Hospice eNews       

What the Media Said about End-of-Life Care This Week

Week of September 6, 2005

…a service of Florida Hospices and Palliative Care

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NHPCO ADDRESSES RESPONSES TO HURRICANE KATRINA

 

            In response to the devastation of hurricane Katrina, NHPCO distributed a news release to health editors across the nation, offering “insight into the magnitude of reactions being felt across the country.”  “Ultimately,” the release says, “tragedy can show people they have more resiliency and strength than they realized.  Neighbors help neighbors.  Communities come together to rebuild.  It becomes clear that survival is possible.  While we cannot stop the dominance of Mother Nature, we learn that the care and support of family and friends is essential to bolster our resolve.”

 

            “Hospices have counselors specially trained in grief and bereavement, and many offer support groups or can assist in referrals to other community resources,” the release said.  J. Donald Schumacher, NHPCO President and CEO, said that NHPCO is coordinating efforts of hospices across the country that are offering “professional staff support, supplies, and financial donations to hospice and palliative care providers in the devastated regions.” 

 

            NHPCO is also serving “as a conduit for the release of assistance grants from the National Hospice Foundation to state organizations coping with this disaster.”  Donations of money sent to the National Hospice Foundation, at www.hospicefoundation.org, will be directed to hospice and palliative care providers. 

 

            Hospice professionals had a number of suggestions for coping with the tragedy.

            *  Talk to children.  Answer their questions honestly.  These conversations will identify their fears and allow you to see how disaster has affected them.

            *  Reassure children.  Adults should let them know that parents and guardians will keep them safe.

            *  Be aware that physical symptoms, such as headaches and fatigue, often accompany intense emotional response.

            *  Listen to friends and coworkers who need to talk about their feelings.

            *  Identify organizations in your community that may need assistance.

            *  Don’t keep the television on non-stop.  Take a break from the coverage.  (PR Newswire, 9/1) 

 

 

PALLIATIVE CHEMO COSTS STRAINING HOSPICE BUDGETS

 

            Florida Medical Business News includes an article about how hospices face the decisions and costs involved in offering palliative chemotherapy for hospice patients.  Many new chemotherapeutic drugs, says the article, are more effective against cancer and have far fewer side effects.  So doctors are prescribing them more frequently as palliative agents.  But they’re also usually very expensive and hospices all across the nation are faced with deciding what they can and cannot provide.

 

            Some organizations say they will offer palliative chemotherapy in spite of the expense.  Dr. Gail Austin Cooney, medical director of the Hospice of Palm Beach County, Inc., says, “We have a commitment as an organization to offer palliative chemotherapy to patients.”  But Dr. Jorge Ramirez, medical director of Catholic Hospice, Miami Lakes, points out the math shortfall.  Medicare pays about $120 per day, he says, and that has to cover everything related to the terminal illness.  Xeloda alone, the article says, for a 150-pound woman, costs $108 per day, and Iressa costs $60.

 

            Some hospice providers don’t offer aggressive chemotherapy because they disagree with the philosophy.  Bob Wilson, president and CEO of the Hospice of the Comforter, believes that kind of treatment is “inconsistent with hospice.”  The medical director of the same hospice, Dr. Linda Lukeman, doubts the effectiveness of such agents on their own and worries about side effects.  The Hospice of Citrus County, Inc., doesn’t cover palliative chemotherapy, but the CEO said they would consider admitting someone on it, then consult with the physician to “titrate the person off the drugs.” 

 

            Researchers at excelleRx, Inc. of Philadelphia, surveyed Hospice Pharmacia customers and found that 60% provide oral agents, but only 10% offer IV chemotherapy.  Terri Maxwell, director of research, says that the strongest predictor is the size of the hospice.  Many Florida hospice programs are very large, and, says the article, they usually offer open access.

 

            NHPCO supports the use of palliative chemotherapy, believing that it may encourage earlier hospice admissions, the article says.   Stephen Connor, vice president for research and international programs, believes that the revenue from those earlier admissions may offset the additional cost but acknowledges that hospices may lose money on individual cases.  Fort Myers’ Hope Hospice President and CEO, Samira Beckwith, agrees.  Hope Hospice’s average length of stay is 70 days, far longer than the national average, and Beckwith believes that is because “we accept all people appropriate for hospice care, regardless of what palliative treatments they need.”

 

            Others, however, disagree that it raises early enrollments.  Lisa Kalaf, executive director of Wuesthoff Brevard Hospice, is one who is not convinced.  Her hospice provides palliative chemo, but, Kalaf says, “We’re not doing it to get people earlier, we’re doing it because it’s the right thing to do.”

 

            All are agreed that changes in reimbursement are needed.  This year, Aetna began offering larger customers a comprehensive end-of-life care program that provides simultaneous curative and palliative care and expands expected life expectancy to 12 months.  Some expect that the discussion will heat up as more drugs come on the market and that hospices that provide the drugs may have a competitive advantage.

 

            Cooney says, “It’s important that physicians know hospice programs vary in terms of what kind of palliative therapies are covered.  If you have a person with certain end-of-life needs, it’s worthwhile trying to see if there is a hospice program that can meet them.”  (Florida Medical Business News, 8/9)

 

 

PAIN NOTES

 

            *  The American Pain Foundation website has an alert about hurricane Katrina evacuees and the abrupt withdrawal of pain medications.  See www.painfoundation.org for an informational piece on helping individuals “understand withdrawal symptoms, warnings, and tips about how to deal with withdrawal.”  The APF is asking for help in disseminating the peer-reviewed information.  (American Pain Foundation Website)

 

            *  Stanford University researchers are using real-time functional magnetic resonance imaging (FMRI) to look at nerve activity in the brain to “see where pain is being activated, to see how it’s being processed and how that experience of pain finally comes about.”  Dr. Sean Mackey says that patients can “see where the pain in their brain is.”  “Pain is real,” Mackey says.  “It’s a neurological process, but ultimately all pain is in our brain.  No brain, no pain.”  (NPR’s Morning Edition, 7/6)

 

            *  The FDA has requested that Purdue Pharma stop selling Palladone, a pain medication introduced by the company last winter.  The FDA “determined that the risk of patients potentially drinking alcohol while on Palladone capsules … could not be adequately managed with product warnings.  Purdue Pharma agreed to the FDA request.  (Fairfield County Business Journal, 8/1)

 

            *  The August issue of PainAdvocacyCommunity is online at www.partnersagainstpain.com/painadvocacycommunity.  Click on “E-Newsletters” to get the PDF file.  (PainAdvocacyCommunity, 8/2005)

 

            *  Nearly 1,000 separate lawsuits were filed in Staten Island against Purdue Pharma, maker of OxyContin.  The plaintiffs allege that the company’s marketing of the pain pill was dishonest, and that it did not tell of the drug’s addictive qualities.  A Staten Island judge recently declined to certify a class-action suit.  (AP, 8/27)

 

 

OTHER NOTES

 

            *  In the wake of Katrina, concourse D of the Louis Armstrong New Orleans International Airport is for the dead.  Those near death wait just outside gate D-1, but they are not alone.  Air Force Captain Terri Leitch, and other nurses, make sure patients will not die alone.  Leitch takes her time, kneeling among them, dripping water into their mouths with syringes, wiping their heads with damp cloths and praying for them.  (The Houston Chronicle, 9/4)

 

            *  Vermont’s new “advance directive” law replaces two older statutes and allows state residents an easy way to direct their own end-of-life care with a single instrument.  The Vermont Ethics Network has sample forms at www.vtethicsnetwork.org.  The state Health Department plans to set up an Internet registry so that healthcare providers can easily access patients’ wishes.  (The Barre Montpelier Times Argus, 9/1)

 

            *  “Spending on hospital care is rising and there’s little hospitals can do about it,” says the American Hospital Association about a recently released AHA-commissioned study.  The AHA study found that 52% of the increase in hospital spending is due to the higher cost of goods and services and 75% of that is driven by higher wages.  (Modern Healthcare, 8/29)

 

            *  A $1.4 million grant, given by the National Institutes of Health to a research team led by a University of Rochester School of Nursing professor, will “investigate how well palliative care services are delivered in hospital settings.”  The project’s principal investigator, Sally Norton, PhD, RN, says, “The palliative care service model grew out of the hospice setting.  That’s a very different culture than a hospital.”  (Hospice Letter, 9/2005)

 

            *  Karen Ann Quinlan’s mother, Julia, has written a memoir, My Joy, My Sorrow:  Karen Ann’s Mother Remembers, “about how she and her late husband, Joseph, became accidental pioneers for patients’ rights and hospice care.”  Julia Quinlan said, “Today, we question our doctors about our rights.  We have the advance directives and living wills that I hope young people have filled out.  That’s the purpose that Karen’s life served, and is still serving.”  (AP, 8/29)

 

            *  The New York Times published an article about Dr. Larry Zaroff’s and his 92-year-old mother.  His mother flew from her home near Washington to her grandson’s in California to visit her great-grandchildren and teach her grandson her “famous Jewish recipes.”  In a two-hour session, videotaped by the family, she taught him to make potato latkes, kreplach, sweet and sour cabbage and chopped liver.  Her one last recipe, her son says, was for a good death, which occurred not long after her California visit.  (The New York Times, 8/30)