The Hospice e-News
What the Media Said about End-of-Life Care This Week
Week of August 22, 2006
…a service of
ASSISTED
An article in Assisted
Living Executive looks at the partnerships formed between assisted living
centers and hospices to provide care until the end of life. “Seniors move to assisted living because they
want a home, so partnering with a hospice means they can stay home through the
rest of their life,” the article says.
The article notes, however, that not all states permit hospice residents
to live in assisted living communities, but both NHPCO and Assisted Living
Foundation of
Joan Linsky, senior
clinical liaison for Allegiance Hospice and Palliative Care, based in Lowell,
Massachusetts, thinks it’s a good idea.
Her mother-in-law lives in an assisted-living community and requires
hospice care. She can eat with other
residents if she chooses, but, if not, a hospice staff member will prepare
breakfast for her in her own apartment.
She once told Linsky she never thought dying
could feel so good.
Linsky says that such partnerships assure
consistency of care with a community’s culture and can be a “powerful sales
tool” if communicated well. Linsky urges senior housing providers not to fear telling
current and potential residents about hospice.
The key is educating people about what hospice is. “It doesn’t mean that their place is going to
be associated with dying because hospice is not about dying,” she says. “It’s
about living.”
Linsky also sees the partnerships as a way
to encourage earlier entry into hospice for those who need it. “Hospices can provide assisted living
providers with the training and tools both to recognize residents who become
eligible for hospice care and to educate those residents about the benefits of
hospice care,” the author says. “And
senior housing providers can help hospice providers with the referrals they
need to assure people are getting the greatest benefit from hospice.” Holli Hallmark, a
senior director for VITAS, says, “You have to recognize someone who has a need
for hospice care. If you miss, that
person may end up in a hospital or nursing home and not be able to come back to
assisted living.”
Sunrise Senior Living has recently formed
partnerships with VITAS Healthcare Corp. and VistaCare
Inc. for hospice services.
It also has local and regional partnerships and does not mandate that
any resident use a hospice that it has partnered with, leaving them free to
choose another hospice if they wish. Vice-president Gregg Colon says, “The ‘why’ is
pretty basic.” “Our mission at
One of the benefits of the partnerships, says the
article, is the ease of developing consistent programs to educate residents and
staff about hospice and end-of-life issues.
Another is that the senior housing provider can train hospice staff
about its best practices.
In other cases, such as Silverado Senior Living
Inc., the senior living company establishes its own hospice division. Scott Robinson, vice-president of hospice for
Silverado, says that getting into the hospice business yourself is the
“ultimate way” to make sure that end-of-life care meets the expectations of
your company’s standards and can also be a good source of new revenue. Robinson thinks you need “a very large base of
operations” to successfully operate your own hospice. “If you’re serving five to 10 residents with
hospice, you’re better off partnering because Medicare will pay for the hospice
costs but will not cover over-head,” he says.
The article suggests five questions to be answered
before a housing community decides to get into the hospice business.
* Who will your
hospice serve – just your residents, or the larger community?
* If just your
residents, what will your average hospice census need to be just to break even?
* What will you have
to do in order to be licensed as a hospice?
* How long will it
take you to obtain a license?
* Are there places
that you can share staff to control costs?
VITAS’
Hallmark recommends asking the following questions of any potential hospice
partner.
* Is the hospice
properly licensed and certified? If so,
can they provide all the levels of care needed by residents?
* What kinds of grief
counseling and support does the hospice offer for family members, residents and
staff?
* Is everybody, from
senior executives down to community leaders, on board with the program? (Assisted
Living Executive, 6/2006)
MANY
FACTORS IMPACT HOW CHILDREN DEAL WITH GRIEF
An article in Chicago
Hospital News says, “Children are unique in their understanding of death
and their response to grief, depending on their developmental level, cognitive
skills, personality and religious and cultural beliefs, as well as input from
the media and what they learn about death and grief from the adults in their
lives.” The article uses five stages of
childhood to suggest concepts of death and grief responses but says that
readers should keep in mind “that no child falls neatly into any one category.”
* Infants to second birthday: They don’t understand death, but are aware of
separation and loss, reacting more to the emotions of the adults in their
lives. Grief reactions may include a
change in sleep habits, protest, weight loss or decreased activity.
* Two to four year olds: Death is temporary and, in their thinking, can
be reversed. They are usually “more
concerned about altered patterns of care or the emotional reactions of adults
in their lives.” They may experience
frightening dreams, be agitated at bedtime or show regressive behavior, such as
wetting the bed.
* Four to seven year olds: Death is still seen as reversible, but the
child may use “magical thinking,” believing that their own thoughts or actions
are responsible for the death. Their
reactions may include “repetitive questioning about the death process,” or they
may act as if nothing has happened.
Eating and sleeping difficulties can occur, as well as anger, sadness or
regressive behavior.
* Seven to eleven year olds: Children in this age group can recognize that
death is final, though they don’t want to see it that way. They may think that their own efforts can
keep death from occurring. They are
concerned with specific details about the death and about how others feel about
it. School difficulties are common and
sadness and anger may be acted out. Some
become worried about their own health.
Other responses may include denial, sadness, shock and regression.
* Adolescents: They “recognize death as final and
irrevocable.” They may express grief
with physical symptoms such as head or stomach aches, mood swings or
anger. Some may withdraw while others
act out with inappropriate behavior.
Depression and/or sleep disturbances can occur. Some may idealize their deceased loved ones,
wearing their clothes and adopting their mannerisms. (
RESEARCH
& RESOURCE NOTES
* Raising an Emotionally Healthy Child When a Parent is Sick is
reviewed by Dr. John Glazer of The
* Harry Moody, director of academic affairs
for AARP , calls services such as those offered by elder-care mediators “silver
industries, services developed to respond to the special needs of an aging
population.” Elder-care mediators, many
of whom have a legal background, “work with families and seniors to develop
solutions for conflicts around such issues as housing, health care, end-of-life
directives, emergency situations, finances and even when mom or dad should hang
up the car keys.” (The
* September is again
Pain Awareness Month, and the American Society of Pain Educators (ASPE) will
have several events to educate healthcare providers on pain management. Two critical factors drive the current focus –
the inadequate pain management education that physicians receive during their
training and “the serious need for evidence-based pain management education
among healthcare professionals treating the growing population of aging adults
and the elderly.” Clinicians may
register for a variety of resources at the ASPE website at http://www.paineducators.org/PainAwarenessMonth.asp. (Medical
Device Law Weekly, 8/27)
PAIN
AND END-OF-LIFE NOTES
* Children watching
TV have less pain than those who don’t.
An even more disturbing factor, according to the author of a recent
study from the British Archives of
Diseases in Childhood, is that Mom is less comforting than cartoons. Other experts agree, saying that parental
attempts at comforting often backfire, because the child thinks “something must
really be bad” if they need soothing.
Experts have long known that distraction helps divert children’s
attention from pain, but Dr. Stephen Hays, of Vanderbilt Children’s Hospital,
says it has to be a passive distraction, like TV, because when children are
asked to actively play, they report increased pain levels. (The
* Art Buchwald isn’t the only hospice
patient to outlive his doctor’s prognosis.
“Doctors are notoriously poor at prognosis,” says Dr. Andrea Miller,
medical director for Wuesthoff Brevard Hospice and
Palliative Care. But, Miller adds, they
usually overestimate how long a patient will live, rather than underestimate. Some estimates suggest that 8% of hospice
patients that are given a six-month prognosis live longer than a year. One reason is that the type of patients seen
by hospices is shifting, with more chronic and not immediately life-threatening
illnesses. (
*
An editorial in The Columbus
Dispatch suggested that Kansas Senator Sam Brownback’s (R) Assisted Suicide
Prevention Act is a violation of the states’ right to regulate the practice of
medicine. The writer says that states
“should be free to try new approaches to solving problems without fear of the
federal government pouncing on them…
Perhaps the people of
* Debbie Gunter, director of clinical
services at the hospice inpatient unit at
NURSING
SHORTAGE NOTES
*
*
The National League for Nursing says that baccalaureate nursing programs
saw an 16% increase in applicants last year, and associate degree programs had
a 28% increase. But nearly 150,000
qualified applicants, 18% more than in 2004, were turned away because there
aren’t enough nursing professors.
Nursing professors make only about half as much as clinical nurses. Another problem is a lack of clinical
placements to train students. (The New York Times, 8/13)
OTHER
NOTES
* Michael Schiavo
has emerged as “a political weapon in this year’s midterm elections.” Schiavo “did not
vote or follow the news until recently,” but spoke on behalf of Democrat Ned
Lamont, who defeated Senator Joe Lieberman in the recent
* In an article on
*
The cost of a dose of Erbitux to a patient
whose insurance won’t cover it is more than $18,000 and increasing number of
patients are facing the choice of paying for treatments as they live longer
with terminal disease. The high costs of
extraordinary care for the dying creates a dilemma that is “challenging
governments, employers and insurers, who all help finance
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.
* There will be no publication of The Hospice e-News on the week of September 12, 2006. *