At 92, Pearl* is a prime example of how VNSNY’s cardiac hospice program gives patients a priceless quality of life, even in their final days. “She’s the kind of woman who’s made friends with the gardeners in Central Park,” says her hospice nurse, Katarina (Katie) De Hoog. “Her doormen have said that all they need to have a good day is for her to come down and talk to them.”
Katie especially loves Pearl’s sense of humor. “The other day she told me, ‘All of a sudden I got old. It was like I went from 25 to 90 overnight. I don’t know what happened!’”
Not every interaction is so lighthearted, of course. The upper Fifth Avenue resident recently had two valve replacement surgeries and lives contentedly at home, having learned to keep her congestive heart failure symptoms in check. Pearl tends to retain fluids, which causes shortness of breath. That raises her anxiety and can lead to other complications. “We monitor those symptoms closely to avoid hospital readmission,” says Katie. “The home health aides take her weight every morning and check for fluid retention and normal breathing.”
Should a problem arise, Pearl’s hospice team knows the protocol, which includes immediately increasing diuretics and other medications that help with symptoms of shortness of breath, ordering more oxygen, or calling Pearl’s cardiologist if needed. This protocol—closely monitoring the patient’s condition and responding proactively if symptoms appear—is at the heart of VNSNY’s cardiac hospice program, which is designed to improve quality of care while preventing unwanted trips to the hospital.
To help avoid hospital readmissions, cardiac hospice patients and their families are taught ways to manage symptoms at home, including the anxiety that comes with flare-ups. The program also encourages cardiac hospice patients to put in place advance directives, which helps give them and their families peace of mind. To help patients develop their own plan, VNSNY Hospice uses a team approach that includes spiritual counselors, social workers, nurses, and physicians.
Heart failure remains the number one hospital diagnosis for patients over 65 as well as the most common reason for readmission. However, it can be hard for heart failure patients—and health care professionals—to know when it’s time to transition to hospice care. Often, patients mistakenly think they are getting better after a hospital admission for acute symptoms. “It’s also difficult for health care providers,” says Frances “Fran” Dooley, a cardiac nurse practitioner and the coordinator of VNSNY’s cardiac hospice program. “There can be confusion about when it’s time to stop treatment and focus on quality of care and comfort measures.”
But when patients transition from aggressive medical treatment to hospice care at the appropriate time, there’s significant benefit: Studies show that when patients with chronic heart failure and certain pulmonary conditions receive hospice care, most actually do better in terms of quality of life and even live longer than patients who delay starting hospice! “The program has definitely improved quality of care for our cardiac patients,” says Fran.
* The patient’s name has been changed for privacy.