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Palliative & Hospice Care

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Palliative & Hospice Care

"Sometimes doctors and patients confuse palliative care with hospice care,
which is for people who no longer need or want to treat their condition but
want help managing their pain. Palliative care, on the other hand, is often
meant to help people who are still fighting their disease. But some fear palliative
care because they think it means giving up." (AARP Bulletin, June 2011, p.15)

  • Palliative Care - PowerPoint Presentations
    1. Beverly JeffsSteele,
    2. Joe Mattern III,
    PowerPoint Viewers can be downloaded for free. Click!]

    Wellness Forum on Palliative Care:

    "Improving Quality of Life in the Face of Life-threatening Illness"

    The Port Ludlow Village Council Wellness Committee will hold its third wellness forum

    on Wednesday, March 7, 2012 6:00 PM at the Beach Club.

    Our speakers will be:
    Beverly JeffsSteele, Doctor of Osteopathy, Medical Director Palliative Care Services, Harrison Medical Center;
    Joe Mattern III, MD, Chief Medical Officer and Medical Director for Hospice
    and Golda Posey, RN, both of Jefferson Healthcare Home Health and Hospice.

    Palliative care is all about improving quality of life, whatever the illness. That may be through the relief of pain and stress, and it addresses both the patient and the family. It is a growing and evolving specialty, and it is not just for hospice situations.
    Please join us for an informative evening, and bring along your questions and your neighbors.
    No reservation is necessary.
    Palliative Resources: See below!

    • Related Pages (Resources)

    • Palliative Care Organizations

      • National Palliative Care Research Center The mission of the National Palliative Care Research Center (NPCRC) is to improve care for patients with serious illness and the needs of their families by promoting palliative care research. In partnership with the Center to Advance Palliative Care, the NPCRC will rapidly translate these findings into clinical practice.

      • Resources [incl. measurement & evaluation tools]
      • Washington's Rating of Palliative Care by National Palliative Care Research Center/Center to Advance Palliative Care

      • Center to Advance Palliative Care [Mount Sinai School of Medicine] “When you are facing a serious illness, you need relief. Relief from pain. Relief from other symptoms, such as fatigue, nausea, loss of appetite and shortness of breath. Relief from stress. [....] The goal of palliative care is to relieve suffering and provide the best possible quality of life for people facing the pain, symptoms and stresses of serious illness. It is appropriate at any age and at any stage of an illness, and it can be provided along with treatments that are meant to cure.

      • Palliative Care and Hospice Care Across the Continuum

      • National Consensus Project for Quality Palliative Care [American Academy of Hospice and Palliative Medicine ( "Physicians Caring for Patients with Serious Illness")] "The National Consensus Project for Quality Palliative Care (NCP) represents a groundbreaking initiative to further define and underscore the value of palliative care and to improve upon the delivery of palliative care in the United States. Palliative care is both a philosophy of care and an organized, highly structured system for the delivery of care. A major objective of the NCP is to heighten awareness of palliative care as an option in treating those with a life-limiting or chronic debilitating illness, condition or injury, and to raise public understanding of the growing need for such care."

    • Palliative Care: Making the Case Univ. of Wash. Grand Rounds Video Speaker: Robert Martensen, MD, PhD, director, Office of History, National Institutes of Health, May 25, 2010. (58 min) "Description: A physician, medical historian and bioethicist, Martensen pulls no punches: beyond the marvels of modern medical technology lies a treacherous morass of ethical, moral and spiritual dilemmas most of us are not ready to even consider: whether to opt for aggressive treatments, when to stop them, and how to die well. Too often the choice of aggressive treatment and heroic measures becomes an extended death by intensive care in grim hospital units designed more like prisons than places of healing. Martensen lays blame across the board, from patients with unrealistic expectations and doctors who don't explain treatment options fully, from profit-driven hospitals to an insurance bureaucracy that spurns routine health maintenance."

    • Early Palliative Care: Improving Quality of Life [Video,] A landmark study on the integration of palliative care during early onset of a cancer diagnosis was recently published in the New England Journal of Medicine. Jim Windhorst, a stage IV, lung cancer patient describes how palliative care helped him cope with his illness.

    • PDQ Cancer Information Summaries: Supportive and Palliative Care: topics include Anxiety & Distress, Fatigue, Nausea & Vomiting, Pain, Sleep Disorders, Grief, & Family Caregivers in Cancer

    • Palliative Care in Cancer [NCI] [Related Care-Giving Sites] This fact sheet describes the role of palliative care, which is comfort care given to a patient who has a serious or life-threatening disease, such as cancer, from the time of diagnosis and throughout the course of illness. This fact sheet discusses the difference between palliative care and hospice care, how to locate palliative care, who pays for this type of care, and where to find information about research on this topic.

    • WebMD's Palliative Care Center: "For patients and caregivers alike, a chronic illness or life-threatening health condition presents an array of tough questions and challenges. From the physical to the emotional, WebMD's palliative care center is here to help."

    • The "Caring Connections" Web site was created by the National Hospice and Palliative Care Organization to provide free, easy-to-understand resources on a variety of issues. Information on care and end-of-life issues include topics such as hospice information; palliative care; advance care directives; care giving, pain; grief; financial planning; issues relating to the workplace

    • The Palliative Care Provider Directory of Hospitals is a resource to help you or a loved one locate a hospital in your area that provides palliative care. The directory is based upon the American Hospital Association (AHA) Annual Survey Database™ and the National Palliative Care Registry™. *Hospitals marked in green with an asterisk are verified through the National Palliative Care Registry™ e.g. Harrison Medical Center

    • Harrison Medical Center: Palliative Care Services:
      Beverly JeffsSteele, DO, Medical Director, 360-744-5618 Palliative Care Services: Compassionate Care for those with Life-limiting Illness: "Palliative care is specialized medical care that focuses on relief of pain, symptoms, and stress of serious illness. Our goal is to help people live comfortably. We strive to ease suffering and promote quality of life for patients and their families. We offer in-depth support with care planning and transitions...The word palliative comes from Latin and means blanket. You can think of Harrison’s palliative care as a warm, comforting blanket during a difficult journey with illness."
      (incl. attached Brochure)

    • Franciscan Palliative Care Outreach [1-800-338-8305] Dealing with a painful or serious illness can bring overwhelming challenges. The good news is, you do not have to face your illness alone. Special care, called "palliative care," is available to help you. The primary purpose of palliative care is to relieve pain and other symptoms related to your illness and to help you address the difficult decisions related to your illness. [...] Our team will visit you in your home or a long-term care setting to help you manage your pain and symptoms, understand all of your medical options, learn what to expect as your illness progresses, and make informed choices with dignity.

    • Americans are treated, and overtreated, to death by MARILYNN MARCHIONE (AP); Kitsap Sun, June 28, 2010. "... Americans increasingly are treated to death, spending more time in hospitals in their final days, trying last-ditch treatments that often buy only weeks of time, and racking up bills that have made medical care a leading cause of bankruptcies. More than 80 percent of people who die in the United States have a long, progressive illness such as cancer, heart failure or Alzheimer's disease. More than 80 percent of such patients say they want to avoid hospitalization and intensive care when they are dying, according to the Dartmouth Atlas Project, which tracks health care trends...."

    • "Palliative Care’s Healing Powers for Caregivers, Too". AARP Blog, Jan 2012

    • Nursing Institute of Nursing Research: Symptom Management Research "Throughout its twenty-five year history, NINR has supported research on new and better ways to manage the symptoms of illness. Symptom management research supported by NINR focuses on understanding the biological and behavioral aspects of symptoms such as pain and fatigue, with the goal of developing new knowledge and new strategies for improving patient health and quality of life... This webpage provides a broad overview of NINR’s activities in symptom management research, highlighting recent program initiatives and research findings."

    • ePrognosis: Estimating Prognosis for Elderly "The information on ePrognosis is intended as a rough guide to inform clinicians about possible mortality outcomes. It is not intended to be the only basis for making care decisions, nor is it intended to be a definitive means of prognostication. Clinicians should keep in mind that every patient is an individual, and that many factors beyond those used in these indices may influence a patient's prognosis."
      "ePrognosis was created with the support of the Division of Geriatrics at the University of California, San Francisco. However, its content is strictly the work of its authors and has no affiliation with any organization or institution."

    • Palliative Care For Seniors, Care Givers and Families --- Help make their last years better years []

  • What is Hospice? "Hospice is a special concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments." [ Hospice Foundation of America]

    • Hospice Directory for Washington State

    • Medicare Hospice Benefits: 15 pg booklet; [pdf]
      Covers: Who is eligible; What Services are included; How to find a hospice program; and Where to get more information. [CMS Product No. 02154; Revised August 2011]

    • Hospice Services Reimbursed by Medicare for East Jefferson:

      1. Hospice of Jefferson Health Care [Hospice: Caring & Compassionate Services for People Approaching Life’s End: 360-385-0610] "Our focus is on reducing pain and enhancing quality of life while providing comfort and support. We develop an individualized program providing medical, emotional, psychological, financial, social, and spiritual care when requested."

      2. Assured Hospice (Sequim)
        • Hospice - A Home Based Service [LHC Group] "Our hospice program is perhaps the best example of our mission in action. Every professional on our team embraces the philosophy of always putting patient needs ahead of all else. In hospice care, this is crucial to the physical and emotional well-being of the patient."
          • Locations: Sequim + 3 others in WA State (2011)
            24 Lee Chatfield Way 
            Sequim, WA 98382-3593
            Tel; 360.582.3796
            Port Hadlock Phone: 360.344.3258 (according to 2012 brochure)
            or: 1-800-833.9404
    • Hospice of Kitsap County "Hospice is a concept of caring that emphasizes palliative (comfort) rather than curative treatment; quality of life rather than quantity of life. Expert medical care is given, and the most effective pain symptom relief is provided. The patient and family are all included in the care plan and emotional, spiritual and practical support are given based on the patient’s wishes and family’s need "

    • Hospice of Kitsap County to partner with Harrison," Kitsap Sun April 11, 2012 "The intention is that we stay separate. That being said, we can't predict the future," said Jim Page, Hospice board president. Within two years, Harrison and Hospice leaders will re-evaluate the full merger question.... Harrison's palliative-care services, which help provide comfort to people with serious illnesses, already are at Harrison in East Bremerton. Hospice and palliative-care services go hand in hand.`"

    • Fred Lowthian Care Center [attached to (behind) the Stafford/Belmont Nursing Facility on 570 Lebo St] [to our knowledge, this is the only Hospice Facility on the Kitsap and Olympic Peninsulas (March 2012)]
    • Hospice services and resources for patients and their families facing life-threatening illness. []

    • Group Health Hospice Care "... is for patients who are receiving end-of-life care from a friend or relative, usually at home. The Hospice Program offers physical, emotional, and spiritual care for patients who are in advanced stages of incurable illness. Hospice also helps patients' families cope with the illness."

    • Living Every Day: For patients nearing end of life, hospice offers a way to maximize quality of life. Northwest Health, Summer 2012 By KJ Fields "[...]For patients with terminal illness, the conversation about hospice care is worth having with their doctor. According to Linda Norlander, RN, associate director of Home Health and Hospice and author of several books on end-of-life care, doctors are waiting for patients to bring up hospice and patients are waiting for their doctors to do so. "You can ask about hospice care at any time, and it's important to be well informed.[...]"
    • Franciscan Hospice Care, Tacoma Since 1989, Franciscan Health System has provided home-based hospice services in which nurses and other caregivers visit the homes of terminally ill patients. Franciscan is the largest provider of home-based hospice services in the South Puget Sound region. For more information about Franciscan’s long-established home-based hospice care and its inpatient hospice services, please call 253-534-7000. Franciscan Hospice House; 2901 Bridgeport Way W.; University Place, WA 98466-4631; Phone: 253-534-7000; Toll free: 800-338-8305; Map & driving directions (PDF)

    • Hospice Foundation of America Mission Statement: Hospice Foundation of America provides leadership in the development and application of hospice and its philosophy of care with the goal of enhancing the U.S. health care system and the role of hospice within it.

    • Some Questions to Ask in Selecting a Hospice for Your Loved One
    • National Hospice and Palliative Care Organization (NHPCO)
      • History of Hospice Care "The term “hospice” (from the same linguistic root as “hospitality”) can be traced back to medieval times when it referred to a place of shelter and rest for weary or ill travelers on a long journey. The name was first applied to specialized care for dying patients in 1967 by physician Dame Cicely Saunders, who founded the first modern hospice—St. Christopher’s Hospice—in a residential suburb of London."

    • National Association for Home Care & Hospice " the nation's largest trade association representing the interests and concerns of home care agencies, hospices, and home care aide organizations."

    • End of Life: Helping with Comfort and Care from [probably out-of-print; not online] "This publication is based on research... supported by the National Institute on Aging, part of the National Institutes of Health. This research base is augmented with suggestions from practitioners with expertise in helping individuals and families through this difficult time."

    • Hard Choices for Loving People: CPR, Artificial Feeding and Comfort Care for the Patient with A Life-Threatening Illness 5th ed., 2009.

    • About DNR Orders (Do-not-resuscitate orders) 800-628-7733

    • POLST: Physician Orders for Life-Sustaining Treatment: medical orders on a bright green form which describes patient‘s code directions:

    • Founded in 1997, the agenda of Americans for Better Care of the Dying (ABCD) includes helpful education resources such as an online "Handbook for Mortals: Guidance for People Facing Serious Illness", by Joanne Lynn and Joan Harold. Chapters can be accessed on decision-making areas such as foregoing medical treatments; tube feedings (nutrition and fluid); adult resuscitation (CPR); and ventilation. Links to other helpful resources such as advance care planning, care giving, pain and other symptoms, hospice and palliative care are also provided on this site.

    • The Washington State affiliate of Compassion & Choices National, "provides client services to those who are facing the end of life and desire a humane, peaceful death. Our Client Support Volunteers help patients explore their options for pain management, comfort care, and hospice. We will also provide support and guidance to qualifying terminally ill individuals seeking to use the Washington Death With Dignity Law." This non-profit organization... set a new standard in Washington for advance planning documents with their Compassion & Choices of Washington Advance Directive, distributed without charge; and also promotes the use of the Physician Orders for Life-Sustaining Treatment (POLST) form."

      "Patients are encouraged to call"in the early stages of illness: "This gives our volunteers time to establish a relationship and to discuss all of the important questions surrounding your end-of-life choices. A Client Support Volunteer can come to your home and talk with you at your convenience. All services are free of charge. To request client support services, call our office at 206-256-1636 or 1-877-222-2816, toll-free."

    • The Conversation Project The Conversation Project is dedicated to helping people talk about their wishes for end-of-life care. Too many people are dying in a way they wouldn’t choose, and too many of their loved ones are left feeling bereaved, guilty, and uncertain. It’s time to transform our culture so we shift from not talking about dying to talking about it. It’s time to share the way we want to live at the end of our lives. And it’s time to communicate about the kind of care we want and don’t want for ourselves. -

    • Compassion & Choices of Washington is a nonprofit organization that advocates for excellent end-of-life care, patient-centered care, and expanded choice at the end of life.

      August 5, 2015
      Advance Planning Seminar
      1:00 – 4:00 P.M.
      Where: The Bay Club
      120 Spinnaker Pl.,
      Port Ludlow, WA 98365

      Registration begins at 12:30 p.m.
      Have you had “that” conversation with your grown children? You know, the one where you talk about the reality of your dying? The one where you want them to understand what you want done or don’t want done when you are at the end of your life? The one where you ask them to support your end of life wishes, even when they are not ready to let you go?

      If you saw yourself in this description, then this is the event for you!

      In the first half of the program you will learn about all your end-of-life options and have a chance to ask and get your questions answered. You will learn about how to communicate your end-of-life wishes to your loved ones. You will be given tools to talk to your physicians about your end-of-life care. All too often these discussions and decisions don’t get addressed until the very end, if at all, preventing you from having the kind of care that will maximize your quality of life in your final days. This subject is not easy to talk about but by attending this seminar, you will know how to navigate through these crucial conversations.

      The second half of the program will guide you step-by-step through the Compassion & Choices of Washington Advance Directive. This document is the result of a number of years of research and development by legal and medical experts. It has been widely praised by health care professionals, advance planning advocates and attorneys who specialize in elder and estate planning. It combines the Durable Power of Attorney for Healthcare as well as a Living Will into one document. You will be able to leave the seminar with an essentially completed document as well as have a chance to ask and have your questions answered about the choices offered in this important document.

      The Advance Planning Seminar is co-sponsored by the Community Enrichment Alliance of Port Ludlow, Compassion & Choices of Washington, and the Hospice Foundation for Jefferson Healthcare.

      Space is limited to 100. RSVP by August 3rd to either:

      End of Life Choices and Conversations (Resources)

      Karen Griffith, or
      Judy McCay,, 360.437.2156
      Or sign up at the Beach or Bay Club

      You are encouraged to bring your adult children to participate with you in this seminar, thus assuring that you all hear the same information and can then more openly talk about this difficult subject.

      Karen Griffith & Judy McCay

      Cost of this seminar: FREE

      View the seminar flyer HERE!

    • Elizabeth Trice Loggers, M.D., Ph.D. et al., Implementing a Death with Dignity Program at a Comprehensive Cancer Center, New England Journ of Medicine, April 2013 [full article] | [Abstract] "In 1997, Oregon became the first state in the United States to pass legislation that offered a “physician-assisted” approach to dying for adults with poor short-term prognoses. The Washington State legislature followed Oregon more than a decade later, passing an almost identical law, the Washington Death with Dignity Act, in November 2008....
      In response to the Washington law, Seattle Cancer Care Alliance developed a Death with Dignity program, adapted from the existing programs in Oregon. This article describes the implementation and results of our Death with Dignity program, designed to adhere to legal regulations, maintain safety, and ensure the quality of patient care...."

    • Numerous Articles on ElderCareWay INCLUDING: ¦What is the difference between palliative care and hospice care? ¦What is hospice? ¦What types of services are provided by a hospice care service? ¦How do you pay for hospice? ¦How do I know if my loved one is ready for hospice? ¦Who provides hospice care? ¦What does a hospice nurse do? ¦What does a hospice doctor / medical director do? ¦What does a hospice social worker do? ¦What does a hospice medical director do? ¦What does a hospice aide do? ¦What does a bereavement counselor do? ¦What does a spiritual counselor do?

      ¦Where can hospice services be provided? ¦What is the difference between an in-home hospice service and facilities-based hospice? ¦What to look for when choosing a hospice? ¦What do I do if my loved one refuses hospice care? ¦How do I know if my loved one is receiving quality hospice care? ¦Can you change hospice providers? ¦How long does hospice last? ¦What if my loved one gets better? ¦What if my senior wants to stop hospice?

    • Dr. Ira Byock, long time palliative care physician and advocate for improved end-of-life care, and a past president of the American Academy of Hospice and Palliative Medicine, provides written resources, as well as organizations, web sites and books to empower persons with life threatening illness and their families to live fully. Some recommended websites can be found at this page:

    • Gone From My Sight: The Dying Experience, 2009 written by hospice nurse. "I feel it is important to make living with a life threatening illness, dying, death, and grief a graceful process. It is my wish that family, friends, patients & clients experience these with dignity and reduced fear. I think our materials assist in that process."

  • What really matters at the end of life | BJ Miller - YouTube (Ted Talk) [Published on Sep 30, 2015]

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