When to
BY K ATHRYN RUSCITTO, ADVISOR
IT MAY BE E ARLIER THAN YOU THINK.
HELPING ANYONE ON their end-of-life
journey is hard, and having a good support
system for families is crucial.
I once watched a family struggle in the
ICU to help their family member on the
journey. I wondered if their physician had
suggested hospice. Did they know they
could seek palliative care support from
hospice even if their loved one didn't qual-
ify for full-time hospice care? Maybe the
family refused to have the conversation or
maybe they just weren't ready. What else
might we have done to help them through
such a difficult time?
Recently, I had the oppor tunit y to
interview Dr. Zaki Badawy, the Medical
Director of Hospice & Palliative Care of
Chenango County.
I asked him when a clinician should
reach out to hospice. This is what he said:
" When a person is in the final stage of
an illness ... and clearly is in the last six
months of life and not seeking life-pro-
longing care, the patient needs additional
support to remain at home or in their
current setting. If a patient does not meet
the criteria for admission to hospice,
they may still qualify for palliative care
support. Hospice provides a team to sup-
port the patient, with 24-hour access to
a physician. Patients
can be accepted with
Medicare, Medicaid,
pr ivate insura nce
and under the alter-
n at e pl a n of c a r e
in most long ter m
care policies."
M a n y t i m e s ,
patients and families don't wish to face
this difficult conversation. How do we
as healthcare professionals find the best
way to engage? By being prepared with
resources, or helping them do their own
research. The A ARP website has a wealth
of resources on the subject.
Dr. Badaw y says Medica l Orders for
Life-Susta ining Treatment (MOLST)
from the New York State Department of
Hea lth is a lso pa r t of the conversation.
The initiative states:
" The (MOLST) prog ra m is desig ned
to improve the qua lity of ca re seriously
i l l people receive at t he end of l i fe.
MOLST is based on the patient's current
hea lth status, prog nosis a nd goa ls for
care. The discussion emphasizes shared
medica l decision-ma k ing t hat helps
the patient understa nd what ca n a nd
ca n not be accomplished . The resu lt
is a set of medica l orders that must be
honored by a ll hea lthcare professiona ls
in a ll settings."
At the time a MOLST form is com-
pleted, maybe then patients and families
will be encouraged to consider hospice
in their pla nning.
Tha nk you to a ll the clinicia ns who
choose this highly va lued and honorable
work. Dr. Badaw y rema rked that end-
of-life ca re suppor t is a n underutilized
ser v ice i n ou r hea lt h s y s t em — a nd
hospice tea ms have much to offer. n
Kathryn Ruscitto, Advisor can be reached
at linkedin.com/ln/kathrynruscitto or at
krusct@gmail.com.
References for end-of-life conversations
1.
A AR P: aarp.org-caregiving/basics/info-
2020/end-of-life-talk-care-talk.html
2. Chenango County: hospicechenango.org
3. CNY and the Finger lakes: hospicecny.org
4.
Oswego County: health.oswegocounty.com/
programs/1 _hospice/index.php
5. Cortland County: hospicare.org
6. Oneida County: hospicecareinc.org
7.
National Hospice and Palliative Care
Organization: nhpco.org
8. molst.org
Zaki Badawy, MD
Reach Out
to Hospice
M D N E W S . C O M /// M D N E W S C E N T R A L N E W Y O R K
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