Friday, February 26, 2010

Choosing Hospice and Palliative Medicine as a Subspecialty

The new blog hosted by the American Academy of Hospice and Palliative Medicine (AAHPM) included a recent post by medical student Jacqui O’Kane. She writes about the reactions she receives from friends and family when they hear about her subspecialty, and why she feels hospice and palliative medicine is an important field.
Fortunately, doctors do much more than cure. We are in the business of healing, and healing does not always mean curing, nor does it even necessarily mean affecting a physical improvement. Physicians may heal in other ways too, encouraging emotional, mental, and spiritual convalescence in patients and their families.

In fact, it is in these “alternative” forms of healing that the HPM physician shines.

Wednesday, February 24, 2010

Supporting Grieving Teens Grants

Hospice Foundation of America announces its new funding program to support grieving young people ages 13—17. Applicants must be non-profit hospices or other non-profit bereavement organizations whose programs are available to the entire community in which they are located. Hospice Foundation of America will award one $10,000 grant for program-related expenses (including but not limited to purchase of equipment or materials, publications, or other curriculum-related materials.) Priority will be given to programs who offer innovative programs for young people ages 13—17, with a special priority given to programs that focus on outreach to diverse populations. HFA will also award a number of smaller $1,000 grants for noteworthy programs.

To be considered for funding, please submit the following information in a one-page Letter of Intent (250 words maximum):
  • Primary contact: Name, address, phone # and email
  • A snapshot of your organization, including:
    • Mission statement
    • Number of professional staff and volunteers
    • Geographic region served by your programs ; and
    • Programming provided to children, adolescents and their families
  • A brief description of how funds from HFA would be used

Letters should be submitted via email to by Wednesday, March 10. Letters will be reviewed on an ongoing basis. Selected organizations will be invited to submit a full proposal, which will be due on Wednesday, April 21. Grants will be awarded by June 15.
View more information on the About Us - Grant Programs page of the HFA website.

Tuesday, February 23, 2010

LGBT Issues and End-of-Life Care

Lesbian, gay, bisexual, and transgender seniors can face unique challenges at the end of life. Some recent news items and a new documentary highlight these concerns:

  • In Minnesota, same-sex couples are advocating for a law to protect the rights of surviving members of domestic partnerships to make end-of-life care decisions.
  • The Hartford Advocate (CT) writes about a home care and hospice agency that is starting a bereavement support group specifically for gays, lesbians, transgenders and bisexuals.
  • In Massachusetts, a nursing home specifically for LGBT seniors is opening this month Chelsea.
  • This documentary, Gen Silent, explores the fear of discrimination that causes some LGBT seniors to hide their orientation as they age. (Thanks to the Hospice and Nursing Homes blog for sharing.)

HFA's 2009 teleconference companion book, Living With Grief: Diversity and End-of-Life Care included a chapter, "Aspects of Death , Grief, and Loss in Lesbian, Gay, Bisexual, and Transgender Communities," by Brian de Vries. See the complete Table of Contents and other resources from the teleconference.

Thursday, February 18, 2010

April 2010 Webinar - Bereaved Children and Adolescents: Lessons from Research

Bereaved Children and Adolescents: Lessons from Research
with Kenneth J. Doka, PhD, MDiv; Irwin N. Sandler, PhD and J. William Worden, PhD, ABPP

Webinar Program
Wednesday April 14, 2010
1:00pm - 2:30pm EDT

Registration Now Open!

Increasingly, grief counselors are called to defend their practice. Are there perspectives and approaches that can be considered "evidence-based"? This seminar offers information about two of the most significant research projects to date on the effects of parental loss on children and adolescents. The work of William Worden and the Harvard Child Bereavement Study, and that of Irwin Sandler and the Family Bereavement Program, offers insights not only on the experience of grief in children and adolescents, but also on the factors that can help identify the children most at risk. This webinar is essential for all who work with children and adolescents. Social workers, guidance counselors, child life professionals, counselors, educators, clergy, and funeral directors will glean insights and intervention strategies that will enhance their ability to support grieving children and adolescents.

One and a half hours of continuing education is available for social workers, nurses and counselors. For more information see

Registration options:
  • Individual registration: $35 per registration, 1 CE certificate for 1.5 hours will be granted

  • Organization registration: $100 per registration, unlimited viewings of the archive of this webinar through April 13, 2011, unlimited CE certificates for 1.5 hours will be available to viewers of both the live and archive webinar

  • Technical requirements for viewing the webinar can be found at, as well as a link to test your system. Please be sure your system is compatible before you register for the webinar.

    Don't forget that you can also register for the Helping Children and Adolescents Cope with Grief and Loss series at a discount - visit our website for more information or our on-line store to register now.

    HFA is grateful to the support of The Moyer Foundation for its sponsorship of this series. The Moyer Foundation offers encouragement, comfort and support to children in distress; the Foundation created and funds Camp Erin, the largest network of bereavement camps in the country for children and teens who are grieving a significant loss.

    Wednesday, February 17, 2010

    Caregiver Appreciation

    This article in Caring Currents by Paula Spencer discusses how caregivers can feel unappreciated, especially when caring for older family members with dementia.
    Feeling taken for granted as a caregiver is incredibly common. Surveys indicate that more than half of all caregivers do. And yes, these understandable feelings are a stressor. What also adds stress: Feeling sheepish when you want to complain about this.

    "I know it sounds petty to gripe about not being appreciated," apologized a friend who moved her newly widowed mother halfway across the country to an assisted living near her home. "But every little thank-you is like gas in the tank that keeps me going."

    Spencer gives some strategies to deal with these feelings given various caregiving situations. Struggling with the role of caregiver can be difficult even for professionals. In this New Old Age blog post from 2009, Paula Span talks to a social worker who had difficulty transitioning to a caregiver role.
    Susan Katz thought she knew all about caring for old people. Trained as a social worker, she had spent more than 15 years working for home care agencies and for assisted and independent living facilities. So when her own parents began to falter in their mid-80s – her mother had Parkinson’s disease, and her father was debilitated by the aftereffects of prostate cancer treatment – she felt prepared to step in and help.

    The reality has proved very different. Ms. Katz and her family are in some ways fortunate: her parents managed to sell their Long Island home, though not before the housing market had nose-dived. They moved into a continuing care retirement community near her home in Middletown, N.J., and hired an excellent home care aide to assist them four hours a day.

    Monday, February 15, 2010

    Turning Grief to Action

    NPR’s Linton Weeks writes about families who turned the death of a child into action, creating foundations or memorial funds to celebrate the memory of the child. Weeks quotes HFA Consultant Kenneth J. Doka, a professor of gerontology at the graduate school of The College of New Rochelle, who states that by setting these organizations, parents "are creating a bond with their children that goes beyond death." The piece is accompanied by links to several parent-founded foundations and audio from a mother remembering her son.

    An example of one program:
    The Collettis turned their parental energy to creating a memorial for Marc. "Joe and I immediately knew that we had to keep his dream alive," Lorenza says. "We did some research and spoke to a number of people. What we wanted at first was to have a room dedicated to Marc in an aquarium — a hands-on for children to educate them about marine life. That was too expensive."

    Then the Collettis learned of a marine education program at the Science Museum of Long Island in Manhasset. Using family funds, they arranged to fund an annual field trip for middle-schoolers. Every September, six members of the inner-city Boys & Girls Club of Oyster Bay-East Norwich are treated to a daylong boat trip to learn about marine life and the environmental impact of humans on the ocean and the planet. The Collettis hope the students will be inspired to carry on the work their son began.

    "I've been a few times onboard," Lorenza says, "and it's so touching because then in the middle, in the center of the water, they stop the boat and they ring the bell for a minute of silence for Marc. And I know he's watching. And when he's watching I know that all these kids, they are loving the water. And loving what he loves. And his spirit is around in that moment. I just love it."

    HFA's 2007 teleconference companion book, Living With Grief: Before and After the Death, edited by Kenneth J. Doka includes two chapters that touch upon this topic: "Inner Reality and Social Reality: Bonds With Dead Children and the Resolution of Grief" by Dennis Klass and "Grief as a Transformative Struggle" by Richard G. Tedeschi and Lawrence G. Calhoun.

    Friday, February 12, 2010

    Language Matters: Seniors Experiencing Grief and Loss

    Paula Span at The New Old Age blog writes about the different losses experienced by seniors, not only the death of friends and family members, but the loss of companionship as people move. She addresses how our expectations of how older people should grieve may be inappropriate.
    When old people lose their friends, she added: “We think, ‘You should be able to manage this. This is what happens. You should be used to it.’ Because if we ask what it’s like, we may hear what it’s like. We fear opening the floodgates of sadness.”

    But we wouldn’t tell a 55-year-old friend who had attended three funerals in two months to just buck up, would we?

    “When there’s been loss, to expect happiness is just denying the truth,” Ms. Moscowitz continued. “It opens up a divide between older people who then deal with the sorrow privately, knowing nobody wants to hear about it, and younger people who want them to be cheerful all the time.”

    For more resources on caregiving and loss, see HFA's section on professional resources for caregiving.

    Wednesday, February 10, 2010

    Study Examines Use of Feeding Tubes for Patients with Advanced Dementia

    The Feb. 10, 2010, issue of JAMA (the Journal of the American Medical Association) includes a study by researchers from Brown University and Harvard Medical School that examines the use of feeding tubes in hospitalized nursing home patients with advanced dementia. The study's authors observe that "hospitals with certain characteristics, such as those that are larger or for-profit, are more likely to have a higher rate of feeding tube placement." The researches note that feeding tube use varies widely.

    Hospitals with a culture of aggressive care at the end of life were nearly three times more likely to insert a feeding tube, according to the study. Larger or for-profit hospitals tended to use them more. Smaller, rural hospitals not affiliated with medical schools used them far less frequently.

    Second author Dr. Susan Mitchell, associate professor of medicine at Harvard Medical school, said the data points to a clear need to examine how treatment decisions are made for patients with advanced dementia.

    "Our results call for acute-care hospitals to examine how decisions are made for nursing home residents with advanced dementia, to ensure the decisions reflect patient wishes and values," Mitchell said.

    Still, Teno said, there should always be exceptions, particularly if the use of feeding tubes reflects a patient's religious wishes.

    "If a patient has strong religious wishes that they receive every bit of life-sustaining treatment regardless of outcome, we are still a society where we have to honor those wishes," Teno said. "But we need to make sure these decisions are based on patients' wishes and values."

    Dr. Eric Widera at the GeriPal blog, Joanne Kenen at the New Health Dialog blog, and Drew Rosielle at Pallimed have also posted about this study.

    Monday, February 8, 2010

    Highlighting Hospice during Black History Month

    In honor of Black History Month, the Milwaukee Courier published this list of prominent African Americans who receive hospice care, written by Clarene Mitchell, Community Liaison for VITAS Innovative Hospice Care.
    On a national level, only 8 percent of hospice users are African American. Yet, with the disproportionately higher African American mortality rates, many more could benefit from the end-of-life care. There are various reasons that contribute to the racial health disparity; some of which includes African Americans either not knowing enough about hospice and/or believing that it is only available to other populations. In contrast to this, there are many prominent and accomplished African Americans who have benefited from hospice care as they transitioned into death.
    Gloria Thomas Anderson, MSW, wrote a booklet, The African American Spiritual and Ethical Guide to End of Life Care, that addresses some concerns African Americans may have about hospice care. The booklet is being used by Kansas City Hospice as part of their outreach efforts. HFA interviewed Ms. Anderson and Jeannette Ford, Kansas City Hospice's Director of Community Relations.

    HFA examined why hospice is under-utilized by African Americans in this special report produced last year. The report looks at African American attitudes about care at the end of life, offers explanations as to why hospice, historically, has not been a choice for many African Americans, looks at grief and the African American community, and suggests ways to reach out to African Americans who are making end-of-life decisions.

    Friday, February 5, 2010

    End-of-Life Care In and Out of Prison

    Researchers from Penn State University and employees from six Pennsylvania prisons and the state's Department of Corrections will be examining end-of-life care options for prisoners. The research is being funded by a $1.27-million grant from the National Institute of Nursing Research. An intervention toolkit will be developed as part of the project, to be used at prisons across the United States.
    Prison workers, including health care professionals, chaplains, prison society volunteers and corrections officers, will provide information on current limitations, strengths, existing perceptions of end-of-life care among prison stakeholders and areas of care that bear improvement. Using the data collected, researchers will create a set of educational strategies for use by prison staff that they can tailor to fit individual prison's needs.

    Researchers selected Pennsylvania prisons that represent the diversity of those nationwide. They include varying levels of racial/ethnic concentrations and range from minimum- to maximum-security facilities. Included are prisons for male and female inmates. The study also includes a prison with an oncology unit, a prison that holds a primarily geriatric population, two prisons that house inmates facing death penalties and a prison that has a mental health unit.

    New York state and many other states allow for compassionate release of terminally ill prisoners, reports the New York Times. However, few prisoners are actually released under these types of laws.

    The embrace of compassionate release comes as the nation’s prison population is at a historic high — 1.6 million people as of 2008, according to the Justice Department — compounded by a surge in aging and sick inmates serving longer sentences. In 2008, there were 74,100 inmates age 55 and older, a 79 percent increase from 1999. New York estimates the cost of caring for a gravely ill inmate at $150,809 a year.

    Once released, they are usually cared for by family members or placed in nursing homes or hospices, their expenses largely covered by Medicare or Medicaid.

    But while the new state guidelines led to a rise in applications for medical parole — 202 inmates last year, compared with 66 in 2008 — they have hardly led to more releases.

    Thursday, February 4, 2010

    February 2010 Palliative Care Grand Rounds

    The second edition of Palliative Care Grand Rounds for 2010, a "monthly blog carnival" highlighting blog posts related to hospice and palliative care, is up at the Alive Hospice blog.

    FDA Approves Morphine Sulfate Oral Solution

    Last spring the U.S. Food and Drug Administration initially banned, then allowed a form of liquid morphine (20 mg/ml morphine sulfate solution). Now it has released an official approval:
    The U.S. Food and Drug Administration approved Morphine Sulfate Oral Solution for the relief of moderate to severe, acute and chronic pain in opioid-tolerant patients. This medicine will be available in 100 milligrams per 5 mL or 20 milligrams per 1 mL.

    This is the only FDA approved morphine sulfate oral solution available at this concentration. Although the use of this medicine to manage pain has been common practice for many years, this form and concentration of morphine was not FDA approved until now.
    Hospice organizations and hospice professionals expressed concern about limiting these forms of morphine, and those concerns were heard by the FDA. View other posts about this change at the Center to Advance Palliative Care, and the GeriPal and Pallimed blogs.)

    Wednesday, February 3, 2010

    Changes to Medicare Hospice Claim Form

    The Centers for Medicare & Medicaid Services (CMS) recently issued CR6791 which requires hospice agencies to report a separate line item for each time the levelof care changes.
    For hospice claimssubmitted on or after April 29, 2010, hospices should report separate line itemsfor the level of care each time the level of care changes. This includes revenuecodes 0651 (Routine Home Care), 0655 (Inpatient Respite Care) and 0656 (General Inpatient Care).
    Read the complete release on the CMS website.

    Tuesday, February 2, 2010

    Arizona Stops Funding for Some Medicaid Hospice Services

    The Arizona Daily Star reported yesterday that the state's Medicaid program (known as the Arizona Health Care Cost Containment System) no longer funds hospice services for some Medicaid patients. Patients enrolled in the long-term care program will continue to receive hospice benefits, however. The article reports that the 541 patients who received care under the program last year would not be eligible today.
    State legislators, in an attempt to balance the budget, have cut care options for some terminally ill Arizonans, and hospices may have to repay the state for services already provided.

    A footnote in the Legislature's 2007 General Appropriation Act allowed the Arizona Health Care Cost Containment System to match federal funds for hospice services needed by acute-care patients. It was a one-year appropriation that was renewed in 2008, but not for the fiscal year that began on July 1, 2009. Even though legislators approved the budget in July, AHCCCS continued authorizing hospice payments for another six months.

    Last month, AHCCCS sent a letter to providers telling them that the funding had been eliminated, and it suggested they would have to repay the state.