Wednesday, April 16, 2014
PLACERVILLE, CALIFORNIA
99 CENTS

Comfort, dignity and respect

EDITOR:

No one likes to think about death and dying, but it’s something everyone has to face eventually. There’s an incredible resource in our community that provides comfort, dignity and respect to all those coping with a serious or life-limiting illness. It’s Snowline Hospice.

November is National Hospice and Palliative Care Month, a time to reach out to our community to raise awareness about the compassionate care that hospice and palliative care offer.

One of the most important messages is to help people understand that hospice and palliative care help patients and families focus on living, even near the end of life.

Hospice is more than traditional healthcare. It’s high-quality care that focuses on the whole patient. Hospice and palliative care programs provide pain management, symptom control, psychosocial support and spiritual care to patients and their families when a cure is not possible. Both hospice and palliative care combine the highest level of quality medical care with the emotional and spiritual support that families need most when facing the end of life.

The hospice team provides expert medical care that keeps patients comfortable and able to enjoy time with loved ones. As part of this care, the hospice team answers questions, offers advice to patients and families on what to expect, and helps families with their caregiving duties. The team also provides emotional and spiritual support for the entire family.

Hospice care is provided wherever the patient is currently living, whether it’s in their home, a nursing home, an assisted living facility, or a long-term care center. Hospice care is covered by Medicare, Medi-Cal, and by most insurance plans and HMOs.

Hospice care is available to people of all ages, with any illness. When you contact Snowline Hospice, medical professionals and trained volunteers will ask you what’s important and listen to what you say. They make your wishes a priority.

If you or a loved one is facing a serious or life-limiting illness, the time to find out more about hospice and palliative care is now. The sooner patients can take advantage of this compassionate and expert care, the more the hospice team can help them meet the end of life with the dignity and respect they deserve.

FERN ALEXANDER, PH.D.
Board President, Snowline Hospice

Letters to the Editor

LEAVE A COMMENT

Discussion | 24 comments

  • Ray AllenOctober 23, 2013 - 6:50 am

    It tends to be difficult for all involved to "enjoy time with loved ones" when you are placed in a morphine induced coma.

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  • Vicki MartinOctober 23, 2013 - 9:07 am

    Ray Allen - harsh. May you never have to deal with the pain of cancer that is slowly taking away your life.

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  • DavidOctober 23, 2013 - 9:19 am

    Ray Allen...Why would you be so rude and show such a lack of compassion?

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  • Ray AllenOctober 23, 2013 - 11:14 am

    David and Vicki, I speak from direct personal experience with Snowline Hospice and my dying mother. What lack of compassion am I showing. Should I be grateful to an organization that euthanizes people? BTW Vicki Martin I am a cancer survivor. Thankfully my battle had nothing to do with hospice.

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  • MorrisOctober 23, 2013 - 1:02 pm

    Thankfully Ray Allen your cancer battle 'did not'. A blessing for you indeed being sparred the horrible pain present in those final months. Should you actually have experienced it however you would know that the decision to accept or decline the medication is yours.

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  • Ray AllenOctober 23, 2013 - 1:19 pm

    No one questioning the Hospice ad by their board president. Pure hypocrisy. First I'm ignorant and heartless. Now I'm lucky to have euthanasia as a viable alternative. Hospice is a program to mitigate cost to insurance companies plain and simple.

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  • CatherineOctober 23, 2013 - 4:25 pm

    Ray Allen, I'm so sorry you felt that your mother was euthanized, although I doubt that she actually was. If you have any evidence that this is truly the case, you should present it to the county and file a complaint. I'm a hospice volunteer, not with Snowline, but with some experience with various death processes and palliative protocols, and euthanasia is not a hospice practice. In the absolute worst-case pain scenario, a process called palliative sedation is very infrequently employed to manage intractable pain, with patient or caregiver consent. And morphine is used palliatively not just for pain, but to improve breathing in some end-stage diseases. With or without morphine, many people are in a coma and not rousable for many days before they pass on. I hope you have taken your complaint back to the hospice team and given them a chance to respond. Your comments are sad, but I'd hate to see them mislead someone who might benefit from hospice care.

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  • Ray AllenOctober 23, 2013 - 9:49 pm

    Catherine, a volunteer for hospice. OK. My mother and Father were unaware that when hospice came in that no other form of care could be provided. She was in a morphine induced coma provided by hospice for 27 days. No IV, the only way my father could hydrate her was spoon feeding water to her. He BTW lost 40% of his body weight during the process and experienced a full breakdown. When I took over I brought in a certified nurse who took my mother off morphine. She came too miraculously. The Hospice refused to provide care with a nurse in the house and took their equipment out including the hospital bed that I had bought. The very next day. Our family and mother enjoyed deeply the many months we shared before she passed. There is nothing you can say to convince me that hospice is anything but a death business.

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  • CatherineOctober 23, 2013 - 10:27 pm

    Ray, I'm so sorry this happened, but your letter reflects some misconceptions about what hospice does and what they can provide, and I don't want others to think your experience is in any way the norm. A person enters hospice via a prescribing doctor who is responsible for communicating palliative needs with the hospice team, and who in most cases continues to be responsible for the patient. (I wonder where your mother's primary-care doctor was for those 27 days.) Hospice includes many forms of palliative care, but it does not provide full-time nursing staff to patients; the family has to purchase those services from other providers. Hospice is heavily regulated by Medicare and private healthcare plans, and families need to take a little time to become informed, because Medicare/insurance rules are clear, but not always obvious. Statistically, if that's of interest, people live a couple of months longer under hospice care than they do if hospitalized for a similar condition. Also, in most cases, durable equipment like a hospital bed is rented, not purchased and, again based on Medicare rules, when the patient is no longer covered under hospice, the equipment quickly goes back to the vendor. I hope you'll identify the doctor and medical director you worked with, and the timeframe for this terrible experience. Snowline should definitely respond privately to your complaint, if they haven't already, if only to clarify their perspective. I'm glad your final months with your mom went well--that's what really matters.

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  • Oh BrotherOctober 23, 2013 - 10:35 pm

    The morphine does NOT have to be started immediately...I have unfortunately seen and heard similar stories. The elderly folks need an advocate to help in these decisions..advocate always for yourself if possible and if not have someone who can stand up for you..the advocate does need to be well informed and confident with the decisions that need to be made...it is such a difficult situation when a spouse of many years and is elderly themselves is left with all of the responsibility. It is a very sad situation all the way around..hospice is a good organization but I have heard other families say they feel that the pressure is on when hospice steps in...I hope the criticisms are constructive. There are many excellent and caring people that work for hospice and perhaps there are just a few that believe or act differently that may cause these situations. I don't know the answer but all should be listened to; hopefully toward the positive. 27 days? wow..

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  • Oh BrotherOctober 23, 2013 - 10:37 pm

    and then months shared?? Does sound as if there was too much morphine involved too soon..(sorry didn't finish the first comment)

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  • CatherineOctober 23, 2013 - 10:48 pm

    There's got to be more to Ray's story. Hospice nurses usually come once a week. Morphine doses are usually very small and in pre-measured syringes given by the family or caregiver after medical instruction by a nurse. Medicare/insurance would not pay for a daily visit unless there was a documented medical crisis. How can someone be in a 'morphine coma' if there is not a daily nurse providing morphine? many questions here. But any family who feels they've been 'pushed' by Snowline needs to meet with them and talk. No hospice team would want a family to walk away feeling as Ray does. My experience is that hospice teams work their butts off to do the right thing, but the constraints under which they operate aren't always understood by the family, because the family receives the information when in crisis.

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  • Oh BrotherOctober 23, 2013 - 11:02 pm

    Pre measured syringes?? That must be new since just a few months ago. The morphine is liquid in a bottle that comes with a syringe (without the needle) and the caregiver draws it up and administers it under the tongue. At least the hospice in this county does and in Sacramento also. The patient can be in a "morphine coma" if the elderly caregiver either doesn't understand or because that age group does what they are told to do by the healthcare provider (nurse in this instance). They give the dose as instructed and on time...I have been involved in several hospice cases myself and wonder why the nurse that comes in once a week didn't have some concern with 27 days. Or the Social worker, Home Health Aid, volunteers???

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  • MorrisOctober 24, 2013 - 2:18 am

    A person I loved deeply was in hospice care (not Snowline) for 10 days as an inpatient. The level of comfort and assistance provided to amazes me to this day; thr Hospice volunteers and staff are truly Angels. To patient. And to those closest. Everything we could possibly have needed was anticipated; laundry, meals in a family kitchen, hotel-like accommodations....all taken care of as if by magic. Within a functioning hospital disguised as a really large log cabin in the mountains. So we could focus on those last days together. I am grateful for those days. I am indebted to those Angels who made this possible. One of those gifts - to us at least it was a gift - might fit the classification of 'morphine coma'. In the final few days, struggling valiantly with pain became agonizing dignity-robbing pain. It was tortureous. So with consent, awareness and full understanding, the decision was made to connect a morphine drip that allowed for patient or automated control. It ended the pain. Within about two days I think, the flow induced something like a coma. We were aware that this could happen. And a few days later, the most beautiful soul departed. Hospice did not in anyway euthanize. No one did. There was simply no chance at recovery and only agonizing pain that almost no pain killers could longer control. The morphine - even with the eventual coma - provided relief and dignity. It was a blessing. As are the individuals who choose this branch within their profession. I'm convinced that 99.9% of us lack the strength and heart for this job. Thank God 0.1% does.

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  • Phil VeerkampOctober 24, 2013 - 9:09 am

    Beautifully and lovingly related, Morris. Kudos. Though completely different yours reminded me of my Dad's day of passing. That narrative will remain private. But I will allow this. Family needs to OWN end-of-life decisions. The day my Dad passed was at the same time the most terrifyingly painful and the most magnificently beautiful of my life. It was family.

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  • EvelynOctober 24, 2013 - 7:25 am

    Twice I have been involved with Hospice. Each time they were a true blessing. When morphine entered the picture I was carefully instructed. Both patients under Hospice care never were in morphine-induced comas and could not have been unless I had been seriously disregarding instructions. Even had I been, Hospice would have noticed, and I'm confident would have taken immediate remedial action. I have never known a caregiver who was not eternally grateful for the assistance of Hospice's competent and compassionate staff in what is a most trying situation. It's difficult to believe that Mr. Allen is referencing Snowline.

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  • Fran DuchampOctober 24, 2013 - 8:21 am

    I have lost many people in my life...and Hospice was there alongside of them...making sure that we knew how to care for our friends and loved ones. They have nurses come in and help learn the equipment.The Hospice people help set up a variety of help...even bringing in people to talk about what the caregiver and family is facing. It is not easy on a family to care for a loved one--Hospice makes it easier. My grandmother was never on pain meds. My friends who had to have drugs towards the end...were able to still converse with us. I am sorry that this person had a different experience. But I will always be thankful to Hospice here and in Los Angeles. As far as any drugs...the doctors would decide on those (and from experience people can react badly to many drugs)--not Hospice-- who came to help cherished people leave with dignity.

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  • cookie65October 24, 2013 - 8:42 am

    One of my first hand experiences with hospice was a $600/8oz. bottle of pure opiate syrup with the instructions to pour 15ml. down the throat of the patient every time they showed any sign of discomfort or even stirred the slightest bit. It wasn't a long drawn out process where the patient lingered for weeks.

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  • EvelynOctober 24, 2013 - 9:16 am

    Was 15 ml. for extraordinary pain? My first experience administering morphine started with 1/4 ml. and never exceeded 1 ml.

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  • cookie65October 24, 2013 - 9:20 am

    Evelyn, yes and it was only a matter of hours. The bottle didn't get finished.

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  • CatherineOctober 24, 2013 - 10:33 am

    I'd encourage anyone who has been unhappy with hospice to name the provider, describe the illness, and tell us the era. There have been tidal shifts in practices, first in the 80s-90s, and recently, as the government tries to get a handle on hospice costs--a rapidly increasing part of the Medicare budget. It's always sad to see a person enter hospice within days or weeks of their death, because with proper information, it can be the most humane and generous benefit a person will ever receive. No one has to die in physical pain, and very few people choose to do so but some do, for a variety of personal reasons. Morphine is not always part of the protocol, but it's a fascinating drug with multiple uses and incredible dosing ranges. (And caregivers take note, you'd never pour anything down an elderly or dying person's throat--they'd aspirate for sure! In my experience, nurses pre-filled under-the-tongue syringes to assist overwhelmed caregivers.) Death, like childbirth, appears to be effortful, and also like childbirth, every death has dignity, whether the person dies on hospice, in the hospital, on machines, or from an accident. The biggest benefit of hospice is that it brings loved ones together in a familiar environment, reducing stress and giving people time to deeply cherish each other.

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  • Oh BrotherOctober 24, 2013 - 8:54 am

    15ml?? I doubt it...and Hospice pays for the medications..there are always good and bad stories about healthcare...we shouldn't detract from or put down Mr. Allens' experience..I have had poor experiences with SOME personnel from yes Evelyn, even Snowline Hospice. I also had some issues with a couple of other Hospices in California...that being said, Hospice does provide a wonderful service and provide a great service to the community, the dying individual and their loved ones. I too hope Mr. Allen converses with Hospice so that he can give them some insight as to what his experience was and provide them the opportunity to only improve on their great organization. Once again, advocacy from family, friends and caregivers is number one...

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  • cookie65October 24, 2013 - 8:58 am

    Hospice may have paid for yours.

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  • EvelynOctober 24, 2013 - 9:18 am

    There are, in fact, some expenses not covered by Hospice, but in my experience, they were the exception.

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