The Hospice e-News
What the Media Said about End-of-Life Care This Week
Week of July 18, 2006
…a service of
EXPERTS SAY PARADIGMS
OF END-OF-LIFE CARE SHOULD SHIFT
One of the big challenges identified by the survey
of 35 experts reported in the last issue of State
Initiatives in End-of-Life Care (see HNN,
7/11) was the need to shift the reform paradigms. Historically, the publication notes, reforms
in end-of-life care “have been focused on the quest for legal rights and
advances in professional education and clinical treatment for mainstream
populations.” Experts in the field now
urge attention to other matters such as addressing spiritual and cultural
matters, increasing public engagement and addressing discrimination and
diversity.
Changing the current paradigms will require new
approaches, the article says. In
addressing spiritual and cultural matters, Gwendolyn London, DMin, former executive director of the DC Partnership to
Improve End-of-Life Care, says, “We must realize that dying is a spiritual
process with medical implications, not a medical process with spiritual
implications.” Dr. Richard Payne,
director of the Duke Institute on Care at the End of Life, says, “The real
challenge for the near-term is to find effective ways to teach practitioners to
use nonpharmacological treatments – psychological,
psychosocial, and spiritual interventions – and provide ways to integrate them
into medical approaches.” Payne would
like to see structured training and “cross-talk” between clergy and clinicians.
Dr. Ira Byock, director
of palliative medicine at Dartmouth Hitchcock Medical Center, says, “Faith
communities can teach Americans healthy ways of dying. We’ve only been shown what not to do: die in hospitals. We need community-based discussions of what a
good death is in our culture.”
Another issue that needs emphasis, the experts say,
is greater public engagement. Dr. Joanne
Lynn says, “We really need people to be more activist and supportive of
activism. We need to advocate for good
standards, coherent funding, and … taking the message public. We need a more robust policy agenda and more
groups engaged…”
Byock agrees and wants to see mobilization
of communities to provide supportive care.
“There are not enough professional resources on anybody’s spreadsheet to
meet baby boomers’ needs, so it is in our enlightened self-interest to build
models of caring in the community:
intergenerational programs, programs operating out of churches, schools
and workplaces that share responsibility with the health care system.”
Greater public dialogue on hot issues, the experts
agree, is also needed. The article says
that the Terri Schiavo issue pointed out that the
“once widely accepted legal framework governing end-of-life was under serious
attack and that many Americans lacked the basic information needed to separate
fact from demagoguery regarding ‘persistent vegetative states,’ the legal right
of surrogates, and the nature of hospice care.”
Many experts also saw the Schiavo controversy
as an effort by the “religious right” and vitalists
to “create a specious link between abortion and the legal right to withhold
life-sustaining treatment. Maryland’s
assistant Attorney General, Jack Schwartz, says, “From a policy perspective,
the most important issue is to prevent reform from becoming another front in
the abortion wars.” To prevent this,
Schwartz calls for “honest, sensible, humane conversation.”
The third paradigm requiring change is that of
discrimination and diversity. The
experts say that “attention to the needs of groups of color is just beginning.”
Diane Lewis, coordinator for policy at
the
This article is one of a series from the recent
last State Initiatives in End-of-Life
Care issue. (State Initiatives in End-of-Life Care, 5/2006)
MAKING PAIN MORE
BEARABLE AT THE END OF LIFE
Researchers at the
Most of the 150 currently enrolled patients have
been referred from Seattle-area hospices and researchers hope to enroll 300
patients before ending recruitment next summer.
Participants receive random assignments to receive “either
massage, meditation or so-called friendly visits, and are interviewed
frequently about their physical and emotional well-being, including questions
about intellectual ability, if they feel at peace with themselves and their
fear of death.”
According to the article, a recent study found that
86% of
Sue Ries, Group Health
Cooperative hospice administrator, says, “We have lots of anecdotal
(information) that says our patients do better and find relief from a variety
of comfort measures, but it’s not as good as reliable studies.” Two respondents featured in the article agree
that the measures do offer relief. Kay
Faulkner’s half-hour massages are “about an hour and a half too short.” Meditation helps 84-year-old Doris Jean
Powers plan for her own death. In a
recent study-sponsored session, she visualized herself being carried to her
grave with her grandsons as pallbearers.
“The bottom fell out of my casket,” Powers said. “The look on their faces, I wish I was an
artist. It was hilarious.”
The study includes hospice patients with no
cognitive impairments and non-hospice patients with advanced cancer or AIDS. (The
EMPLOYER’S COSTS FOR
ELDER CAREGIVING ARE RISING
A recent study from the MetLife Mature Market
Institute reports that the lost productivity of caregiving
employees is $33.6 billion per year. An
employer’s cost for an average caregiver is $2,110 per year and, for caregivers
providing “the most intense levels of care,” $2,441. Employers’ costs have risen 16% since a
similar study was conducted in 1997.
Other
findings of the study include:
* The cost to replace
the employees who stop working altogether (184,000 women, 200,000 men) is $6.6
billion.
* Partial absenteeism
costs employers nearly $2 billion, while full-day absenteeism costs $5 billion.
* Interruptions to
the workday of at least one hour per week per caregiver cost $6.3 billion.
* Sixty percent of
working caregivers have had a crisis that required attention during a workday,
and cost employers $3.8 billion.
* Additional lost
productivity items include $1.8 billion in costs for supervision, $3.4 billion
for unpaid leave costs, and $4.8 billion resulting when employees move from
full-time to part-time status.
Sandra Timmerman, EdD,
director of the MetLife Mature Market Institute, says, “Working caregivers who
juggle work and caregiving responsibilities make many
workplace adjustments, such as coming in late or leaving early, reducing their
work schedules or dropping out of the workforce entirely. Employer costs related to caregiving
are often hidden ones and can be significant.
To stem the losses, employers should consider implementing eldercare
programs for employees with a focus on individualized care planning and
flexible work arrangements. It also
helps when managers and supervisors are sensitive to caregivers’ needs; that
sensitivity often leads to increased worker productivity.”
Employers can use a workplace productivity
calculator to estimate the lost productivity to their businesses by visiting www.eldercarecalculator.org. The calculator needs to know the size of the
business, the average hourly wage of the employees, and the number of employees
who are caregivers in order to calculate the lost productivity cost.
The report, which includes a list of low-cost
resources to help employers establish flexibility for employees, can be
downloaded from the National
PAIN AND PALLIATIVE
CARE NOTES
* The European Association for Palliative
Care (EAPC) and the International Association for Palliative Care (IAHPC) have
recently created a strategy to “develop and promote a global palliative care
research initiative, with a special focus on developing countries.” At a recent meeting, the group adopted The
Declaration of
* An opinion column in
* By a vote of 4-2, the
OTHER NOTES
* Bill Colby, author of Unplugged:
Reclaiming Our Right to Die in
* The Atlantic Philanthropies and HHS
recently announced a $15 million initiative designed to “improve the health and
quality of life for older Americans at the local level.” Working through the National Council on Aging’s Center for Healthy Aging, the moneys will fund
mobilization of public/private collaborations which “support the delivery of
evidence-based programs for seniors at the community level.” (Philanthropy
News Digest Press Release, 7/12)
* The
*
“Odyssey Health Care Inc., the second largest provider of hospice care
in the United States, will pay the federal government $12.9 million to settle
claims of Medicare overbilling, according to the U.S.
attorney's office in Milwaukee” A woman
fired by Odyssey Health Care Inc. after questioning Medicare billings by the
company will get $2.3 million in the settlement. See http://www.jsonline.com/story/index.aspx?id=466917
for the full article. (
Thanks to Don Pendley and
Anne Koepsell for contributions.
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.