially when the caregivers learn to take care of themselves as well.  The book is also what it says it is- a guide to caregiving.  The authors are Nancy L. Mace and Peter V. Rabins, both affiliated with the Department of Psychiatry and Behavioral Sciences at the John’s Hopkins University School of Medicine.  Don’t think, though, that it is written with sophisticated terminology or an excess of medical jargon, making it heavy and dense.  To its credit, the style is easily understandable and presented in a conversational, caring, and concerned tone directly to the reader who may already feel overwhelmed when first facing the challenge of caring for a spouse, a parent or grandparent, a sibling, or another acquaintance living with dementia.  Above all, it is a practical volume, with all sorts of advice when confronting the many challenges of this type of care.  Since its appearance in 1981, the book has been revised and edited six times to keep up with new information as it emerges.  Over three million copies have been sold worldwide as of the publication of the 2017 edition.

The reader/caregiver is immediately immersed into the experience as the first chapter opens with the case history of a woman who begins to notice her memory is slipping and moves along as her limitations compound.  The focus is first on her.  What is she experiencing?  What is she feeling?   What can she do?  Woven through this are brief accounts of her family members’ attempts to care for her and their experiences and feelings as their involvement becomes more complex.  It recounts a loss of skills around self-care and social interaction, moving us all the way through her journey which ultimately end with her admission to a long-term care facility when her family arrives at the point of no longer being able to care for her.

In this introductory section, there is a brief presentation raising the question “What Is Dementia?”  The book is careful to explore all sides of the challenges of caring for someone with dementia.  The authors really walk alongside the readers/caregivers in taking the first steps toward assuming the responsibility of caregiving. Having read the book, I am hard-pressed to discover any stone that has been left unturned.  Let me be quick to say that not all dementia patients end up in nursing homes.  Caregiving story endings vary from case to case, very much the result of the many factors both patients and caregivers bring to their own unique circumstances.

The practicality of the book is manifest in addressing particular experiences from both positive and negative perspectives. This is done throughout the book as it anticipates a wide variety of responses and reactions from patients and caregivers alike.  It progresses from dealing with initial manifestations of the disease through its more serious and complex concerns and on to end-of-life care.  The development of this style moves from what to do about things like home safety, nutritional needs, medical needs, and personal hygiene on to “sun downing” (worsening behavior as a day moves toward its end) and “shadowing” (a clinging trailing after the caregiver) and on to more serious behaviors as wandering, combativeness, and inappropriate sexual behavior.  These are only a smattering of the features presented throughout the book.  The work is chock-full of all sorts of valuable information.  A very simplified example of considering various sides of a problem might go something like this:  “If your father is doing X, try redirecting him toward trying Y.  If it works, and you can keep reinforcing it, all well and good.  If he is unsuccessful or refuses to try Y, try Z.  If the problem persists and remains unresolved, you may have to learn to tolerate X to avoid frustrating and angering the both of you.”  (Not a direct quote)

What comes through quite clearly is that the caregiver/s must make changes in themselves as their loved ones become less and less the persons we knew them to be.  Our intervention helps to support them and compensate for what they have lost.  This is not easy.  It is emotionally costly.  It becomes the nub for the necessity of self-care for the caregiver/s.  There is a whole chapter on “Getting Outside Help”.  The authors draw on a tremendous fund of knowledge and experience in their offerings of factual knowledge about dementia and practical suggestions pertinent to caregiving.  In many places, there are “Who to call or contact” directives regarding particular concerns.  Of course, readers/caregivers will need to locate those types of resources available in their own area.

The chapter entitled “Special Arrangements If You Become Ill” and its subsection “In the Event of Your Death” both contain practical information for anyone whether or not they are currently in a caregiving role.  The COVID pandemic has served to heighten our awareness for the need of preparedness in the possibility of emergency.  It is to be hoped that it also has brought home to us the preciousness of our loving connections so that we do not over-burden our loved ones through our lack of practical foresight.  There is another whole chapter “Caring for Yourself”. There is also a chapter regarding the needs of children and teenagers who may be living in a home setting where caregiving is being done.  There are also sections and chapters on end-of-life care, financial and legal issues, and considerations about relocating care outside the home.

It is not until Chapter 17 (“Preventing and Delaying Cognitive Decline”) that the book returns to a more specifically medical and scientific consideration of dementia and its causes (Chapter 18) and research about dementia (Chapter 19).

Click here and learn more about our PBCH support groups!

In drafting this review, it was challenging for me to try to choose items that might grab a reader’s/caregiver’s attention in order to reveal the book’s appeal.  I do hope I have done it enough justice so that you might consider borrowing a copy through the library you patronize or purchasing a copy for yourself.  I have seen copies of the book on the shelves of our independent bookstores (Innisfree Bookshop in Meredith, Bayswater Books in Center Harbor, and Gibson’s Bookstore in Concord).  Of course, it is readily available through Amazon and Books A Million.  Quite simply, it is a superb guide, and I recommend it most highly.

~Written by Guy Tillson, MDiv, MA, Hospice Chaplain

What Does an Occupational Therapist Do?

Occupational therapy helps people with an injury, illness, or disability learn or re-learn to do everyday activities. For adults, this could include activities like getting dressed, cooking, and driving. For children, this could include activities like learning or playing. Occupational therapy got its name from its focus on helping patients with everyday activities—or “occupations.”

Occupational Therapists (OTs) and Occupational Therapy Assistants (OTAs) are a part of your health care team. They think about your physical abilities, like which parts of your body you can and can’t easily move. They think about your mental abilities, like what your brain can and can’t process. And they think about your environment, like where you live, work, or go to school—and how you get there.

Your OT will ask you questions about what’s important to you, like driving your car or folding your laundry, so treatment focuses on meeting your goals. They might change the way you do an activity, like putting an extension on your steering wheel or suggesting grab bars to help you get in and out of the shower. OTs and OTAs will usually go wherever you need them so you can practice your skills where you’ll actually be doing activities, like your school, house, office, or nursing home.

  • Occupational therapy activities support what you want to do. All of your occupational therapy treatment activities should have meaning and be things you want and need to do. They should help you reach your goals and make you more functional and independent. The following are examples: Self-care or activities of daily living (brushing teeth, buttoning clothes, using eating utensils), Hand-eye coordination (writing on a classroom whiteboard, copying in a notebook what the teacher writes on the board), Fine motor skills (grasping and controlling a pencil, using scissors).

Real Life Example: If you had a stroke, you may still want or need to prepare your own meals while you’re recovering. Your OT or OTA should spend time helping you reach this goal by showing you the best ways to do things like reaching into cupboards and turning on the stove.

  • Occupational therapy activities that challenge your mind have a purpose. Just like your movement-based occupational therapy activities help you reach your physical goals, your mind-based activities should help you reach your cognitive goals. Your OT and OTA will think about how your brain uses information to help you reach your goals.

Real Life Example: If you have a brain injury from an accident, you may still want to do your own grocery shopping. This might include planning your meals, making a grocery list, managing your money, and finding items in the grocery store.

How do I choose an occupational therapist? Your doctor may refer you to an OT, but you can also choose one on your own.

Make sure your OT or OTA is licensed. Federal and state laws license and regulate OTs and OTAs. Contact your state’s Occupational Therapy Licensing Board or Agency to confirm that your OT or OTA is licensed.

Check your insurance coverage. Ask your health insurance plan if they cover occupational therapy. Many do, including Medicare and Affordable Care Act plans. Also ask if the OT and/or OTA you want to see is in your plan’s network, how much you may need to pay, and how many appointments are covered.

Contact Pemi-Baker Community Health today to set up an appointment in your home or at our office on Boulder Point Drive. 603-536-2232

~written by Anna Swanson

PBCH is First Home Health Agency in Central NH Offering Homebound Vaccination Clinics

Emily Reid, Pemi-Baker Community Health RN administering a Covid-19 vaccination to a homebound patient and caregiver in Plymouth, NH

Pemi-Baker Community Health is partnering with the Central NH Regional Public Health Network (RPHN) to bring COVID-19 vaccine to homebound patients within their 22 town service area. This unique collaboration is just one example of many partnerships the Central NH RPHN has throughout the region addressing complex public health issues.

The Central NH RPHN is one of 13 regional public health networks funded by the New Hampshire Department of Health and Human Services (DHHS) to convene, coordinate, and facilitate an ongoing network of partners to address the delivery of public health services. Services can include: public health emergency preparedness, substance use disorder, and other disease prevention and health promotion activities to improve population health and community resilience.

Angel Ekstrom, the Central NH Public Health Network Coordinator, has been instrumental in coordinating partners to vaccinate homebound residents throughout the region reaching the most vulnerable. “Partnering with home health care agencies to vaccinate residents who are homebound affords homebound vaccine recipients to receive their vaccine from a familiar and trusted healthcare provider who, in many cases, regularly enters the recipient’s home. For those who are not clients of the home healthcare provider it connects homebound recipients to available services they may need” says Ekstrom.

Through Central NH RPHN COVID-19 response efforts, Angel has collaborated with partners across sectors in providing situational awareness, aiding partners in obtaining Personal Protective Equipment (PPE), standing up and demobilizing an Alternative Care Site (ACS), coordinating and operating mobile vaccine clinics addressing inequities, securing vaccine to meet Central NH RPHN needs and recently this partnership with PBCH to administer COVID-19 vaccine to homebound residents.

“We are very excited to offer vaccines to our homebound patients and their caregivers. We have been compiling a list of our own patients who cannot leave their homes to travel to a vaccine clinic and 211 NH has also given us names” said Kara Hamill, PBCH Senior Operations Director. Jenn Stewart, Infection Control Nurse, Penny Conlon, RN,  Emily Reid, RN and Macayla Noble, LPN have undergone specialized training and have been conducting homebound vaccination clinics for three weeks, vaccinating over 80 people thus far.

Jenn Stewart, Infection Control LPN preparing vaccines.

To date, Pemi-Baker Community Health is the only Home Health (VNA) agency offering this homebound service in Central NH. “We are honored to collaborate with Angel and the Central NH RPHN and are very proud of the fact that although we have serviced multiple patients with Covid-19, we haven’t had a single Pemi-Baker clinician contract Covid-19 from a patient over the past year. While out in the community our employees have been very diligent following CDC, NH state guidelines and the guidelines that the PBCH Covid taskforce has laid out” said Jenn Stewart, LPN and Pemi-Baker Community Health’s Infection Control Nurse.

If you or a loved one cannot leave the house (homebound) and would like more information about this service please call Pemi-Baker Community Health at 603-536-2232.

~written by Anna Swanson

March is National Nutrition Month- Are you programming your biology for health or disease?

March is National Nutrition Month and Pemi-Baker Community Health’s newest Community Partner, Denise Poudrier Normandin, founder, and CEO of Enlighten Nutrition & Wellness wants us to make every bite count. In December, the updated Dietary Guidelines for Americans 2020-2025 were released, and the aim is to promote health and prevent disease. With over two decades of experience as a Registered/Licensed Dietitian and Health Education, Denise helps make sense of the new findings.

Choosing a healthy lifestyle is key to promoting, maintaining and/or regaining health. Therefore, it is important to consider if your lifestyle choices are programming your biology for health or disease. One of the most significant ways we impact our biology is by the food choices we make on a regular basis. Food can be healing or harmful to our bodies. That is why it is important to choose whole, real foods, the way they are intended from nature.  “Let Food Be Thy Medicine and Medicine Be Thy Food” – Hippocrates. Hippocrates of Kos was a Greek physician of the Age of Pericles, who is considered one of the most outstanding figures in the history of medicine. He is often referred to as the “Father of Medicine.”

Just about everyone, no matter their health status, can benefit from shifting food and beverage choices to better support health.

The review of the scientific evidence on diet and health that informs the Dietary Guidelines is representative of the U.S. population—it includes people who are healthy, people at risk for diet-related chronic conditions and diseases, such as cardiovascular disease, type 2 diabetes, and obesity, and some people who are living with one or more of these diet-related chronic diseases.

The Dietary Guidelines is not intended to contain clinical guidelines for treating chronic diseases. Chronic diseases result from a complex mix of genetic, biological, behavioral, socioeconomic, and environmental factors, and people with these conditions have unique health care requirements that require careful oversight by a health professional. These largely preventable chronic diseases put people at a greater risk for illness, including COVID-19.

Are you ready to make every bite count and start programming your biology for HEALTH?

Here are a few tips for the dietary guidelines to get you started:

  1. Follow a healthy dietary pattern at every life stage.
  2. Customize and enjoy nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations.
  3. Focus on meeting food group needs with nutrient-dense foods and beverages and stay within calorie limits.
  4. Limit foods and beverages higher in added sugars, saturated fat, and sodium, and limit alcoholic beverages.

A healthy dietary pattern consists of nutrient-dense forms of foods and beverages across all food groups, in recommended amounts, and within calorie limits.

The core elements that make up a healthy dietary pattern include:

  • Vegetables of all types—dark green; red and orange; beans, peas, and lentils; starchy; and other vegetables
  • Fruits, especially whole fruit
  • Grains, at least half of which are whole grain
  • Dairy, including fat-free or low-fat milk, yogurt, and cheese, and/or plant-based
    sources
  • Protein foods, including high quality proteins; beans, peas, and lentils; lean meats,
    poultry, and eggs; and nuts, seeds, and soy products
  • Oils, including vegetable oils and oils in food, such as seafood and nuts

Denise is accepting new patients and is a preferred provider of Medical Nutrition Therapy (MNT) and is available to meet one-on-one to create a healthy eating plan that works for YOU! She is committed to building stronger, healthier individuals, families and communities through face-to-face individual and group nutrition consultations, telehealth, corporate training workshops, wellness retreats, health, and lifestyle coaching, and speaking engagements. Most recently, she became a board-certified diplomat in Lifestyle Medicine by the American College of Lifestyle Medicine and the International Board of Lifestyle Medicine. “My passion is to inspire healthy living practices to improve health and transform lives!” Private insurance and Medicare accepted. To learn more email Denise or visit her website: denise@enlightenlivewell.com or enlightenlivewell.com

With over 50 years of experience, serving clients from 22 towns in central and northern New Hampshire, Pemi-Baker Community Health is committed to creating healthier communities. Services include at-home healthcare (VNA), hospice and palliative care, on-site physical and occupational therapy, and aquatic therapy in their 90-degree therapy pool.

PBCH is located at 101 Boulder Point Drive, Plymouth, NH. To contact us please call: 603-536-2232 or email: info@pbhha.org 

Benefits and Considerations for In-Home Physical Therapy

A physical therapist (PT) is a specialist trained to work with you to restore your activity, strength, and motion following an injury or surgery.  Physical therapists can teach specific exercises, stretches, and techniques and use specialized equipment to address problems you might be experiencing. Pemi-Baker Community Health’s compassionate, experienced PT’s will come to your home for your therapy and once you are able, you can transition to Outpatient Physical Therapy(OPT), where you travel to them at their clinic in Plymouth, NH.

Physical therapy care may be provided in a variety of different settings. Obviously, if you are hospitalized, your therapy may be provided by a physical therapist who works at the hospital. If you require sports therapy, you may go to an OPT clinic. Some patients have difficulty leaving the house to go to physical therapy. In-home physical therapy is the perfect solution.

So what is in-home physical therapy, and how might you benefit from PT in your home?

Physical therapists are trained to identify deficiencies in the bio-mechanics of the body. Working with a physical therapist can target specific areas of weakness in the way our bodies work. They can relieve stress and help the body function without pain.

Physical therapists are knowledgeable about surgical procedures and treatment goals and can tailor their efforts to improve your well-being. After surgical procedures, it is important that therapy is guided by the surgical procedure. Physical therapists are knowledgeable about your body’s limitations after surgery and can help ensure a successful outcome.

Stretching Tight Muscles and Joints: Stretching is vital in maintaining a good range of motion with joints and the flexibility of muscles. If you have stiff joints or tight muscles, normal activities, such as climbing stairs or reaching overhead, can be severely affected. With proper stretching, these functions can be preserved.

After an injury or surgery, scar tissue forms and soft tissue contracts. It is important to regularly stretch in these situations to ensure that scar formation does not get in the way of your rehabilitation.

Exercises to Strengthen Your Body: Strengthening exercises are performed to help you improve the function of your muscles. The goal is to improve strength, increase endurance and maintain or improve range of motion. Post-operative exercises should always be guided by your doctor and physical therapist, as there may be specific restrictions for your injury. One of the most recent developments in physical therapy is the emphasis on core strengthening and stability. The core of your body is like the foundation of your house. If you were to build your house on a weak foundation, you could risk damage and collapse. Similarly, bodies with a weak core are susceptible to acute injury and chronic overuse syndromes.

Who Benefits from In-home PT?

Anyone experiencing:

Is In-Home PT Effective?

Many people wonder if home-care physical therapy is effective. Why? Because many believe that you need expensive, heavy equipment and exercise tools to engage in an effective rehab program. This is not necessarily true. Your home-care physical therapist is trained to utilize available resources to maximize your rehab experience. He or she can also bring light equipment to your home to ensure you get the most out of your physical therapy.

How Do You Get Home care PT?

Most patients who receive home-care physical therapy are referred to the service by their physician. Your doctor can make the referral to a local visiting nurse service that offers physical therapy, and he or she can attest that home services are medically necessary. This medical necessity report will likely also state that home-care physical therapy is needed because you are unable to leave the house due to your condition or circumstances. Patients can choose who they go to for services, they just need to mention the organization to their physician. (Keep in mind if you have insurance you should always check to confirm what providers are included).

If you feel you may benefit from physical therapy at home, you can also call your local physical therapy clinic or visiting nurse association like Pemi-Baker Community Health. Those organizations can help you navigate the pathway to receiving home-care PT.

~written by Anna Swanson

The Chaplain? What For?

Whenever a person is about to be admitted to hospice end-of-life care, a social worker meets with the patient, family, and other caregivers to advise them of the various supportive services that are part of hospice. One of these services is Spiritual Care, provided by the Spiritual Counselor or Chaplain. The whimsical title used above is a fairly common response to the social worker’s inquiry regarding including Spiritual Care in the treatment plan. Generally speaking, only about a third of our prospective hospice patients and the families are receptive to the visits of the Chaplain. There are a number of factors that figure into this.

First off, when people hear “Spiritual Care” they probably think “Religion” “Church” “Preaching” and “Praying”. We live in a time when these values are not well-accepted. Statistics from some years ago reported that only about 35% of New Hampshire citizens identified themselves as being affiliated with a religious denomination or formal spiritual practice. That percentage squares rather nicely and neatly with the average amount of people who respond positively for spiritual support as part of their hospice care, at least in our area. For whatever reasons, many people choose not to participate in these values that were formerly a major characteristic of our American way of life. Perhaps they had bad experiences associated with religious and spiritual practice. Perhaps they are members of recent younger generations who have never been exposed to these values, and are lacking in knowledge or awareness of what they can mean and signify in our human lives. Recent research has called this group “the Nones” meaning they check “None” on any surveys that inquire about spiritual and religious practice or affiliation.

A second factor is that, since hospice is end-of-life care, the image a Spiritual Counselor or Chaplain conjures up is that of the Angel of Death, or at least one of its minions. Persons and their caregivers have already taken a huge step in agreeing to hospice care. They are already in a mode of mourning as they prepare for the death that will occur. Perhaps declining the services of the Chaplain is perceived as a way to forestall that awesome but inevitable reality, at least for a little bit.

So, what does the Hospice Chaplain do?

The Hospice Chaplain does not interfere in the active religious practice or formal affiliation of those patients and families who subscribe to these things. If they wish to rely on their own clergy for their end-of-life spiritual care that is something hospice care encourages. If they have fallen away from their connection to their religious fellowship and wish to renew it, the Spiritual Counselor can function as a liaison in helping that to happen. In some instances, the patient may wish to have the Chaplain serve as an auxiliary to their own clergy. Hospice will do this in consultation with the clergy person involved. If the patient identifies generally with a religious tradition, but does not wish to reestablish a formal link to that tradition, the Chaplain will try to respect that tradition in his or her service to that patient and care giving system.

In my three years of service as Hospice Chaplain for Pemi-Baker Community Health, I have been able to draw upon the interfaith background of my own family heritage. Although I am most aligned with Roman Catholic, Anglican/Episcopalian, Lutheran, and Eastern Orthodox practices, I have family-­related experience with Methodist, Presbyterian, Baptist, and Pentecostal beliefs and practices. I grew up in a Jewish neighborhood in New York’s mid-Hudson Valley. I have lived in metropolitan areas where religions of other cultures were present. I see ecumenical respect and reverence as a central feature in my responsibilities as the Spiritual Counselor for Pemi-Baker’s Hospice Program. I am not out to convert anyone. I do not preach at anyone. I will pray with anyone, read the Scriptures, and even sing hymns to anyone if that is their request. But I do other things, too- and a patient does not have to be religiously disposed to engage my services.

Hospice practice usually regards Spiritual Care broadly.

That can sound squishy and fluffy to some people, but since hospice is end-of-life care, a great deal of my work is facilitating what is called “life review”. What is the unique story of this person’s life? Where are they from? Where did they grow up? What did they do for work and livelihood? Whom did they love? What was important to them? What did they enjoy and find interesting? Sometimes there are deeper existential questions. “Why is this happening to me?”, “Is God punishing me?”, or “Have I lived a good life?” and “Have I done anything worthwhile?” So I listen a lot. I affirm their accomplishments. I try to soothe any regrets they may have. I celebrate the memory of their joys. If there is “unfinished business” with family members or acquaintances, I can offer to be a bridge toward resolving and healing those things.

To offer you some specific examples, there are these.

For the lady who loved gardening, I will take a book of photographs of flowers and trees and we will look at it together. I will read a book about World War II to the Naval veteran who served in the South Pacific. I will listen to classical music to the patient who loves a particular symphony or opera. I will talk recipes with the woman who likes to watch different TV cooking shows. I will read Morning Prayer for the Episcopalian who can no longer see well enough to use his prayer book. I will spend longer time with a patient whose caregiver may need some time to go out to pick up a few groceries, giving that person some often-needed respite. When a patient is actively dying, I will “sit vigil” with them regardless of whether or not they can engage in conversation with me. I think you can see that the bulk of my work is not what is usually understood as “religious” or “spiritual”.

One of my favorite memories in my service as Hospice Chaplain is about a woman who was initially suspicious about my coming to see her. Before I first met with her, her paid caregiver told me, “She mentioned when I was getting her up that “Some priest or minister is coming to see me. I’ll see what it’s like. I don’t think I’ll want him to come again.” We had a pleasant visit, mostly life review. I did not press her to pray. Somewhat surprisingly, she was willing to have me come back for companionship support. In subsequent visits, she tended to shy away whenever I tried to move toward conversation about faith and belief, so I chose to respect that. After four or five weeks of my seeing her, she had a mini-stroke, but was able to return to her home. When I saw her next, toward the end of the visit, she asked me rather matter-of-factly, “Can you say a prayer for me?” which I naturally did. It was the first opening I had in moving in the direction of assisting her with her faith, but I thought it was an isolated event. The next week, I went for my usual visit. One of her nieces was visiting with her. As the visit came to an end, I stood up to leave, but as I passed by her chair, she reached out and grabbed my forearm tightly, and asked, “No prayer?” I turned and looked at her niece and said, “The lady wants a prayer” so I knelt down right by her chair and offered a prayer.

So, if you’ve read this article, at some time in the future are ever involved in accessing hospice care for a family member (or even yourself), I hope you might pause before asking “The Chaplain? What for?” I’m rather easy to get along with. I’m caring and supportive. I’ll pray with you only if you want me to-though I’ll pray FOR you silently and quietly while I’m with you and as part of my own daily prayer routine and whenever I may think of you.

~written by Guy Tillson, Mdiv, MA, PBCH Hospice Chaplain

How Home-Based Palliative Care Can Help You or a Loved One

If you or a loved one are living with cancer, heart or lung disease, Alzheimer’s disease, kidney or liver diseases or another serious illness, you may need help managing symptoms, improving your quality of life, or reducing stress. Palliative care through Pemi-Baker Community Health can help.

Whether receiving palliative care at a hospital, outpatient clinic, or at home (home-based palliative care), there are options for getting the care that you or your loved one needs. In this article, we explore one of the options – home-based palliative care – with answers to some commonly asked questions.

What is Palliative Care? Is Home-Based Palliative Care Different?
Palliative care (pronounced pal-lee-uh-tiv) is specialized medical care for people living with serious illnesses. This type of care is focused on relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a specially trained team of doctors, nurses and other specialists, who work together with a patient’s other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness, and it can be provided along with curative treatment.

Palliative care is available in various settings, so that the person living with a serious illness can receive it where they need it. Whether that’s at home or in a hospital, the goals are the same. And home-based palliative care can help you avoid unnecessary hospitalizations by managing complex symptoms before they get worse.

 

What can I expect from home-based palliative care?
You or your loved one would have a specially-trained team — which may include a doctor and a nurse — dedicated to helping improve your quality of life. They would work with you, your family, and other doctors to treat symptoms like pain, shortness of breath, anxiety, and more. The team would get to know you as a person and provide care tailored to your needs and what you would like in addressing your symptoms, emotional stress and spiritual needs. In many cases, they can help arrange for necessary medical tests to be done at your home, such as x-rays or blood work. And the palliative care team also communicates with your other doctors to make sure everyone is aware of your needs and care.

Will the home-based palliative care team listen to me as a patient?                                                           Pemi-Baker’s palliative care team will spend time listening to you, and getting to know you and your family. They want to learn what’s important to you; and based on that, they’ll develop a treatment plan.

How do I know if home-based palliative care is available where I live?
Originally, palliative care was only available to patients and families within the hospital. But now that doctors see the many ways that palliative care can help, and the Affordable Care Act was passed, it is becoming more widely available in other settings.

While availability is growing, it’s not yet an option everywhere. If you or a loved one are having difficulty with a serious illness, it’s important to talk to your doctor about palliative care to learn what services are available where you live. A referral is typically necessary.

How to Get Palliative Care with Pemi-Baker Community Health     Ask your doctor for a palliative care referral with Pemi-Baker Community Health (PBCH). PBCH services the following 22 towns: Alexandria, Bristol, Bridgewater, New Hampton, Meredith, Moultonborough, Sandwich, Center Harbor, Holderness, Ashland, Plymouth, Hebron, Groton, Campton, Rumney, Wentworth, Waterville Valley, Thornton, Ellsworth, Warren, Woodstock, Lincoln and other towns upon request. Once PBCH receives the referral from your doctor they will contact you via phone to answer and ask questions and set up a meeting with you at your home.

Covid-19 Guidelines                                                                                                  As members of your local community, we strive to act in the best interests of patient, employee and community by complying with CDC guidelines and taking precautions as necessary. Appropriate PPE are worn by our visiting nurses, doctors and social workers and our infection control team conducts daily screenings according to the CDC.

To learn more about Palliative Care and how it can help you, please contact Pemi-Baker Community Health.  We are located at 101 Boulder Point Drive, Plymouth, NH. Please call:  603-536-2232 or email: info@pbhha.org

~written by Anna Swanson

Thank You for 12 Amazing Years of Leadership!

We are at once happy and sad to announce the retirement of our CEO, Chandra Engelbert. She has been an outstanding leader for more than 12 years of dedicated service at Pemi-Baker Community Health and a true inspiration for all of us.

The entire Central NH/Plymouth community has benefitted from Chandra’s leadership for much longer than that though. Chandra began her career earning a B.S. in Nursing at Northeastern University in Boston, MA and her MBA from UNH’s Whittemore School of Business and Economics. Chandra’s professional expertise included: Nursing in Medical Surgery, Intensive Care Unit, Emergency Department, Recovery Room, Home care and Hospice. Profit and nonprofit administrative background included management of home care and hospice, Vice President of Diagnostic Services at LRGHealthcare and ICU/ED Manager at Weeks Medical Center in Lancaster, NH.

Over the years she served on the Home Care, Palliative Care and Hospice Alliance of NH and the Central New Hampshire Chamber of Commerce Boards, Central NH Health Partnership, Rural Healthcare Association, Plymouth State University Nursing Honor Society and Nursing Advisory Board and the Central Service Health Network; participating in emergency preparedness efforts and public health initiatives in NH.

Creating a collaborative effort between PBCH, Mid-State Health Center and Speare Memorial Hospital is one of her most proud accomplishments and instilling the ‘Ubuntu’ philosophy for the employees of Pemi-Baker Community Health, creating a culture for them filled with respect, honesty and value.

She will be deeply missed but we can only feel happy for her after many years of service to our community and hope that she enjoys her well-deserved retirement.

~written by Anna Swanson

Advance Care Planning-An important home health service you shouldn’t overlook

FREE Zoom Workshops to help you ‘FILL OUT YOUR FORMS’, hosted by Pemi-Baker Community Health, in Plymouth, NH.

Have you wondered how to talk to your loved ones about what medical care you would or wouldn’t want in a medical crisis?  Does your health care provider want you to have these conversations and fill out your end of life wishes?  Would your wishes change if it was COVID-19 related?  Pemi-Baker Community Health can help with all your advance care planning needs.

Advance care planning (ACP) is a process of understanding, reflecting on and discussing your experiences, values and beliefs in an effort to identify how you want to live if faced with a serious or life-limiting illness. It may include identifying the care you would want at the end of your life or the care you would want if you were too injured or ill to speak.

Download a Conversation Starter Guide

It is also important to choose someone to speak on your behalf if you are unable to make your own decisions, and take comfort in knowing that person will convey your wishes. This person is called a Health Care Proxy, in NH it is termed Durable Power of Attorney for Healthcare.  It could be your partner, a sibling or a close friend.

Download a Guide to Choosing a Health Care Proxy/Durable Power of Attorney

Once you decide what care you want and who to help voice your opinions, you will be ready to complete an ACP document, often referred to as an advance directive. This is the legal form from your state that puts your wishes on paper and legalizes them with witness signatures. When this form is complete, you will want to give it to and communicate your wishes to your family, friends, clergy, other advisors, physicians and other health care professionals to help ensure that your wishes are honored.

Download the New Hampshire Advance Directive

Take time to plan ahead now so future healthcare challenges don’t create difficult questions and unnecessary worry for family caregivers and decision makers. Pemi-Baker Community Health offers free monthly Zoom workshops to help you ‘FILL OUT YOUR FORMS’. Download the advance directive form from our website, poor a cup of coffee and join us for a group Zoom meeting to walk you through the form and answer any questions you might have.

Couple attending zoom workshop
Couple filling out advance directive forms with help from zoom workshop

Pemi-Baker’s Social Workers will be neutral guides helping you reflect on and identify the values, beliefs and goals that shape the way you make health care decisions.  As experienced facilitators, they will explain how important sharing this information is to others so that decisions can be made for you if you ever cannot speak for yourself.

 

~written by Anna Swanson

The Rewards of Being a Hospice Volunteer

While I was familiar with Hospice for many years, I only have been a hospice volunteer with Pemi Baker Hospice and Home Health (PBHHH) since October 2021.  When I retired, I began searching for volunteer work that would allow me to give back to my community.  A newsletter from PBHHH arrived in my email announcing training for hospice volunteers.  My family had experienced the need for hospice twice, once in Ohio and again in Florida.  The relief my family and I felt when the hospice volunteers arrived was beyond measure.  I want to bring the same kind of assistance to others.  PBHHH given me that opportunity by providing professional training with knowledgeable nurses, doctors, social workers and other health care professionals.  Their guidance has enabled me to meet the challenges of being s hospice volunteer, and I am very glad that I did it.

Connie C.

Pemi-Baker Hospice & Home Health
2022-06-27T12:20:25-04:00

Connie C.

While I was familiar with Hospice for many years, I only have been a hospice volunteer with Pemi Baker Hospice and Home Health (PBHHH) since October 2021.  When I retired, I began searching for volunteer work that would allow me to give back to my community.  A newsletter from PBHHH arrived in my email announcing training for hospice volunteers.  My family had experienced the need for hospice twice, once in Ohio and again in Florida.  The relief my family and I felt when the hospice volunteers arrived was beyond measure.  I want to bring the same kind of assistance to others.  PBHHH given me that opportunity by providing professional training with knowledgeable nurses, doctors, social workers and other health care professionals.  Their guidance has enabled me to meet the challenges of being s hospice volunteer, and I am very glad that I did it.

You give of yourselves day & night without end!

To the Pemi-Baker Hospice Team--Words really can't express my feelings-

Your help during one of the most difficult times of my life is SO appreciated.  I'm so grateful that because of you, Doug was able to get his wish not to spend the last of his days in a hospital, but at home with those of us who loved him.

And to be constantly reassured that if I needed anything you would be there-oh my gosh-ANYTIME!  Well, you people need to know how much you are appreciated.  You give of yourselves day & night without end!  God Bless you and thank you!

Pam O.

Pemi-Baker Hospice & Home Health
2020-06-11T07:31:14-04:00

Pam O.

To the Pemi-Baker Hospice Team--Words really can't express my feelings- Your help during one of the most difficult times of my life is SO appreciated.  I'm so grateful that because of you, Doug was able to get his wish not to spend the last of his days in a hospital, but at home with those of us who loved him. And to be constantly reassured that if I needed anything you would be there-oh my gosh-ANYTIME!  Well, you people need to know how much you are appreciated.  You give of yourselves day & night without end!  God Bless you and thank you!

“My home physical therapy was fantastic.”

Pemi-Baker provided very good home therapy. All their therapists were pleasant, helpful in offering suggestions for better functioning after surgery, and practiced good health protocols. They were also very prompt in showing up for scheduled appointments.

Elizabeth B.

Pemi-Baker Hospice & Home Health
2019-11-07T12:26:12-05:00

Elizabeth B.

Pemi-Baker provided very good home therapy. All their therapists were pleasant, helpful in offering suggestions for better functioning after surgery, and practiced good health protocols. They were also very prompt in showing up for scheduled appointments.

“Your generosity with your time and your loving care is appreciated more than you know.”

Thank you to everyone who played a role in taking care of my mother and giving her the freedom of remaining home while suffering from dementia. Your generosity with your time and your loving care is appreciated more than you know. A special thanks goes to Macayla and Colleen, who visited her on a regular basis, and to Lauren who was helpful in connecting us with state services.

Terry W.

Pemi-Baker Hospice & Home Health
2020-01-17T12:43:19-05:00

Terry W.

Thank you to everyone who played a role in taking care of my mother and giving her the freedom of remaining home while suffering from dementia. Your generosity with your time and your loving care is appreciated more than you know. A special thanks goes to Macayla and Colleen, who visited her on a regular basis, and to Lauren who was helpful in connecting us with state services.

“Pemi-Baker Hospice services provided kind, professional, competent services every step of the way-and even vaccinated us all for Covid/19!””

Our primary nurse, Fred, was outstanding, and others who filled in (Cathy, Penny, Colleen) were wonderful and a credit to your organization. Fred, you were amazing, not only for mom but for my husband and I as well. I will forever be grateful for your support, wisdom, humor and kindness, all along the end of life journey for mom. I am so deeply thankful that circumstances conspired such that mom was able to die at home, and your role made that time as seamless as it could be made.

Paula W.

Pemi-Baker Hospice & Home Health
2020-01-17T12:31:13-05:00

Paula W.

Our primary nurse, Fred, was outstanding, and others who filled in (Cathy, Penny, Colleen) were wonderful and a credit to your organization. Fred, you were amazing, not only for mom but for my husband and I as well. I will forever be grateful for your support, wisdom, humor and kindness, all along the end of life journey for mom. I am so deeply thankful that circumstances conspired such that mom was able to die at home, and your role made that time as seamless as it could be made.

“Everyone is so understanding supportive and kind.”

From the director to the nurses to the health care workers.  So cheerful, helpful and accommodating.  This is our second time receiving assistance from Pemi-Baker and we are very lucky to have found this amazing group!  Thank you for your excellent care and compassion.

Leila L.

Pemi-Baker Hospice & Home Health
2020-01-17T13:19:24-05:00

Leila L.

From the director to the nurses to the health care workers.  So cheerful, helpful and accommodating.  This is our second time receiving assistance from Pemi-Baker and we are very lucky to have found this amazing group!  Thank you for your excellent care and compassion.

Your courage during Covid-19 does not go unnoticed

Hello. We just wanted to take a moment and let you know how much we truly appreciate all that you do for us in these trying times. You're commitment to the health of our community is a special thing, and we know that you are working under stressful conditions due to the Covid 19 crisis. We realize that in order for you to treat those who may be ill, you are putting you're own lives and even you're own families lives in danger, and that is truly a courageous and honorable thing to do. We want you to know that it does not go unnoticed. Thank you all for all that you do!

Bryan and Renee C., and our mom Joan

Pemi-Baker Hospice & Home Health
2020-06-11T06:27:43-04:00

Bryan and Renee C., and our mom Joan

Hello. We just wanted to take a moment and let you know how much we truly appreciate all that you do for us in these trying times. You're commitment to the health of our community is a special thing, and we know that you are working under stressful conditions due to the Covid 19 crisis. We realize that in order for you to treat those who may be ill, you are putting you're own lives and even you're own families lives in danger, and that is truly a courageous and honorable thing to do. We want you to know that it does not go unnoticed. Thank you all for all that you do!
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