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Hospice reaches out to community providers on end of life care

Hospice of the Red River Valley served their first patient in 1981. Since then they have expanded and now serve, on average, 287 patients every day. In 2016, they served 1,582 patients. More than half of their patients live in a long-term care facility and more than half of them have a diagnosis other than cancer.

Hospice provides end of life care with comfort and support for individuals with a terminal illness as well as their families by attending to their physical and emotional needs.

They serve patients in all or part of 29 counties in Minnesota and North Dakota, including Hubbard County.

Dr. Tricia Langlois, medical director with Hospice of the Red River Valley, spoke to the medical providers at CHI St. Joseph's Health last week about why Hospice is so important in the medical system.

In college, Langlois discovered that she wanted to use her love of science to help people. She became a physician with training in internal medicine, then took her training further and became a geriatrician.

"That's why I journeyed into medicine. And throughout that journey up until I was a fellow in geriatrics, taking care of old sick people did it ever dawn on me that my patients would die," Langlois said. "I had no idea going into medical school that I can't fix them, that what I know and what I learned wasn't going to help them. And that was my first inkling."

Langlois said doctors still deal with death very abstractly because they are trained to fix, cure and treat.

"It's hard to be thoughtful as a physician, to take a step back and say, 'is this the right course for this patient?'" she explained. "As I've morphed from a geriatrician into Hospice and more palliative medicine one of the things that we find is that conversations aren't had with people at any age as far as what they want. When they are had, they're had too late. They're had between providers and patients who don't know each other. One of the goals we're trying to figure out is how we can make these conversations more routine and a normal part of life."

According to Langlois, Hospice tries to educate providers on what Hospice does, how to use it and how to use it timely. The topic of death is still considered a taboo topic by many, and now they are trying to figure out how to get people talking about it.

Part of the Hospice criteria is that an individual has to have a life expectancy of six months or less. When the notion of dying is presented to a patient they are so surprised by the information. When Hospice comes in, often times the patient's response is, "I don't want it" or "I'm not dying." They are clinging to whatever small percentage of survival they have been given.

"We really have so much work to do to change the perception of that," Langlois said referring to the shock the patient feels after hearing their prognosis.

According to Langlois, 28 percent of new Hospice patients will die in seven days or less.

"We have such a great opportunity to walk a patient and their family through the last stages of their illness but when we get them and they're dying rather than when they have a terminal prognosis, the ability to help them is so limited and we need to change that," Langlois said. "We need to figure out how to help patients and their families think about their health care goals a lot sooner. That's what we set out to do."

Hospice has ramped up their efforts by reaching out to medical providers, such as doctors and nurses, and members of the community. They provide education to nursing students as well as social work students and medical students, but unfortunately traditional care is so ingrained in the medical system as a whole.

"The only thing that's going to change physician behavior is when patients force that change," Langlois said. "I'm not so keen on speaking to providers because they're forced to be there, they're not engaged. You go to a community talk and those are great because they want to be there, they ask great questions and they see the importance."

According to Langlois, in the last year of a patient's life, they're going to see 20 different physicians or providers. They will be in and out of a nursing home to rehab, in and out of the hospital, they will have to endure physical therapy. It will be a lot of work, not only for the family but for the patient and at some point in time it is important to ask, what is the benefit they're getting?

"We can simplify that. And if the patient's wishes are to be home, we can make that happen and they don't have to keep going down this rabbit hole of traditional medical care when the risks to the patient far outweigh the benefits," she said.

"Most people think that Hospice is for those last hours or days. Hospice and palliative care is about helping you live your life to the fullest until the end," Brenda Iverson, director of community relations for Hospice of the Red River Valley said. "How can we help you live the way you want to as best as you can at the end?"

Hospice of the Red River Valley, along with CHI St. Joseph's Health, Heritage Community, Greenwood Connections, Essentia Health and Knute Nelson will be sponsoring a free screening and discussion of the Emmy-nominated PBS Frontline documentary "Being Mortal," based on the best-selling book by Dr. Atul Gawande on May 11 from 6 to 8 p.m. at the Park Rapids Area High School Auditorium.

The film explores the hopes of patients and families facing terminal illness and their relationships with the providers who care for them.

The discussion will feature Dr. Langlois along with Vicki Teske, CNP with Essentia Health and Pastor Laurie Kantonen with Hubbard United Methodist Church.

For individuals interested in attending visit bit.ly/beingmortalevent or call (800) 237-4629, ext. 1525.

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