Grief During the Holidays: Some Tips

The winter holidays are generally perceived as “the most wonderful time of the year.” But for those who are facing grief after the death of a loved one, the holidays may instead be a time filled with pain and sadness.

Even those for whom grief is not as fresh, the holidays may serve as an annual reminder of the loss—not only of that person, but of tradition and celebration.Multi Generation Family Meal

Bereavement professionals working in hospice and palliative care understand how difficult this season can be. They support families coping with loss all year long. Bereavement counselors stress the importance of making decisions that feel right to the grieving person, and giving oneself permission to make new or different choices at the holidays.

Experts in Grief offer some tips:

Be Willing to Change Traditions

Holidays often center on certain traditions and rituals. For some, continuing these traditions without a loved one may be an important way to continue sharing their memory. For others, it may be more comforting to develop new rituals to help lessen the pain and immediacy of the loss.

Help Reduce Stress

While the holidays can be filled with meaning, they can also be filled with pressure and stress because of additional tasks such as shopping, baking and decorating. Grieving people should be encouraged to prioritize what needs to be done, and focus on those projects that may bring them pleasure. Perhaps the gift list can be pared down, cards need not be sent out, or another family member can cook the family dinner this year.

Remember those Who Have Died

The holidays can bring opportunities to remember the person who has died in a way that is personally meaningful. Some families choose to participate in holiday events at a local hospice. Others may choose to share special family stories over a meal. Some may find that making a donation to a special charity or volunteering time to help others in need may be a comforting way to honor their loved one.

The professionals at Houston Hospice know of the importance of providing emotional and spiritual support to those who are grieving but most importantly, they remind us that a person grieving should do what’s most comfortable for him or her during this time of year.

Houston Hospice offers a variety of grief support groups as one way to manage grief. All support groups are open to the public at no charge. If you or a loved one need help, please call 713-677-7131 to learn more.

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From Oil Executive to Hospice Volunteer

Changing Roles

At the end of 2016 Judy Calabria faced a life event that most of us encounter several times. She was leaving a job — the only job she’d ever had. Judy joined Shell Oil Company as a programmer in 1984. Her work took her to places like The Hague and Kuala Lupur occasionally, but Houston remained home base. At the time of her retirement, Judy was managing people and processes related to major IT outages, disaster recovery and crisis response. Even though Shell had been her only employer, Judy wasn’t leaving all of her work routine behind. Rather, she decided to engage more fully into her role as a Houston Hospice Volunteer — a position that was already vying with the oil business to define her.

Judy began volunteering at Houston Hospice in February 2009, and she was named Houston Hospice Volunteer of the Year for 2017. Volunteer Coordinator, Elisa Covarrubias says that Judy assists with anything that needs to be done. “She delivers meals at Thanksgiving and gifts and cards to our patient families for Christmas. Every Friday she visits patients in the inpatient care unit. She has even made numerous emergency visits to be with patients who were in distress at the request of our nursing staff. Judy spends hours visiting and comforting as many patients as necessary. Truly, she does anything we ask. She visits patients, assembles and delivers Angel Bags of groceries and hygiene items for our families in need, trains new volunteers, works in the office and stocks and cleans the snack bar.”

VolunteerismJudy Calabria

Judy credits Shell with encouraging her volunteerism. “When I got to Shell in 1984 they had a really robust volunteer program for their employees. For many years I got involved in Veteran’s Day parties at the VA Hospital, Martin Luther King, Jr. Community Center Easter egg hunts, chaperoning kids to the zoo, holiday projects, fixing up homes, and many other volunteer projects that Shell offered to their employees. I liked being able to give back and help others. In the late 1990s I got away from volunteering for 7 or 8 years because I was traveling internationally. When my father passed away in 2008, I started thinking about things in my life that I missed and that made me happy. Volunteering was one of them. Both of my parents were under hospice care up in Ohio, and I really liked how hospice helped my family, so I asked the Ohio hospice for advice on how to select a hospice in Houston.”

The staff at nonprofit Valley Hospice in Ohio suggested Judy look for a nonprofit hospice in Houston. They also told her to look for specific accreditation. Houston Hospice met the criteria, so Judy signed up and applied the skills she’d learned at Shell to help hospice patients.

Applying Executive Skills to Hospice

“At Shell, I learned the importance of truly listening to what is being said and not assuming too much too fast. At Houston Hospice, these qualities are just as important. Communications is key when volunteering at hospice; knowing when to say something to a family member, patient, or a hospice employee, and knowing what to say during difficult or emotional interactions. It’s even knowing when to listen versus talk.”

Judy believes the tight deadlines at Shell taught her how to prioritize. “I prided myself on being able to juggle my work and the work of my team based on priorities. My motto when volunteering at Houston Hospice is that I’ll do anything the Volunteer Coordinators ask me to do. That’s why I have been so lucky to be involved in so many different activities at Houston Hospice. I look forward to continuing to help Houston Hospice in any capacity they need. I also appreciate all the Houston Hospice volunteers who do a smaller subset of hospice activities. They are just as vital to making Houston Hospice such a special place.”

Judy’s global experiences taught her about diversity and respecting the value that everyone brings to the table. “That has helped me a lot in working at Hospice, whether I’m talking to patients, family members, friends, or hospice employees. I’m always amazed at our similarities and our differences, and how there always seems to be a way to bond us together, even during difficult times.”

Opportunities to Smile

People often ask Judy why she volunteers for a hospice because they assume it would be depressing. Judy tells them that there are some conversations that are sad, but there are opportunities to smile and help people in ways that she would not have imagined. “I don’t sing, but one day I was asked to hum Christmas carols to a patient. I was amazed at the calming effect my humming had on the patient. Once I sat with a gentleman who was alert but rarely spoke or responded to anyone. I was telling him a little about me and how lucky I was to have been able to see and do things I never imagined. He actually spoke to me and even held my hand.”

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 Communications Specialist

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They’ve Made Houston Better: Spirit Award Recipients Sally and Bob Thomas

We all have that friend. The person who has seemingly endless energy and creativity. They accomplish more by noon than most of us do all day. This describes Sally and Bob Thomas — and when you Sally and Bob Thomasharness that kind of energy for good, you make a difference. They have had a positive impact on Houston and we are delighted they will receive the 2017 Laura Lee Blanton Community Spirit Award on October 12, 2017.

Sally Thomas

Sally Thomas was born in Tulsa, Oklahoma and earned a BS in Geology from the University of Oklahoma. She worked as a geologist with Humble Oil Company when she met Bob Thomas. After marriage and the birth of their four daughters, Sally has dedicated her life to her family and community. She organized and taught Red Cross and Girl Scout swimming programs for over 32 years; taking her synchronized swimming team all the way to the Junior Olympics in Nebraska. Sally is currently an Advisory Trustee of the Retina Research Foundation, and she has served as a member of the Interfaith AIDS Respite Team at St. Cecilia Catholic Church where she is also a Lector and Eucharistic Minister.

Sally has shared her love for geology as a docent at the Houston Museum of Natural Science Gem and Mineral Hall. She was President of Memorial Women’s Club, and Houston Hospice previously honored Sally with the Betty Evans Award for Service as both a patient volunteer and board president. In 2012, The University of Oklahoma recognized her as a Distinguished Alumna of the Mewbourne College of Earth and Energy.

Bob Thomas

Bob Thomas was born in Maramec, Oklahoma and graduated from the University of Oklahoma with a BS in Geological Engineering. After graduation, he served in the United States Air Force as a pilot, including a combat tour during the Korean War. Bob returned to the University of Oklahoma for graduate studies and joined Tenneco’s domestic exploration and production operations as a junior engineer in 1956. His distinguished career culminated in his election as Chairman and Chief Executive Officer in 1990. Bob retired in 1994.

Like Sally, Bob has dedicated his life to community service. He served on the Houston Hospice Board of Directors from 2002-2012 and co-chaired two major fundraising campaigns. Bob has served as Trustee of the Houston Museum of Natural Science and as a member of the Board of Governors for Houston Forum.

Bob is a lifetime member and past Chairman of the Board of Stewards of Chapelwood United Methodist Church. He served on the church’s Building Committee and supervised the construction of a $25 million expansion of church facilities. Bob is currently serving as a Life Member of the Association Board of Directors for the YMCA of Greater Houston. He was elected to the Board in 1988 with past service including terms as Vice Chairman and Chairman of the Board. Bob’s service to the YMCA has included leading major fundraising efforts in 1996, 2004 and 2005, helping The YMCA of Greater Houston become the third largest YMCA in the U.S.

The 19th Annual Community Spirit Award Dinner

“Sally and Bob have made a profound, positive impact on Houston Hospice and our entire community,” says Cynthia Nordt, Vice President of Development and External Affairs for Houston Hospice. “They personify the essence of the Laura Lee Blanton Community Spirit Award. They have made Houston a better place.”

The public is invited to celebrate Sally and Bob Thomas as they are recognized for their unwavering service at the 19th Annual Laura Lee Blanton Community Spirit Award Dinner on Thursday, October 12, 2017 at River Oaks Country Club at 1600 River Oaks Blvd., Houston, Texas. Dinner tickets and table sponsorships will help fund nonprofit hospice care in Houston and 10 surrounding counties. Visit  www.houstonhospice.org/spirit_award_dinner or contact Cynthia Nordt at 713-677-7123 for tickets and table sponsorships.

—Karla Goolsby, Houston Hospice Communications Specialist

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Shedding New Light On Hospice Care: No Need To Wait For The ‘Brink Of Death’

Nurse checking a patient's blood pressure

The Biggest Misperception

A few weeks ago, Kathy Brandt’s 86-year-old mother was hospitalized in Florida after a fall. After rushing to her side, Brandt asked for a consult with a palliative care nurse.

“I wanted someone to make sure my mother was on the right medications,” Brandt said.

For all her expertise — Brandt advises end-of-life organizations across the country — she was taken aback when the nurse suggested hospice care for her mother, who has advanced chronic obstructive pulmonary disease, kidney disease and a rapid, irregular heartbeat.

“I was like — really?” Brandt remembered saying, struggling with shock.

It’s a common reaction. Although hospices now serve more than 1.4 million people a year, this specialized type of care, meant for people with six months or less to live, continues to evoke resistance, fear and misunderstanding.

“The biggest misperception about hospice is that it’s ‘brink-of-death care,’” said Patricia Mehnert, a longtime hospice nurse and interim chief executive officer of TRU Community Care, the first hospice in Colorado.

In fact, hospice care often makes a considerable difference for those with months to live. “When someone is further out from death, we can really focus on enhancing their quality of life,” said Rachel Behrendt, senior vice president of Hospice of the Valley, which serves the Phoenix metropolitan area.

New research confirms that hospice patients report better pain control, more satisfaction with their care and fewer deaths in the hospital or intensive care units than other people with similarly short life expectancies.

What should seniors and their families, the largest users of hospice care, expect? It’s fairly well understood that patients forgo curative therapies in favor of comfort care when they enter hospice. Here are additional features:

Four Levels Of Care

Hospice providers are required to offer routine care in patients’ homes (this includes seniors who reside in assisted living or nursing homes); continuous care at home for people with out-of-control symptoms such as pain or breathing problems; inpatient respite for families that need a break from caring for a loved one; and general inpatient care for medical crises that can’t be handled in any other setting.

With continuous care, a nurse must be on-site in the home for at least eight hours a day, helping to bring symptoms under control. Usually, this will happen in one to three days. Respite care has a maximum limit of five days.

Some hospices have their own general inpatient facilities and “it’s a common misconception that patients are sent to inpatient hospice to die,” said Jean Cohn, clinical manager at Montgomery Hospice’s inpatient facility, Casey House. “In fact, we’re frequently fine-tuning patients’ regimens in inpatient hospice and sending them back home.”

Intermittent Care At Home

Routine care at home is by far the most common service, accounting for about 94 percent of hospice care, according to the latest report from the National Hospice and Palliative Care Organization.

While services vary depending on a patient’s needs, home care typically involves at least one weekly visit from a nurse and a couple of visits from aides for up to 90 minutes. Also, a volunteer may visit, if a patient and family so choose, and social workers and chaplains are available to address practical and spiritual concerns.

Hospices will provide all medications needed to address the underlying illness that is expected to cause the patient’s death, as well as medical equipment such as hospital beds, commodes, wheelchairs, walkers and oxygen. Typically, there is no charge for such gear, although a copay of up to $5 per prescription is allowed.

What families and patients often don’t realize: Hospice staff will not be in the home every day, around the clock. “Many people think that hospice will be there all the time, but it doesn’t work that way,” Brandt said. “The family is still the front line for providing day-to-day care.”

In assisted living, patients or their families may have to hire nursing assistants or companions to provide supplemental care, since hands-on help is limited. In nursing homes, aides may visit less often, since more hands-on help is available on-site.

Self-Referrals Are Allowed

Anyone can ask for a consultation with a hospice. “We get many self-referrals, as well as referrals from family and friends,” said Behrendt of Hospice of the Valley. Usually, a nurse will go out and do a preliminary assessment to determine if a person would qualify for hospice services.

To be admitted, two physicians — the patient’s primary care physician and the hospice physician — need to certify that the person’s life expectancy is six months or less, based on the anticipated trajectory of the patient’s underlying illness. And recertification will be required at regular intervals.

You Choose Your Physician

You have a right to keep your primary care physician or you can choose to have a hospice physician be in charge of your medical care.

At JourneyCare, the largest hospice in Illinois, “we prefer that the patient keeps their primary care physician because that physician knows them best,” said Dr. Mark Grzeskowiak, vice president of medical services.

These arrangements require close collaboration. For instance, if a nurse observes that a patient with heart failure is experiencing increased shortness of breath, JourneyCare staff will get in touch with that patient’s primary care physician. The physician is responsible for altering the treatment plan; the hospice is responsible for implementing that plan and giving clear instructions to the patient and family.

Concerns About Medications

“There’s a misconception that you’re going to be medicated to a highly sedated state in hospice,” said Dr. Christopher Kerr, chief executive officer and chief medical officer for Hospice Buffalo Inc. in upstate New York. “The reality is our primary goal is to increase quality wakefulness. Managing these medications is an art and we’re good at it.”

Family caregivers are on the front line since they’re responsible for administering pain medications such as morphine. “Absolutely, there’s a great deal of fear and anxiety around all the issues associated with giving medications,” said Cohn of Montgomery Hospice. “We try to reassure caregivers that the doses we start with are very small and we’ll see how the patient reacts and go slowly and deliberately from there.”

Because most hospice stays are short — the median length is only 17 days — and because the diversion of painkillers from people’s homes is a risk, doctors have begun writing prescriptions for a week or two at a time, said Judi Lund Person, vice president of regulatory and compliance for the National Hospice and Palliative Care Organization. If concerns exist, hospices can have a lockbox for medications sent to the home.

Discharges Are Possible

Estimating when someone is going to die is an art, not a science, and each year hundreds of thousands of hospice patients end up living longer than doctors anticipated.

If physicians can document continued decline in these patients — for instance, worsening pain or a noticeable advance in their underlying illness — they might be able to recertify them for ongoing hospice care. But if the patient is considered stable, they’ll be discharged, various experts said.

In 2015, nearly 17 percent of hospice patients were so-called live discharges, according to a report from the Medicare Payment Advisory Commission. Two days before a discharge, hospices are required to give the patient or family members a Notice of Medicare Non-Coverage. Expedited appeals of discharge decisions can be lodged with a Medicare quality improvement organization.

There are no regulatory requirements governing what hospices should do to facilitate live discharges. Some hospices will spend weeks helping patients make arrangements to receive medications, medical equipment and ongoing care from other sources. Others offer minimal help.

At The Very End

Almost 1 in 8 hospice patients don’t get visits from professional staff during their last two days of life, according to a study published in JAMA Internal Medicine last year. And this can leave families without needed support.

Some hospices have responded by creating programs specifically for people who have a very short time left to live. “We’ve put together a special team for people who are expected to live 10 days or less because that requires a different kind of management,” said Ann Mitchell, chief executive officer of Montgomery Hospice. “Instead of a nurse for every 15 patients, a nurse on this team will have five to six patients and a social worker is available seven days a week.”

“One-third of our patients are here for less than seven days and often we get them in a crisis,” said Kerr of Hospice Buffalo. “We’ve had to repurpose our services to address the urgency and complexity of these patients’ needs and that means we have to be ever more present.” Across the board, Hospice Buffalo requires that patients be seen within 24 hours of an expected death.

for Kaiser Health News

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

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Five Ways Hospice Can Help

The vast majority of Americans say what they want at the end of life is to die in their own homes, as comfortable and pain-free as possible. The hospice philosophy is about making sure that a Patients prefer to stay at home. Grandfather and child.

patient’s experience reflects their wishes. Here are five ways that hospice helps to deliver this:

Hospice gives you comfort

Hospice professionals are experts at managing life-limiting illness. The hospice team ensures that medication, therapies and treatments all support a care plan that is centered on the patient’s goals. And hospice services can be offered wherever the patient calls home, allowing friends and family to visit freely—something they might not be able to do in a hospital ICU setting.

Hospice gives you peace

Beyond physical relief, hospice strives to help patients and families find emotional and spiritual comfort during what is often a very traumatic time. Hospice organizations are able to provide families with counselors, therapists, spiritual care advisors and bereavement professionals who can best support their struggles with death and grieving. These services are part of the hospice benefit, covered by Medicare, Medicaid or most private insurances.

Hospice gives you something extra

Hospice is not only about compassionate medical care and control of pain. Art and music therapists inspire joy; pet therapy and massages are offered at many programs as well.

Hospice gives caregivers guidance

Most families are not prepared to face the death of a loved one. In addition to caring for patients, hospice also offers services for families and loved ones that provide emotional support and advice to help family members become confident caregivers and adjust to the future with grief support for up to a year.

Hospice gives you more

Be it more joy, more love, or more quality of life in general, the goal of hospice is to offer patients the ability to enjoy the time they have remaining, and create meaningful memories for their families. Hospice offers more moments of life.

Learn more at www.MomentsofLife.org

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Why Hospice is More Important Today than Ever Before

The Affordable Care Act is driving all health care providers to find ways to improve outcomes in an environment of declining reimbursements. As payments go down, it’s important to consider how health care as a whole can increase efficiencies by providing hospice and palliative plans to end-of-life patients who need them most. A few facts to consider:

If you’re starting to think my suggestion to bolster palliative care is singularly financial, consider the study excerpts below:

Bottom line: hospice is not a bleak sentence; it’s a healthy option preferred by patients and their families.

Hospice caregivers make house calls.

Maggie Riley, a nurse practitioner at the Atlanta VA Medical Center puts it this way: Palliative care is about therapeutic relationship-building and interpersonal skills. It’s about listening intently, restating and reclarifying, so that you understand what a patient knows and what they need or want to know in order to make good decisions.

Serious illness affects a person physically, psychologically, socially, and spiritually. Patients are often confused about many aspects of their situation. Some can’t comprehend what they’ve been told about their disease state and their likely outcomes. Others don’t understand their treatment options or know about their medical benefits. In some cases, they may be hoping for a cure that just is not possible.

Patients and their families need to know and understand their options.

Riley says it like this: No one wants to talk about these things but talking about them early can relieve stress and suffering, and make sure that a patient’s wishes are honored.

Having these discussions is terribly difficult but absolutely necessary. Not because the cost to care for these patients is reduced when they accept the inevitable, but because we have access to data-driven tools that provide the benefit of time — time that can be used to ensure quality of life.

On a personal note, I don’t want my parents and loved ones to exit this world in the clinical sterility of a hospital room surrounded by dedicated and capable strangers, but strangers nonetheless.

Further, I unequivocally do not want to die in a hospital. I am one of the 70 percent of Americans who wants to die at home. I will be in my bed, surrounded by people who love and care for me, who

Patients deserve to be informed.

Patients deserve to be informed.

are all bawling in an almost debilitating manner so that I am afforded one last little dose of ego stroking before I go. But that’s just me.

We, as a health care community, have the tools to make this scene — tears or no tears — a reality for more people than we ever have before. Predictive modeling is the answer. It can analyze clinical data and glean from that data a comparative insight into a patient’s likely term far earlier and more accurately than ever before. These analytics can provide families and patients a longer runway to consider, evaluate, and understand their options. What critically ill patient wouldn’t want to be made aware of palliative options if it meant a more comfortable existence and possibly even a longer one?

One of the fibers of our fabric as Americans is an attitude of eternal optimism and perseverance.

Never Give Up!—

Undeniably words to live by, but not to die by.

It is incumbent upon us to embrace our inevitable mortality when that stage is reached. It is incumbent upon us to guide patients into the right care venues to afford them an opportunity to seize and savor that last segment of life.

Thirty days of pain-free time at home with my loved ones is a far better option for me and for most people, than six months of procedures and needles and hospital rooms. We owe it to our patients to give them this option and we have the tools to do so.

As shown in the bullet points above, there is a major mismatch between people’s preferences for where they would like to die and their actual place of death. We can and should improve upon this. That is why using the emerging predictive technologies to better deliver hospice and palliative care is more important now than ever.

 

Dan HoganAbout the author: Dan Hogan is the CEO and founder of Medalogix. His company is a predictive modeling web service that analyzes data, like patient records, that post-acute agencies already have on hand to generate valuable patient insights. In 2012, the Healthcare Information and Management Systems Society awarded Medalogix the Health Information Technology award, which recognizes the software as one of the best emerging technologies in the Southeast. Dan can be reached at dan@medalogix.com.

 

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5 Surprising Facts About Palliative Care

There’s an important medical term that you may not have heard of: Palliative Care. “Palliate” means to make comfortable by treating a person’s symptoms resulting from a serious illness. Hospice is one form of this care that many Americans have heard of. Palliative Care is much more comprehensive than many people realize.

1. It’s More Than Just Pain Relief

Palliative care focuses on helping a person be comfortable by addressing all symptoms that cause physical distress: pain, digestive issues, swelling, difficulty breathing, etc. Palliative care professionals are experts at managing all symptoms associated with serious illness. Additionally, this care addresses the spiritual and emotional needs of patients.

2. It’s Delivered By A Team

Hospice and other palliative care providers utilize teams consisting of doctors, nurses, nurses aides, social workers, counselors, chaplains, and trained volunteers, working together to provide, physical, emotional, social and spiritual care.

3. Palliative Care Includes The Patient’s Family

The goals of care are to improve the quality of a seriously ill person’s life and to support that person and their family (or support network) during and after treatment.

4. It’s Not Limited To Hospice

For more than thirty years, hospice programs have been providing palliative care for people at the end of life. Hospice serves more than 1.65 million patients and their family caregivers each year. Hospices are the largest providers of palliative care services in the county. However, this very same approach to care is being used by other healthcare providers, including teams in hospitals, nursing facilities and home health agencies in combination with other medical treatments to help people who are seriously ill.

5. It’s Available At Any Time During Illness

If it can help make life more enjoyable, why wait? Palliative care may be given at any time during a person’s illness, from diagnosis on. Under hospice palliative care, a patient focuses on comfort and quality of life. Under palliative care outside of hospice, a patient may continue with curative treatments.

Houston Hospice can help you understand more about palliative care and all the services offered by Houston Hospice. Contact our 24/7 help and information number at 713-468-2441.

Additional information on caregiving and advance care planning is available from the National Hospice and Palliative Care Organization’s Caring Connections at www.CaringInfo.org.

—Karla Goolsby, Houston Hospice Communications Specialist

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The 50th Anniversary of the Hospice Movement

This year marks the 50th anniversary of the hospice movement. It’s been an incredible success story. The Hospice Movement, including advances in palliative care and the introduction of holistic support, has been generally credited by the rise of two influential 20th century figures: (Dame) Dr. Cicely Saunders and Dr. Elisabeth Kübler-Ross.

An Unmet Need Recognized

Dame Cicely Saunders

Dame Cicely Saunders

Englishwoman Cicely Saunders was a medical social worker in 1948 when she developed a relationship with a dying Polish refugee that helped solidify her ideas that terminally ill patients needed compassionate care to help address their fears and concerns, as well as palliative (pain and symptom management) comfort for their physical condition. Saunders began volunteering at a facility for the terminally ill poor, where a  physician convinced her that she could best influence the treatment of the terminally ill as a physician herself. Upon graduation from medical school in 1957, she accepted a permanent position in a hospice facility in East London, where she continued to research pain control.

Saunders introduced the idea of specialized care for the dying to the United States during a 1963 visit to Yale University. Her lecture, given to medical students, nurses, social workers and chaplains about the concept of holistic hospice care, included photos of terminally ill cancer patients and their families, showing the dramatic differences before and after the symptom control care.

St. Christopher's Hospice

St. Christopher’s Hospice

In 1967, Saunders established St. Christopher’s Hospice, the world’s first purpose-built hospice, in a London suburb. It was founded on the principles of combining teaching and clinical research and providing expert pain and symptom relief with holistic care to meet the physical, social, psychological and spiritual needs of its patients and those of their family and friends. Familiar comforts of home were made available to patients, from gardening to salon hairstyling. As Saunders’ protégé Dr. Richard Lamerton later explained, a patient’s home or a home-like setting was found to be essential as a part of therapy, versus a hospital – the last place to be when one needed peace and calm.

A Plea for Empowerment and Dignity

Elisabeth Kubler-Ross

Elisabeth Kubler-Ross

In Chicago, Swiss-born psychiatrist Elisabeth Kübler-Ross was formulating her own response to the treatment of terminally ill patients in late-1960s America. Married to an American physician, she observed what she considered inadequate social responses by his hospital toward its dying patients. She began a study that would lead to more than 500 interviews with terminally ill patients.

On Death and Dying was published in 1969 and became a bestseller. A revolutionarily insightful work, it identified five stages through which many terminally ill patients progress. These stages (denial, anger, bargaining, depression and acceptance) would become widely accepted in the decades that followed as ‘the five stages of grief’. Even into the 21st century, On Death and Dying would continue to be the gold standard for education on the subject. The book was more than a simple explanation of psychological expressions, however. Within it, Kübler-Ross made a plea for care in the patient’s home as opposed to treatment in an institutional setting. She further argued that patients should have a choice and the ability to participate in the decisions that affect their destiny, including patients’ rights to refuse treatment that they felt would not be beneficial or would not improve their quality of life.

Testimony Leads to Federal Support

In 1972, the United States Senate Special Committee on Aging conducted the first national hearings on the subject of death with dignity. Kübler-Ross was asked to testify. In her testimony, she capitalized on the opportunity to emphasize the benefits of patient care in the patient’s own home: “We live in a very particular death-denying society. We isolate both the dying and the old, and it serves a purpose. They are reminders of our own mortality. We should not institutionalize people. We can give families more help with home care and visiting nurses, giving families and patients the spiritual, emotional, and financial help in order to facilitate the final care at home.”

The impacts of Saunders and Kübler-Ross redefined hospice care across the globe: comprehensive care for the patient’s physical, social, psychological and spiritual needs; patient empowerment to make decisions about the type of care they wish to receive or not receive; emphasis on at-home care for best patient comfort when possible; and an expanded circle of care to include the patient’s family and friends.

In 1978, a report by a U.S. Department of Health, Education, and Welfare task force noted both the altruistic and practical advantages of government support for hospice care: “The hospice movement as a concept for the care of the terminally ill and their families is a viable concept and one which holds out a means of providing more humane care for Americans dying of terminal illness while possibly reducing costs. As  such, it is the proper subject of federal support.”

The Hospice Movement Comes to Houston

In 1980, Houston’s first hospice, Houston Hospice, was founded. The same year, New Age Hospice was formed, which later merged with  Houston Hospice. New Age Hospice’s primary organizer, Marion Wilson, was determined to establish a source of humane, caring responses for dying patients and their families, following the loss of three of her children.

In 1981 Houston Hospice (as New Age Hospice) began accepting patients. Its first Medical Director was Dr. Richard Lamerton, a revered

authority on care of the terminally ill who had been the first intern trained by Dame Cicely Saunders at St. Christopher’s Hospice in London.

A 1985 visit by Princess Diana to St. Joseph’s Hospice. One of its founders, Dr. Richard Lamerton, became the first Medical Director of Houston Hospice.

—Karla Goolsby, Houston Hospice Communications Specialist

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Are Baby Boomers Changing the Way We Die?

Quality of life. Hope. Living before leaving.

The nature of death and dying has evolved dramatically over the past century, driven in great part by Baby Boomers.

“A Good Death: How Boomers Will Change the World a Final Time” asserts that many in this generation are embracing the idea that quality of life should be the most important issue for patients and families facing terminal illness.

Think You’ve Covered the Bases? Better Check Again.

Tom Brokaw felt confident that he was prepared until this TED Talk. Here his doctor daughter interviews the NBC journalist about his future health care wishes.

Get Started (Hint: You Don’t Have to Be a Boomer)

Call 713-677-7118 or email to request an Advance Planning Packet filled with information about how to write a Life Review, how to talk to your family, and necessary legal forms such as Medical Power of Attorney and Texas Directive to Physicians and Family or Surrogates. You may also download Advance Directive forms here.

—Karla Goolsby, Houston Hospice Communication Specialist

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Veterans’ Day: A Reminder that Heroes Walk Among Us

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Frank Hay

The 68-year-old courier has tried to put his memories of the unpopular war in Southeast Asia behind him. He certainly doesn’t think of himself as a hero. Nevertheless, while Frank Hay was making his rounds at Houston Hospice recently, his Vietnam Veteran ball cap was spotted by a staff member who thanked him for his service. He nodded his thanks and thought he’d be on his way until the staff member invited him to talk about the war. Houston Hospice is part of The National Hospice and Palliative Care Organization’s “We Honor Veterans” program. As a result of learning more about the needs of veterans and their families, staff members have a tendency to notice vets.

An 18-Year-Old in America

In 1966, 18-year-old Frank Hay and his family lived a quiet country life on the banks of a lake outside North Guilford, Connecticut. North Guilford is a pleasant town with a volunteer firehouse, a general store and a gas station. As a kid, Frank got a kick out of walking on the lake’s barely submerged island to the astonishment of visitors who thought he was walking on water. With a school career frustrated by dyslexia behind him, Frank went to work as a Railway Postal Clerk. He counted bags of mail that were loaded and unloaded from rail cars as part of the Railway Post Office (RPO). Frank’s family knew young men were being conscripted to assist with a conflict in a place called Vietnam, so they weren’t surprised when he was drafted.

Frank was sent to Fort Gordon, Georgia for pre-induction physical examinations and testing. His dyslexia caused the army to suspect he was faking to get out of service. However, additional testing revealed a high IQ and the kid who grew up deer hunting in the woods of Connecticut was trained to be a gunner on a helicopter. During basic training Frank recalls thinking the war was a game. “I thought we’d come in and say ‘John Wayne’s here. Step aside.’ The first time someone got shot, I thought, ‘Wow! This is real.”’

Confusing New World

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Frank’s first impressions of Vietnam were clouded by confusion. “We’re in our own world in the U.S. and when you go there you realize things are not the same.” He felt disoriented to be in a place where people were so impoverished that they were forced to sell a child rather than part with a cow. Frank had been in Vietnam only seven months when his helicopter was hit by enemy fire and crashed killing the pilot and co-pilot. He was captured immediately by the enemy who took him into the jungle where they were holding other prisoners of war. There were no POW camps at that time so the enemy cut the sole of Frank’s foot to prevent him from escaping.

Prisoner of War

He remembers being moved constantly for 14 months. “I talked with other prisoners but I didn’t become close because a lot of them died. Some of them went loony.” Fellow POWs died of disease and starvation. Frank figures he lost about 50 pounds. “We’d stay in a hole dug in the ground with bars over it. They fed us rice and fish. I’ll never eat rice again.” During the constant moves, the prisoners were separated and brought back together. Whenever Frank’s foot began to heal, it was cut again. “I took my anger out on God. I’d say ‘Why did you let this happen?’ ‘Why don’t you do something?’ I couldn’t be mad at the enemy. They were soldiers too.”

One day while the prisoners were out of their holes for a move, their encampment came under fire from a U.S. Army helicopter. Everyone ran. Guards ran. Prisovietnam_1967ners ran — in all directions. Frank ended up half running and half hobbling with two other prisoners. “We just kept running until we ran into a U. S. Army unit.” He was taken to a field hospital where he was treated and debriefed. From there, Frank went to a VA hospital. After his injuries healed he was sent home.

People Asked Why I Was There

Frank didn’t stay in touch with any of the guys he met in Vietnam. He didn’t keep a uniform, or a photo or any memento of his service. “After the war, people asked why I was there and why I was fighting and killing. We were just soldiers on both sides. We were only doing what we were told. I just wanted to get on with my life.” Frank recalls being spit on and called a baby killer. He went to the VFW Hall in Guilford, Connecticut where he was ridiculed. “The other vets said that Vietnam was not really a war.” Frank resents being denied camaraderie at the hall. “In those days they had dances, parties and baseball games. Now it’s just a place to go drinking. I’m tired of older people coming up and shaking my hand. Where were you when I came home?”

Frank doesn’t like to talk about the war. But in an act of extreme generosity, he did. He did move on. He moved to Houston and, at 50, met and married his wife who hails from Buffalo, New York. Frank has no desire to return to Vietnam. The courier has moved on but some wounds remain.

We Honor Veterans

About Houston Hospice: As a leader in hospice care for people of all ages and all walks of life, nonprofit Houston Hospice provides for the distinct needs of Veterans and their families through its We Honor Veterans Program. Care is provided to patients and families in private homes and in residential facilities throughout Houston and 10 surrounding counties. Inpatient care is provided in the Houston Hospice Margaret Cullen Marshall Hospice Care Center in the Texas Medical Center. To learn more about the We Honor Veterans Program and other services, call 713-468-2441 or visit www.houstonhospice.org.

—Karla Goolsby, Houston Hospice Communication Specialist

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