A Touch of Mercy Palliative Care Room Eases Passage for Dying Patients

Even as Dr. Shawn Charest studied internal medicine in the hospital setting, he felt that something was missing.

“I saw people suffering and not dying well, and I wanted to be able to offer them a better death, and their families a better experience,” said Charest, a staff hospitalist at Mercy Medical Center.

So he helped do something about it, undergoing additional training in palliative care and promoting some ambitious projects in that field of care at Mercy. As a result, he now wears several other hats at the hospital, including director of the Mercy Hospice program, chair of the facility’s Palliative Care Task Force, and medical director of Companions for the Journey, a program that trains volunteers to sit with and comfort patients who are actively dying.

Change often comes slowly in the hospital setting, but after several years of petitioning the administration, about a year ago Charest saw the arrival of Mercy’s palliative care room, one of the only programs of its kind in the region.

“It was tabled for at least two years, but then we saw a resurgence in interest,” he told The Healthcare News. Still, he considers the room — a $10,000 investment — to be a no-brainer.

“I’m a hospitalist, and all we do is inpatient hospital care,” he said. “We see the sickest of the sick people. They come to the hospital with high acuity, many of them are elderly … and what we saw were these patients dying in double rooms with little physical space and no emotional space.”

The palliative care room, on the other hand, is located on a quiet corner of the hospital, away from nurses’ stations and general din. “We restructured the room and reappointed it, everything from the lighting to the painting, and tried to make it feel more like home as much as we could.”

Families are encouraged to sleep overnight on the pullout couch, and a large, flat-screen TV provides another touch of comfort.

This month, The Healthcare News examines the ambitious steps Mercy has been taking to grant that “better death” so important to patients and families alike.

Comforting Thoughts

Besides its external hospice service, Mercy offers something called Companions for the Journey, a program that has, at its heart, a desire that no one should die alone. Volunteers sit with dying patients, around the clock, until the end.
Charest, if he had his way, would see that entire program take place in a suite of palliative care rooms, but for now, not every dying patient can access the one busy room, so many still die in regular patient rooms.

Still, he said, Companions for the Journey has had a profound impact on people’s lives during the most difficult hours.

“We had a woman in her 80s, in failing health herself, who had been married 50 years to this man who was dying. She was with him all the time. But when she was offered this program, she was able to go home and sleep and bathe. She told us, ‘it’s so much of a relief to know my husband doesn’t have to be alone.’”

Thirty volunteers are active in the program, logging more than 600 hours with dying patients in the past year.

“This has been a profound experience for families, to know that a complete stranger will take time in the middle of the night to come and show up at the bedside,” he added. “I’ve been very moved at how it affects families.”

Beyond that, Charest envisions a formal palliative care consultation service — in effect, another hospital department — to guide families through the difficult process of making some of the final health care decisions for their loved ones, and beginning to let go.

“The administration has been receptive to it, but there are issues with appropriating money for it,” he said. “The staff has been trying to utilize the resources in place as opposed to bringing in outside resources. Right now, we’re dealing with a Medicare crunch, and the reimbursement to physicians will be cut again in 2008. The hospital has to consider the bottom line.”

Still, Mercy does offer many different pieces of what would be a formalized program, one that deals with between 15 and 18 patients and families on an average day, helping guide them through decisions like hospice, medications, and other symptom management.

“We’ve had for many years a palliative care task force that’s basically a group of nurses, pharmacists, physicians, and social workers,” he said. “But we don’t have a formalized, interdisciplinary consultation service, and that’s something being developed and offered at the majority of academic and tertiary-care centers. No one in Western Mass. offers that kind of service.”

Waiting List

Charest concedes that one palliative care room is not enough, and the hospital is looking into the possibility of adding at least one more.

“I’ve looked at the statistics for how many patients in the hospital are receiving comfort measures only, and how many are using the room — only about half of them are able to get in there,” he said.

Families recognize the need as well — and express their gratitude in a way that might lead to a second room even sooner.

“The response has been so overwhelming from families,” Charest said. “They say, ‘this is such a simple but profound gift for us; how can we repay you?’” That’s when they’re told there is a way: to donate money in memoriam of a loved one toward developing more palliative care rooms. Some have even mentioned the giving option in obituaries.

“Since last January, we’ve received $10,000 in unsolicited donations just on the basis of families having been in that room,” he said. “But it’s not $1,000 here and $1,500 there. It’s $10 or $20 — what people might spend on flowers. The number of donations really blows my mind.”

A little generosity at a time, after all, makes a difference. As does a little comfort — and mercy.