By Jane Erikson, The Arizona Daily Star, Tucson
Jun. 4–Tucson Medical Center is preparing to open its new hospice for terminally ill patients, many of whom may live a bit longer just by being in hospice care.
Peppi’s House, on the northwest corner of the Tucson Medical Center campus at 2715 N. Wyatt Drive, is awaiting final inspections before opening to patients.
The $5 million facility, built entirely with donations, includes 16 private patient rooms that open onto secluded courtyards landscaped with flowering desert plants and fountains — a serene environment that might make anyone feel better.
But the benefit may be much greater, according to a new national study of about 4,500 patients who died of heart disease or cancer. The study revealed that those receiving hospice care before they died lived, on average, 29 days longer than those who were not in a hospice program.
The study, based on patient data from the Centers for Medicare and Medicaid Services, shakes a finger at the common misconception that people in hospice die sooner than those who continue with aggressive treatment for their illness.
“The reason we did this research is we’ve seen a lot of patients who come to us as train wrecks and they look like they’re going to die soon, then they get better for a while. I’ve been in this field for 31 years, and I’ve seen it a lot,” said Stephen Connor, a vice president of the National Hospice and Palliative Care Organization and lead author of the study.
“I don’t want to over-reach and say we’ve proven that all hospice patients live longer,” Connor said, “but what we can say clearly is that people in hospice don’t just give up on life and die sooner, as many people believe.”
The study — conducted by the hospice organization and Milliman Inc., a leading actuarial firm — does not show why people in hospice gained an extra month of life.
One possible explanation, Connor said, is that people in hospice avoid what he called “over-exposure to the health-care system.”
Terminally ill patients not in hospice are more likely to be hospitalized, which puts them at increased risk of infections from other patients, getting the wrong medication and receiving aggressive treatment when they are too ill to tolerate it, Connor said.
The 4,493 patients enrolled in the study included 540 who were dying of congestive heart failure. The rest had cancer of the breast, colon, lung, pancreas or prostate.
The greatest survival benefit was seen in heart-failure patients in hospice care, who survived an average of 81 days longer than their nonhospice counterparts.
Hospice Patients with colon, lung or pancreatic cancer lived up to 39 days longer, on average, than their counterparts who did not choose hospice care. The survival benefit for patients with breast or prostate cancer was not statistically significant. That’s probably because it is more difficult to alter the course of those cancers, Connor said.
Dr. Evan Kligman, medical director of Casa de la Luz Hospice in Tucson, called the study’s findings interesting “because we tend to think we are not going to make a major change in life expectancy.”
He agreed with the theory that hospice patients face fewer risks than terminally ill patients being treated in hospitals.
For example, Kligman said, hospice patients are given medications to control pain, help them breathe and otherwise keep them comfortable, but they generally receive less medication than hospitalized patients. That puts them at lower risk for medication errors, estimated by the national Institute of Medicine to total 400,000 in this country each year.
“It may also be that if someone is in a hospice setting where they are getting good pain control, and their other symptoms are being managed, maybe the will to live lasts a little bit longer,” Kligman said.
Mary Steele, a registered nurse and director of Tucson Medical Center’s hospice program, said she often sees patients improve for a while once they enter a hospice program.
“The nurse is helping them with their medications, the aides are helping them with bathing and hygiene, and I think the socialization with the staff all add to a patient’s quality of life,” Steele said. “I think that extends life.”
Often when patients choose hospice, “a lot of tension leaves when we stop poking them and just let them rest,” said Dr. Larry Lincoln, medical director of TMC’s hospice program. “The stress just melts away, and that has a physiological effect.”
Peppi’s House is designed to help terminally ill patients let go of their stress in a homelike setting. The beds are all topped with quilts, some of them hand-made. The landscaped courtyards are abloom with star jasmine and blue plumbago.
The “house” is named for Rose “Peppi” Grosse, a philanthropist who volunteered at TMC before developing cancer and enrolling in TMC’s hospice program. One of her final decisions was to donate $1 million for a new hospice building. She was 73 when she died on May 22, 2000.
About 25 percent of TMC hospice patients will be admitted to Peppi’s House; the rest will be cared for in their own homes.
“I love it. I absolutely love it,” Pam Varner, the youngest of Grosse’s three adult children, said of the hospice building that bears her mother’s name. Varner had a role in designing the building and insisted on the wide French doors that will allow patients’ beds to be rolled out into their courtyards.
“My Mom died at home, and the sliding glass doors to the outside were open all the time,” Varner said. “She really wanted that fresh air. I think people in that stage of their lives feel better when there’s fresh air.”
Hospice at a glance
–In 2005, there were more than 4,100 hospice programs nationwide, according to the National Hospice and Palliative Care Organization.
–The Arizona Department of Health Services licenses 10 hospice programs in Tucson.
–More than 75 percent of hospice patients receive care in their homes or residential care facilities. Nurses and other caregivers visit them as frequently as their conditions warrant, helping them remain comfortable in familiar surroundings in the company of family and friends.
–An inpatient hospice facility, like the soon-to-open Peppi’s House at Tucson Medical Center, is for patients who need closer monitoring to keep their pain and other symptoms under control. Inpatient hospice also admits patients whose caregivers need a break.
–People with terminal cancer account for 46 percent of hospice patients nationally, according to the hospice organization. Heart disease, dementia, debility and lung disease are the other most common illnesses of hospice patients.
–Approximately 1.2 million Americans received hospice care in 2005, the hospice organization reports.
“I don’t want to over-reach and say we’ve proven that all hospice patients live longer, but what we can say clearly is that people in hospice don’t just give up on life and die sooner.”
Stephen Connor
Vice president of the National Hospice and Palliative Care Organization
The first hospice program in the United States started in 1974 in New Haven, Conn., and just three years later, Tucson had one of the first three comprehensive hospice programs in the country, with both inpatient and at-home services. It was Hillhaven Hospice, which opened in 1977 at 5504 E. Pima St. The National Cancer Institute funded Hillhaven for four years. St. Mary’s Hospital took over Hillhaven in 1981.
–Contact reporter Jane Erikson at 573-4118 or at [email protected].
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