The Hospice e-News

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

Week of April 3, 2006

…a service of Florida Hospices and Palliative Care

MARYLAND AG’S OFFICE ISSUES END-OF-LIFE GUIDE

Maryland is offering a guidebook to making end-of-life decisions. The guide, Making Decisions for Someone Else, was created in collaboration with the American Bar Association Commission on Law and Aging. According to an article in the Baltimore Sun, “The authors hope that the guidebook will become a model for other states and help families avoid legal battles.” Jack Schwartz, a Maryland assistant attorney general, said, “The court is one of the worst places for trying to resolve issues about difficult medical decisions.”

Making Decisions for Someone Else covers such issues as what it’s like to be a healthcare proxy, what to do when you have to make medical decisions, how to work within the healthcare system, how to resolve disputes and get help, and examples of issues often faced by proxies. It also contains a quiz about the patient’s end-of-life desires that both patient and proxy can take and compare answers.

The website, at www.oag.state.md.us/Healthpol/proxyGuide.htm, has a link for downloading the handbook and links to other related sites. There are sites for downloading advance directives, information on the patient’s plan of care, legal advice on healthcare decisions, Alzheimer’s disease care and other writings by the attorney general’s staff. (Maryland Attorney General Website; Baltimore Sun, 3/30)

HOSPICE OFFERS VETERANS SUPPORT IN THEIR FINAL BATTLE

A VFW article encourages veterans to take advantage of early admission to hospice, saying that failure to do so causes them “to miss out on the full benefits of this service and its expertise – something that helps to maximize the quality of life when its quantity is in short supply.”

In addition to addressing the basics of hospice and palliative care, the author puts emphasis on VA services to terminally ill patients. Dr. Scott Shreve, national director of Hospice and Palliative Care for the VA, says, “Hospice and palliative care are now part of the basic benefits package for enrolled veterans in all settings.”

Most states have hospice-veteran partnerships and other collaborative relationships between VA medical centers and community organizations are growing, says the author. The VA’s involvement in hospice “reflects the stark fact that 1,600 veterans die every day in this country.” Dr. Ira Byock, director of Palliative Medicine at Dartmouth Hitchcock Medical Center, says, “It also demonstrates a national commitment to offering veterans care and expertise at the end of their lives.” Byock adds that veterans are “entitled to help in sorting out treatment options and just getting through the day. Hospice professionals can help you explore the fears we all have about what happens next and how we will be remembered. All of that is worth its weight in gold at this time of life.”

Some veterans feel more comfortable getting their hospice or palliative care directly from the VA. At Bay Pines VA Medical Center in St. Petersburg, many volunteers in the program are either veterans or spouses of veterans. Deborah Grassman, clinical coordinator of the hospice unit at Bay Pines, says that veterans may differ from other hospice patients at the end of their lives. She thinks it may be because they’ve already faced death or that they could be struggling to resolve traumas experienced long ago on the battlefield. But VA staff and volunteers deal with those issues. Grassman says, “It's like coming home to die. We're going to continue to honor your service to your country all the way through the last phase of life.” (VFW, 2/2006)

STUDIES EXAMINE OUTCOMES OF PRAYER FOR THE SICK

An article in The Washington Post says, “Prayer is the most common complement to mainstream medicine, far outpacing acupuncture, herbs, vitamins and other alternative remedies.” Paul Parker, professor of theology and religion at Elmhurst College, says, “Every religion believes in prayer for healing.” In recent years, several studies have attempted to validate the results of prayer for the sick, with “mixed and highly controversial results.” The author of the Post article says, “Skeptics say the work is a deeply flawed and misguided waste of money that irresponsibly attempts to validate the supernatural with science. And some believers say it is pointless to try to divine the workings of God with experiments devised by mortals.”

The American Heart Journal will soon publish the results of the “largest, best-designed” project, which reportedly will say that there is no benefit in praying for the sick. Mitchell W. Krucoff, of Duke University, says, “I will guarantee you that study will have a very interesting impact on a lot of people’s thinking. But how you interpret the results will probably depend on your point of view.”

There have been previous studies which found that “the devout tend to be healthier,” or that those who were prayed for “needed fewer drugs and less help breathing.” But critics say these studies were poorly designed, “looking at so many outcomes that the positive findings could easily have been the result of chance.” Richard Sloan, a Columbia University researcher, calls it “the sharpshooter’s fallacy. The sharpshooter empties the gun into the side of a barn and then draws the bulls-eye. In science, you have to predict in advance what effect you may have.”

Sloan says he “would like to see us stop wasting precious research dollars putting religious practices to the test of science. “It’s a waste of money, and it trivializes the religious experience.” And some who support prayer for the sick agree. The Reverend Raymond J. Lawrence says, “I don’t see how you could quantify prayer – either the results of it or the substance of it. God is beyond the reach of science. It’s absurd to think you could use it to examine God’s play.”

Both researchers and believers say that none of the studies are likely to change anyone’s mind. Trish Lankowski, who started a healing room at Silver Spring’s Immanuel’s Church, says, “I don’t think it will alter my beliefs one way or another. I believe in the power of prayer wholeheartedly. I know it works.” (The Washington Post, 3/24)

BUSINESSES AND BABY BOOMERS STRUGGLE WITH ELDER CARE

Companies are trying to respond to employees who need to care for elderly parents, says an article in The New York Times, but often use child care benefits as a model. Two obvious problems stand out – children live by schedules but elders from crisis to crisis, and children live at home, while elderly parents may be far away. One woman says of her company, “They say they want to do the right thing. But when it comes down to it, they’re not seeing the true picture.”

Companies are cutting back on the benefits they offer in several arenas and the most commonly offered elder care benefits, referral services or unpaid leaves, don’t cost the company much. One person who used her company’s referral service called it “like going to the yellow pages,” since she still had to deal with contracting and supervising the services from afar. Therein lies another difference from child care – “guiding the decisions of an elderly parent also requires mastery of arcane legal, financial and medical matters.” Nearly all children are also eligible for flexible spending accounts and nearly all elders are not.

In 1997, according to a study by the MetLife Mature Market Institute, the cost of elder care to employers was between $11.5 and $29 billion. Replacing lost workers cost the most ($4.9 billion), followed by $3.7 billion for workday interruptions and $885 million for absenteeism. The loss to employees includes lost salary, Social Security and pension benefits because they must refuse promotions, work part-time rather than full-time, or retire early.

One company, Prudential, thinks that the investment in elder care services will save the company money. Prudential subsidizes emergency care. Employees can call the Work Options Group and, for a $4 an hour co-payment, get help for parents by the next morning. Prudential expects to save $650,000 over a three year contract, because employees will be able to focus on work. (The New York Times, 3/25)

RESEARCH AND RESOURCE NOTES

* A recent article in Archives of Internal Medicine focuses on discontinuing drugs for very old or very sick patients. The article recommends that, when prescribing drugs for elderly patients, physicians should consider the patient’s life expectancy, how long it will be until treatment shows any benefit, the goals of care for the patient, and “whether the treatment target should be palliation, maintenance of current status, treatment of acute illness, or prevention of morbidity and mortality.” A MedPage article about the AIM article is online at www.medpagetoday.com/PrimaryCare/Geriatrics/tb1/2939. (Archives of Internal Medicine, 2006;166:605-609; MedPage, 3/27; Chicago Sun-Times, 3/28)

* A recent Spanish-language report, presented at the 3^rd Congress of the Latin American Association of Palliative Care, “provides information about the availability of opioid analgesics in the world and for countries in the region of Latin America.” The PDF file is available at www.medsch.wisc.edu/painpolicy/publicat/monograp/venezuela06.pdf. (PPSG News Alert, 3/28)

PUBLIC POLICY NOTES

* Florida’s Office of Public Policy and Program Analysis (OPPAGA) has released a report, titled “Florida’s Certificate of Need Process Ensures Qualified Hospice Programs: Performance Rating is Important to Assess Hospice Quality.” The report recommends to the legislature that, if new for-profit hospices are allowed to operate in Florida, they should be approved through the CON process. The report, which can be found at http://www.oppaga.state.fl.us/reports/health/r06-29s.html, also urges Florida hospices to participate in the NHPCO data set. (OPPAGA website)

* The Georgia House of Representatives passed a bill allowing hospices to care for persons with incurable progressive diseases. Representative Buddy Carter (R), sponsor of the bill, said, “What we want to do is to have this expertise that these hospice teams are able to offer to be extended out to two years.” (Florida Times-Union, 3/14)

* HHS’s Office of the Inspector General recently issued a new advisory opinion that is possibly of interest to hospice compliance officials. An OIG listserv announcement says, “The OIG has previously stated that incentives of nominal value are not prohibited but this opinion goes on to note the OIG set $10 per incentive as the threshold for ‘nominal.’” See www.oig.hhs.gov/fraud/docs/advisoryopinions/2006/AdvOpn06-01A.pdf to download the opinion. (Office of the Inspector General Website)

OTHER NOTES

* During the anniversary week of Terri Schiavo’s death, many articles and broadcasts occurred in the nation’s media marking that event. Michael Schiavo appeared on The Today Show and Larry King Live, and the Schindler family on Good Morning America. Both Schiavo and the Schindler family have new books about Terri’s life and death. (NBC’s Today Show, 3/24, 3/26-27; CNN’s Larry King Live, 3/27; ABC’s Good Morning America, 3/27-28; Time, 4/3; St. Petersburg Times, 3/27; AP, 3/29)

* There are 12,000 hospitalists in the US today and that number is expected to grow to 30,000 in the next five or six years. The Society of Hospital Medicine says that 71% of hospitals with 500 or more beds have hospitalist programs, compared to 55% in hospitals of 200-500 beds, and 45% of hospitals with 100-200 beds. (Modern Healthcare’s Daily Dose, 3/29)

* When Stewart Selman was told that he had a malignant brain tumor, he began an audio diary to leave for his wife and children. An interview with his wife about their last year together, and excerpts from the diary, are online at www.npr.org/templates/story/story.php?storyId=5303770. (NPR Website, 3/27)

* Several South Florida hospices are working to overcome prejudices against hospice in the black community. Boca Raton’s Hospice by the Sea has started Opening Doors, an outreach effort aimed specifically at blacks. Gold Coast Home Health and Hospice is planning a training program for minority caregivers. Janet Neigh, vice-president of the Hospice Association of America, emphasizes the importance of black nurses and coordinators on hospice staffs. (South Florida Sun Sentinel, 3/29)

Glatfelter Insurance Group is the national sponsor of Hospice News Network for 2006. Glatfelter Insurance Group provides property and liability insurance for hospices and home healthcare agencies through their Hospice and Community Care Insurance Services division. Ask your insurance agent to visit their website at www.hccis.com.

Thanks to Sandy Kuhlman and Paul Ledford for contributions.