Has anyone read this?

Journeying East : Conversations of Aging and Dying

by Victoria Dimidjian

I saw a reference to it on the growthhouse site and it looks really interesting.

No, that one I have not read, but I will definatly look it up...how about "final gift"? I have read that one and we give it out to famlies. wonderful expressive book. definate must read.

Hi! I just came across this site, today http://growthhouse.net:8080/~growthhouse/guests

It has a really interesting article about how President Bush intends to cut hospice funding :http://growthhouse.typepad.com/les_morgan/2006/02/bush_cuts_hospi.html

This is a terrific site for families and professionals.

I haven't seen that one.

How about "Crossing The Cree... A Practical Guide To Understanding Dying Process," written by a nnurse.

http://crossingthecreek.com

Has anyone read it?

Yes, I've read it. Written by an old, and I mean "old" coot somewhere in

the desert of New Mexico with too much time on his hands and trying

to peddle his wares. LOL!

Actually I read this mini-book/maxi-article a few years ago when I first got into

hospice and it was an excellent resource and I would recommend it highly;

covers all aspects of the dying process; excellent resource for caregivers also!

I have given the website info to numerous coworkers and caregivers.

I would like to see Mr. Holmes write a book that includes all his teachings,

wisdom, and experiences under one cover and have published and available in

bookstores for a reasonable price. Hint-Hint!

I haven't seen that one.

How about "Crossing The Cree... A Practical Guide To Understanding Dying Process," written by a nnurse.

http://crossingthecreek.com

Has anyone read it?

yes, i've read the 3 books he wrote.

i could relate to many of his experiences, and agreed with his personal findings.

"final gifts" was another outstanding book; easy to read and eloquent writing.

furthermore, michael holmes, maggie callanan/patricia kelley have very similiar experiences, further vindicating the spiritual elements in dying.

aimee, i will try and find some feedback....

eta: whoops! i see this post is dated to 2005. nevermind aimee. :)

leslie

EmptytheBoat…

Old Coot! Old Coot!

Well… getting old beats the alternative I guess.

Don’t complain about the price too much. Last year my net income was 0. The year before that I netted $176… probably about what you make in a day. But I am slowly building up my infra-structure.

Who knows… maybe someday I’ll start a hospice and make some REAL money (before HCFA stamps on the whole thing like a roach in the kitchen… which probably won’t be too much longer by the way.)

I have not read Final Gifts. I would like to but am legally blind and can’t read (I’m an illiterate write.) I did not read it before my eyes went bad because I did not want it to influence my writing.

Leslie…

I am glad to hear my writing and that of other authors is in general agreement. I expected that it would because I have found that people are people and go through the same process… so any serious student of dying process should discover similar things. Dying is like life; i.e. everyone charts a unique course but the rules and stages are the same for all.

A couple of my favorite authors/speakers are Fred Allen Wolf & John Hagelin. They are both quantum physicists who have branched out into studying consciousness as well. Both were involved in the movie What The Bleep Do We Know… which I recommend highly by the way. Lots of quasi-scientific thinkers contend that the possibility of life transcending death is “unscientific.” Well, leading thinkers in the field of quantum physics do not think so. According to them the physical universe is an illusion… a manifestation lf “unified consciousness,” of which we are but a part.

When I first wrote Crossing The Creek I knew I was going out on a limb (spirituality wise) but can now relax knowing that quantum physics is on my side.

Hey, I'm glad this thread was re-threaded. Way back in the mid 80's I worked inpt hospice. Very eclectic group, SW was a Buddist monk. We all read alot of great stuff. My favorite was Ram Dass and his books. Basically he writes It is THEIR dance NOT yours and BE HERE NOW. I'm in the field. Pt is surrounded by all THEIR stuff. Cool. Lots of stuff in hospice is still great. Some not so great and some very weird. Right now the entire management staff in the office has no hospice experience so u have explain things REAL simple. sounds like this:

Manager: Why do you need that expensive medicine?

Little Old Hospice Nurse: Because kind one, my pt is sick and grimaces in pain.

Manager: All the time?

L.O.H.N.: Just when he breaths.

maybe i should buy them some books. whatdayathink?

Yes… buying them some books might help, although it may be too late.

When hospice was relatively new it attracted idealists… people who really believed in what they were doing. It was an experimental program really… quite innovative. It worked… but was only loosely regulated. Most of the people involved were passionate about their work… not passionate about getting rich.

As time went on more and more business types became involved… and they finally figured out how to take advantage of the hospice benefit… its capitation (reimbursement) system. Few hospice nurses understand the capitation system. Any time I have brought it up here no one even responds… but hospice administrators have learned how to milk it for all its worth.

The numbers do not lie. In 2000 the number of hospices exceeding the cap was 10… and they had to pay back 5.9 million dollars in revenue. In 2004 the number of hospices exceeding their cap was 138… and they had to pay back over 96 million dollars in revenue.

Now the government is trying to figure out how to stop the money leaks, but one of the problems they have is that it has been so loosely regulated that they do not have sufficient statistical data upon which to base proposed changes… they don’t know whether to modify the current system or ditch the whole thing and start over. But they do know something has to be done… it is just a question of what and when.

Administrators have also learned that to increase profits they must push the nurses harder. So slowly but surely caseloads have inched up… giving nurses less & less time to spend with patients & families. The emphasis has gradually shifted from personal care to symptom control… and that symptom control is becoming increasingly pharmaceutical in nature. Rather than helping a dying person resolve their life issues the trend is more towards drugging them into a “peaceful” state. That approach is quicker… more efficient.

Perhaps instead of “end of life care” we should be discussing the “end of hospice care.”

Buying some books for your manager might help… but I’m not so sure they would get it. Besides, hospice may already be on a slippery slope.

Any time I have said anything negative about the for-profit mentality that is coming to dominate hospice I receive a few lame excuses; e.g. “Oh gee… I know of a good for-profit hospice… they aren’t all bad.” That is sort of like defending the behavior of your drunken uncle. But what few hospice nurses seem to realize is that their drunken uncle is driving the car they are riding in.

NHPCO’s boards are dominated by large hospices and their focus is aimed at benefiting large hospices… and themselves of course. Information that is helpful to nurses and patients; e.g. recommendations for caseloads, is buried so deep that most hospice nurses don’t even know it exists.

Before constructive change can be made one must have the courage to face the facts… which ain’t always pretty. Hospice nurses are in a position to know whether or not good care is being provided by their agency. Some of the posts (here) by hospice nurses telling of what goes on in their agencies are simply appalling; e.g. high caseloads, visiting patients briefly once every two weeks, keeping non-terminal patients on the roles, etc. I am sometimes tempted to advise them to call their State health board or HCFRA or JCAHO and complain about their own agency… although that is a little like shooting the horse you are riding on. But only in the short run. In the long run, NOT reporting things is like shooting the horse you are riding on.

Most hospice nurses like the work they do, but if you don’t do something to protect hospice’s integrity the hospice you know & love may soon pass away. The Pollyanna approach does not seem to be working.

On second thought, yes… maybe you should buy your manager a couple of good books.

I've been in the field a while, now in the office. Looking forward to moving next year to a small county (1460 pop.) The clinic there when I visited, said they would like to try to start their own hospice- none in area. I know there must be tricks for small communities to help them have their own hospice. If any of you out there are from a small hospice that is medicare funded, please respond. They are currently trying to draw up a plan and I am trying to help them both because it's the right thing to do and from self interest in wanting to keep working...not rich..it's all good... love my work...:)

Hmmm, I don't know a thing about starting a hospice. I have worked for a number of them in large metro-mess areas. I don't know of any not for profits anymore. Yes, req-read (or is that Mr. Coot?) I too was there. Heady stuff. If our not for profit went over reimbursement, we politely called it pro bono. I still think of those fund raisers. All dressed up and lots to eat. (I'm now in pie rehab.) In this city, we had rival philanthropists with rival hospices. Don't u think it funny how Hospice Care means morphine and the quick bye-bye and Palliative Care means anything and everything that will be reimbursed. In the 1970's cancer was big, bad and often kept a secret from the pt! Culture is doing better with cancer but, boy, that door that says "Death and Dying" is still shut, sealed and locked. We are an interesting culture of peoples.

I've enjoyed everyones posts on this thread. I, too have been in hospice work a long time. Most of my work has been in non-profit. There is a new hospice opening up on every corner and it is becoming more and more difficult to practice in this cut throat environment. The whole medical arena has become a big monster. I'm pretty convinced that if the US could turn our medical system into somewhat of a socialized system, then the only people that would get into it are the ones who want to help people.

BeExcellent…

I looked at your profile & see we are peers… but I’ll take the “Coot” designation since it probably has more to do with temperament than age.

In terms of: Has Anyone Read This… I recommend the Rand study on the Hospice Benefit. I found it via NHPCO’s website… but I don’t see it there now. That doesn’t mean it isn’t there somewhere… legally blind guys don’t see lots of things. But if you can’t find it and want to read it send me an email and I will forward it to you (PDF file.) It’s a little dry as reading goes, but the stats are telling.

river1951

Moving from large metro to rural aye? It is a different world!

For one thing, what are the demographics? Some ethnic & religious groups are inclined to “take care of their own.”

Second… if your population is small your hospice population will be small and erratic… which means your income will be small and erratic. You will have to do more of everything yourself and rely as much as possible on volunteer help. Securing required team members (doctor & MSW) can be a really big problem. The bereavement person is much easier.

Another key is understanding the cap. I keep mentioning this and no one ever responds so I don’t know if it is well understood or not. Suffice to say, when I started running a rural hospice I sought advice from experienced hospice people and they gave me bad info. It took a couple of years to figure it out on my own… but here is a clue to what I am hinting at (if you understand this you will know what I mean.) DO pick up patients you know will probably die within a day or two. You will lose money on them but gain in the long run. The shortest time I ever had one patient was one hour… and he signed himself in.

The good thing about rural hospice is the down home, friendly attitude. People who live out in the boonies really appreciate someone coming out there and spending time with them. They also tend to be self reliant. If they weren’t, they wouldn’t be out there in the first place. Teaching is extremely important with them because you probably won’t have time to get there when death is imminent… especially when you will probably be the only nurse and may be on the opposite side of the county when that occurs.

You will get to sample some really good home cooking.

Get a pickup… you may be delivering some DME. Also, find a place to store donated commodes, wheelchairs, bedside tables, etc. so you don’t have to keep buying/renting them.

Once a JCHO agent asked me what we did with dirty sharps. I told her we dropped them in the cattle guards on our way back to the office.

Ha, ha, ha.