Hospice Care

Service of Remembrance Brings Closure for Hospice Worker

Every six months Gloria Garza coordinates a service of remembrance. Gloria’s been putting together these biannual observances for 15 years; since she came to work for Houston Hospice in 2000. CandlesShe invites families, makes sure the ceremony runs smoothly, and organizes a reception with food and punch. At the service on April 30, 2015 at St. Thomas’ Episcopal Church in Wharton, 135 people were remembered. “This event means a lot to our families. They get the opportunity to see the staff that helped them with their loved ones again,” said Gloria. “And, we get to see how the families are doing. After the service, we walk over to the fellowship hall and have refreshments and the families talk to the staff and exchange stories, hugs, tears, and appreciation for the care and for the service they just attended.”

The services of remembrance began when hospice employees realized that both they and the community needed a way to honor their patients and to have closure. After fifteen years of planning some thirty services, the April 30 observance was different for Gloria. As usual prayers were recited, music was played, and, as their loved ones’ names were called, families were invited to the altar to light a candle. However this time, the name of Gloria’s mother, Lena Quintanilla, was among those called.

Lena, the family matriarch, suffered a massive stroke on January 8, 2015. Four days later her doctor told the family there was nothing more they could do. Gloria responded saying, “Call Houston Hospice now.” As a hospice employee, she knew she had a right to select the hospice of her choice, and because she was designated as her mother’s medical power of attorney agent, she knew it was what Lena wanted. “We already talked about what she wanted and what I should do,” said Gloria. “It made it so much easier. I had a hard decision to make. Even if it was not what I wanted, I had to honor what she wanted. She didn’t want to linger. She didn’t want to be a burden.” Gloria feels strongly about Medical Powers of Attorney and Living Wills. After she helps her siblings complete theirs, she plans to speak to community groups and help others, so that their wishes can be carried out should they become incapacitated.

Lena Quintanilla was a doting and energetic mother of five, and she had touched countless lives working as a hospice volunteer since June 2004. “She was a loving and caring mommy to me and to

Gloria Garza and Lena Quintanilla

Gloria Garza and Lena Quintanilla

everyone that knew her. She could cook Spanish rice and hot sauce like no one else. Just ask our El Campo office,” said Gloria. “My father is grappling with how to go on. She did everything for him. They were married for 72 years. She was only 14 and he was 17 when they got married. She did everything around the house. She even paid the bills. All he did was work and he was a good provider with only a second grade education.”

“About 40 people attended and the service was beautiful and peaceful,” said Gloria. “I’m normally busy helping. I sat back by the pianist like I always do, but this time my family was there. It [the service] helped us to take it in and gave us some closure that this really did happen. It means our loved ones are not forgotten and we have to go on.” Gloria stilled a slight quaver that threatened to expose her sorrow and continued, “My oldest sister, who lives in Clear Lake came and she was so touched that we do this every six months. She told me she wants to come to the next one. I asked why since she wouldn’t know anyone and she said she would light another candle for mama.”

Houston Hospice is Houston’s only nonprofit hospice, providing care for patients and families throughout ten counties. To learn more about the local bereavement services offered by Houston Hospice, visit www.houstonhospice.org, or call 979-578-0314 or 800-420-6193.

-Karla Goolsby, Houston Hospice Communication Specialist

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Pat Matthes: A Heart for Hospice

After a long career dedicated to helping others, Bay City native, Pat Matthes, is retiring at the end of May. Pat has served as a Social Worker for Houston Hospice for thirteen years.

Pat Matthes

Pat Matthes

During that time, he regularly traveled throughout a 50-mile radius of his El Campo office; helping patients and families during their times of greatest need.

Pat’s career as a Social Worker began in 1976. During an almost 40-year career he worked in private practice, helped special needs patients in Bay City, and tried his hand at Hospital Administration before filling a rewarding niche as a Social Worker for Houston Hospice. “I love my job very much,” said Pat. “I love the team. I love the people at Houston Hospice. They’re a class act.” When asked what he’ll miss most Pat answered, “I’m going to miss hearing people’s stories. There are always beautiful stories in hospice.”

Pat’s colleagues anticipate that his absence will be strongly felt. Houston Hospice Professional Relations Liaison, Tiffany Livanec said, “If there was a national ‘Heart of Hospice’ award, Pat would certainly be the recipient. I’ve rarely met anyone who didn’t know him, and I’ve never met anyone who didn’t sing his praises. He will definitely be greatly missed.”

Volunteer Coordinator, Gloria Garza said of Pat, “We have been together for so many years with Houston Hospice – El Campo. He is an amazing, compassionate and kind soul. I am greatly going to miss my friend!”

Pat’s not exactly sure what he’ll do in retirement, but he knows it will involve helping people. He plans to volunteer for First Baptist Church of Bay City where he’s a member. Pat said he likes building things and looks forward to helping the Baptist Men’s Association, a group that provides assistance in the aftermath of disaster. He said he might consider volunteering with hospitals and hospice too.

Houston Hospice is Houston’s only nonprofit hospice, providing care for patients and families throughout ten counties. To learn more about Pat’s retirement celebration or the local services offered by Houston Hospice, visit www.houstonhospice.org, or call 979-578-0314 or 800-420-6193.

-Karla Goolsby, Houston Hospice Communication Specialist

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A Bucket List Fishing Tale

FishOne day late last summer, the Houston Hospice Intake Team was answering calls as usual on a Wednesday morning when my colleague, Marcy Antiuk, received an unexpected call, and an unusual request. A doctor phoned to tell us that her patient wanted to be admitted to our inpatient hospice care center, but he had one last desire before discontinuing treatments and surrendering to his disease. You see, this man’s disease had progressed to the point that ceasing treatment would decrease his life expectancy to a matter of days. He needed to be transitioned to hospice services that day due to symptom management issues, but first, he wanted to go on one last fishing trip. In fact, . Working in the hospice field, we’re accustomed to satisfying end-of-life requests, and we often grant day passes out of our facility for this purpose. These are typically outings to visit other family members or to have a meal out. Journeying to the edge of our coverage area for several hours was not an issue. However, this man had a severe and painful wound at the base of his spine that made moving him difficult — transportation would be the key to successfully executing this bucket list wish. The family had already inquired about private-pay ambulance transport, but the quote they received was overwhelming — several hundred dollars, maybe even a thousand. Gathering a team of individuals (Larissa Williams, Dr. Elizabeth Strauch, Jayne O’Brien and me), we discussed the patient’s condition and possible complications. We determined that the request was reasonable as long as the patient was safe, and stable enough to make the trip. An evaluation by our Admitting Nurse, Debbie Breaux, confirmed that the patient’s symptoms were manageable, however it also revealed that pain management was a concern. Because of the expensive private ambulance quote, the man’s family had decided to transport him to the fishing pier in a family vehicle. He desperately wanted this last fishing trip, but we feared the car ride would cause excruciating pain. The only safe option was transportation via ambulance, so we started calling our contracted ambulance companies asking if they would consider a full or partial charity transport. Orion EMS came to the rescue. After gathering only a small amount of information, they immediately agreed to cover all transportation expenses in order to fulfill this last request! Arrangements were made to pick up the patient the very next day. Houston Hospice provided a wheelchair and oxygen for the patient to use during the trip. Hollie Sims and I assisted while Orion EMS transported the patient to his fishing pier. The water, the pier, the landscape—everything was perfect. The late summer sunlight shimmering from the water was matched only by the twinkle in our patient’s eyes. After he finished fishing, Orion EMS provided a safe and comfortable ride to the inpatient unit. This was a great collaborative effort by many people with a triumphant blessing as an end result—just another reason why we love this work so very much.

Thomas Moore, Houston Hospice Patient Care Manager

 

 

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Is Profit Seeking Trumping Care? Nonprofit vs. For Profit Hospice

The truth is, most people don’t think about hospice at all until it becomes a necessity. The concept of hospice is relatively new in the United States. However, as the number of hospice providers grows, with varying degrees of quality, it’s important to be informed. Hospice places its emphasis on quality of life with care that’s tailored to the unique needs of each individual and their support network. When curative treatments cease to help, the relief of palliative care can bring a new form of hope for terminally ill patients and their families, as hospice services help them make the most of their time together. In 2007, research published in the Journal of Pain and Symptom Management reported that hospice patients lived an average 29 days longer than similar patients who did not have hospice care.

When it came to the United States from England in the 1970s, the hospice movement began as a grass-roots campaign to address the unmet needs of patients with terminal illnesses. The benefits of this care were quickly recognized by the medical establishment. In a 1978 report, 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.” In 1982, Congress included a provision to create a Medicare hospice benefit in the Tax Equity and Fiscal Responsibility Act.

With hospice services covered by Medicare, what started as a purely charitable movement became a probable source of revenue. As a result, the number of for-profit agencies entering into the business of hospice has grown exponentially, with

alarming results. An article published by the Washington Post on May 3, 2014 entitled “Terminal neglect: How some hospices treat dying patients” reported that the quality of care provided by 920x1240hospices varies widely. A Washington Post investigation analyzed Medicare billing records for over 2,500 hospices, obtained an internal Medicare tally of nursing care in patients near death and reviewed complaint records at hundreds of hospices. At many hospices, they discovered that little care was provided for patients most in need. The investigation ascribed this absence of care to skimping on nurses, and to the failure of these hospices to have access to a facility where continuous crisis care could be provided. The investigation found that about 18 percent of U.S. hospices did not provide a single day of crisis care.

The investigation noted that the absence of crisis care at those hospices stands in stark contrast to most others, where such care is common. Medicare payment rates and their unintended financial incentives may be responsible. Providing routine care such as semiweekly nursing visits can be very lucrative. However, symptom management that requires continuous nursing care or inpatient care can be financially draining and logistically problematic, especially for smaller agencies.

An area of great concern is the burgeoning growth of home health care businesses that offer hospice. “For-profit home care agencies are bleeding Medicare; they raise costs by $3.3 billion each year and lower the quality of care for frail seniors,” said Dr. Steffie Woolhandler, professor of public health at CUNY’s Hunter College, lecturer at Harvard Medical School. “Letting for-profit companies into Medicare was a huge mistake that Congress needs to correct.”

William Cabin, assistant professor of social work at Temple University and lead author of a nationwide study published in the August 2014 issue of the journal Health Affairs said, “While our study is the first to show that profit-making has trumped patient care in Medicare’s home health program, that’s no surprise. A large body of research on hospitals, nursing homes, dialysis facilities, and HMOs has shown that for-profits deliver inferior care at inflated prices.”

Researchers believe that most hospices are providing quality care and many nurses in the field consider palliative medicine as much a calling as a job. When the hospice movement took root in the United States, hospice practitioners were typically part of religious groups, or were community-supported like the Texas Medical Center’s Houston Hospice. However, since for-profit businesses have come to dominate the industry, early planning and investigation of hospice care options is a necessity.

Karla Goolsby

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I Remember Tommy: Coffee, Cigarettes, Harley Davidson and Hospice

Patsy Piner

Patsy Piner

I remember the first time I saw Tommy. He came for a tour of the Hospice with his aunts. He sat on the couch in the first floor family room where he nodded off several times while I answered the many questions his aunts asked. When we walked down the hall of the first floor, Tommy made comments and had questions too, “Don’t put me in no pink girly room. Do you have an orange and black room? Those are Harley Davidson colors. Manly colors – loved and revered by bikers.” Tommy was a biker, had a Harley and loved to talk about it. He had plans to ride again – just as soon as he felt better. He was here to get his medicines regulated so he could get on with his life. This hospice stuff was an inconvenience he was dealing with begrudgingly.

Tommy was young, in his early forties, and had pretty much lived life on his own terms until brain cancer stopped him in his tracks. He had dealt with the treatments and surgeries the best he knew how, with blend of humor, reality, anger and denial. A kind of cocktail that he partook of each day just to keep going. Little doses of each when needed so he could hear what he had to hear, see what he needed to see and do what must be done.  After his initial visit, Tommy was in the inpatient care center several times and we always knew when he was here. He had been a large man with an outgoing personality before cancer and treatments had taken their toll; his body had changed but his personality remained intact. He made his presence known.

Tommy was blessed by his loving family who took turns caring for him at home and being with him while he was here. The few times he was alone here, he had the volunteers and/or the staff jumping. We all knew Tommy. Ask anyone who met him while he was here what his two favorite things were and I am sure the response will be, “Coffee and cigarettes.” Tommy loved good coffee, particularly Blue Mountain from Central Market and his smokes. I could see Tommy from my desk, sitting outside drinking coffee, smoking, and visiting with his friends, old and new. A few times he managed to sneak out alone. He would sit on the bench, smoke a little and doze a little. On those occasions, I would walk over, gently wake him up, sit and chat for a moment so he could finish his cigarette safely. We would amble back to his room and he usually had me making fresh coffee before I went back to work. Old coffee was a no-no according to Tommy, so the Volunteer department bought a little coffee machine that made just enough to fill a travel cup. That was Tommy’s pot, Tommy’s cup and Tommy’s coffee.

When the last days of Tommy’s life were approaching, his family brought him back here for the end. I saw very little of Tommy that last time; he wasn’t going outside for a smoke and his coffee dispenser was idle. He was in his room on the 2nd floor quietly preparing to die. His mother held his hand and sang “Hush little baby, don’t you cry.” She wanted to be as close to him as she could get, so a nurse found a small plain wooden stool for her. She pulled it close to his bed and stayed there holding his hand and singing for hours. When the time came for Tommy to take his final breath, he did so while being cradled in his mother’s arms – one last time. After Tommy was gone, his mother wanted to do something meaningful in his memory. A simple wooden stool had made such a difference in her last hours with her son that she and her family and friends acted on a suggestion made by the nurse who was with Tommy when he died — every room should have a stool. Now, we have stools in every room and they are there because of Tommy, and his mom, and his family and his friends. Even though they are small plain wooden stools, there is nothing little or ordinary about what they will be used for. We will think of Tommy and his mom each time we see someone sitting on a plain wooden stool close to a bed, saying goodbye. —Patsy Piner is the Houston Hospice Volunteer Coordinator 

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Houston Hospice Nurses: Every Word, Every Action A Gift

I was surprised that within my first two months of working at Houston Hospice, a childhood friend contacted me to say that her grandmother was being admitted to our inpatient unit. She was 96 and very much beloved from a long life. After emergency brain surgery to remove a blood clot, she continued to have tiny, persistent strokes. Days of monitoring, setbacks, bad news, and countless decisions left the family’s nerves frayed. Then, they made the difficult decision to stop trying to save their loved one.

“Mimi” was admitted after business hours on a Tuesday. When I arrived at the room, the family was just getting settled, and we all started crying. Fortunately, I soon realized that the tears were more of relief and assurance than of sadness. The family told me that even though they had only been at Houston Hospice for a few minutes, they were already feeling at peace. Mimi seemed to be sleeping deeply and in the greatest comfort.

While I was there, the nurses and aides were remarkably gentle, professional, and accommodating. My friend and her mother were overwhelmed with the calm that these women transferred to them. Every action or word was a gift. I’ve heard great things about our inpatient unit staff, and I have been with my own mother for weeks in ICU and other recovery areas of a hospital setting to witness outstanding, attentive care — but our Houston Hospice nurses and aides take care to a whole new level. Their skill sets include wisdom and patience that I have never observed before. I cannot believe how proactive they are with questions and suggestions to anticipate patient and family needs.  A lot of wonderful people can be responsive, but when support persons are proactive in offering help, the effect is incredible.

My friend, her family, and I were amazed by Sarah, Darlene, Sophia, Ellen, and Kristin on the night shift – and all of the devoted nurses and aides at Houston Hospice.  THANK YOU for truly caring and for giving every patient and family the gentle help they so desperately need. You are shining examples for all of us.

Martha Cambell, Houston Hospice Community Outreach Coordinator

holding hands

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Houston Hospice Nurses: Life Matters And This Is What It’s All About

As I walk the halls of Houston Hospice’s inpatient unit, whispers can be heard coming from multiple patient rooms. Peering into one room, a nurse is seen comforting an elderly man wondering what life might be like when his wife of 54 years will no longer be at his side. Across the hall, a nurse listens as a teenage boy asks her what heaven might be like when he gets there; nervous that he won’t know anyone when he gets there. Continuing down the hall, I see into the room on the left, a nurse is teaching a man’s sister how to administer his medications in preparation for him to go home; something he has been longing for since the day he found out he was ill. In the room up ahead to the right a nurse works diligently at the bedside of her newly-admitted 31 year old patient to get the pain caused by her breast cancer managed as the patient’s parents stand watching with tears streaming down their faces. I continue walking the hall, and I feel an overwhelming sense of pride for my wonderful team of nurses.

Here at Houston Hospice, the inpatient unit nurses provide a full-spectrum of physical, emotional, psychosocial, and spiritual care with the goal of preventing suffering and relieving symptoms to support the best possible quality of care for our patients and their families. As we enter National Nurses Week 2014, I would like to recognize and sincerely thank each and every Houston Hospice inpatient unit nurse as they are leaders in providing uncompromising and compassionate end-of-life care to our patients and families.

“And what nursing has to do … is to put the patient in the best condition for nature to act upon him.” – Florence Nightingale, Notes on Nursing: What it is and what it is not.

Thank you, nurses, for all you do,

Jessica Rousseaux
Inpatient Unit Patient Care Managerholding hands

 

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Lessons from a Butterfly Family: Parenting a Dying Child


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National Hospice Month: Kathy Flinn and Tiffany Livanec

Kathy Flinn and Tiffany Livanec

Featured for National Hospice Month for the week of November 26 are Tiffany Livanec and Kathy Flinn. Tiffany is a Professional Relations Liaison and has been working at Houston Hospice El Campo office for five years. Kathy Flinn is the RN, PCM-IPU and has been working with Houston Hospice at the Texas Medical Center location for the past 14 years.

(Tiffany) What do you love most about working at Houston Hospice?
I love educating the community about hospice and knowing that many will have a much greater quality of life due to our efforts. 

 

(T) What draws you to your position?
My grandmother was on our services several years ago. The GIFT of hospice to our family is so dear to my heart that I feel incredibly blessed to have the opportunity to work for such an amazing organization.

(T) What have you gained from working at Houston Hospice?
I have gained a greater appreciation for life, even less fear of death, and an increased faith!

(T) If you hadn’t become a Professional Relations Liaison, what might you have become?
If I weren’t called to be a liaison, I would like to be a chaplain.

(Kathy) What has been a pleasant discovery for you in the hospice community? 
Meeting the dedicated people who do this work because they perceive it as a”calling”… not just a job.

(K) What impact has hospice had on your life?
It reminds me that this life is temporary. It’s the next life that is really important.

(K) If you hadn’t become a nurse, what might you have done?
A travel journalist.

(K) Who was the person who most influenced you, and how?
Jane Sidwell.  She was PCM of the Inpatient Unit in 1996 when I oriented to my role as on-call nurse. I spent a 3-week rotation in the PCC (Patient Care Center) as it was called back then. Jane is the epitome of what I perceive to be an effective manager.

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National Hospice Month: Robynette Hall & Elizabeth Erwin

Robynette Hall & Elizabeth Erwin

 

Elizabeth Erwin & Robynette Hall share their hospice experiences for National Hospice Month. Robynette Hall has worked with Houston Hospice for the past five years as an RN for the On-call Team and works throughout the city.  Elizabeth Erwin, Senior Accountant has worked at Houston Hospice in the Texas Medical Center for the past 15 years.

 

 

(Elizabeth) What has been a pleasant discovery for you in the hospice community?
There are some who don’t know what hospice is all about and then there are others who look at me with admiration when they hear I work at Hospice.

(E) What draws you to your position?
I love Accounting!

(E) What have you gained from working at Houston Hospice?
Respect for what the nurses and doctors do on a daily basis. And let’s not forget the Finance staff who book and report the results of their work!

(E) If you hadn’t become a Senior Accountant, what might you have done?
Forest Ranger – I love nature – the backyard outside my window helps with the forestry side of my accounting!

(Robynette) What do you love most about working at Houston Hospice? 
I love the Team work and how much everyone truly cares for the patients and their families.  I also like how many Disciplines are involved taking care of our patients and their families.  It takes an army to care for them.

(R) What has been a pleasant discovery for you in the hospice community? 
This is where I belong, working Hospice and how rewarding it is to be able to help the patients and their families.  I feel truly blessed.

(R) What impact has hospice had on your life?  
The company is terrific and growing, the Team work has been the best I have ever witnessed and I feel everyone really cares about each other.  Knowing how much impact you have on the patients and families is a great reward unto itself.  As well as being able to work for one of the only nonprofit hospices in the Houston area.

(R) If you hadn’t become an RN, what might you have done? 
This is my third career and my second career move as a nurse.  I think I am hooked as a hospice nurse however.

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