Going home to die

"When he started declining, he did it all at one time. The doctors said he was breaking from the inside," said 63-year-old Sadler, also a member of the San Mateo County Commission on Aging.

The age-old image of dying in a sterile hospital room is fading as people choose to spend their final moments at home with family caring for them assisted by in-home services. Hospitals and nonprofits are beginning to look beyond the scientific side of death to palliative care, a practice that combines spiritual, emotional and medical needs.

Palliative care focuses on relieving the suffering and improving the quality of life for people faced with chronic illnesses that can only be treated with pain management. Unlike hospice where people are dying from terminal diseases like cancer, palliative care patients are elderly and dying from natural causes.

"Why shouldn't it be a peaceful time of life when people get to reflect on their life," said Helen Wood, a geriatrics nurse in charge of palliative care at South San Francisco Kaiser Permanente Medical Center.

In a recent national study, 83 percent of adults said they'd prefer to die at home if faced with terminal death. While not a surprising response, there were not resources for actually accomplishing it until recently.

Too often, one family member is stuck doing everything for the dying loved one, but "everything also means asking for help," Wood said.

Palliative care seeks to do just that - provide one-stop shopping for dying health care needs. It offers people a person or a team to help guide them through the confusing health care system while they deal with their grief.

The practice has been around since 1986, but hospitals are just beginning to take it seriously, said Dr. Michelle Caughey, physician-in-chief at SSF Kaiser.

By 2020, the number of people in San Mateo County over the age of 60 will out number the amount of people under the age of 20. In 2030, they are expected to be largest age group in the county, representing 28.6 percent of the population.

One in five hospitals in the United States already has a palliative care program, one quarter of hospices provide palliative care services outside the Medicare hospice benefit and a growing number of nursing homes are establishing palliative care programs. The Kaiser palliative care program began in April and involves a specialized team consisting of Wood, two other nurses and a doctor.

When a patient is facing chronic illness that cannot be corrected, a doctor will usually call Wood to speak to the family. Wood's team will sit down with a family and ask a series of questions pertaining to the elderly person's end of life wishes.

It's an uncomfortable situation that invokes a range of emotions from anger to disbelief, but it almost always results in relief, Wood said.

The team will create a plan to get the ailing family member home, set them up with regular nurse visits and provide the family with grief and religious counselors.

In a six month period this year, the team dealt with 25 patients in cases that lasted between two days and five months. The majority of patients were "well over 70," Wood said.

The program is critical for families trying to navigate through the confusing health care system while dealing with the grief of losing a loved one.

Sadler could have benefited from a similar program. There were a number of resources provided by the VA hospital, but there was never a central coordinator, she said.

It took her three weeks to gather all the items she needed to care for her father, including a fully automatic hospital bed, several different walkers and medicine. She spent the next two years waking at 5 a.m. to bathe, change and feed him before a van picked up him up for adult day care.

Sadler took care of her father for two years until he died two weeks before his 88th birthday in March. Although Sadler wouldn't exchange her time with her father for anything, she said she'd never take on that role again without additional help.

"There are a lot of resources out there, but without an advocate he or she doesn't get what they need," said Sadler.

Dana Yates can be reached by e-mail: dana@smdailyjournal.com or by phone: (650) 344-5200 ext. 106. What do you think of this story? Send a letter to the editor: letters@smdailyjournal.comBox:

For more information about palliative care visit the National Hospice and Palliative Care Organization at www.nhpco.org