The Hospice e-News
What the Media Said about End-of-Life Care This Week
Week of October 10, 2006
…a service of
VA
EXPERTS OFFER END-OF-LIFE CARE ADVICE
Some hospice experts say that
community hospice professionals often don’t realize how much veterans’ military
and/or war experiences color their feelings about death, says an article in Hospice Management Advisor. The VA is working to educate both VA and
community hospice and palliative care staff about “the unique problems and
needs at the end of life.” The Hospice Management Advisor cites Deborah
Grassman, hospice coordinator at Bay Pines VA, as
saying that one generalization that can be made about veterans is that “they
typically value stoicism,” which was indoctrinated into them when they were
young soldiers. According to Grassman, that stoicism can cause difficulty at the end of
life, because stoics “underreport their pain and fear and behave as though
everything is always fine,” even when it is not.
Grassman also
says that dying veterans may have a sudden onset of post-traumatic stress
disorder (PTSD) as they near the end of their lives. “Our conscious minds start receding, and our
unconscious minds start expanding as we die.
As our conscious mind gets weaker, it is less able to push down those
traumatic memories,” she says.
Beginning in 2003, the VA directed
all facilities to develop palliative care consult teams (PCCTs). Dwight Nelson, coordinator of the Veteran
Integrated Service Network (VISN) 23 in Minneapolis, says that VISN-level
hospice and palliative care teams act as resources for, and oversee, facility PCCTs. The VA also
works with community hospices to provide end-of-life care for veterans.
The VA provides a reference card for healthcare
practitioners to use when beginning discussions with veterans. The questions include:
* “Tell me about your military
experience.”
* “When and where do you/did you serve?”
* “What do you/did you do while in the
service?”
* “How has military service affected
you?”
* “Were you a prisoner of war?”
* “Did you see combat, enemy fire, or
casualties?”
* “Were you wounded, injured, or
hospitalized?”
* “Did you ever become ill while you
were in the service?” (Hospice Management Advisor, 10/1)
ARTICLES
EXPLORE AFRICAN-AMERICAN EXPERIENCE OF HOSPICE
Pamela Joy, the director of
African-American outreach for Hospice of Michigan, is “the hospice lady for
black people”. The Detroit Free Press says she’s “got a lot of myths to demystify and
barriers to break in an African-American community that doesn’t quite trust the
mainstream medical profession. She busts
stereotypes by building relationships and through one-on-one
conversations.”
Only one-third of Hospice of
“Serving Equally While Serving
Uniquely: The Ethics of Caring for
African-Americans at the End of Life,” in the September NHPCO Newsline, explores the reasons why
African-Americans often insist on aggressive treatment at the end of life, even
if there is little hope that health will improve. “Such requests are based primarily on
mistrust and negative experiences with healthcare systems,” the article says,
and “a further explanation may be the belief that any option that fails to
include aggressive treatment is a breach of the standard of care to which the
patient feels legally entitled.”
The author sees “significant
opportunities for positive change,” however, including the increased emphasis
on advance care planning since Terri Schiavo’s
illness and death. But, the article
says, “Clinicians who care for African-American patients must be willing to
explain advance care planning while demonstrating sensitivity to these
patients’ cultural values and beliefs.” Other
opportunities include community outreach efforts with a “culturally appropriate
educational model to train and enhance the skills of healthcare professionals
[that] must address the issue of health disparities and provide relevant
content unique to the end-of-life culture of African-Americans.” Providers and organizations should develop formal
diversity infrastructures and management teams that reflect the community. Last, the article says, “It is imperative
that the community receive relevant and accurate information on end-of-life
care services.”
It is not enough, the article says,
to remove the barriers to quality healthcare.
Medical professionals also need to understand “cross-cultural issues, in
which religion, gender, age, socioeconomic status, ethnicity, sexual orientation and acculturation status impact
end-of-life care decisions.” “Through
these efforts we can assure communities of color that good hospice and
palliative care is part of the overall range of equitable care, and that, in
fact, hospice is the gold standard for care at the end of life – the very best
that medicine can offer.” (NHPCO NewsLine,
9/2006)
PAIN
NOTES
* Dr. Roland
Myers, a Mississippi physician nationally known for “treating poor patients and
battling insurance companies,” is fighting with the DEA over its requirement
that he obtain a second DEA registration to write prescriptions at his clinic
in Oklahoma. “I may be the only doctor
in
* University of Mississippi School of Pharmacy
researchers plan to use an $11 million grant from the Center of Biomedical Research
Excellence to develop mini-patches made from THC (tetrahydracannabinol,
the active ingredient in marijuana) and to study the euphoric effects of
marijuana. THC cannot be given in pill
form, so the mini-patches will be applied in mouth above the gum line. One researcher said, “The advantage is by
taking the drug orally, very little is absorbed through the GI tract, which
means we don't have to use as large as a dose and the patient usually won't
become nauseated.” (University Wire, 10/4)
* A survey
by
*
HOSPICE
& PALLIATIVE CARE NOTES
* The
Accreditation Council for Graduate Medical Education (ACGME) has approved an
accreditation process for fellowship training programs for hospice and
palliative medicine physicians. ACGME
will being accepting applications in the summer of 2007 and, in the meantime,
will adopt hospice and palliative medicine program requirements, develop
program information forms and develop a review process. (Hospice
Letter, 10/2006)
* In its 2007
workplan, the HHS Office of Inspector General (OIG)
will examine hospice plans of care and payments to determine whether
“beneficiaries are receiving services billed for and whether hospices are
billing for services at the correct level of care.” The OIG will also check to see whether “plans
of care accurately reflect the patient assessment.” Other areas of scrutiny include whether there
are duplicate payments for drugs under hospice and Medicare Part D, overlaps in
services by hospices and nursing homes, and duplicate reimbursement by Medicare
hospice and Medicaid. (Home Health Line, 10/2)
* According to benchmark data from Strategic
Healthcare Programs in Santa Barbara, the median length of stay for hospice patients
increased from 14 days in 2001 to 21 days in the year ending June 1, 2006. The average length of stay rose from 36 days
to 78 in that same period of time. NHPCO’s database shows comparable increases. Non-cancer patients, with diseases such as
end-stage heart disease, lung disease, debility, dementia and end-stage renal
disease, are driving the increase in length of stay. (Home
Health Line, 10/2)
*
* Art Buchwald
is hardly the only person to leave hospice alive, since about 13% of the
900,000 Americans who enter hospice each year are discharged that way. Some leave because they prefer aggressive
treatment of their disease, others move out of the
service area or don’t like the program or the staff. But living longer than the six-months
prognosis is happening more often in elderly patients with non-cancer
diagnoses. “It happens all the time,”
says geriatrician Joanne Lynn. “The idea
is as you get older, you’re skating on thin ice – and no one can tell you how
thin it is or when it will crack.” (The
OTHER
NOTES
* Cancer patient
Vera Belle Tiani was determined not to lose her hair
during chemotherapy, something her oncologist said would invariably
happen. Tiani
tried Guided Imagery, imagining “dozens of funny little people pushing the hair
roots into the scalp.” It didn’t
work. So Tiani
tried another image – “little folks wedged into her hair follicles, holding
them in,” and to the astonishment of her doctors, never lost another hair. When a tumor appeared on her face, doctors
recommended surgery that would possibly leave her face paralyzed. Tiani came up with
a visualization of a tornado sucking the tumor out,
and the tumor disappeared. Both Tiani and her husband are licensed mental health counselors
and are trained “Healing Touch” therapists.” (
* Linda Riley,
associate professor of nursing at the University of
* To
illustrate the need for better end-of-life communication, Dr. David Lipschitz relates the story of a relative declining from an
acute hematological disease. Faced with
differing recommendations from several doctors, the family is left in
confusion. “The youngest son is urging
hospice, the older son is straddling the fence, and the daughter only hears
things that offer a glimmer of hope.” Lipschitz says, “Doctors must make sure that grieving
families, desperate for positive news, truly understand the prognosis and their
options. Families must be willing to listen
to bad news and make sure they truly understand the chances for recovery.” (
* An article
in The Birmingham News says, “While
the physical and emotional impact of cancer is most obvious and sometimes deadly,
the spiritual aspect of the disease is often the most profound.” Many cancer survivors report the spiritual
growth that often occurs after a cancer diagnosis, sometimes called
post-traumatic growth. Cheryl Holt,
social psychologist at the University of Alabama, Birmingham, has received $1.1 million
grant to “study the impact of religion on cancer risk, prevention and screening
behaviors.” Holt says, “If we learn more
about the role of religion and spirituality in people's health … we can use
that information to promote healthy behaviors.”
(The
Correction:
In “New Report Cared Issued on State
Pain Policies,” last week’s issue of HNN
said, “In 2000, almost half the states had a grade of A or B. That figure rose to 67% in 2003 and 82% this
year.” Instead of “A
or B, “it should have read “had a grade of C+ or better.” HNN
regrets the error.
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.