Hospice and Other Options for a Quality End of Life

Sharon (paraphrased): Welcome to the Sharon Kleyne Hour. My guests today are Nancy Heyerman and Diane Kosmatka, of the Providence Hospital hospice program in Medford, Oregon. Nancy has been an RN for 31 years and Diane is program Director. Nancy, how long have you been involved in hospice and what got you interested?

Nancy Heyerman (paraphrased): I’ve been with the Providence program about three years. Actually, Diane got me interested.

S: How would you describe your professional mission?

N: To assist patients nearing the end of life to achieve the highest possible level of health and functioning. Also, to allow patients to take charge of their passing so that it is as comfortable and meaningful as possible.

S: Diane, how would you describe your professional mission?

Diane Kosmatka (paraphrased): I see myself as the interface between family and patient at this extremely important time of life. The end of life is not only important to the patient, it hugely impacts the surviving family.

S: At my company, Bio-Logic Aqua, we are extremely concerned about stress and terminal illness. Stress can interfere with the will to live and the ability to be proactive and fight. One thing we’ve learned is that stress can be caused in part by dehydration. Nancy, what does “hospice” mean?

N: In the broader sense, it is the comfort and caring for an individual and their family at a crossroads. In the medical meaning in the US, it refers to caring for patients with a life expectancy of six months or less, often through the Federal Medicare program, which means they must be over 65 or disabled (other insurance also provides for hospice care). Hospice provides medication, comfort, specialized beds, nursing care, etc.

S: Tell us more about the care you provide?

N: We don’t actually provide care, we arrange care. Our teams work closely with families, nursing homes, adult foster homes, and other providers.

S: So what types of care are available?

N: In larger cities, there are actual in-patient hospice centers. In most communities, however, there are not. At Providence, our teams work with patients in the patient’s own home, the home or a relative or friend, adult foster homes or nursing homes. We provide case managers, social workers, chaplains, home health aids and so forth.

S: Who keeps track of all this? I understand the application forms are very long and complicated.

D: The social worker is in charge of dealing with the family and processing paperwork. Also, since Medicare doesn’t provide in-home custodial care, the social worker would have to find a way to provide this if needed. Actually, though, the paperwork isn’t that burdensome. There are only four places to sign. And the family is not billed for hospice services.

Caller: I have several questions. Do you have any advice to patients to avoid obsessing on death? Also, what advice do you have for families in relating to a dying loved one? And is there ever any joy or laughter in the final phase? Can you recommend any books on this subject?

N: Those are excellent questions. Unfortunately, end-of-life is made much more difficult by the fact that our culture doesn’t like to deal with it. As a result, hospice tends to get involved very late in the game, like the last few days. With the full six months, we can do a lot more.

S: Does your program offer grief counseling outside the six month window?

N: Definitely. We can assist the family during the final phase and continue counseling for up to a year after the patient’s death.

S: What kind of care do you recommend for hospice patients?

D: It’s very individual because everyone approaches their own death differently. It depends on their profession, personality, finances, family situation, etc. We’d treat an artist, for example, very differently than a lawyer. With an artist, we might recommend keeping a journal or creating art work. Artists tend to be concerned with creating a memorable experience for those around them.

N: Hospice is largely about providing choices at a time of multiple loss. Often, the patient can’t eat very much, drive, go to the bathroom, concentrate or go to church, and many of their lifelong friends have died. Hospice attempts to put a positive spin to improve quality of life.

S: I believe that we always have the choice to be immortal and make our life a masterpiece. Life is a gift and Earth is a gift. And your life can have an impact far beyond your brief time here. In that way, we are immortal. That’s why I believe in the catch-phrase, “never say goodbye”. I was with my brother when he passed and we never said “goodbye”. We didn’t have to.

N: Closure doesn’t necessarily mean “goodbye”. You could say “thank you” or “I love you”.

S: And whatever your disappointments, you had the amazing gift of life.

D: I’m grateful for being able to help patients realize this. The end of life can be a powerful time to reflect on the fabric of your life, your family and friends and how you impacted them.

S: I might add that we should never take for granted the nurses, doctors and employees in nursing homes, hospitals and retirement centers. Their work is so vital! If you’ve listened to this show before, you’ll know that I close each show with a poem about embracing the gift of life and not hurting others. The poem ends, Earth is whispering, never say goodbye you CAN be immortal. Do either of you have any final words?

D: Just a reminder that there is a lot of avoidance surrounding death. Children rarely ask parents what they want for their final care or funeral. They not only need to know this, they need to have it in writing in case there’s a dispute.

S: Thank you very much Nancy and Diane for a very informative discussion. My next guest is Matt Folz, Operations Manager at Crater Lake Lodge. Crater Lake is one of my favorite places and one of America’s oldest National Parks, located about 70 miles from where I live in southern Oregon. Matt will tell us about the natural history of the lake and year round visitor opportunities in the park, including two brand new restaurants and the historic lodge.

Leave a Comment