Good Medical Care for the Elderly and How to Get It

Patient characterisitics and end-of-life decisions

While access to hospice and palliative care in America has become far more available, recent studies show that minorities do not often choose this as an end-of-life care strategy, preferring to seek extraordinary measures even when it is obvious that death is not only inevitable but near. The Washington Post reported on March 11, 2007 on studies showing that only 7.5 percent of hospice patients are black, and only 4.8 percent are Hispanic -- less than half their representation in the general population.

An ongoing Harvard project funded by the National Cancer Institute is the largest study to examine the question. Participants in this study are about 800 terminally ill cancer patients in Massachusetts, Texas, Connecticut, New Hampshire and New York. The Harvard group is finding that African Americans are two to three times as likely as whites to want everything possible done to keep them alive, to get life-prolonging care and to die in intensive care.

Hospice Care and Dignity at End of Life

Only once have I participated in a hospice experience. Friends and neighbors gave hospice care to Sharon's mother at the end of her life. At first, I was reluctant to intrude. I called and offered meals on Mondays, Wednesdays and Fridays. I delivered the meals to Sharon and John's kitchen at 6 PM, with hand-written instructions about what was needed as a finishing touch. Sometimes, I'd also bring flowers cut from my garden.

Finally, one day, I arrived as Sharon and her "Healing Harp" group were playing for her mom -- surrounding her bed with the lilt of Celtic music. I was invited to move to Sharon's mom's bedside. Later, I was asked to give Sharon brief respite so that she could take a walk. I learned to give drops of "liquid gold," to soothe, and to giving comforting touch to a lady who was in a coma.

I've always believed -- well, since I ever first thought about this -- that even though people are comatose, they can doubtless hear everything said at their bedside. They can feel comforting touch.

Sharon's mom died about 6 weeks after she arrived to lie dying in Sharon and John's living room. At the memorial service, filled with loving memories of her mother and filled with joyful recollections, Sharon said: "And then John and I debated. Shall we tell Jeanne that Mom has died? Or can we keep this a secret a little while longer. Her meals are so good!"

Sharon and John's invitation to me to share their hospice experience moved me to choose hospice for my mom. Unfortunately, Mom died the night before she was to arrive in my home.

I was inspired by an article that I read recently in the New York Times describing a Hospice that I've not experienced -- a Hospice movement in which coaches actually prepare everybody for that last breath, tell you what to expect, give you permission to fully participate in the dying experience and not to perceive it as a sorrowful or frightening moment. This must be what is known as "A Good Death."

Here's a link to an article on Hospice written by Jane Gross, and published in the New York Times on May 20, 2006. "For the Families of the Dying: Coaching as the Hours Wane."

It inspired me. I highly recommend it to you.