Hospice demonstrates the importance of good palliative care

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This has not been a good day for Yasmin Teja. She’s feeling weak from the cancer that has riddled her lymph nodes, her brain, and her breast. But as she lies close to death in her private room at the North Shore Hospice, Teja wants to get a message out about the importance of good palliative care.

“This is a very well-run facility,” she says in a near whisper to the Georgia Straight. “They run a tight ship. People that are in our situation, we need something like this.”

Teja adds that she doesn’t want to run down the treatment she received in hospital, but she emphasizes that the care she receives in the hospice is “above and beyond” what was available in the wards. She should know, having spent 50 days in hospital after her brain surgery. “The rooms are all private, and they have it decorated,” Teja continues. “It’s a pleasanter surrounding. The nursing staff is very good, the care aides excellent. And then the volunteers, they are tremendous.”

She acknowledges that the nursing staff are occasionally a little late with medication, but says that’s only because of staffing levels. “If an emergency comes, they have to deal with that and they don’t have enough time to deal with less urgent patients,” she notes.

Teja, who formerly worked at the U.S. consulate, is one of 10 terminally ill patients in the North Shore Hospice, which opened in November. A few minutes after Teja offers her thoughts, her sister-in-law, Khanum Schmitz, tells the Straight that Teja’s husband died from cancer about a year ago. “She has no parents, no siblings, no children,” Schmitz, a former UN official who lives in Texas, says. “I am the sole caregiver.”

Fortunately, the hospice lets family members sleep on the premises so they can spend more time with their loved ones. Schmitz offers effusive praise for the medical care, saying the doctors are the best she has ever seen. She notes that the nursing care is focused entirely on the patient’s comfort, which differs from what takes place in an acute-care setting, and the care aides have a high regard for patients’ personal hygiene. It’s no wonder she says that if she had a terminal illness, this is where she would like to be.

“This is more like a five-star resort,” Schmitz quips. “It’s a very nice place. No matter how sick people are, there is a smile on everybody’s face. When you are at that stage, that is important.”

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Bo Olson
I ´m proud to say my daughter works there.
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RNcompanion
People with dementia, although it is a terminal disease, do not end up in hospices or palliative care - they end their lives in long term care facilities, often special care units.

The PPS tool is not used in residential care for a number of reasons - the main one being that the criteria in the PPS does not accurately relay the status of the resident in a long term care facility. It is a tool designed to identify the effect of active disease (primarily cancer) on the functionality of the patient to predict the eventual outcome. With some variation, that path is fairly predicable.

Aging, combined with dementia/heart disease/stroke/parkinsons/diabetes/renalk failure/liver failure/chronic respiratory diseases (all conditions seen in residential care), is simply not that predicable.

For example, I have cared for many residents with advanced dementia who remain ambulatory, but are in need of total care in all other areas of function. They wander, they walk around, they get into things but do not know or remember how to feed themselves, or to even recognize food, are unable to bath or dress themselves, and yet continue to live for sometime at this level - a PPS score simply does not apply. It is difficult to determine when they will sucumb to the extensive loss of brain function.

People with dementia, heart failure, stroke etc do not access palliative care services unless their symptoms are so severe that nursing/medicine in residential care can not manage them. (a rare occurance). These people live out their lives in long term care facilities. The care teams in these facilities use palliative care services on a consultative basis as needed. The gerontological teams caring for these elders in facilities - nurses, geriatricians, OT/PT/Dietitians etc are very skilled not only in the complexities of aging, but in the delivery of palliative care as well.

Hey Charlie, how about an article about gerontological teams??
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