Caring for people is passion of new hospice executive
Sangre de Cristo Hospice is a homecoming for Carmen Ermel.
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Carmen Ermel
Posted: Sunday, September 19, 2010 12:00 am
Caring for people is passion of new hospice executive By LORETTA SWORD | lorettas@chieftain.com The Pueblo Chieftain | 0 comments
Carmen Ermel has spent most of her professional life helping older people live independently and adapt to some of the losses that aging guarantees.
Her newest job involves helping people die — with dignity, and without some of the burdens that dying so often brings along on its unpredictable journey.
Ermel took over July 26 as chief executive officer of Sangre de Cristo Hospice. It was a homecoming in several ways.
The 58-year-old grew up in Beulah and graduated from South High School. She started college at the University of Northern Colorado in Greeley, then transferred to the University of California at San Bernadino, graduating with degrees in business administration and social science.
She eventually returned to Pueblo as a community relations representative for a local nursing home.
That was 20 years ago, when the concept of hospice care was just beginning to take hold nationwide. Pueblo was ahead of the national curve with Sangre de Cristo Hospice, founded primarily by longtime CEO Joni Fair, who retired in January.
Ermel said she had contact with hospice volunteers at the nursing home, and decided to get some training from Fair so she would understand how the two organizations could better serve Pueblo’s most vulnerable citizens.
“That was my introduction to hospice, and I’ve been connected to hospice services throughout my career since then,” she said. That connection continued in her next job as director of the Area Agency on Aging for Custer, Chaffee, Fremont and Lake counties.
Ermel’s most recent position was as senior vice president of operations for Spectrum Retirement Communities, an organization with 1,000 employees that operates retirement and assisted-living communities and Alzheimer’s care facilities in seven states.
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“I coordinated with hospices in each market, so when our seniors needed services they could stay in the assisted-living community rather than having to move to a skilled nursing facility,” Ermel said.
She had always planned to return to Southern Colorado, she said, and she heard about the opening at the Pueblo hospice right about the time she had begun pushing herself to finally make the move.
“It was always my goal to get back down here permanently. I also had reached a point where I wanted to be involved in ‘total service’ for seniors — something that didn’t involve real estate,” she said.
Ermel counts among her goals continued outreach in all of the communities the organization serves to provide education about hospice services and recruit more volunteers.
Finding new funding streams also will be imperative, with Medicare reimbursement for hospice care due to take major cuts over the next decade.
Taking the reins of an organization that has flourished for nearly 30 years under the leadership of its passionate founder is both an honor and a welcome challenge, Ermel said.
Fair plans to remain connected to hospice as a volunteer, and Ermel said she’s been generous with her knowledge and experience.
“She’s very graciously opened her mind and her heart to help,” she said.
“I’m very excited to really get started applying my experience, my skills in collaborative efforts, and my energy to this job. Failure is not an option. This is such an important and humbling service that we provide.
”It’s a position I don’t think anyone should pursue as a paycheck. It’s truly a calling and a mission, and it’s a humbling honor to be selected.”
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Posted in Local on Sunday, September 19, 2010 12:00 am. | Tags: Hospice, Health, Assisted Living, Nursing Home, Medicine
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The Overlake Hospital Foundation has received a $150,000 grant from the Regence Foundation to implement a hospital-based palliative care program at Overlake Hospital Medical Center. Palliative care is a medical specialty geared toward helping seriously ill patients find relief from the symptoms of their disease.
The Regence grant will help Overlake implement its palliative care program, planned with the help of foundation-provided training from the Palliative Care Leadership Center (PCLC) and a financial grant in 2010. PCLC is a national training and mentoring initiative to help hospitals start and expand high-quality palliative care programs.
“The Regence Foundation’s grant enables us to implement a Palliative Care Consult Service for patients and their families coping with advanced illness and in need of symptom management,” said Cathy Whitaker, vice president of patient care services at Overlake.
She estimated about 200 patients a year would benefit from the service, delivered by physicians, nurses and support staff including social workers, chaplains, pharmacists, care management and physical therapy.
by Bruce Campbell, MD
For everything, there is a season…
- Ecclesiastes“Are you giving up on me?” My patient looks at me severely. “There must be other treatment options! Aren’t there some experimental drugs out there? I have beaten this cancer twice before. Are you saying that I can’t beat it again?”
No one can ever know with absolute certainty whether my patient’s newly recurrent cancer might miraculously disappear with one more treatment. His recurrence, however, has developed very quickly and is growing very rapidly. New cancer nodules are developing weekly. I have never seen a patient with a cancer this aggressive have a meaningful, sustained response to further treatment. The research literature confirms my impression.
It is always difficult to know what to recommend. Although “no further treatment” is always an alternative, I routinely run through all of the options, reviewing whatever is available, and hoping that we land on the combination that offers that improbable, one-in-a-thousand cure. However unlikely, we sometimes set up appointments and hope for the best.
Today, though, my sense is that it is time to focus on new goals.
The decision not to pursue more studies and more treatment can be very, very difficult. Surgeon and journalist Atul Gawande in an essay in The New Yorker entitled “Letting Go,” writes about how difficult it can be for physicians and patients to halt cancer treatment as the end of life draws near. The dilemma, he concludes, “arises from a still unresolved argument about what the function of medicine really is — what, in other words, we should and should not be paying for doctors to do.” In Gawande’s view, the profession should equip and supply doctors and nurses “who are willing to have the hard discussions and say what they have seen …”
In most circumstances, this moment might be the first occasion that the patient hears a physician say clearly, “I do not think we should continue with the cancer treatment. It is time to stop focusing just on the cancer and spend more of our effort focusing on the rest of you.”
Those are very difficult words to say. On the other hand, I cannot begin to imagine what it must be like to hear your physician utter them.
At some point, the topic of stopping cancer treatment must be approached clearly and compassionately. An essay by Albert Lim, MD, sent to me by a patient, reminds us that physicians often avoid these difficult discussions. We push on with futile treatments and expensive tests because “it is difficult to say ‘no’ in today’s world.” Coupled with our own doubts, the patient and family sometimes want us “to do something, anything, everything.” There are situations where we need to learn to think through the choices and then choose to do nothing.
A recently published article might help me navigate these difficult discussions in the future. Dr. Jennifer Temel and other cancer physicians at Massachusetts General Hospital followed two groups of patients who were suffering from advanced, uniformly fatal lung cancer. One group received “standard” cancer care with chemotherapy and aggressive treatment. The other group was offered the “standard” care but also met very early on with the Palliative Care team. Overall, the Palliative Care group went on to have less intense treatment, less futile cancer treatment near the end of life, an overall better quality of life, and significantly less depression. They were more likely to have talked with their relatives about their end-of-life wishes.
Surprisingly, the Palliative Care group, despite receiving less intense cancer treatment, also lived a bit longer! For this group of incurable cancer patients, less aggressive care actually resulted in longer and higher quality survival.
As the conversation wraps up, my patient reviews all of his options. His previous therapy was difficult and he is not interested in spending any more time at the hospital than absolutely necessary. He and his family go back and forth. Finally, they all decide against any further cancer treatment. They will continue the conversation at home.
I am relieved. He has made what I consider to be a good choice and appears to be at peace with the decision. The most difficult decision he and his family have ever had to make had, in the end, been simple. The time had arrived.
Bruce Campbell is an otolaryngologist who blogs at Reflections in a Head Mirror.
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Palliative care prolongs life, reduces suffering
There are no secret passwords in medicine, no mysterious handshakes or signals to use when seeking the best care for a serious illness.
But experts say two words come close: palliative care.
Many people have never heard of palliative care, a comprehensive service that aims to relieve suffering in people with serious illnesses, such as cancer, lung disease or kidney failure.
Some patients — and even many doctors — confuse palliative medicine with hospice, a form of palliative care for people in the last six months of life. Other patients mistakenly worry that doctors won’t work as hard to cure them if they ask for palliative care, says Gail Cooney, former president of the American Academy of Hospice and Palliative Medicine.
Those notions could change in light of recent research.
A study of 151 patients published last summer in The New England Journal of Medicine showed that getting early palliative care — in addition to regular medical treatment — helpedpeople with lung cancer live three months longer, compared with those given standard care.
In comparison, chemo can give newly diagnosed lung cancer patients an extra two to three months of life, says study co-author Thomas Lynch, director of the Yale Cancer Center.
“If this was a drug, this would be on the front page of every paper in the country, talking about ‘New advance in lung cancer,’ ” Lynch says.
But palliative care patients didn’t just live longer. They also lived better, with less depression and a higher quality of life, he says.
Tailored to the patient
It’s never too early to ask about the service, doctors say.
People can begin palliative care as soon as they’re diagnosed with a serious illness, even if they still hope to be cured, says Thomas Smith, medical director of palliative care at Virginia Commonwealth University’s Massey Cancer Center in Richmond.
Teams that provide palliative care focus on talking to patients, trying to understand people’s values and tailor care to the patients’ goals, Cooney says.
These teams — which often include psychologists, social workers, pharmacists, nutritionists and chaplains — also coordinate treatment, which can be especially important if people are being seen at more than one center, says Ira Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.
The teams also support caregivers, who have a critical role in patients’ health.
‘People need to ask for it’
Because of her work, Cooney knew to ask for palliative care when she was diagnosed with advanced ovarian cancer nearly three years ago.
“I wanted it all,” says Cooney, 58, who’s also the assistant medical director of Hospice of Palm Beach County in Florida. “I received very aggressive chemo. But I used a program of palliative care to control my symptoms and allow me to tolerate the chemo.”
In addition to undergoing surgery and chemo at a hospital, Cooney sought palliative care through an outpatient center, the Sari Asher Center for Integrative Cancer Care in Palm Beach.
Though about 80% of large hospitals offer some kind of palliative care, there are fewer ways for patients to get support outside the hospital, where cancer patients today receive much of their care, Cooney says.
She used both acupuncture and conventional drugs to avoid nausea and felt well enough to indulge in milkshakes to keep up her strength and weight.
Palliative care helped with many aspects of cancer therapy, which put her in remission for two years, Cooney says.
She joined an ovarian cancer support group, received one-on-one counseling with an oncology social worker and met with a nurse educator to better understand the many drugs she was taking.
After her cancer began growing again last fall, Cooney resumed intravenous chemo and hopes for a good response.
Cooney says she wishes that more patients and their caregivers knew to ask for palliative care. “People think, ‘My doctor will ask if I need it,’ ” Cooney says. “But people need to ask for it. It can be tough to challenge a doctor. But if people begin asking and advocate for themselves, generally doctors will say OK.”
Saving money
Palliative care also could help cut spiraling medical costs, Smith says. Studies show it can save hundreds of dollars a day, keeping patients out of the hospital or expensive intensive-care units.
Kaiser Permanante, an integrated system in which the same company operates hospitals and insurance plans, found that people cared for by a palliative team live just as long as or longer than others and had fewer symptoms.
Their caregivers also experience a lighter burden because the programs address their needs as well, Smith says.
“No death panels here — exactly the opposite,” he says.
In spite of these benefits, palliative programs struggle to reach everyone who might need them, Smith says. That’s because few health systems are as coordinated as Kaiser, he says.
The bottom line
In most cases, the cost savings from palliative care are spread throughout the system — saving money for Medicare, for example — instead of returning money to individual hospitals or programs, Smith says. So in the short term, individual hospitals may lose money, even if the country overall saves money.
“It would be terrific to have more family support, more chaplain support,” he says. “Most programs don’t have any way to pay for that.”
The Massey Cancer Center pays for a psychologist partly by reducing physician salaries, Smith says. His team also does fundraising to pay for a chaplain, who he says “is critical to help people come to terms with their illness and often the end of life.”
Without enough resources for everyone, palliative care programs often give first priority to people with advanced or fast-moving cancers, such as pancreatic tumors, Byock says.
“Even the most robust palliative care programs have limited resources,” he says. “If someone has a serious diagnosis and they have only the ‘ordinary’ level of stress, we’d likely not see them.”
But patients shouldn’t give up.
“It really does take one-on-one advocacy,” Byock says. “You have to be savvy enough to ask for it. Just say, ‘We want the best care for our loved one.’ “
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When this student was asked why he wanted to take the hospice volunteer training, the reply was
I want to help others that are facing the end of life, or a loved ones life, find the peace and comfort that a hospice team helped me find.
It is wonderful to have a program that can be utilized for hospice volunteer training and now, after a couple of years, I continue to be in awe of the wonderful people who participate in the training. It is obvious with every answer that we are surrounded by people who want to be of service.
CM said, “The video on caregiving was the most valuable to me. It provided much insite into the lives of actual caregivers and their needs.”
Whether it’s a personal goal or a professional one, each potential volunteer presents awesome reasons for volunteering and great feedback for the most important aspects of the course.
As we begin our goodbyes to winter, there are still a few cool evenings to log in and begin training so you can find your reason for volunteering. Somebody is waiting just for you.
http://volunteertrainingonline.com/courses
Get Involved16 Feb 2011 11:11 amJoin Us in Delivering Random Acts of Kindness to Seniors #RAKsr
UPDATE: 2/11: Join us for our second annual celebration of Random Acts of Kindness Week. To commemorate the week’s festivities, we’re relaunched our #RAKsr initiative. See below for more details!
February 14-20 is Random Acts of Kindness Week — a reminder for each of us to do something nice, and unexpected, for someone else.
What random kindness can you bestow on a senior?
Whether it’s helping with manual labor around the house – spending an afternoon just chatting and catching up — cooking dinner together — or going to the movies, we want to hear about it.
SeniorsforLiving.com is on the hunt: Who will join us in delivering random acts of kindness to seniors next week? Here are just a few thoughtful ideas to help you get started.
We’re encouraging as many people as possible to participate. But, performing an act of kindness is just one step. Here are some other ways you can get involved:
- Leave us a blog comment sharing your experience.
- Are you a blogger? If so, write about about Random Act of Kindness Week, and encourage your readers to do something nice for a senior.
- Tell your Facebook friends about this project and ask them to get involved
- Share random acts on Twitter using the hashtag #RAKsr
- Post video to YouTube or photos on Flickr using the #RAKsr tag
We’ll post some of the best stories throughout the week on our Facebook page. Make sure you’re a fan so you can keep track of all the kindness.
An added bonus: SeniorsforLiving.com Facebook fans who participate in this project will be entered into a drawing for a $50 Amazon gift certificate.
To be entered into the drawing, fans simply need to email their stories to connect@seniorsforliving.com before February 20 at 10 a.m. EST. We’ll announce the winner on Tuesday 2/22/11.
Let’s see how much out-of-the-blue kindness we can deliver in one week.
The comments are yours: How will you show kindness to that special senior in your life?
*2/22/10: WINNER UPDATE: Congratulations and thank you to Mike Gamble of Aging Parents and Eldercare who is the winner of our random #RAKsr drawing for a $50 Amazon gift certificate. And a big thank-you to all of you who shared news of #RAKsr, performed amazingly generous acts of kindness, and — in short — spread love and expanded the everyday boundaries of the heart. We were touched numerous times a day all last week by your fabulously unselfish acts, thoughts, and sentiments. Let’s keep the KINDNESS going….
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11 Responses
- Kaye Swain Says:
after publication. }–> February 10th, 2010 at 11:23 amThat’s so sweet – and perfect timing with Valentine’s Day. I’ll definitely help spread the word
- Carin Arrigo-Zimmer Says:
after publication. }–> February 10th, 2010 at 1:18 pmThis is wonderful! So happy to find you guys! Definitely a fan of helping seniors… =)
- Kathy Cox Says:
after publication. }–> February 10th, 2010 at 7:41 pmThis is what the world needs more of! Kindness needs to be shared with everyone–what a difference a smile makes.
- Make a Difference in a Senior’s Life! Says:
after publication. }–> February 12th, 2010 at 5:57 pm[...] about Random Acts of Kindness Week. They’re heading up an outstanding movement to generate random acts of kindness for seniors. How beautiful is that?!?! Read their suggestions and jump in with both feet and a full [...]
- Happy Valentine’s Day to the Sandwich Generation | SandwichINK.com Says:
after publication. }–> February 14th, 2010 at 11:14 am[...] Kindness Week. Seniors for Living has made it even more specific, using it to remind us to put into practice Random Acts of Kindness for one or more of the Senior Citizens in our lives. For those of us in [...]
- Kaye Swain Says:
after publication. }–> February 14th, 2010 at 5:03 pmHey hey hey – Happy Valentine’s Day!
Have a wonderful week!
- Kaye Swain Says:
after publication. }–> February 15th, 2010 at 12:01 pmAaaaahh – sorry for the mega oops – and Happy Random ACTS of Kindness Week.
- Carissa Says:
after publication. }–> February 15th, 2010 at 1:16 pmI have a neighbor couple who are seniors and we’d love to surprise them with something unexpectedly random this week.. I’ll let you know what we come up with!
- Dale Carter Says:
after publication. }–> February 18th, 2010 at 12:36 pmYesterday I was in the grocery store, waiting in produce behind an elderly woman who was picking out yams. I got my plastic bag and just waited patiently behind her. When she finished, she turned and apologized for taking so long, and I said “no problem at all”. Then, she kind of mumbled to herself, “where do I get a bag?” I just reached out my open bag and said, “take this”. The look in her eyes was priceless; such a small gesture but it meant so much to her. I won’t forget that sweet lady anytime soon!
- Kaye Swain Says:
after publication. }–> February 19th, 2010 at 11:00 amAwesome, Dale! Great example!
- Kaye Swain Says:
after publication. }–> February 23rd, 2010 at 12:42 amMega Congrats Mike!!!
Leave a Comment
I have a passion and extreme support of hospice care. My career goal is to work for Hospice, as I currently hold my BSW and I am pursuing my masters. I feel Hospice is a very positive thing and that the community should be educated on it and the amazing things Hospice offers.
A.E.
I love getting the submission on the final essays of the training site for hospice volunteers.
Every time I read the essays by “students” of the course, my goals are clearer and my passion for hospice is strengthened by every entry.
Become a hospice volunteer. Ask your local hospice if they use the hospice volunteer training online program. If not, you can begin the training at http://volunteertrainingonline.com/courses
Allow me to brag a little bit. I work for an amazing hospice agency. We provide top notch care in a very diverse and populated county. I’m extremely fond of all my co-workers (no, really! I mean it!) and we really work together as a team to provide our patients with the highest quality of care. Part of that is due to excellent leadership and two of Hospice of the Valley’s leaders were recently nationally recognized.
Sally Adelus, President and CEO of Hospice of the Valley in Santa Clara County, was named to the Board of Director’s of the National Hospice and Palliative Care Organization in January. Adelus will represent the West Geographic Area which includes Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, Oregon, Utah, Washington, and Wyoming and will serve a three-year term: January 2011-December 2013.
“Sally’s previous experience on NHPCO’s Governance Committee and her leadership as Past Chair of the California Hospice Foundation and the California Hospice and Palliative Care Association will serve her well,” said J. Donald Schumacher, PsyD, President and CEO of the National Hospice and Palliative Care Organization. “Sally has a solid foundation and keen insight into the trends and changing dynamics facing our industry.”
“I am truly honored to serve on the NHPCO Board of Directors and represent our geographic area membership,” said Sally Adelus, President and Chief Executive Officer of Hospice of the Valley, San Jose CA. “I look forward to representing the voting members and bringing my expertise to the Board in support NHPCO’s altruistic mission. Ultimately, it’s all about patients and families and the preservation of quality palliative and hospice care,” affirmed Adelus.
Dr. Neal Slatkin, Chief Medical Officer at Hospice of the Valley in Santa Clara County, was recognized by Castle Connelly as one of America’s Top Doctors in Cancer, in recognition of his work in the diagnosis and treatment of cancers in adults and children. For four consecutive years: 2007, 2008, 2009 and now 2010, Dr. Slatkin has been named Top Cancer Doctor for his work in cancer; additionally, he was named Top Doctor in Pain Medicine in 2007 and in 2010.
“I’m pleased to be recognized by my peers as one of America’s Top Doctors in Cancer and Pain Medicine,” said Neal Slatkin, MD, DABPM, Chief Medical Officer of Hospice of the Valley. “I’m equally honored to be among the nation’s most outstanding physicians for the diagnosis and treatment of cancer in adults and children.”
Okay, so I might be a little biased but you have to admit: Congratulations are in order!
Using Words That Heal
The document he held in his hand read like a lawyer had charged him for more than time and effort. It was the beginning of healing and such benefits would be priceless. Ethical wishes made their way into the legal swamp of bequeathing and here-to-fore’s. His worldly possessions, though few, were distributed according to his wishes. With caution and inner searching, words of “why” certain choices and decisions were made were clarified. A man’s last will and testament also became his ethical will by injecting small doses of his reasons for certain decisions. He was healed of an infection that had rendered him angry prior to releasing his frustration in a document that would be witnessed and acknowledged after his death.
Ethical wills take many forms yet can be the conduit to resolution and completion in our lives and the lives of our patients.
Patients and families come to hospice when the end is usually much nearer than the six month allotment of supposed time and therefore ethical wills are rarely addressed.
Nurses are in critical mode, hurriedly addressing pain and symptoms in an effort to begin working to alleviate emotional pain. Social workers are ecstatic to have actual counseling time but are most likely struggling to make the initial visit or complete the loose ends of other advanced directives and wishes not yet addressed.
The chaplain and volunteers are often requested to not visit until the need is anything but writing an ethical will. The spiritual pain is often lost in silence and never gains ground in being expressed to family and friends.
What is an ethical will? Of biblical origin, the ethical will was once an assignment of blessings and statements from the elder fathers to their sons. Today we see these wills in a disguise of journaling and personal notes.
There is no appropriate or designated format for this type of will. The contents are magical in their powers to heal and the magic is not formed in following specific criteria for form. There can always be healing – even when experiencing the end of life.
A piece of paper, a notebook, or a beautiful handmade leather journal may all serve the same purpose. The words are written to explain the reason for choices made, the expectations of life and family, ideas, forgiveness, explanations.
No formal will and testament gives an ear to the discomforts of the soul, except the ethical will. As an agency or an individual, you can begin the healing of your patients by encouraging the documentation of those thoughts and feelings that have surfaced with the intrusion of death.
The ethical will may take the form of a terminally ill mother writing her blessings and wishes in a journal to leave for her daughter, a young man who wants his siblings to understand his heart and the reasons for actions he has taken as the obstacle of death stands fast in his way, or the couple who have no one but each other that leaves their legacy of love in writing for someone to acknowledge or witness.
It has been said that all any of us really need are witnesses. We need a witness that our life holds great meaning and purpose; a witness that we have loved and are loved; a witness to our life. As members of the hospice community or any health care programs it is an honor to be the witness that our patients need in this new realm of spiritual discovery.
If it is a hospice patient or ourselves contemplating the presentation of an ethical will, some tried and true tips will help move the words from heart to hand to paper with the impact and magic that the compilation evokes.
- Just start writing.
I often suggest that in writing our life stories it is best to just designate a few minutes daily to writing anything. Let the words flow and then bring them together like a soup. All the ingredients are gathered and the final product is savored given that the brew has time to cook. Unlike the life story journals, the final product should be a stepping-stone to resolution of an incomplete section of our journey. The finality is certain but the journey is not. Make the steps toward completion of information an adventure in discovering the deepest thoughts that have anchored our intentions and actions.
- Find stillness.
Absolute quiet and serenity will help thoughts bubble up and dissipate. The remaining pieces are slow to rise but will as we practice stillness. Those remnants of thought that do not disappear are the ones to address and to nurture. These are the engines that have given us motivation and fear, desire and dread, dreams and complacency. When we discover or our patients discover these remnants, the dissection of their meaning bring serenity and power.
- Be grateful, find moments of happiness, question why and then document the discovery and understanding. These are emotions developed into words that will be read by future generations or possibly by only one person. The moment we arrive at our reasons for being, we become our own witness.
- The ethical will is the ultimate instrument for eternal wellness. As the master of the tool we hold the ability to assist others on their journey. It is a marvel that words hold such keys to power and that a moment of guiding others to learn to use this tool helps our own healing powers develop. Of all the medicines, words from the soul may be the most potent.
Robin Watts is a hospice care consultant with Regency Hospice located in the serene mountain vistas of Northeast Georgia.and founder of the Hospice Volunteer Training Online program.
rmw44. (Dec 31, 2007). The Power of Ethical Wills. Retrieved Monday, Feb 14, 2011, from http://allnurses.com/showthread.php?t=270820
