Hospice And Quality Of Life
June 30, 2010
By Anna Loengard
Anna Loengard
Co-medical director of St. Francis Hospice
Where did you receive your schooling and training?
I went to State University of New York at Stony Brook for medical school. I did my residency in internal medicine at the Beth Israel Deaconess Medical Center at Harvard Medical School followed by a fellowship in geriatrics at the University of Arizona School of Medicine in Tucson. After my fellowship, I went to work at Mount Sinai School of Medicine in New York in its department of geriatrics, where I took care mainly of homebound elderly patients.
What brought you to Hawaii?
My husband and I were looking to leave New York. We came here on vacation and both of us really liked it. One of the important things for us was to go someplace that was culturally diverse, where our kids could grow up in a place where everyone didn’t come from exactly the same place that they did. We’ve been in Hawaii for about eight months.
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You were recently appointed co-medical director. What’s your role and responsibilities?
I work with Wen-Yu Lee, M.D., who is the co-medical director. My primary responsibilities are for the home hospice program, which has about 185 patients right now. I do consultations for other physicians on pain and symptom management, and for some patients I take care of them entirely. I also do house calls, so it’s a pretty complex patient case load. I’m also very interested in education for care-givers, because there are many who need all the support and information they can get to be effective at caregiving and advocating for the people they care for.
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You mentioned 185 patients. Is that an average amount?
This is actually an increase, and we are expanding to serve more patients and families by converting to an electronic medical record system to streamline operations and accepting referrals and admissions on weekends. There’s certainly a need. Nationally, about 38-39 percent of people are admitted to a hospice program, but in Hawaii, it’s about 20 percent, so there is an under-utilization of hospice here for various reasons. Part of my job is getting people to understand what hospice is and the support it can bring to families and patients during a very difficult time of life.
Can you talk more about the support that the hospice program offers?
Hospice is a team effort - nurses who go into the home, social workers, aides who give baths, volunteers and chaplains - providing physical, psycho-social and spiritual support. We recognize that the family and caregivers are just as important as the care team helping with that patient. One of the beauties of hospice is that it is for families and patients who want to focus on quality of life and make the most of the time they have left. It’s bringing expert care into the home, a nursing home or an inpatient facility. However, most people prefer to be at home.
You mentioned a team going into the home. Is it usually the same group that stays with the patient?
A liaison nurse does the initial admission. Then the nurse and the social worker assigned after admission will stay with the patient throughout, so they can build a relationship with the family. We also try to do this with the aides so there’s continuity and a level of trust.
What are some of the misconceptions about hospice?
The greatest misconception most people have is that it’s for the last days of life. But when people come to hospice at that point, they have suffered unnecessarily. Hospice is for patients with six months to live. If you get better or find out that it’s not what you want, you can get off the program very easily. Another misconception is how hospice is paid for. Medicare and most private insurances pay for hospice, so it’s completely covered.
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There also are bereavement services offered. Why is this an essential support element of hospice?
It’s actually one of the greatest selling points of hospice, because it’s the only way in this country to have any kind of organized bereavement, for up to one year, after a loved one dies. Bereavement support can make a big difference in helping people process their grief and being freed of it rather than ending up living with grief for the rest of their life.
Do you anticipate any significant changes with hospice within the next 10-20 years?
Absolutely. Our population is rapidly aging. As the baby boomers get into their 70s and 80s, we will see a big spike in the number of patients. We look forward to continuing to provide quality care for Hawaii’s patients and families.