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Cover Story April 12th, 2007

  Untitled Document


by lyle e davis and evelyn madison

Kerry Allen was 36 years old. He was terminally ill with what started out as testicular cancer, later spreading throughout his body. He was married, with three kids. He knew he was dying and had prepared both himself and his family for this end of life experience.

One of the greatest fears many of us have is dying alone in a sterile, impersonal surrounding. We don't want to be hooked up to tubes, and cut off from our family, friends, loved ones, and things that are familiar. We also fear dying in pain. We would prefer, if possible, to spend our final phase of life at home pain-free and alert as possible surrounded by the people and things we love.

An end-of-life care option that provides dying patients and their loved ones with comfort, compassion, and dignity does exist. It's called hospice care.

We are fortunate in that we have a number of hospice organizations that serve North San Diego County. Kerry Allen, whom we have just described, was a patient of our good friends at The Elizabeth Hospice. According to the National Hospice & Palliative Care Organization (NHPCO), in 2005, 2.4 million people who died in this country were in hospice care. This is an increase of 150,000 from 2004.

You will note we refer to Kerry Allen in the past tense. One day after we finished our interview with him back in November of 2000 for a cover story dealing with hospice, his wife called to tell us he had passed that morning.

What moved us so strongly was that Kerry had awakened, knew this was his last day of life, got out of bed, said goodbye to his wife and kids, went back to bed, and died. Peacefully.

Evelyn and I, who had interviewed him, could not imagine a greater gift than to be able to say goodbye to our loved ones before we left this life. It is a moment in time that shall remain with both of us forever.

Several days later an elderly tennis player approached me and told me The Elizabeth Hospice was $1000 richer because of the story we had done about Kerry. He had passed the story around his bridge club . . . they in turn passed the hat . . . and $1000 was donated to The Elizabeth Hospice.

Kerry and his family would have been pleased to learn that. As were we.

There are many patients receiving hospice care . . . and several hospitce organizations serving them. We propose to look at them . . . get to know them . . get to know the hospice organizations . . . and, hopefully, let you begin to know much more about hospice.

Hospice organizations all believe the final stages of life need not be painful, depressing, or frightening. Instead, the last days, weeks, and months of a person’s life can be a celebration of that life and a loving time shared with family and close friends. In the following stories . . .you will see how a variety of patients have adapted their lives to hospice. You will meet Bill Ryherd of Oceanside, Daphne Dunn of Vista, Vailia Dennis of Rancho Bernardo and Marjorie Castle, also from North County. Each of these folks are receiving hospice care. You’ll hear directly from them what is happening and what they have, and are, experiencing. You will also learn about a totally unique service, The Children's Program at San Diego Hospice & Palliative Care. Yes, sadly, children develop terminal illnesses too . . . and there is a hospice program for them.

There’s much to learn. Let’s get started:

Bill Ryherd is a piece of work. You talk to him on the phone and sense the excitement in his voice. This doesn’t sound like a sick guy . . . this sounds like a guy that is full of life and anxious to get on with it.

What’s more, Bill has lived more in his life than most of us would in two or three lifetimes. Born in Lubbock, Texas 87 years ago, he was an Army Air Corps bomber pilot in World War II, was shot down over France, he and his crew safely parachuted down to safety. He was attempting to work his way back to Allied lines when he and 168 other pilots were betrayed by a member, or members, of the French Underground and captured by the Nazis. He was held briefly at Stalag Luft III, the infamous home of “The Great Escape,” later, he would be assigned to Buchenwald . . . the dreaded concentration camp. He and his fellow pilots were scheduled to be executed . . . but were liberated.

After the war he became an engineer, enjoyed a 63 year, two month and 20 day marriage to his beloved Maxine, before she passed in January of 2006. Maxine had also received hospice care from The Elizabeth Hospice.

“Maxine developed breast cancer in 1986,” says Bill. “She had one year of chemo, a shot every week for 52 weeks. She improved so much she left hospice and we went on a holiday. In September, 2005, the cancer had returned. Hospice cared for Maxine to the very end,” he went on. At about the same time Bill was diagnosed and put on hospice care.

Bill has a large black and white photograph of Maxine on his bedroom dresser, looking right at him. “She’s talking to me every day,” he says. “I say or do something out of line and she kicks sand at me. Every day.”

Bill entered hospice while Maxine was still being cared for by hospice. He has a pulmonary condition that requires constant adminstration of oxygen. Technically, he’s ambulatory and can still get in his car and drive somewhere . . .but he’s always got to have his bottle of oxygen. He’s been a hospice patient with The Elizabeth Hospice for a year and a half. Asked his impressions of The Elizabeth Hospice . . . “I’m in love with them,” he says gleefully. “No one like them.”

Bill Ryherd
Bill Ryherd

This is a common feeling from hospice patients. Hospice programs tend to attract both staff and volunteers who genuinely love and care for their fellow man. They get great joy out of helping those in pain, those in need. And it shows.

Bill is a patient of The Elizabeth Hospice, probably the best known hospice organization in North San Diego County. Since The Elizabeth Hospice opened its doors in 1978, services have been provided to more than 70,000 patients and their families at the most critical time in their lives.

Another hospice organization making the most of each moment in the lives of seriously ill residents in North County is San Diego Hospice & Palliative Care. San Diego Hospice & Palliative Care is the County's original non-profit hospice program, since 1977. San Diego Hospice & Palliative Care improves the lives of those adults and children throughout the entire county, including the North County, affected by serious illness. Medicare, Medi-Cal, HMOs, and most insurance plans include a benefit that covers the cost of standard hospice care. Community members faced with life-threatening illness have improved access to affordable hospice and palliative care programs and, in most cases, can choose their hospice provider.

For Rancho Bernardo resident, Vailia Dennis, San Diego Hospice & Palliative Care was her choice to provide the care she needed.

At 86, Vailia is a single mother and retired sales representative, living on a modest budget. When her doctor informed her that she had a life-threatening illness, Vailia wanted to make sure that she was going to receive care to help manage her symptoms. She chose San Diego Hospice & Palliative Care to deliver that specialized care, while remaining in the comfort of her own home.

"I think people don't realize all the services that are provided by San Diego Hospice & Palliative Care," said Vailia. "I receive home visits by the hospice team members, necessary medical equipment related to my illness, and medications." Vailia adds, "People don't realize that hospice is quality care that is affordable."

Care is also provided in the organization's Inpatient Care Center, the only specially licensed hospice-hospital in the area, as well as the San Diego
Hospice Care Centers located within GlenBrook Skilled Nursing Center in Carlsbad. "Hospice helps to bring peace of mind to me and my family. I know I'm receiving the best care possible. I visit with my family and friends, I spend time reading, and most importantly, I'm enjoying each day to the fullest."

Vailia Dennis (with her dog, Nicky) values her independence
and appreciates the care she receives by San Diego Hospice in her home.

In addition to adult patient care services, the organization offers the only nationally recognized hospice program for children and infants in the area. The organization's goal is to enhance the quality of life for patients and their loved ones, while supporting their cherished traditions and beliefs.

The Children's Program consists of three components: care for the seriously ill child or infant; emotional support and counseling for children of a seriously ill loved one; and the innovative Perinatal Hospice Program for adults whose unborn child is diagnosed with a life-limiting illness.

"The SDHPC Children's Program cares for seriously ill children and their families as a whole through compassion, empathy and medical, psychosocial, and spiritual support," said Michele Goldbach, Children's Program Manager at San Diego Hospice & Palliative Care. Through education and support from a hospice team that is specially trained in the care of children and infants, parents and family members are given the tools and support to confidently care for their seriously ill child at home. They also gain some sense of control over the situation, and their lives, finding courage and hope within the context of the child's care.

San Diego Hospice Program for Children

Daphne Dunn is a lovely, refined lady of 87 (“I’ll be 88 in October,” she reminds us). She speaks four languages, English, French, Italian and German. (And, she points out, “I’m studying Spanish). She and her daughter, Mary, live in a home with a beautifully landscaped yard/garden, complete with pool and boat . . . and lots of palm trees.

Ms. Dunn also has lived quite a life. She lived in Europe from age one through 21, in Italy, Austria . . . 10 of those years she lived in France. She’s lived in Japan and Hawaii as well. And, oh yes, for a time she lived in Chattaqua, New York, home of a current candidate for president whose name presently escapes me.

Daphne Dunn entered The Elizabeth Hospice program in September 2006. She had developed bronchitis and a subsequent bronchoscopy revealed she also had an infection within her bronchial tubes. That is being treated medically but in the meantime she is confined pretty much to home. She has difficulty standing and having any kind of locomotion at all. She has a powered wheelchair and needs help to shower and to get from one end of the house to the other. She raves about her caregivers from Elizabeth Hospice. “They’re really wonderful,” shes says. “We have a nurse who comes in once a week, and Licensed Vocational Nurse comes in as well. I have hospice visits on Tuesday, Wednesday, Thursday, more often if I need it. If I have a problem, I call them and they respond almost immediately.”

“They offer so much love and interest in you. They have a chaplain who will come on a moment’s notice, a social worker who comes to visit . . . and you can always call if you need anything at all. The Elizabeth Hospice is just a wonderful organization!”

Daphne Dunn has long been a supporter of hospice organizations, even before she became ill enough to require their services. “I was an active volunteer for the Friends of Hospice in Marin County, California,” she says. “We gave Hospice By the Bay, the hospice organization in Marin County, a check for $30,000, proceeds from a Thrift Store run by a Support Group we had operated in that area, the first year of operation.”

She correctly points out that it is often difficult for hospice organizations to find volunteers and they are always needed. She enjoyed her years as a volunteer and regularly saw the results of her work. It gave a heartwarming feeling and a sense of accomplishment in making life more comfortable for others who needed help.

Daphne Dunn

Marjorie Castle lived with intensive, continual pain for months and endured several failed attempts to alleviate her pain through various referrals. As she and her family sought medical advice about relieving her pain and improving her quality of life, it was finally suggested that she look into hospice care. Marjorie and her son contacted and met with San Diego Hospice team members to evaluate her healthcare needs.

Because of the acute pain symptoms Marjorie was experiencing, she was initially admitted to the San Diego Hospice Care Center at GlenBrook Skilled Nursing in Carlsbad. Within 48 hours, her pain symptoms were successfully managed and she began to feel "normal" again. Jim compared the dramatic transition in his mother's condition to a movie.

"If you can envision a screen being dark gray, that would reflect my mom's life before San Diego Hospice, because she was living with so much pain. When San Diego Hospice came into the picture, everything brightened."

Once her acute pain symptoms were under control, Marjorie was able to return to the comforts of her own home, where she continued to receive San Diego Hospice care in her home.

Marjorie and her family were grateful for the hospice referral they ultimately received; they only wish it had come sooner. San Diego Hospice & Palliative Care Medical Director, Frank Ferris M.D. agrees. "Earlier referrals to hospice and palliative care are vital to improving quality of life for people with serious illness."

Marjorie and her family were relieved that she no longer lived with "fear, anxiety, or unbelievable pain" thanks to programs like San Diego Hospice & Palliative care. Marjorie noted, "It would have been a shame not to have known about hospice."

San Diego Hospice patient Marjorie Castle received care in her home by a hospice team.
She shares a smile with San Diego Hospice nurse Susan Bazzo, RN.

Yet another hospice organization serving North San Diego County is Sharp HospiceCare, a Medicare-certified hospice program, accredited by the Joint Accreditation Commission of Health Care Organizations (JACHO), and is affiliated with National and California Hospice and Palliative Care Organizations. They also provide services in the comfort of patients’ homes, at the hospital, nursing homes, assisted living facilities, and in board and care homes. Staff is available 24-hours a day, seven days a week. Sharp HospiceCare is part of the Sharp HealthCare system and provides care throughout San Diego, including North County.

Sharp HospiceCare supports more than 1,800 patients annually. Those suffering from any chronic, life-threatening illness are accepted as Sharp HospiceCare serves patients with all terminal diagnoses (e.g., cancer; cardiac disease; neurological disorders; respiratory disease; congestive heart failure; chronic obstructive pulmonary disease; Parkinson's Disease; renal disease; liver disease; Alzheimer's; AIDS). Sharp HospiceCare works closely with the patient’s physician and hospice medical directors to ensure comprehensive and compassionate care is provided.

The Sharp HospiceCare interdisciplinary team assembles a plan of care to meet each patient’s psychological, spiritual, emotional and physical needs, observes family dynamics, and respects cultural and religious differences. It is this team approach—that supports comprehensive, coordinated care with minimal gaps or overlaps—that truly distinguishes hospice as the preferred care delivery model.

Sharp HospiceCare has several unique programs and services including its annual weekend long Journey to My Heart Family Bereavement Camp which is held every spring in Julian, the Memory Bear Program, and its Teen Volunteer Program including its Life Legacy productions, a very active volunteer program with more than 125 volunteers, and LakeView Home, a residential care home located in La Mesa serving those with life limiting illness and their families.

Another, smaller hospice organization serves North County as well. For twenty-seven years Hospice of the North Coast has provided caring service to terminally ill patients and their families and bereavement services for children, teens and adults.

Located in Carlsbad, Hospice of the North Coast serves North County coastal and inland areas. Its smaller size and area of service allows personalized care and shorter response time whenever the need, night or day.

The non-profit organization is community-based and governed by a loyal and dedicated Board of Directors dedicated to providing only the highest quality hospice care and bereavement services.

Hospice of the North Coast provides comprehensive bereavement services to the families of hospice patients as well as to community members who have lost their loved ones through any means of death. Camp HOPE (Healing Outdoor Play Experience) is a highlight of the year. This summer week-end grief camp for children ages 6 - 19 and their families is held at Green Oak Ranch in Vista. This weekend gives children an opportunity to connect with others their age as they create crafts, do art projects, swim, meet in small groups, play in a drumming circle and share their feelings with each other in a safe, caring space. Many sounds of laughter are mingled with healing tears and new friendships are developed.

Of importance to note, there is no paid staff at Camp HOPE. Hospice of the North Coast counselors, interns and staff as well as volunteers from the community who specialize in working with children are the camp counselors, and there is always a waiting list of people who want to serve.

There is one hospice organization, however, that has had some problem areas. Tri-City Hospital was hit with a 67-page report published by the State Department of Health Services in July of last year that addressed its hospice program.

The report documents a series of "deficiencies" within the hospital that range from failure to properly document patient treatment to inadequate training on the use of pain medication.

Many of the deficiencies listed in the report address how the hospice department's nurses and caseworkers went about caring for the dying patients they see every day.

Much of the report focuses on a comatose patient, identified repeatedly as "patient 3" who was admitted to the hospice program June 16 with a traumatic brain injury. The report found that the patient "was signed into service without an attending physician in place who would determine and deliver the patient's care." The report also found that nurses who cared for the patient, whose eyes remained open without blinking, did not receive regular eye drops to prevent drying and eventual ulcers and that the hospital failed to create and maintain a "plan of care" as required by state law.

The report also states that nurses who saw the comatose patient grimace and have tremors diagnosed those symptoms as pain and administered several pain medications.

"There was no validity for a (plan of care) to treat pain in a patient with no pain response and to treat anxiety in a patient in a persistent vegetative coma," the report said.

Deficiencies were also observed in how hospice employees handed off patients from one shift to the next, called "continuity of care" in hospital jargon. A Tri-City employee, who did not wish to be named, reported that 15 of the hospice department's 35 employees have either quit the department or have taken stress leave recently.

Vernon Pertelle, senior director of Tri-City's hospice department confirmed that some former hospice employees have quit. But he said that the department's most competent employees have remained.

Patti Roberts, a spokesperson for the Department of Health Services, was quoted as saying there will be consequences for the hospital if the deficiencies have not been corrected.

"If the conditions are not met with DHS approval, the program will be in danger of losing its certification," she said. The problem then is that if the certification is lost then so is Medicare funding. As it turns out, that’s exactly what happened. By September the Department of Health Services did another survey and found the Tri-City Hospice program still had deficiencies and was not up to standard. This, in turn, brought about a letter in November from the U.S. Department of Health and Human Services notifying the hospital that it would terminate the hospice program's Medicare agreement November 28, citing the program's "continued failure to meet Federal health and safety requirements. Contrary to your allegations of correction, however, this resurvey documented your continued failure to meet Federal health and safety requirements," the Medicare termination letter stated.

Medicare coverage was, indeed, terminated but Pertelle said that hospice patients have continued to be admitted and no hospice patient would be denied service. They, Tri-City Hospice, would pay the Medicare fees themselves so no patient would be burdened. "We are absolutely committed to the hospice program," he said.

Termination applies only to Tri-City's hospice department and not to the whole hospital.

More recently, Tri-City has conducted a mock survey on March 31st which was run by an independent auditing group. This was a planning tool, preparing for another upcoming survey by Medicare. According to Pertelle, “we passed with flying colors.”

“We have external groups come in to make mock surveys . . . identify areas where we need work . . . and also areas where we do well in. They said we did absolutely superb. The problem areas were all documentation issues. Those have been addressed.”

Aaron Byzak, a Tri-City public affairs officer reported: “We continue to receive a high level of support in terms of patient satisfaction and family members support. We continue to receive very large gifts from family members for the charitable wing of the foundation. We recently received a $25,000 gift; just prior to that a gift of $5000; and in the last 6 months, one individual family donated $1 million to the Tri City Hospice. This would suggest that those we treat understand that we are delivering care and love to our patients.”

Partelle added that he and other managers in the department have taken steps to increase oversight of hospice employees who work with patients in the field.

"The goal is to provide more supervision of the services and provide more opportunities for education," he said.

Tri-City is working to get re-certified by Medicare, a process that requires verified compliance with all "regulatory requirements for at least 90 consecutive days."

Hospital Chief Executive Arthur Gonzalez was unavailable to discuss the hospice Medicare suspension Tuesday.

The Hospice Movement

The modern-day American hospice movement began in 1974 with establishment of the Connecticut Hospice in New Haven, Connecticut. It was founded on the model of care best identified with Dame Cicely Saunders, MD, who opened her now-famous Saint Christopher's Hospice in 1967 in Sydenham, England. This center became the model for comprehensive whole person and family care at the end of life.

Hospice programs have been at the forefront of efforts in America to involve and include families in providing quality end-of-life care.

To achieve quality, compassionate care at the end-of-life, hospice care almost universally involves a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient's needs and wishes. Support is extended to the patient's loved ones, as well. At the center of hospice is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so. The focus is on caring, not curing and, in most cases, care is provided in the patient's home. Hospice services are available to patients of any age, religion, race, or illness.

How does hospice care work?

Typically, a family member serves as the primary caregiver and, when appropriate, helps make decisions for the terminally ill individual. Members of the hospice staff make regular visits to assess the patient and provide additional care or other services. Hospice staff are on-call 24 hours a day, seven days a week. The hospice team develops a care plan that meets each patient's individual needs for pain management and symptom control. The team usually consists of:

The patient's personal physician; Hospice physician (or medical director); nurses; home health aides; social workers; clergy or other counselors; trained volunteers; and speech, physical, and occupational therapists, if needed.

The plan also outlines the medical and support services required such as nursing care, personal care (dressing, bathing, etc.), social services, physician visits, counseling, and homemaker services. It also identifies the medical equipment, tests, procedures, medication and treatments necessary to provide high-quality comfort care.

Hospice services are available to patients with life-threatening illnesses who can no longer benefit from curative treatment and usually have life expectancies of six months or less, as determined by a physician.

Also offered is bereavement counseling to help patients and their loved ones with grief and loss; medical equipment (i.e., hospital beds); medical supplies (i.e., bandages and catheters); drugs for symptom control and pain relief; volunteer support to assist loved ones; physical, speech, and occupational therapy; and dietary counseling.

According to The Elizabeth Hospice information, here is a brief description of their "Transitions" program; it started in 2002, and they are the first to offer this program in North San Diego County:

"Transitions is a pre-hospice program that assists with advance care planning, provides community resources and emotional support, and is a link to hospice care or home health care for individuals and families facing a life-limiting illness."

How does hospice care begin?

Typically, hospice care starts as soon as a formal request or 'referral' is made by the patient’s doctor. Often a hospice program representative will make an effort to visit the patient on the day the referral is made, providing the visit meets the needs and schedule of the patient and family/caregiver. Usually, care is ready to begin within a day or two of a referral. However, in urgent situations, service may begin sooner.

What kind of support is available to the family/caregiver?

In many cases, family members are the patient' s primary care givers. Additionally, hospice recognizes that loved ones have their own special needs for support. As a relationship with the hospice begins, hospice staff will want to know about the primary caregiver's priorities. They will also want to know how best to support the patient and family during this time. Support can take many different forms, including visits with the patient and family members; telephone calls to loved ones, including family members who live at a distance, about the patient's condition; and the provision of volunteers to assist with patient and family needs.

Counseling services for the patient and loved ones are an important part of hospice care. After the patient's death, bereavement support is offered to families for at least one year. These services can take a variety of forms, including telephone calls, visits, written materials about grieving, and support groups. Individual counseling may be offered by the hospice or the hospice may make a referral to an outside source.

What role does the hospice volunteer serve?

Hospice volunteers enhance quality of life and help reduce the burden of caregiving. They are generally available to provide different types of support to patients and their loved ones including running errands, preparing light meals, staying with a patient to give family members a break, lending emotional support and companionship to patients and family members, and helping out with light housekeeping.

Because hospice volunteers spend time in patients' and families' homes, it is important for a hospice program to have some type of application and interview process. In addition, hospice programs should have an organized training program for their patient care volunteers. Areas covered by these training programs often include confidentiality, listening skills, signs and symptoms of approaching death, working with families, loss and grief, and bereavement support.

How does the hospice work to keep the patient comfortable?

Many patients experience pain and other distressing symptoms as illness progresses. Hospice staff receive special training to effectively anticipate, assess, treat, and prevent all types of physical symptoms that cause discomfort and distress. Because symptom management, especially pain, is such an important component of hospice care, many hospice programs have developed ways to measure how well they do in this area through surveys and studies. Hospice staff works with the patient's physician to make sure that medication, therapies, and procedures are designed to achieve the goals outlined in the patient' s care plan. That plan is evaluated frequently to reflect changes and new goals.

When is the right time to ask about hospice?

Now is the best time to learn more about hospice care and ask questions about what to expect. Although end-of-life care may be difficult to discuss, it is best for family members to share their wishes long before it becomes a concern. This can greatly reduce stress when the time for hospice becomes apparent. By having these discussions in advance, patients aren't forced into uncomfortable situations. Instead, they can make an educated decision that includes the advice and input of loved ones.

Question Checklist

Here is a list of questions to help you select the hospice program best able to meet your needs.

Patient's Needs and Wishes:

How does the hospice staff, working with the patient and loved ones, honor the patient' s wishes?

Family Involvement and Support:

Are family caregivers given the information and training they need to care for the patient at home?

What services does the hospice offer to help the patient and loved ones deal with grief and loss?

Is respite care (relief for the caregiver), including inpatient, available?

Are loved ones told what to expect in the dying process and what happens after the patient’s death?

What bereavement services are available after the patient dies?

Physician Role:

What is the role of the patient's physician once hospice care begins?

How will the hospice physician oversee the patient's care and work with the patient's doctor?


How many patients at any one time are assigned to each hospice staff member who will be caring for the patient?


What services do volunteers offer?

What screening and type of training do hospice volunteers receive before they are placed with patients and families?

Comfort and Pain Management:

Does the hospice staff regularly discuss and routinely evaluate pain control and symptom management with patients and families?

Does the hospice staff respond immediately to requests for additional pain medication?

What specialty or expanded programs does hospice offer?

How does the hospice meet the spiritual and emotional needs of the patient and family?

After-Hours Care:

How quickly does the hospice respond to after-hour emergencies? How are calls and visits handled when death occurs?

Are other services, such as chaplain or social worker, available after-hours?

Nursing Home Residents and Other Residential Care Settings:

How does the hospice provide services for residents in different care settings?

Hospitals and Other Inpatient Options:

How does the hospice work with hospitals and other facilities during the course of the patient' s stay? What will happen if care cannot be managed at home?


What measures does the hospice use to ensure quality? Does the hospice program follow the National Hospice and Palliative Care Organization's ' Standards of Practice for Hospice Programs'?

Do hospice professionals have special credentials in their areas?

Paying for Hospice Care:

Medicare, private health insurance, and Medicaid (in 43 states) covers hospice care for patients who meet eligibility criteria. As with any healthcare program, there may be co-pays and deductibles that families pay to receive care. Many hospices also rely on community support for donations. While each hospice has its own policies concerning payment for care, it is a tradition of hospice care to offer services based upon need, rather than the ability to pay. [For more information about the Medicare Hospice Benefit, the services it covers, and eligibility requirements, refer to the National Hospice Foundation's brochure 'Hospice Care and the Medicare Hospice Benefit .'

Are all of the costs of hospice care covered by the patient's health insurance?

What services will the patient have to pay for out-of-pocket? Are any services provided at no charge?

Often, it is a good idea to visit with people who have gone through a hospice program. Try to find several, each of whom has used a different hospice program so that you might compare.

There are non-profit and there are for profit hospice programs. The Elizabeth Hospice Program, San Diego Hospice, Tri-City Hospice, the Sharp Hospice, and Hospice of the North Coast, are all not-for-profit programs.

Because of the emotional stress that occurs when someone dies, it is a good idea to do this research now, when pressure is not upon you and your family.

We hope it is a long time before you or those close to you have a need for hospice care. Yet you can take comfort in knowing there are a number of outstanding hospice organizations out there, waiting to be of service to you.

Hospice Organizations

The Elizabeth Hospice
150 W. Crest Street
Escondido, Ca. 92025

San Diego Hospice & Palliative Care
1-866-688-1600 or visit online at www.sdhospice.org

Sharp HospiceCare

Hospice North Coast

Tri-City Hospice Care

Our thanks go out to the Public Affairs Officers and/or corporate officers for the hospice organizations - all of whom do a tremendous job for their organization: Lisa Marcolongo and Christina Cadruvi for The Elizabeth Hospice, Melissa DelaCalzada, San Diego Hospice and Palliative Care; Suzi Johnson, VP, Bruce Hartman and Janine Lortscher, Sharp Hospice; Diane Nockey, Hospice of the North Coast; and Aaron Byzak, Tri-City Hospice Care. And, of course, to the patients and their families.









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