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Successful Aging: Help with end of life care

Q We had hospice care for my mother in her home the last three months of her life. The care she received was extraordinary and indispensable. Would you please write something about hospice so your readers will know the importance of this resource?

— D.B.

A Dear D.B:

Indeed, we all should know about hospice. Here is a brief overview: Many think of hospice as a place, which can be confusing. Typically here in Southern California, hospice is not a place but a visiting service. It’s for those who are terminally ill, focusing on symptom management and comfort for the patient. The emphasis is on compassionate care rather than cure based on the belief that each person has the right to die pain-free and with dignity. To be eligible, one must decline curative treatments for the terminal illness. A person can still receive care for problems that aren’t part of the terminal illness.

The most common place to receive hospice services is in the patient’s home. Services also occur in hospitals, nursing homes, large and small assisted living homes and other long-term care facilities. Hospice is available to patients of any age, religion, race, or illness. Medicare, Medicaid, most private insurance plans, HMOs and other managed care organizations cover hospice costs. A person is eligible for hospice after being certified by a physician as having a life expectancy of six months or less after admission. If patients live longer, they can continue to receive services as long as a doctor again documents their eligibility. Patients are free to leave the hospice system at any time.

Hospice takes a team approach made up of individuals who provide expert medical care, pain management, and emotional and spiritual support tailored to the patient’s needs and wishes. Support also is provided to the patient’s loved ones. Often the patient’s physician writes the original referral to hospice. The team includes a physician, nurses, aides, social workers, clergy or other counselors and trained volunteers. They provide comfort while managing symptoms and medications, visiting the patient about two or three times a week for a total of five to ten hours. It is not 24-hour care.

Personal services such as social visits, reading to the patient or limited shopping can be provided by valued hospice volunteers. The bulk of personal care, however, remains the responsibility of the patient and family. Depending on the patient’s needs and the availability of family to help, it may be necessary to hire in-home care or to move to a care facility in the community.

The experience of the late columnist and humorist Art Buchwald is noteworthy. At age 81, Buchwald chose to receive hospice services rather than to continue with more aggressive medical treatment. He did so with every intention to die. Although his kidneys were failing, he refused to continue dialysis and was told he would have two to three weeks to live. For some miraculous reason, his kidneys started to function again. The news spread and visitors poured in such as Sen. John Glenn, Jack Valenti, Ethel Kennedy and Donald Rumsfeld, as well as brass from the Marine Corps. In 2006, he was quoted in the Washington Post as saying, “The more publicity I got, the more attention my kidneys got and instead of going quietly into night I was holding news conferences every day.” His extended life motivated him to write and launch his book, “Too Soon to Say Goodbye.” He died at age 82.

The Buchwald story is likely the exception. The point is no one can write the life-death script. Often, individuals live longer with hospice care because of experiencing less stress and increased comfort. Our communities are enlightened with hospice services with more than 700 certified in California. The two well known in the South Bay are Providence TrinityCare Hospice at 800-535-8446 and Torrance Memorial Hospice at 310-325-9110.

D.B., thank you for bringing hospice to our attention. It is a model for quality and compassionate care for those who face a life-limiting illness. Next week, we’ll talk about a unique model in the South Bay called Caring House.

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