by Miranda Klingenberg
January 14, 2013
It takes two people to bring someone into this world, but how many does it take to help someone leave it?
If the death is one that can be anticipated or planned for, he answer might surprise you.
Hospice is a palliative form of care designed to support a patient and his or her family through the process of dying. And it requires a full team of professionals and sometimes volunteers to ensure that the patient’s physical, emotional, and spiritual needs are fully addressed. The hospice team administers everything from massage therapy and pharmacological management to bereavement and spiritual counseling. The team recognizes the strengths of each member and works together to provide care and support for patients and their families.
Sometimes people come with reluctance. Many do not want to hear ‘hospice,’ but the very word helps people come to terms with what lies ahead. Janel Kaufman, an RN with the Buena Vista Regional Medical Center hospice team said “You’re providing and coordinating care so that they as a family unit can cope with what they need to cope with.”
It takes a special kind of person to devote their lives to the care of those preparing to transition from this world to the next. Caregivers must be compassionate and comfortable with death, but they must also know their own boundaries. One must accept that death is a natural process. Kaufman said, “I had one of my relatives tell me, ‘Remember, if you do this, that they are not your family,’ which is pretty good advice because sometimes people would like you to move in with them and you need to remember it’s not your job to fix things.” More
by Eve Glicksman
Valley News Live
January 9, 2013
Death is not a comfortable subject for most of us. So, it’s no surprise that many people lack basic knowledge about hospice care. When surveyed, a majority say they would prefer to die in their own home … but three out of four Americans don’t realize that hospice care offers that option.
Lack of information, fears and misunderstandings keep many people from reaping the advantages of specialized end-of-life care. Here are the facts about seven common misconceptions:
- Hospice is not a place. Hospice is an approach to caring for someone nearing the end of life. While hospice care can be provided in a freestanding facility, hospital or nursing home, it’s most often offered in the person’s home. Many people opt for hospice precisely because they can stay at home with loved ones and pets while receiving care. Essentially, the hospice team comes to you. You’re visited by doctors, nurses, counselors, therapists, social workers, home health aides or clergy as appropriate. Round-the-clock phone support is available to caregivers.
- Entering hospice does not mean that medical care stops. Hospice care ismedical treatment. In fact, hospice and palliative (pain relief) care is a board-certified medical specialty. The main difference in hospice is that treatment is not intended to cure. Rather, medication or therapies are only prescribed to manage pain or relieve symptoms. The treatment plan is reviewed regularly and revised as needed.
- Hospice is open to people of any age or condition. Many wrongly believe that hospice is only for cancer patients or the elderly. People with diseases from Alzheimer’s to AIDS can receive hospice care, as can children. The main criterion for hospice is that a doctor must determine that the person is not expected to live for more than six months. More
by Dr. Andrew Ordon
The Desert Sun
December 5, 2012
As doctors, we are taught that death is the enemy. We are here to stop it and if a patient dies, we have failed. That mentality has led to an alarming statistic. According to one study, 60 percent of your health care dollar is spent in the last 30 days of life. Wouldn’t those resources be better spent on prevention and defeating curable diseases earlier in life? Why do we try so hard at the very end? One reason is that we think we can defeat the disease and gift the patient with more time. But there are times when that is not a reality.
One obvious example is the terminally ill. People with Stage 4 cancer. That means they have a cancer which has spread from the local area to a distant location. Cancer starts out in one place, and if it is isolated there, it’s called Stage I. If it erupts from its local area but has not spread to lymph nodes it is Stage 2. If it has spread to nodes but has not spread beyond the region of origin, it is Stage 3. If it has traveled by lymph or through the blood stream to a distant organ, that’s Stage 4, which is as bad as it gets. This is when doctors tell you how long they think you have left.
In a study published in November in the Journal of Clinical Oncology, 1,231 patients with Stage 4 lung cancer were evaluated for their End of Life (EOL) experiences. They considered “aggressive” care to be things such as receiving chemotherapy in the last 14 days of life, ICU stays in the final 30 days and an acute-care hospital stay in their last 30 days.
Researchers found that patients who had EOL discussions before the final 30 days were more likely to receive appropriate hospice care than those who did not have EOL discussions. More
by Paula Span
The New York Times
December 3, 2012
I wrote last week about the poor choices facing patients, most very old and within six months of death, who need nursing home care after a hospitalization.
Medicare will pay for hospice, the acknowledged gold standard for those at the end of life and their families, and it will also pay for skilled nursing (known in this universe as the “sniff” benefit, for Skilled Nursing Facility or S.N.F.). But only rarely will it cover both at the same time, which creates a financial bind.
Rather than pay hundreds of dollars a day out of pocket for room and board in a nursing home, most families opt for S.N.F. coverage. But they pay a price in other ways: they lose the visits by nurses and aides and social workers, the comfort care, the pain relief and the spiritual support that can make hospice such a godsend, whether patients are at home or in nursing homes. More
by Michelle Brandt
November 27, 2012
No one likes talking about dying, but Stephanie Pincus, MD, MBA, believes we all need to do more of it. Pincus is one of the key people who participated in the work that resulted in a new Institute of Medicine committee tasked with exploring and preparing a report on the current state of end-of-life care in the country. The committee’s ultimate goal is to ensure that people are able to die as they wish.
“People do not want to die alone, in a hospital bed, hooked up to 15 different machines, with buzzing in their ears. They want to be with their families in familiar surroundings, able to say their good-byes peacefully,” Pincus, who recently gave a talk at the medical school sponsored by the Stanford Palliative Care training program, told me.
“Until about 100 years ago death was part of life. In early times in the U.S. when someone died they were laid out on the kitchen table,” she continued. “But as we moved medical care to the hospital, death became isolated and isolating. We need to reclaim death from the hospital and reintegrate with the family.” More