Report Details Senior Health Care That Misses The Mark
Quality over quantity. As people get older, their health care goals may shift away from living as long as possible to maintaining a good quality of life. In key areas, however, the medical treatment older people receive often doesn’t reflect this change, according to a new study.
The wide-ranging report from the Dartmouth Atlas Project uses Medicare claims data to examine aging Americans’ health care. Among other things, it identified five key areas where too many older people continue to receive treatments that don’t meet established guidelines or, often, their own goals and preferences.
Two of the five have to do with preventive care that may not benefit seniors: screening for breast and prostate cancer. The other three address care at the end of life: late referral to hospice care, time in the intensive care unit in the last six months of life and placing feeding tubes in patients with dementia.
While the measures themselves are quite different, they each highlight the need for better communication and shared decision-making among patients, their families and their medical providers.
“Where there are harms and benefits and people judge them differently, that’s where the shared decision-making comes in,” said Dr. Julie Bynum, an associate professor at the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H.
Despite the simplicity of a mammogram or a blood test to check for prostate cancer, if the screening is positive for cancer, that can set off a cascade of further testing and treatment. Those efforts could cause harm to older patients, whose health may be fragile or who have multiple medical conditions.
In addition, older people may well die from something else before a cancer progresses, said Dr. Richard Wender, chief cancer control officer at the American Cancer Society.
“The single hardest concept for the public to understand is the natural history of finding a cancer through a screening process,” Wender said. “Many people have the sense that had it not been found that cancer would have threatened their life within a couple of years or maybe even a couple of months.”
Experts have cautioned older patients about both tests. The U.S. Preventive Services Task Force, an independent panel that weighs evidence and makes recommendations about prevention services, has concluded that prostate cancer screening isn’t beneficial at any age and said that there’s not enough evidence to know whether women benefit or risk harm by undergoing breast cancer screening after age 74.
Still, the Dartmouth Atlas analysis found that 20 percent of male Medicare beneficiaries age 75 and older got a PSA test to screen for prostate cancer in 2012, and 24 percent of female beneficiaries that age had a mammogram to screen for breast cancer that year.
We Need To Make Decisions Based On The Patient’s Values
Guidelines aside, clinicians and their patients need to discuss the pros and cons of testing and make a decision based on the patient’s values and preferences, experts say.
For example, a 75-year-old woman who is willing to accept that she might actually die of breast cancer within 10 years but wants to avoid the anxiety and harms of treatment, might choose not to be tested.
“I ask people, ‘Do you think you’re going to be around in 10 years? Help me decide’ whether to order a mammogram,” said Bynum, whose work focuses on geriatrics.
As people near the end of their lives, it’s especially important for patients and their family members to discuss their goals and wishes with clinicians. Patients often want to be kept comfortable rather than undergo medical interventions, but physicians and nurses are still trained to do everything possible to prevent death, said Dr. Diane Meier, director of the Center to Advance Palliative Care and professor of geriatrics at Mount Sinai’s Icahn School of Medicine in New York.
The three end-of-life criteria that the Dartmouth researchers cited are areas that geriatrics experts agree are critical but have proven difficult to get providers, health systems and the general public to accept, said Bynum. Late referral to hospice and spending time in a hospital intensive care unit can adversely affect terminal patients’ health, result in higher costs and run counter to their hope for a peaceful death. Feeding tubes in patients with advanced dementia can lead to other complications.
Lost Opportunity: Hospice Comfort Care Services That Are Available For Months Are Not Utilized
The Dartmouth study found that in 2012, 17 percent of Medicare beneficiaries who died were enrolled in hospice only during the last three days of life. Medicare, however, will approve hospice benefits, which generally include comfort care rather than curative treatment, when the physician certifies that someone is expected to live for no more than six months.
The study also found that people spent an average of nearly four days in intensive care during the last six months of life, a figure that is trending upward.
Finally, even though it doesn’t prolong their lives to place feeding tubes in patients with dementia, who naturally lose interest in food and their ability to swallow in the final stages of the disease, 6 percent of Medicare beneficiaries with dementia received them in their last six months of life in 2012.
Communication is key, but the skills that are needed to counsel patients aren’t being taught, said Meier.
“If you unleash an oncologist who does not know how to say, ‘Your cancer has progressed,’ but they know how to say, “I know what we can try,’ that’s why people end up in the ICU and with feeding tubes” at the end of life, she said. “It’s easier than having a difficult conversation.”
Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.
The Champ Did it Right
I’m one of those adults who doesn’t have an up-to-date will or a signed Medical Power of Attorney. I know better, and now, I’m going to take a lesson from the Champ, Muhammad Ali. His funeral was ten years in the making. An Ali family spokesperson said the boxing legend, acclaimed civil rights icon, and humanitarian personally planned the details of his funeral over a ten-year period. Because I work at a hospice and my husband is a pastor, I’m frequently in the know about the end-of-life wishes of elder friends. Here’s the thing though, this task is not just for the elderly.
Ask Yourself Basic Questions
While it may feel scary or overwhelming to think about our own deaths, asking yourself basic questions about how and where you’d want to die is a critical first step. Would you prefer to be at home? Do you envision attempts to keep you from dying with resuscitation and life support measures or do you prefer a natural death? These are not easy conversations to have with our loved ones. But they are necessary ones if we want to leave this world on our own terms and ease the burden loved ones will face when it’s our time to go.
According the National Hospice and Palliative Care Organization, the very people we expect to help guide us through these conversations are not well prepared. A recent national poll found that while almost all doctors think having end-of-life conversations with their patients are important, nearly half said they frequently or sometimes feel unsure of what to say and less than one-third reported having had any formal training specifically on talking with patients and their families about end-of-life care. Because our medical culture default is set up first to keep people alive at all costs. Conversations about how to die can be seen as going in opposition to that cultural norm.
So, What to do?
Identify a legal surrogate decision maker. This person is someone you trust to follow your wishes if ever you are unable to communicate. Any adult can serve as your surrogate regardless of whether they are related to you or not.
Additionally, complete a living will or advance directive. This shouldn’t replace conversations with loved ones or your legal surrogate. However, completing these will express your values and wishes around life support and serve as a guide for loved ones and your healthcare providers. Houston Hospice provides complimentary packets filled with hard copies of information about how to start this important conversation along with Texas Medical Power of Attorney and Texas Directive to Physicians and Family or Surrogates forms. (Email email@example.com or call 713-677-7118 to request a packet.)
Knowledge is Power
Next, familiarize yourself with palliative and hospice care. Palliative medical care focuses on helping seriously ill patients and their families and provides and extra layer of support to address symptoms and the stress of being ill during any phase of treatment.
Hospice utilizes palliative care, plus it adds additional end-of-life medical, social, emotional and spiritual support for patients who have been diagnosed with a life-limiting illness and their families. Hospice care can be provided at home, in an assisted living community, or in an inpatient care setting. Most people do not want to die in a hospital. However, when ill, all roads lead to hospitalization and once in the hospital, many barriers can prevent a transition home. It’s important that loved ones and healthcare providers know your preference in advance.
Most of us won’t need to spend 10 years planning as Ali did. But we need to think carefully about our values and wishes and, most importantly, we need to share our wishes with loved ones.
—Karla Goolsby, Houston Hospice Communication Specialist
Conversations Before The Crisis: National Healthcare Decisions Day April 16, 2016
The Most Important Conversation We’re Not Having
How we want to receive care in the event of a medical crisis represents the most important and costly conversation that we are not having. Some families are so reluctant to discuss medical and end-of-life issues that loved ones die without having the opportunity to express their last wishes. And, physicians often are equally hesitant to discuss these issues. Houston Hospice is promoting National Healthcare Decisions Day (April 16, 2016) to inspire, educate and empower the public about the importance of advance care planning
Advance care planning involves making future healthcare decisions that include much more than deciding what care you would or would not want; it starts with expressing preferences, clarifying values, identifying health care preferences and selecting an agent to express healthcare decisions if you are unable to speak for yourself.
National Healthcare Decisions Day is a collaborative effort of national, state and community organizations committed to ensuring that all adults with decision-making capacity in the United States have the information and resources to communicate and document their future healthcare decisions.
Houston Hospice is offering free resources and consultations to help transform this seemingly difficult conversation into one of deep engagement, insight and empowerment.
Points To Consider:
- Patients have the right — and deserve plenty of time — to discuss their care preferences. It’s best to start those conversations early, long before the threat of serious illness.
- You’re not too young to appoint a loved one to make your healthcare decisions when and if you are unable to make them yourself. That loved one has “medical power of attorney” and should follow your written directions.
- How does the person who has “medical power of attorney” know what type of care you want or don’t want at the end of your life? Do you want heroic measures to save your life? In the case of terminal illness, do you want to receive care at home, surrounded by family and friends? Write it down.
- The focus of hospice care is pain and symptom management rather than aggressive curative measures. Nevertheless, hospice provides more medical care not less to insure patients are comfortable and able to enjoy their lives as long as possible.
- One reason it is so difficult to talk about serious illness and hospice, is that families think it will destroy the patient’s hopes of surviving. Healthcare planning empowers the patient.
Conversations Before the Crisis Dinner
Sharing your wishes can bring you closer to the people you love. Participate in National Healthcare Decision Day by filling your table with comfort food, family and friends and talking about your treatment preferences. Houston Hospice will give you the tools to host your “Conversations Before The Crisis Dinner”. Pick up your Healthcare Conversation Kit with resources such as Advance Medical Directives and Medical Power of Attorney documents and speak to one of our experts at Houston Hospice, 1905 Holcombe Blvd., Houston, Texas. Or download resources from www.houstonhospice.org.
—Karla Goolsby, Houston Hospice Communication Specialist
During a recent volunteer shift, Sylvia Valverde was summoned to the dining room of Houston Hospice. Her initial confusion at seeing a cake, flowers and balloons turned to stunned surprise. The celebration was in her honor because she had been named Houston Hospice Volunteer of the Year. When she retired from a 33-year career as an educator, Sylvia knew volunteering with hospice was what she wanted to do. A very personal experience prompted her to seek opportunities to help others through Houston Hospice.
Unexpected Blessings of Volunteering
Sylvia says her biggest surprise about volunteering at Houston Hospice is how much she loves it. “The patients have given me tremendous insight about living life to the fullest and that the dying process is not to be feared. I’ve especially been blessed to give babies and toddlers love and care in their final days when their parents haven’t been able to be present. That has been my most rewarding experience.”
Because she is bilingual, speaking English and Spanish, Sylvia often translates for patients and families. She enjoys her conversations and says seeing patients and loved ones smile is priceless. “I enjoy visiting with the patients and family members and they like knowing that Houston Hospice is very special to me because my mother was a patient there. That experience connects us and lets them know that I have personally experienced hospice care. While every death is different, I can somehow relate and understand what they’re going through.”
Her mother’s experience is what inspired Sylvia to volunteer. She says the care her mother received in 2003 made a big impression on her. “I always said I wanted to give back when I had the opportunity. I retired from education in August 2011, and I immediately contacted Houston Hospice and began the training that September. God has blessed my life tremendously and He calls us to be servants—this is why I’m here—to serve.”
Volunteer Manager, Patsy Piner said it wouldn’t be Friday mornings without Sylvia Valverde’s lovely smile and sweet spirit. “Whether she is passing out pillowcases to patients, training new volunteers or sharing her delicious homemade goodies, she is a blessing to everyone she visits. We are so fortunate that she chose to volunteer with us.”
It Takes a Village of Volunteers and Staff
Volunteers are an integral part of nonprofit Houston Hospice’s team. To learn more about volunteering at Houston Hospice, call 713-467-7423 or visit www.houstonhospice.org.
—Karla Goolsby, Houston Hospice Communication Specialist
According to Albom We’re All Connected
Mitch Albom, best-selling author, journalist and broadcaster will make a rare Houston appearance to speak at the Houston Hospice 15th Annual Butterfly Luncheon on Tuesday, March 29, 2016. With the humor, insight and compassion that made his first novel, Tuesdays with Morrie, a runaway best-seller, Albom, will talk about the connectedness that serendipitously results from the seemingly random path of life’s journey. This is a major theme of his latest book, The Magic Strings of Frankie Presto, in which he notes that we’re all in a band, in fact several bands of people and groups throughout our lifetime. This book entices us to examine what part we’re playing in each of those “bands”.
A Funny Thing Happened on the Road to Being a Rock Star
An aspiring musician, Albom played in bands throughout his adolescence and worked as a performer after college. When he took an interest in journalism in his early 20’s Albom returned to graduate school, earning a Master’s degree in Journalism, followed by an MBA. He turned full-time to his writing, eventually moving to Detroit, where he became a nationally-acclaimed sports journalist at the Detroit Free Press. His first book, Tuesdays with Morrie is the chronicle of time spent with his beloved professor. Albom wrote the book to help pay Morrie’s medical bills, and to his great surprise it spent four years on the New York Times Bestseller list. A succession of best sellers followed including, The Five People You Meet in Heaven, For One More Day, Have a Little Faith, The Time Keeper and The First Phone Call from Heaven. In his latest book, The Magic Strings of Frankie Presto, Albom has merged his love of music and writing with his virtuoso main character’s Forest Gump-like romp through the music world.
The community is invited to attend the Butterfly Luncheon and hear Mitch Albom on Tuesday, March 29, 2016 at the Houstonian Hotel located at 111 North Post Oak Lane, Houston, Texas 77024. Registration begins at 11 a.m. Individual tickets and table reservations are available at www.houstonhospice.org or by calling 713-467-7423. Copies of The Magic Strings of Frankie Presto will be available for purchase and signing.
Proceeds from the luncheon fund Houston Hospice operations and its Butterfly Program of pediatric hospice care. The Butterfly Program was developed in 1996 to meet the needs of children with life-limiting conditions. Through this program, a team of physicians, nurses, social workers, chaplains, hospice aides and volunteers with expertise in children’s care are devoted to caring for children and their families.
—Karla Goolsby, Houston Hospice Communication Specialist
Grief is never more acutely felt than during the holidays, when there is an empty place at the table. As part of its nonprofit outreach, Houston Hospice offers complementary bereavement support to the community. During their pre-holiday workshops, Houston Hospice grief counselors, Marti Nelson and Tammy Zwahr, help the bereaved navigate the minefield of feelings and expectations they’ll encounter with these helpful tips:
HOW WILL I GET THROUGH THE HOLIDAYS?
10 tips for those who are grieving:
- Accept the likelihood of your pain. The energy you would spend evading what is going on around you will be more creatively spend adapting to the reality of what this particular season holds for you.
- Feel whatever it is you feel. Recognize the fact that something very important has happened in your life which causes reactions within you. Some of the feelings bereaved people feel include: sadness, depression, anxiety, fear, anger, guilt, and apathy.
- Express your emotions. The best means of expression is simple: be yourself. Choose people who will listen and respond thoughtfully. Journaling helps get feelings off your chest, clarifies thinking, and monitors your progress. Use music, pray, dance, or create.
- Plan ahead. Give yourself permission to change plans as you go. Talk things over with people whom you usually share the holidays.
- Take charge where you can. Evaluate holiday traditions. Some changes may be healthy and important to make. Eat healthfully and drink wisely. Maintain an exercise program or begin one. Get the rest you need.
- Turn to others for support. Let others know what you think will help you.
- Be gentle with yourself. Allow yourself time to rest. Avoid over committing yourself. Pace yourself on good days and give yourself lots of latitude on “bad” days and accept that grieving people have their share of these days.
- Remember to remember. You may have a special linking object which you might carry, wear, use, or place in easy sight. Create small remembrance area at home. Look at photos and talk to others about your life together. Remember the deceased in prayer, with a toast, or by lighting a candle at mealtime. Plant a tree or donate to a favorite charity.
- Search out and count your blessings. Stay in the present as much as possible. Savor what there is to savor. Cry and then let the tears pass and see what else you feel. Don’t be afraid to laugh.
- Do something for others. You can reach out and offer something of what you have and who you are, even if it feels like it’s only a little. Baby sit, cook a meal, or check on shut-ins. You can drive, shovel, telephone, mow, clean, trim, deliver, type, greet, etc. depending on your interests and abilities.
*EMOTIONAL WISH LIST
What would the holidays be like if I could have these wishes granted?
- That I could be alone when I choose, or be with others when I want to be…
- That other people would know without asking or guessing when I want to talk about my feelings or my loved one and when I want to remain silent…
- That others would know how to show their concern for me and my situation without being uneasy or awkward or embarrassed for them or me…
- That they could accept me, my tears, my anger, without criticizing or judging me…
- That people would not assume their estimate of when I should be “over it” is the correct one…
- That others would not try to tell me what is best for me…
- That the holiday season would disappear like the magician’s coin trick and reappear only when I am ready for it…
*Adapted from: “Tis The Season to be Jolly?”. Dr. William Alexy. Bereavement Magazine, November/December 1989. Reprinted with permission of Bereavement Publishing, Inc. (713-282-1948).
1 in 4 of All deaths in the U.S. are Veterans
Many Americans do not realize that 1 in 4 of all deaths in the U.S. are Veterans. As the nation honors these American heroes for their military service on Veterans Day, November 11, it’s important to remember that they also deserve recognition and compassionate care when dealing with a serious illness.
As a We Honor Veterans participant, Houston Hospice is providing specialized care to Veterans who are facing a life-limiting illness. The National Hospice and Palliative Care Organization (NHPCO) in collaboration with the Department of Veterans Affairs created We Honor Veterans to empower hospice and other healthcare providers across America to meet the unique needs of seriously ill Veterans and their families.
We’re Intentional About Caring for the Unique Needs of Our Veterans
“Through We Honor Veterans we are taking a giant step forward in helping healthcare professionals and volunteers understand and serve Veterans at the end of life,” said J. Donald Schumacher, NHPCO president and CEO. “It is time that we step up and acquire the necessary skills and fulfill our mission to serve these men and women with the dignity they deserve.” Houston Hospice CEO, Jim Faucett, noted the benefits of the program to patients and families and the organization, “As we’ve trained to meet the unique needs veterans face at the end of life, our staff has become more aware of all veterans. We’ve been enriched by seeking out our veteran volunteers and learning their stories, and we’re less hesitant to introduce ourselves to other veterans and thank them for their service.”
Within the We Honor Veterans program, there are four levels of distinction that hospices can earn based on their involvement with Veteran education and their interaction with the Veterans and their family members that they are caring for. The goal of these levels is to ensure the very best care is being provided to those who have served our country. Houston Hospice is working toward the highest level of participation. It is meeting the specific needs of Veterans by being knowledgeable about the wars in which they served and the associated traumas; such as radiation exposure from atmospheric nuclear weapons tests after World War II, and pulmonary maladies resulting from the oil rig fires of the Gulf War. Houston Hospice is also strengthening its relationship with the Michael E. DeBakey VA Medical Center and offering community outreach educational programs for Veterans’ groups about advance care planning, available resources, and care options.
Houston Hospice volunteer, Mike McCardle, began visiting veteran patients 15 years ago. Because he’s a veteran, he said patients open up to him about their lives and the emotional burdens they’ve carried since battle. “I walk in, give my military pedigree, then they give me theirs and we’re off and running. They know they don’t have to explain. They know I understand.” Mike served in Vietnam from 1964-69. He went to war as a young private and left Southeast Asia just five years later as a battle-seasoned Captain in the United States Army. Often, the wives of the veterans he visits have not even heard the stories their husband’s share with him. “The biggest surprise is how much I get out of it. I form a bond with these guys. I’ve met some real characters. I’ve heard about the Battle of the Bulge, and lots of stories about the South Pacific. I was just mastering my own PTSD and these guys really helped me to know that what I was going through is normal.”
As we celebrate our nation’s heroes this Veterans Day – and every day of the year – we must not forget that it is never too late to give them a hero’s welcome home. Learn more at www.WeHonorVeterans.org.
—Karla Goolsby, Houston Hospice Communication Specialist
Interfaith Blessing of Hands
Houston Hospice Cockrell Chapel
1905 Holcombe Blvd., Houston, Texas 77030
Wednesday October 28, 12 p.m. and 3 p.m.
A Tradition in Many Cultures
Blessing of Hands is a tradition among many cultures and religions as well as in many medical institutions. The Texas Medical Center’s Houston Hospice believes this voluntary, nondenominational act recognizes and unites health care employees, volunteers and caregivers who have chosen the shared journey of caring for patients, directly and non-directly. Blessing of Hands is a spiritual exercise and prayer to honor those who give of themselves each day. Affirming their work through this blessing is meant to strengthen and renew their efforts.
Services are for all Texas Medical Center staff, volunteers and caregivers and last about 15 minutes. For more information about Blessing of the Hands services, contact Chaplain Gordon Robertson at 713-677- 7220.
—Karla Goolsby, Houston Hospice Communication Specialist
First Instrument Of Its Kind To Explicitly Refer To Palliative Care
The resolution that older persons should enjoy all existing human rights and fundamental freedoms on an equal basis, couldn’t be timelier. For years, international conventions have protected the rights of children, women, and people with disabilities—groups recognized as vulnerable to marginalization and human rights violations. Yet the rights of older persons, who are susceptible to the same violations, have been woefully neglected in the human rights framework. Finally, there’s a sign that this is beginning to change.
In late June, the Organization of American States released a resolution in which member countries adopted the Inter-American Convention on the Human Rights of Older Persons. It was immediately signed by Argentina, Brazil, Chile, Costa Rica, and Uruguay, and completed in record time, with drafting efforts initiated in 2012 and final text approved in 2015.
The convention recognizes that older persons should enjoy all existing human rights and fundamental freedoms on an equal basis, and is based on general principles including dignity, independence, proactivity, autonomy, and full and productive integration into society.
The resolution couldn’t be timelier. Advances in science, technology, and medicine have helped make the older population one of the most rapidly growing age groups in the world. Yet older persons are often denied access to health, social benefits, work, food, and housing. They bear a disproportionately large burden of chronic, life-limiting, and incurable illnesses, and they often experience severe, debilitating pain.
This is the first instrument of its kind to explicitly refer to palliative care. It requires countries to provide access to palliative care without discrimination, to prevent unnecessary suffering and futile procedures, and to appropriately manage problems related to the fear of death. It also mandates that countries establish procedures to enable older persons to indicate in advance their will and instructions with regard to health care interventions.
the active, comprehensive, and interdisciplinary care and treatment of patients whose illness is not responding to curative treatment or who are suffering avoidable pain, in order to improve their quality of life until the last day of their lives. Central to palliative care is control of pain, of other symptoms, and of the social, psychological, and spiritual problems of the older person. It includes the patient, their environment, and their family. It affirms life and considers death a normal process, neither hastening nor delaying it.
The Resolution Is Not Without Its Flaws
The resolution is not without its flaws, however. For instance, it does not address important legal aspects of palliative care, such as concerns related to inheritance laws and the future of the patient’s property, access to social benefits, patient confidentiality, and the care of children and grandchildren. These legal concerns are closely tied to emotional distress during end-of-life care, and addressing them is part of palliative care’s holistic approach.
The Inter-American Convention established a follow-up mechanism to monitor progress in implementing its provisions. Countries must submit periodic reports to a committee of experts, and people or NGOs may submit petitions concerning any violation of the convention’s provisions.
The convention will enter into force as soon as two signatory countries ratify it, which is expected to happen soon. Once it does, human rights advocates in Latin America will finally be able to rely on a legally binding instrument to demand accountability for the failure to respect older persons’ rights.
There’s More Work To Do
But the effects of the convention could reverberate even further, helping to interpret the human rights of older people elsewhere in the world. For example, it comes at a critical moment to influence the African Regional Human Rights System, which is currently in the process of considering a draft Protocol on the Rights of Older Persons in Africa. And it strengthens civil society’s long-standing call for a UN convention on older persons, which was repeatedly raised during this year’s sixth session of the UN Open-Ended Working Group on Ageing.
We hope that the Inter-American Convention can set an important precedent for the drafting of other human rights instruments that include the right to palliative care. From the right to decide about end-of-life care, to relief from unnecessary suffering, to the need for adequately trained health professionals, palliative care is a human right the world must come to recognize.
From: Open Society Foundations
Houston Hospice nurses Reagan Denmon and Karen Hoover received the Bronze Excellence in Nursing Award, and Paige Prokop received the Silver Excellence in Nursing award from the Good Samaritan Foundation at a luncheon ceremony on September 1, 2015 at Houston’s Royal Sonesta Hotel. The event was chaired by Craig Cordola, President of the Central/West Region for Memorial Hermann Health System.
Reagan Denmon began her medical career as a Nuclear Medicine Technologist (NMTCB) and certified PET tech (Positron Emission Tomography). Her work with oncology patients created a desire to serve in palliative care. Reagan pursued a BSN at UT School of Nursing, finishing Summa Cum Laude and gained clinical experience at St. Luke’s in the Texas Medical Center as a renal telemetry nurse before joining Houston Hospice as an RN Case Manager in 2013. Since then she earned the Certified Hospice and Palliative Nurse credential (CHPN) in 2015. Reagan was nominated by Clinical Services Patient Care Manager, Jeff Boynton, who praised her saying, “Reagan is a true hospice case manager, and she is able to be proactive in her patients’ care, anticipating their needs and the needs of their families. She always gets high praise from her patients and families and has a can-do attitude.”
Karen Hoover was nominated by Houston Hospice Education Coordinator, Hope Cook, who wrote about Karen’s leadership and commitment to excellence saying, “Karen has been a strong leader on her team. She has promoted a culture of cooperation and concern among the nurses. She works to provide excellent care and this is contagious. She has served as a mentor for many staff members and nursing students. Her positive attitude and hard work to ensure all patients get the care that they need is exceptional.”
Paige Prokop was nominated by her Clinical Services Patient Care Manager, Dianne Gilbert, who wrote, “Paige is a wonderful nurse and human being. She is always thinking outside the box and looking for ways to help others – patients, families and colleagues. Paige is constantly thanked by patients’ families for her kindness and caring. She helps her colleagues by sharing her ideas and thoughts on the challenges we all face as hospice nurses. She is a mentor for our new nurses, and their patients and families benefit from this guidance. Paige is always trying to learn more and encourages others to learn. She enjoys sharing her knowledge with others. Houston Hospice is very lucky to have Paige Prokop as one of their outstanding nurses.”