News from the End of Life

NHPCO observes National Volunteer Week

The National Hospice and Palliative Care Organization (NHPCO) in Alexandria, VA, has recognized volunteers as integral members of hospice’s interdisciplinary care team, providing comfort and compassion to those facing a life-limiting illness. The official recognition was part of the NHPCO’s National Volunteer Week in April.

"The roots of hospice are grounded in the dedicated work of volunteers who want to provide a more compassionate, dignified experience for the dying," says J. Donald Schumacher, PsyD, NHPCO president and CEO. "Hospices in this country served more than 885,000 patients in 2002, and volunteers are an integral part of the care team."

In comments presented by the NHPCO, hospice volunteers talked about why they have chosen to fulfill such an important role.

"My choice to volunteer is one of love," said Coral Rose, a volunteer from Fayetteville, AR. "To give love to others on a truly unconditional basis is an extraordinary experience. The choice for me was born the day of my own father’s passing. Several family members and I tended to him at home with the love and support of hospice. As more and more Baby Boomers are faced with caring for their elderly dying parents, there will no doubt be a rise in use of hospice, and I, for one, am pleased to know that, as a volunteer, I will make a difference when that happens."

An estimated 500,000 people volunteer in the nation’s 3,200 hospice organizations annually, providing more than ten million hours of service each year. Many people become hospice volunteers after experiencing firsthand the compassionate care hospice provided to a dying loved one.

NHPCO, Aetna collaborate on training

The National Hospice and Palliative Care Organization (NHPCO) in Alexandria, VA, will provide information and educational assistance to help train case managers working on Aetna’s Compassionate Care program.

Aetna, one of the nation’s leading providers of health care, announced plans in April that call for expanded benefits, nurse case management, and information to help Aetna members and their families cope with special needs and issues involved in care at the end of life.

Aetna’s Compassionate Care is designed to offer improved pain and symptom management, extended continuity of care, better advance care planning, expanded personal support, and better access to community-based services and resources. It is expected that these benefits will be available to a number of large plan sponsors representing more than 400,000 members beginning in January 2005.

Aetna reported that this broadened coverage for hospice and palliative care services will provide coverage for curative care while in hospice. Respite care and bereavement support also will be included.

"We’re launching this program because it’s the right thing to do," says John W. Rowe, MD, Aetna’s chairman and CEO. "It’s not about reducing medical costs or saving money. It’s about giving people choices and autonomy in the care they receive at the end of their lives."

"NHPCO is proud to work with Aetna to improve care for those patients and families living with life-limiting illness," says J. Donald Schumacher, PsyD, president and CEO of the NHPCO. "The expertise and experience found in the hospice and palliative care community will be invaluable as Aetna reaches out to provide their members with the best end-of-life care possible."

Common senior health care mistakes identified

Based upon information gathered for educational courses and books, the Institute for Healthcare Advancement (IHA) in La Habra, CA, has identified the 10 most common health care mistakes made by seniors.

"Seniors are enjoying themselves and remaining active much later in life," says Gloria Mayer, RN, EdD, president and chief executive officer of IHA. "But they must also take charge of their health care," she adds. By identifying the key areas in which seniors make mistakes, the institute hopes to advance education of seniors as well as family members of senior citizens.

The most common mistakes identified by IHA are:

  1. Driving when it’s no longer safe.
  2. Fighting the aging process and its appearance by refusing to wear eyeglasses, hearing aids, or dentures as well as refusing to use walking aids.
  3. Reluctance to discuss intimate health problems, such as urinary difficulties, with a doctor or health care provider.
  4. Not understanding what the doctor has told them about their health problem or medical condition and not asking for further explanations.
  5. Disregarding the serious potential for a fall by keeping scatter rugs and poor lighting in their homes.
  6. Failure to have a system or plan, such as pillboxes, a written daily schedule, or a check-off record, for managing medications.
  7. Not having a single primary care physician who looks at an overall medical plan for treatment to avoid multiple medical regimens that might cause adverse reactions.
  8. Not seeking medical attention when early possible warning signs occur.
  9. Failure to participate in preventive programs.
  10. Not asking loved ones for help for reasons such as stubborn personalities, a desire for independence, or early signs of dementia.

An easy-to-read, easy-to-understand self-help book for senior citizens titled What to Do for Senior Health has been published by IHA. For more information or to order the book, call (800) 434-4633 or go to and click on the "Bookstore" link. The cost of the book is $12.95.

Improved outcomes in pain management

Kathleen Rose, RN, MSHSA, president and CEO of Vineyard Nursing Association in Oak Bluffs, MA, and Sandi Corr-Dolby, RN, clinical director of Vineyard Nursing Association, will present "How to Integrate Pain Standards and Palliative Care Principles into a Home Care Agency: A Case Study" at the 22nd Annual Meeting and Exhibition of the Visiting Nurse Associations of America. The educational conference will be held April 21-23, 2004, at the Hyatt Regency in New Orleans.

In their 1½-hour program, Rose and Corr-Dolby will demonstrate how Vineyard Nursing Association, a full-service home care agency, has achieved measurable improvement in its chronic pain management program since implementing new administrative and clinical procedures developed by Pain Resources Network (PRN) of Melrose, MA. PRN president Cathy Schutt, RN, MS, ANP, will join Rose and Corr-Dolby in discussing how systemwide changes and interactive clinical tools have helped Vineyard Nursing meet or exceed the standards recommended for pain and palliative care by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and other regulatory agencies.

Improving consistency, effectiveness

"We knew our staff members were highly skilled in traditional curative care practices, but the long-term nature of illness experienced by a large percentage of our client population made us realize that we needed to improve the quality of the palliative care we delivered, as well," Rose explains. "To do this, we needed to address our chronically ill patients’ very subjective pain and symptom management needs more consistently and effectively. We wanted to adopt a comprehensive, interdisciplinary approach to patient care that would view pain as the fifth vital sign. We wanted to integrate the diagnosis and treatment of pain and its related symptoms into our daily clinical routine."

Pain Resources Network worked with Vineyard Nursing to assess the home care agency’s situation, establish goals and objectives, redesign administrative and clinical practices and procedures to accommodate the implementation of recommended pain standards, and train the entire interdisciplinary team in effective pain management and palliative care. PRN also developed hands-on clinical tools that would help each member of the health care team assess pain more accurately, carry out appropriate interventions more confidently, and communicate more consistently with patients, families, and each other.

"We at Vineyard Nursing are now very confident when dealing with our patients’ chronic pain symptoms," Rose says. "The ways in which our staff interacts with patients, families, MDs, and colleagues are measurably more consistent and effective. Our pain and palliative care outcomes have achieved the standards of care set forth by JCAHO, and we have significantly improved the quality of life for those patients who are not heading toward a cure. We are very committed to continuing this program and to training others with whom we work, as well."

The pain management and palliative care program being used by Vineyard Nursing Association is available to all health care providers in the form of an implementation and training system called Integrating JCAHO Pain Standards: Strategies and Tools for Non-Acute Settings, published by Pain Resources Network.

For more information, visit or call Kris Gravina at (781) 620-1919.