Live Well, Die Well: Thoughts On The Best Care Possible Through The End Of Life

This post was originally published in the GrantWatch section of Health Affairs Blog, November 5, 2015.

By Erica Hallock, Director of Communications & Government Relations at Empire Health Foundation.

We as a society are reluctant to discuss end-of-life issues—that was the premise of a presentation by Ira Byock, a leading palliative care physician, at an October 29 forum in Spokane, Washington. Byock contends that Americans plan for every life milestone—birthdays, weddings, and graduations—but not for death.

Given this premise, it was quite challenging for the event planning team to anticipate just how many people would show up for a community conversation on a chilly fall evening. Despite a massive marketing effort, we had no idea if Spokane would turn out for a topic we, understandably, would all prefer to avoid. In the end, the 800 chairs set up at the Spokane Convention Center proved insufficient as the community came out in droves for this important conversation!

Each fall, Empire Health Foundation partners with Eastern Washington UniversityProvidence Health Care, and Group Health to bring in a national speaker focused on some aspect of health. (Previous forums have featured health care reform expert T.R. Reid, and last year Dan Buettner shared his research on “Blue Zone” communities where residents tend to live into their 100s.)

This year’s focus on the best care possible through the end of life was a noted shift from the focus in 2014 on longevity. But, as Byock pointed out, he has yet to meet anyone able to overcome mortality. And, based on the number of hands still raised as we went well over the time allotted for questions and answers, this is a topic worth additional exploration in the future.

As director of Providence’s Institute for Human Caring, Byock, in his remarks, touched on a range of important issues, particularly the need to look beyond a strictly medical care focus to include personal care, because death itself is personal, not medical.

As someone whose life work involves communications, I was most struck by his focus on the importance of relationships and communication during the end-of-life stage.

Byock movingly described the importance of “community” and “family” at this end-of-life stage. We live in community and family, and our deaths should in turn include both. We are wired to be social beings.

Additionally, he keenly noted the importance of healing broken or hurt relationships. This is not only important for the person who is dying, but also for the surviving loved one. Byock spoke of the freeing power of four simple phrases: Please forgive me. I forgive you. Thank you. I love you. These are simple words conveying forgiveness, love, and gratitude. I plan to use them.

Communication is obviously important among families, but it is really important with what can be a large team of medical professionals caring for a loved one. Byock told forum attendees that most Americans say they would prefer to die at home, yet 70 percent instead pass away in a hospital or nursing home. Byock’s work at the institute is focused on improving communication between medical professionals and patients and their families so that patients can be clear about what kind of care they want through the end of life.

Part of this communication entails medical professionals being trained in not only how to approach these conversations, but also the importance of listening.

I wanted to jump up and applaud when Byock called for the need to improve medical education to better prepare medical professionals for end-of-life issues. It is high time our curricula are brought up to date to ensure that our professionals have the skills to communicate with (and listen to) patients to ensure they get the best care possible. As someone who resides in a region (Eastern Washington),where a new medical school is about to open, I hope we take our opportunity to “get it right” and produce these needed, highly skilled medical professionals.

The four sponsors of this event must now do some follow up. How do we continue these conversations? How can we influence our new medical school to ensure that it includes training on end-of-life care? How can we ensure our region is healthy and able to “live well,” but also to “die well?” This is a timely challenge and one our community is clearly hungry to continue discussing.

Highlights from the 2015 White House Conference on Aging

President Obama delivers remarks at the White House Conference on Aging.  July 13, 2015.  Courtesy of the White House YouTube channel.

In case you missed yesterday’s Boomer U article in the Spokesman Review, it gave a great overview of the discussion at the 2015 White House Conference on Aging in Washington DC last week.  As the article explains, our partners at Aging and Long Term Care of Eastern Washington (ALTCEW) came together with Area Agencies on Aging from across the state to generate recommendations for the conference, which took place last Monday, July 13.  This conference, which has occurred every 10 years since the 1960s, has had a key role in shaping U.S. policy on aging for the past 50 years.  Priorities presented at this year’s conference included ensuring retirement security, providing long-term services and supports, supporting healthy aging, and protecting elders from abuse and neglect.  According to ALTCEW executive director Lynn Kimball, while these priorities were consistent with the Washington state recommendations, “it is really up to each state and community to prioritize what needs to happen for healthy aging to occur.”  We could not agree more, which is why we are working with partners like ALTCEW through our Rural Aging Services Initiative to help seniors gain access to needed supports that allow them to live full meaningful lives with independence and dignity in their homes and communities of choice.  One of our favorite quotes from the article came from Washington State Council on Aging member Phillip Lemley:

The biggest thing that caught my ear was that we must change the prospect of aging from fear to optimism.

Check out the full article here, or download below.

As part of our Rural Aging Services Initiative, we are currently working with ALTCEW to expand supports for caregivers in Whitman County.  Stay tuned for more on this partnership as we work together to better serve rural seniors in our region.

Spokesman stories on aging in Ferry County

Spokesman Review journalist Erica Curless, who writes the weekly "BoomerU" feature, wrote a beautiful article on aging in remote Ferry County that ran in the June 28 edition of the paper.  Read the full article here, or click below to download a PDF.

The newest part of the Foundation's work to improve health outcomes in Eastern Washington is focused on helping rural seniors gain access to services that preserve their independence and dignity while aging in their own communities.  We are working with nonprofit partners in our neighboring rural counties (including Ferry County) to develop programs to connect rural elders to services such as health coaching and group education opportunities, with two main goals: to improve participants' feeling of control over their own health, and to decrease unnecessary emergency service utilization.  Stay tuned for more updates on the Rural Aging Services Initiative, our newest grant making program!

Update:  Definitely take a look at this article which ran as the June 29 Boomer U story as well, which features some of our nonprofit partners working to support healthy aging in the Tri-Counties!