[BobbyB]

Hospice workers a special breed
by Gina Phillips, LOCAL COLUMNIST
published September 29, 2007 12:15 am



I keep running into the woman who was present at my mother’s death. She is a Hospice nurse. Our chance encounters in a small town are not unexpected yet it never fails to absolutely take my breath away. I manage a perfunctory chat of protocol and forced humor; I always think she is different, has lost weight, new hair color ... she keeps telling me, no, she’s the same. I wonder about my perception of her?

The Hospice in our county is a dignified group and maintains a low profile in our community. I suppose that’s only tasteful. I often think “the old Hospice gang” will be glad to see me — after all, we were side-by-side in the trenches for almost three years during the deaths of my parents. Truth is they shy away in public and rarely acknowledge me. Are they trained not to impose themselves upon an otherwise cheery event? Do they think they are reminiscent of bad times?


Admittedly, it does bring me to my emotional knees.

Debt that can’t be paid
Perhaps they know that they are statements from an account I cannot pay. That does bother me. Mom and Dad pounded into us to pay our debts, “plus some” to preclude any question of integrity, but this account has simply been closed. All this time and I still entertain such thoughts as these. But then, Robert Benchley says, “Death ends a life, not a relationship.”

I have spoken with four people in the past 24 hours that are affiliated with Hospice. Two were volunteers as a result of personal losses, not exactly payback but rather a springboard of inspiration. One, Mom’s nurse, was an employee. The other is a new beneficiary of their services. I hope I had some influence in that decision. The trick is not to market hospice involvement as a death knell, rather, think of it as a firm step toward claiming stake to what is left of life ... making the most of that!

I know they are on to other cases and have endured many losses since mine. I suppose this column is my on-going therapeutic attempt to purge grief. Or just the opposite — maybe to hang onto it a little longer ... come to think of it, as I’m writing today, it is the three-year anniversary of my father’s passing.

Sometimes I wish I had Hospice. I could often use help making the most of life.

Perhaps I should wait until I’m at least running a fever.

John Cheever wrote a story called The Crow about a woman who always showed up to take care of anyone dying — not for the benefit of others but to insert herself into the center of critical attention. Symbolically crows may be harbingers of death but I view Hospice, at least in my county, as robins — representing Spring, new life. Thanks guys.

Gina Phillips is president of the Samuel L. Phillips Family Foundation and a partner in Great Meadows, Inc. She is also an actor and director. She lives in Spruce Pine. Her columns appear on alternate Saturdays and she can be reached at ginaalisonphillips@yahoo.com.

[Alffe]

http://content.nejm.org/cgi/content/.../DC1?query=TOC

Hope springs eternal...........

[BobbyB]

You may be shocked when you read medicare's criteria for ALS patients below. Just remember, it's only a guideline, and hospices are in business to make money.

CMS Home > Medicare > Medicare Coverage - General Information > Medicare Coverage Database > Search Home > Search Results > View LCD


General Considerations:

1. ALS tends to progress in a linear fashion over time. Thus the overall rate of decline in each patient is fairly constant and predictable, unlike many other non-cancer diseases.

2. However, no single variable deteriorates at a uniform rate in all patients. Therefore, multiple clinical parameters are required to judge the progression of ALS.

3. Although ALS usually presents in a localized anatomical area, the location of initial presentation does not correlate with survival time. By the time patients become end-stage, muscle denervation has become widespread, affecting all areas of the body, and initial predominance patterns do not persist.

4. Progression of disease differs markedly from patient to patient. Some patients decline rapidly and die quickly; others progress more slowly. For this reason, the history of the rate of progression in individual patients is important to obtain to predict prognosis.

5. In end-stage ALS, two factors are critical in determining prognosis: ability to breathe, and to a lesser extent ability to swallow. The former can be managed by artificial ventilation, and the latter by gastrostomy or other artificial feeding, unless the patient has recurrent aspiration pneumonia. While not necessarily a contraindication to hospice care, the decision to institute either artificial ventilation or artificial feeding will significantly alter six month prognosis.

6. Examination by a neurologist within three months of assessment for hospice is advised, both to confirm the diagnosis and to assist with prognosis.

Criteria: Patients will be considered to be in the terminal stage of ALS (life expectancy of six months or less) if they meet the following criteria (must fulfill 1, 2, or 3):

1. The patient must demonstrate critically impaired breathing capacity
a. Critically impaired breathing capacity as demonstrated by all the following characteristics occurring within the 12 months preceding initial hospice certification:
- Vital capacity (VC) less than 30% of normal
- Significant dyspnea at rest
- Requiring supplemental oxygen at rest
- Patient declines artificial ventilation

2. Patient must demonstrate both rapid progression of ALS and critical nutritional impairment

a. Rapid progression of ALS as demonstrated by all the following characteristics occurring within the 12 months preceding initial hospice certification:
- Progression from independent ambulation to wheelchair or bedbound status
- Progression from normal to barely intelligible or unintelligible speech
- Progression from normal to pureed diet
- Progression from independence in most or all activities of daily living (ADLs) to needing major assistance by caretaker in all ADLs.

b. Critical nutritional impairment as demonstrated by all the following characteristics occurring within the 12 months preceding initial hospice certification:
- Oral intake of nutrients and fluids insufficient to sustain life
- Continuing weight loss
- Dehydration or hypovolemia
- Absence of artificial feeding methods

3. Patient must demonstrate both rapid progression of ALS and life-threatening complications
a. Rapid progression of ALS, see 2.a. above
b. Life-threatening complications as demonstrated by one of the following characteristics occurring within the 12 months preceding initial hospice certification:
- Recurrent aspiration pneumonia (with or without tube feedings)
- Upper urinary tract infection, e.g., pyelonephritis
- Sepsis
- Recurrent fever after antibiotic therapy

http://www.patientslikeme.com/forum/...iew=last#48364

[BobbyB]

New hospice care license plate
by Leslie Boyd
updated January 12, 2008 8:05 am


The Carolinas Center for Hospice and End of Life Care in partnership with the North Carolina Department of Transportation offers a new Hospice Care license plate.

Thanks to the legislative efforts of Senator John Snow from Cherokee County, the Hospice Care license plate was approved during the 2007 legislative session, said Jenny Williams, Program Manager of Haywood Regional Medical Center Hospice.


The Carolinas Center for Hospice and End of Life Care needs 300 applications for the DOT to issue the specialized license plate. The annual cost of the plate is $30 over the annual license plate fee. Complete the application, at www.carolinasendoflifecare.org (click on the license plate picture).

Purchase of a new Hospice Care license plate, helps sustain significant programs that improve end-of-life care in North Carolina.

Contact Judy Brunger, president and CEO of The Carolinas Center for Hospice and End of Life Care, jbrunger@carolinasendoflifecare.org 919-677-4123 or 800-662-8859.