Dying in place

Ahospice prognosis once meant that seniors who were living in care communities were required to leave that setting for a hospital or hospice facility. Such a mandate is no longer the case, as care communities, hospice workers, and the home caregiving industry are developing flexible ways to keep seniors in familiar surroundings to the very end.

“We refer to this as dying in place,” says Linda Gaetani, executive director of Denver VistaCare, the local branch of a national hospice organization that serves about 5,000 patients a day in 14 states. “Hospice and home caregivers working together offer a common model when the care becomes greater than the care community can support. So between the care provided by community, the home care staff paid by the family and hospice, that resident is generally able to remain in the home setting,” Gaetani explains.

“We know that most people in end-of-life situations don’t want to move,” Gaetani adds. “It’s traumatic. That’s what makes this a very creative solution to a highly emotional situation.”

It’s this synergy that prompted VistaCare to launch several pilot programs with Home Instead Senior Care, an international home caregiving company with more than 800 franchise offices worldwide.

“Companies like Home Instead Senior Care provide home care services and when you combine that with a level of hospice care, you’re really taking care of all the needs of a patient and their family,” says VistaCare Vice President of Marketing Mike Fleming. “It’s a symbiotic relationship because it’s based on each of us coming together to provide our services to meet the total needs of a client.”

“The structure that we provided for our pilot programs brought our teams together and featured materials that allowed us to educate one another. Most people aren’t aware of everything that hospice can provide or that it’s 100% covered by Medicare, Medicaid, and most commercial insurances. On the other hand, there are those families who don’t have a sense of what private-pay home care companies provide and how efficiently those services are conducted. It can be an eye-opener for everyone involved.”

While hospice is taking care of end-of-life spiritual and medical needs, home caregiving companies are providing companionship, meal preparation, and light housekeeping. Such a relationship benefits seniors in several ways.

Laurie Hamilton, a Harrisburg, Pennsylvania, Home Instead Senior Care franchise owner, says that her CAREGivers^SM often become the people who seniors in an end-of-life situation rely on and trust completely. “The CAREGivers truly become involved and so many go so far above and beyond. They want their clients’ last months and days to be as comfortable as possible, and will do almost anything to make that possible,” Hamilton says.

The relationship between the two industries works well, with hospice recommending that families call home care companies when more companionship is needed for their loved ones, and home care companies referring to hospice when they realize an end-of-life situation might be near.

Often it’s the families of loved ones themselves who reach out, wanting to keep their senior as close to home as possible. Such is the poignant story of Deb LosKamp, a New Cumberland, Pennsylvania, insurance professional, and a senior named George. LosKamp, a cancer survivor, met George’s late wife at a cancer survivors’ group. They became close friends and, when it appeared to George’s wife that she wouldn’t survive her cancer, she asked LosKamp to watch out for her husband after she was gone, making her power of attorney over the older man. “I always felt that God had placed me with George’s wife for a reason. The couple had no children and only a few extended family members far away,” LosKamp says.

After George’s wife died, LosKamp helped him move into an independent care community and looked out for his needs until September 2006, when George was diagnosed with esophageal cancer. “Since George was living in an independent care setting, I didn’t know what to do because he could no longer care for himself,” Los Kamp says. “That’s when I was contacted by care community representatives who said, ‘We don’t think you should move him if he’s that close to the end.’ The community manager recommended Home Instead Senior Care and that’s when I called Laurie Hamilton.

“She set up people right away to stay with George. At first it was a challenge finding the right personalities to get along with him. Finally, we found four pretty close CAREGivers who came and went around the clock. When I first met Laurie at the hospital she advised me to contact hospice. Hospice nurses came two or three times a week to prepare George’s medications and help with meal preparation. I also stopped by every day after work to see how things were going because George depended on me a lot.”

Staying at The Manor at Oakridge, where he had been living after his wife died, allowed George the normalcy that helped him enjoy life to the end. “George was very hard of hearing and almost completely blind,” says Mary Lee Bigelow, a community manager at The Manor at Oakridge. “He had a friend-Max-who’d lived in the community as long as he’d been there. Max died about six months before George got sick and he took that very hard. When George was diagnosed with cancer, he wasn’t expected to live long and he didn’t, dying just three months later in December 2006. But his CAREGiver would transport him to lunch and entertainment, and he had that spark going on until the very end. I believe it was because he was surrounded by everything that was home for him.

“George was alert and wise and an amazing soul. I still get a great picture of him in my mind with this big smile on his face. LosKamp did turn into the daughter George never had. There was nothing but generosity that came from her. George had great care and loving support to the very end. Because dying is such an important part of living, it’s wonderful that it can all be done in the same place.”

In situations like George’s, hospice workers become part of the larger team, says VistaCare’s Gaetani. “We have a full staff that is employed to provide end-of-life care including registered nurses (RNs), certified nursing assistants (CNAs), social workers, and chaplains.” The total care provided to patients oftentimes can alter outcomes, Gaetani notes.

“It’s a known phenomenon that frequently, when seniors get involved with hospice, their medical condition will stabilize and often improve,” Gaetani says. “If someone arrives to care for a senior from a home-care company and hospice, an older adult is being shown kindness and respect and life. One can appreciate to an extent why that happens. We’re human. We all need to be nurtured, loved, and respected. On the flip side, we can let people know that it’s OK to admit they’re tired and hurting…that it’s OK to let go.”

Georgene Lahm is a writer based in Omaha, Nebraska. With more than 750 independently owned and operaed offices in the United States, Canada, Japan, Portugal, Australia, Ireland, New Zealand, United Kingdom, Taiwan, and Spain, Home Instead Senior Care is the world’s largest provider of nonmedical home care services to the elderly.

For more information, visit https://www.homeinstead.com. To send your comments to the author and editors, e-mail lahm0509@iadvanceseniorcare.com.

Long-Term Living 2009 May;58(5):33-37