06-22-2022 Primetime Livnig - Flipbook - Page 31
A Special Advertising Section of Baltimore Sun Media Group | Wednesday, June 22, 2022 31
Quality of life, continued
from previous page
Movement disorder,
continued from page 4
Hospice care, palliative care
and Medicare
Steff Walker, divisional director of business development, home health and hospice – Central Division with ProMedica,
talks about access to hospice for older
adults. “Hospice is a Medicare Part A
benefit. You have to be diagnosed with an
illness that has a prognosis of six months
or less, when you’ve exhausted curative
treatments available, or are in constant
decline. It was created to be provided in a
patient’s home. If it’s too burdensome, you
may be transferred to an inpatient setting.
Patients are provided end of life care with
the goal of increasing the quality and catering to whatever that person wants for their
remaining time.”
“All Medicare-certified hospices are
required to offer four levels of hospice
care depending on patient and caregiver
needs. Medicare-certified hospice care is
usually given in your home or other facility
where you live, like a nursing home. You
can also get hospice care in an inpatient
hospice facility. Original Medicare will still
pay for covered benefits for any health
problems that aren’t part of your terminal
illness and related conditions, but this is
unusual. Once you choose hospice care,
your hospice benefit will usually cover
everything you need,” as stated at www.
medicare.gov/care-compare/resources/
hospice/levels-of-care.
Routine home care
• Most common level of care in hospice. Patient is generally stable and
the patient’s symptoms, like pain or
nausea and vomiting, are adequately
controlled.
• Usually provided in the home.
General inpatient care
• Crisis-like level of care for short-term
management of out-of-control patient
pain and/or symptoms
• Usually provided outside the home,
in an inpatient setting at a medical
facility like a hospital or skilled nursing facility.
Respite care
• A level of temporary care provided
in nursing home, hospice inpatient
facility, or hospital so that a family
member or friend who’s the patient’s
caregiver can take some time off.
• This level of care is tied to caregiver
needs, not patient symptoms.
Depending on your terminal illness and
related conditions, your hospice team will
create a plan of care that can include any
or all of these services:
• Doctors’ services.
• Nursing and medical services.
• Durable medical equipment for pain
relief and symptom management.
• Medical supplies, like bandages or
catheters.
• Drugs for pain management.
• Aide and homemaker services.
• Physical therapy services.
• Occupational therapy services.
• Speech-language pathology services.
• Social services.
• Dietary counseling.
• Spiritual and grief counseling for you
and your family.
• Short-term inpatient care for pain
and symptom management. This care
must be in a Medicare approved facility, like a hospice facility, hospital, or
skilled nursing facility that contracts
with the hospice.
• Inpatient respite care, which is care
you get in a Medicare-approved facility (like an inpatient facility, hospital,
or nursing home), so that your usual
caregiver (like a family member or
friend) can rest. Your hospice provider
will arrange this for you. You can stay
up to 5 days each time you get respite
care. You can get respite care more
than once, but only on an occasional
basis.
• Any other services Medicare covers to manage your pain and other
symptoms related to your terminal
illness and related conditions, as your
hospice team recommends.
Continuous home care
• Crisis-like level of care for short-term
Medicare doesn’t cover room and
management of out-of-control patient board when you get hospice care in your
pain and/or symptoms
home or another facility where you live (like
• Usually provided in the home.
a nursing home).
in the wrist with gentle electric shocks.
The therapy is being evaluated through
clinical trials, and thus the Food & Drug
Administration (FDA) is still determining
its value.
Focused ultrasound
The University of Maryland Medical
Center (UMMC) is the only health care
provider in the state of Maryland to offer
focused ultrasound (FUS) for treatment
of essential tremor. With focused ultrasound, pinpointed acoustical energy is
specifically directed to the targeted areas
of the brain that are responsible for movement difficulties. Magnetic resonance
imaging (MRI) is used to locate targets
and create a heat map for the procedure, and the MRI technology guides the
physician to visualize the targeted areas
in real time. These pinpointed spots are
treated with low energy to the lesions and
evaluated before increasing the intensity
to remove the affected brain cells.
With its gradual process, FUS enables
physicians to interrogate the target and
evaluate for changes in sensation and
muscles strength, before initiating permanent changes to tissue.
“You can perturb that part of the
brain enough so you can see the tremor
go away,” Dr. Eisenberg explains. “The
tremor is significantly reduced, and there
are no off-target effects. Then, the energy
is stepped up for ablation to make the
change permanent.”
During the procedure, patients remain
awake and undergo function testing
throughout the several-hour treatment.
They return home the same day – some
even drive themselves home – and
resume regular activity within a few days.
Patients notice improvement almost
immediately following the procedure, and
typically experience up to a 70% reduction in symptoms.
“With focused ultrasound, we can get
enough energy to go through the skull
and be specifically applied to the target
area,” says Dr. Eisenberg. “There are
multiple adjustments that can be made
to account for variations in the skull and
to specifically pinpoint the areas that are
causing the movement abnormalities.
This procedure has proven to provide
significant reduction in tremors and other
movement concerns.”
Over the last five years, Dr. Eisenberg
and his colleagues at UMMC directed groundbreaking research that led to
authorization for unilateral (to one side of
the brain) use of the procedure for essential tremor by the FDA and Centers for
Medicare and Medicaid Services (CMS).
The use of FUS unilaterally for tremor
predominant Parkinson’s disease also
has been approved by the FDA and in
some states by CMS. FUS unilateral
treatment for Parkinson’s disease has
received FDA approval but not yet CMS
approval. Research study of the use of
FUS bilaterally (both sides of the brain at
once) for essential tremor has been completed; data analysis is underway.
“Deep brain stimulation is still the gold
standard, but for patients who don’t feel
they can tolerate deep brain stimulation,
or they don’t want to have electrodes
implanted in their brain, they choose
focused ultrasound,” Dr. Eisenberg says.
“This a great option for these patients.”