End-of-Life Choice, Death with Dignity, Palliative Care and Counseling


Terminally Ill Patients Bracing for Medicaid Hospice Cuts

by Britney Glaser
January 22, 2013

Some of the state’s poorest people in their final days of life are about to face a big cut in health coverage.

Starting February 1st, Medicaid will no longer pay for hospice care in Louisiana.  7News looks into what is behind the falling budget axe and what it means to dying patients.

It has only been three months since Eric Tillman of Lake Charles watched his wife, Cynthia, take her final breaths.  “She had done chemo,” he said, “and the cancer went into remission for a year.”

A diagnosis of stage four ovarian cancer limited his wife’s final days, but hospice care ensured they were not filled with pain and a hospital stay.  CHRISTUS St. Patrick Hospice Nurse Director, Michele Hurley says hospice care allows terminally ill patients to pass away with dignity.  “We work toward having the best quality of life possible for patients that are terminally ill,” she said.

Hurley says her passion is her hospice patients, but state cuts taking effect next month will mean Medicaid patients will no longer have hospice care covered.  “Eliminating the hospice benefit for Medicaid recipients, you’re creating a whole pool of unfunded patients,” she said.

The changes are because of a mid-year budget gap. Medicaid hospice is just one stripped program. Sherrill Phelps with the Louisiana-Mississippi Hospice Association says this will deprive terminally ill patients of the opportunity to die comfortably and with care.  “They’re deserving to have the help and the support and the financial payment to provide that care for those people,” he said.

Louisiana will become one of only two states to eliminate Medicaid hospice. Arizona was in that mix, but has already reinstituted it because it costs more.  “You’re going to pick them up and bring them to the emergency room, to the hospital, which costs considerably more than the $140/day paid for by the state for the Medicaid program,” said Phelps. More

Hospice Myths to Avoid

by Joyce Baldrica
TC Palm
January 15, 2013

Hospice care offers the services you want. What stands in the way of more people choosing hospice care, is limited awareness of what services it offers and how to find it. When making a decision about hospice care, it helps to have a good understanding of what hospice is, and what it isn’t. Here are some of the most common misconceptions about hospice, along with the true facts about this special kind of care.

Myth: Hospice is a place.

Fact: Hospice care usually takes place in the comfort of your home, but can be provided in any environment in which you live, including nursing homes, assisted living facilities, and hospitals.

Myth: Hospice means that the patient will soon die.

Fact: Receiving hospice care does not mean giving up hope or that death is imminent. The earlier an individual receives hospice care, the more opportunity there is to stabilize your medical condition and address other needs. Some patients actually improve and may be discharged from hospice care.

Myth: Hospice care starts a few days before death.

Fact: Hospice is not just for the last few days or weeks of life. The benefit is designed to provide care for six months, or longer. For most people, it is a relief to find that there is another source of help and support. Hospice care, at any stage of illness, bur particularly early on, can significantly lighten the burden for both the patient and family.

Myth: Families have to pay for hospice care.

Fact: Hospice care is a Medicare benefit. Most private insurers also cover hospice care as well. Some Hospices have a charity program, which helps to care for all patients, regardless of an individual’s ability to pay.

Myth: Hospice is only for cancer patients.

Fact: A large number of hospice patients have congestive heart failure, dementia, chronic lung disease, or other conditions. More

Hospice: a Caregiving Experience

by Miranda Klingenberg
Pilot Tribune
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

7 Things You May Not Know About Hospice Care

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:

  1. 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.
  2. 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.
  3. 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

End-of-Life Care, Talks Help Folks ‘Die Well’

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