Diane E. Meier, MD

Meet Dr. Meier, a leader in the non-hospice palliative care movement. She is currently the director of the Center to Advance Palliative Care (CAPC).

” … The CAPC provides health care professionals with the tools, training and technical assistance necessary to start and sustain successful palliative care programs in hospitals and other health care settings. CAPC is a national organization dedicated to increasing the availability of quality palliative care services for people facing serious illness …”

Palliative Care and the Elderly

An article, “The TLC Model of Palliative Care in the Elderly: Preliminary Application in the Assisted Living Setting” in the Annals of Family Medicine, describes 5 barriers to palliative care with the elderly who live in assisted living facilities. We can definitely generalize this to most situations where the elderly would benefit from palliative care.

Basically, the 5 barriers to palliative care for them are:

• the perception that palliative care is only terminal care.
• palliative care is defined as mutually exclusive of cure directed treatment.
• the decision if palliative care should be the sole form of care is not ” … negotiated among patients, family members, and providers … “
• making treatment choices is given more importance than discussing the reality of life with a chronic debilitating illness
• palliative care is treated as an either/or decision instead of an integrated part of the treatment plan.

In a nutshell, palliative care is appropriate and possible regardless of which disease process a person has, what the prognosis is or what cure directed treatment choices a person makes. Palliative care should be interwoven concurrently with cure directed treatment. It can either be used with treatment intended to cure or as the sole form of treatment.

Palliative care (regardless of other treatment plans being used) optimizes quality of life and when your energies are not spent coping with pain, nausea, breathlessness, fatigue and the immobility (among other things) resulting from this, there is more energy to cope with the manifestations of the disease. When a person is comfortable, they eat more, sleep better, not as fatigued, not as depressed and at least have the possibility of enjoying their day.

Non profit? for profit?

There is a blogpost with some interesting points and comments that I’d like you to read, The Danger of For-Profit Hospices.

The title alone gave me chills, did it do it to you too? I guess in some people’s minds, only those working in non-profits have the hospice heart, or give the best service and of course that is not true. It totally depends on the company.

Who owns the company is a good question Read more

Got Hospice?

I wanted to revisit a study that came out 2 years ago (in case any of you missed it). I remember I had been looking for quite awhile for a study that would validate what we know in hospice–that if you come into hospice sooner, you have a good chance of living longer.

There was not one. The closest I came to was an article written by a doctor stating another doctor Read more

Breathing patterns

When someone is dying a natural death, there is a breathing pattern that usually happens. It goes something like this: a deep breath or 2, then holding it, followed by a shallow breath or 2, and so on. It is an uneven pattern of inhales and exhales. It can be scary if you don’t know it is coming.

Another thing that happens is as the person gets closer to death, the time between inhales widens. When breaths are towards

Read more

Tell a Story

When a person is dying, she is retreating from everything outside of her. She has little energy for anything outside of what is going on in her internal world.

She cannot respond the same to conversation. It takes much effort to answer questions. To engage someone in the normal back and forth conversational style can be overwhelming for her. Instead, tell a story. 

Tell her what you did today or whatever is on your mind. But don’t ask questions. What she has energy to tell, she will. Do not be concerned if she does not respond to you the way she used to or even with a hint of a smile. She cannot.

It is not about you. Just keep talking to her if you want to verbally connect. Otherwise, your presence is enough.