End-of-Life Choice, Palliative Care and Counseling

Posts Taggedend of life

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

What Doctors Need to Learn About Death and Dying

by Karen M. Wyatt, MD
Huffington Post
December 6, 2012

“The old man and the young woman sat across from one another stiffly perched on plastic chairs, staring down at the floor — doctor and patient. The tension in the room, exaggerated by the silence between them, was almost unbearable. Then the patient, stroking a trembling, emaciated hand across a hairless scalp, spoke haltingly, “Doctor, promise me I’m not going to die.”

According to a recent post in the New York Times by columnist Jane Brody, this type of interaction with a terminally-ill patient creates occupational distress for many doctors who are not equipped emotionally to handle such a difficult situation. She states that doctors who are unable to cope with “their own feelings of frustration, failure and helplessness … may react with anger, abruptness and avoidance” toward their patients who are dying. When this occurs, doctors may recommend futile treatments to patients at the end of life because they cannot connect with those patients on a human, suffering level and have nothing else to offer them.

The article touts mindfulness meditation, a practice recommended by palliative care specialist Dr. Michael Kearney, as a solution for discontent and disconnected doctors. I wholeheartedly agree that mindfulness meditation can be a very helpful practice for calming anxiety and learning to be present. However, I believe that this problem — doctors who find themselves unable to cope with perceived failure when a patient is dying — requires a deeper and more fundamental solution: Doctors need a new understanding of death and, therefore, life. More

Do Seniors Turn to the Right Places at End of Life?

by Andrew Seaman
Chicago Tribune
October 1, 2012

A new study says almost one third of Medicare’s beneficiaries use the program to pay for end-of-life care at nursing homes, which may not be equipped to treat or prevent pain and suffering.

Those palliative care services are usually associated with hospice care, while nursing homes are typically for rehabilitation and long-term care.

The study’s researchers, who published their findings in the Archives of Internal Medicine on Monday, say the findings suggest that palliative or hospice care should be incorporated into Medicare’s nursing home benefits.

“Often our focus on these patients is trying to keep them functional or independent for as long as we can. What we may be overlooking is that they are on an end-of-life trajectory,” said Dr. Katherine Aragon, the study’s lead author from Lawrence General Hospital in Massachusetts. More

Boomers Want Control of Their End-of-Life Care

By Jonathan Walters
September 28, 2012

Assisted suicide. Euthanasia. Death panels. Rationed health care.

There’s nothing like a well-chosen phrase to inflame talk about end-of-life care — how the health-care system cares for those who are in the last stages of a terminal illness and how much control patients and their families have over that process.

It can be an emotional and divisive issue, and for lawmakers, a dangerous business. That’s certainly something President Obama quickly learned when a provision in the Affordable Care Act (ACA) that encouraged doctors to engage patients in discussions about end-of-life care quickly deteriorated into a nationwide war of words over whether such one-on-one discussions between patient and physician would result in “death panels” determining who should receive care.

But with America rapidly aging, the subject of end-of-life care isn’t going to go away. It has the attention of any legislator or government official trying to make sense of health-care budgets in general and Medicare expenditures in particular. That’s because in their last year of life, older adults consume more than a quarter of Medicare’s expenditures, costing more than six times as much as other beneficiaries. It also has the attention of hospital officials. Under the ACA, hospitals will be penalized by Medicare for high readmission rates. That means there will be more focus on avoiding the ping-ponging of terminally ill patients that often takes place between nursing homes and hospitals as people near the end of their lives.

Meanwhile, an increasing percentage of Americans say they want more control over how they will be treated should they become terminally ill. Faced with the mechanistic environment of hospital intensive care units, many older patients say they prefer to die at home, surrounded not by machines but by their family. Others want every option explored, every high-tech trick tried to prolong their lives, even if they are unconscious.

Today, the discussion over end-of-life care is alive and well — but not on a national level. “It’s pretty quiet right now, and has been since 2009 and the whole death panel debate,” says John Carney, president and CEO of the Center for Practical Bioethics, formed in 1984 to parse out complicated ethical issues around medicine and medical research, including issues like end-of-life care. Rather, the debate and press toward a political solution are currently taking place at the state level. There, policymakers and advocacy groups are managing to defuse the raw emotional responses that national, partisan-fueled battles elicited when the ACA was being debated.

The reason for that is straightforward. Rather than pursuing the “death with dignity” approach to end-of-life decisions — which immediately inflames the right-to-life lobby — a low-key movement has evolved in the states. This movement is focused on giving patients facing tough decisions about end-of-life care more say in what medicine and medical procedures they want or don’t want.

If advocates for more rational and patient-centered end-of-life care can avoid the specter of death panels and health-care rationing, there’s the real possibility of progress. Dr. Susan Tolle, who practices general medicine in Oregon and serves as director of the Center for Ethics in Health Care at the Oregon Health & Sciences University (OHSU), says, “When people are using language like ‘death panels,’ there’s more emotion and fear than if you say you want to honor the wishes of this individual.” More

Wisconsin Medical Society Wants Planning for End of Life

By Guy Bolton
Milwaukee Journal Sentinel
September 20, 2012

The Wisconsin Medical Society is launching a statewide initiative to make advance care planning – including the sensitive and often difficult conversations about end-of-life care – a standard part of patient care.

The initiative – Honoring Choices Wisconsin – is modeled after a communitywide initiative in La Crosse that has drawn national attention as well as a similar initiative by the Twin Cities Medical Society in Minnesota.

The goal is for the state’s health systems eventually to have people on staff trained to help patients understand and document the care they would want if they could not make decisions themselves.

“We know the tragedy of not having these conversations,” said Tim Bartholow, chief medical officer of the Wisconsin Medical Society. More