The 93-year-old woman lying in a bed at The Willows nursing home of Presbyterian SeniorCare had her head cocked to the side, eyes half open, as voices cooed at her, hands gently patted her own, lips brushed her forehead with a kiss.

Months, weeks or perhaps days from death while suffering from dementia, she may not have known her visitors. They were neither relatives nor employees of the 199-bed nursing home, where the staff is often pressed for time.

Nurse Julie Baumgardner and aide Deb Nosseck were instead part of a team from Family Hospice and Palliative Care that works full time at Presbyterian SeniorCare's campus in Oakmont. They and two colleagues supplement the regular long-term care staff by providing hands-on care for people approaching death. There's no shortage of such patients, though nursing homes hardly enjoy advertising that fact.

"In the old days, we weren't talking about death and dying," said Fatemeh Hashtroudi, executive director of Presbyterian SeniorCare, which operates more than 50 senior living properties.

Recognizing its patients and families needed better end-of-life care, the large organization formed a partnership six years ago with another regional nonprofit, Family Hospice. Their joint program, called Woodwell, set out to provide greater quality of life for people housed in institutions and diagnosed with terminal illness. It relies on extensive coordination between nursing home and hospice staff who work for different agencies, but overlap in helping patients.

The hospice participants receive extra care, paid for by Medicare, to tend to personal needs, to provide therapies such as massage, to offer spiritual help and sometimes simply to give the "tender loving care" so hard to find in large institutions. The emphasis is on comfort and pain reduction rather than hospital trips and medical procedures. The nursing home staff still provides basic care, such as bathing and feeding, but the extra hands assure they're monitored and assisted more frequently.

"Sometimes it's just sitting and letting them know they're not alone," Ms. Baumgardner said.

Long-term care operators have always contracted with hospice providers to make visits as needed for individual patients, but Woodwell represented a new dimension: The same hospice workers showed up every day to get to know nursing-home workers and patients; hospice possibilities were raised more quickly with patients' family members; every nursing home employee, even housekeeping and maintenance workers, received training on death-related issues; on-site memorial services were initiated within 24 hours after every patient's death; bereavement support was offered at Presbyterian SeniorCare for both workers and family members.

For all that, the American Hospital Association lauded Woodwell last month with one of three Circle of Life awards given nationally to efforts to improve end-of-life care.

Since the collaboration began six years ago, Presbyterian SeniorCare has expanded the program to its entire network of facilities providing nursing, assisted-living and independent care. At latest count, 885 of its residents have received Woodwell's late-life help.

Although most Americans die somewhere other than a nursing home, two-thirds of dementia patients do so, and they represent at least 90 percent of the Woodwell program participants. Of 165 Presbyterian SeniorCare nursing home patients who died in a recent year, 115 did so receiving the supplemental hospice care, far more than would be typical of other settings.

Ms. Hashtroudi said she knew the program was a success several years ago when a speech therapist and dietitian -- rather than a doctor or nurse -- were the ones to recognize and speak up about a particular patient's appropriateness for hospice care. It showed that the hospice-benefit philosophy had become part of the institution's culture, not just an administrative goal.

That's not to say every patient, or every guardian representing them, rushes for the hospice option.

"Sometimes it's a difficult decision for the family, and sometimes things happen quicker than we anticipate" with death, said Mary Snyder, Presbyterian SeniorCare director of social work. "When they first hear 'hospice,' there's a lot of fear from families."

Deb Skokut, the Family Hospice registered nurse based at Presbyterian SeniorCare, said relatives frequently question the hospice staff about how long the patients are expected to live, which can be difficult to assess. Some dementia patients end up lasting in hospice care far beyond six months, even though they must be diagnosed as likely to die within six months to be eligible for hospice benefits.

Spending the bulk of their time with dementia instead of cancer patients distinguishes the Woodwell program staff from their hospice counterparts elsewhere. It means the patients don't necessarily know they're receiving hospice care and may never have the kind of discussions about death and afterlife that other end-of-life patients work their way through.

"A lot of them do say, 'I want to go home,' " which is their way of referring to death, said Nancy Hitechew-Myers, a spiritual care counselor from Family Hospice.

Jacqueline Stack of Monroeville, whose 86-year-old mother died as a dementia patient in The Willows July 17, said she benefited from seven months of hospice care there after her doctor recommended it. Sometimes it meant just an extra person sitting with her, but Ms. Stack said that was a significant benefit.

"It helped to make her feel more comfortable and secure," she said. "Everybody always talks about how difficult it is for the caregiver of an Alzheimer's patient, but if you think about the patient, they have no idea who anybody is, of where they are, and they're constantly afraid. It's a great help to have hospice staff coming in holding her hand and talking to her."

While patients, relatives and Presbyterian SeniorCare all have reasons to support the program, Family Hospice President Rafael Sciullo said his organization benefits by the additional use and promotion of hospice care, which is still used by a minority of people before dying.

In the time since its Woodwell partnership began at Presbyterian SeniorCare's invitation, Family Hospice has set up similar collaborations with other long-term care nonprofit organizations including Baptist Homes of Western Pennsylvania, Asbury Heights and UPMC's senior living division. Those all now have regular staffing by teams from Family Hospice, which was never the case before.

"It makes a big difference when the administration [of a long-term care facility] is supportive of something like this," Mr. Sciullo said. "The national threshold is that about 10 percent of patients in any given facility at one time are candidates for hospice care, and many feel it's been under-utilized."

Right now, 17 of the nearly 150 patients of The Willows are receiving Family Hospice services. It's plenty to keep its team based there busy, though they can't meet every need.

"Can't you bring me a redhead?" 87-year-old Garnette Gobrish, perennially jovial in search of a certain style of male companion, asked Ms. Skokut as she checked the patient's blood pressure and heart rate Thursday. The hospice nurse couldn't meet the request, but she did leave Ms. Gobrish with an adjustment to her oxygen treatment and a smile on her face.

The article above was found on Google and was published originally on Pittsburgh Post-Gazette

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