At 92, Pearl* is a prime example of how VNSNY’s cardiac hospice program gives patients a priceless quality of life, even in their final days. A resident of Manhattan’s Upper East Side, Pearl recently had two valve replacement surgeries and lives at home, having learned to keep her heart failure symptoms in check. “She’s the kind of woman who’s made friends with the gardeners in Central Park,” says her VNSNY Hospice nurse, Katarina (Katie) De Hoog. “Her doormen told me all they need to have a good day is to have her come down and talk to them.”
Pearl’s days aren’t always lighthearted, of course. She tends to retain fluids, which causes shortness of breath, a symptom that can lead to acute anxiety and possibly other complications. VNSNY’s cardiac hospice team is trained to manage such symptoms proactively and tamp them down quickly, so that patients like Pearl don’t end up in the hospital—exactly where they don’t want to be when trying to navigate their last months in serenity at home, surrounded by their loved ones.
“Our team monitors symptoms closely. Our hospice home health aides track changes to the cardiac patient’s weight every morning to spot any fluid retention, and we check continually for normal breathing,” explains De Hoog. Should a problem arise, Pearl’s hospice team moves into high gear, immediately increasing diuretics and other medications that help with symptoms of shortness of breath, ordering more oxygen, and calling the patient’s cardiologist if needed.
“It’s about connecting the advanced heart failure patient with the right level of care,” says Frances Dooley, a cardiac nurse practitioner and coordinator of VNSNY’s cardiac hospice program. “Bringing a nurse trained in cardiac care into the home quickly is a key element,” she explains. “Trying to talk patients through these symptoms doesn’t work. You have to have a nurse there. If we intervene early, we can establish a trust that helps patients relax and become confident that they don’t have to leave their homes to get treated.”
When patients enter the cardiac hospice program, VNSNY works with them to develop their own hospice plan and goals using a team approach that includes spiritual counselors, social workers, nurses, and physicians. The team encourages patients to put in place advance directives and maintains an ongoing conversation with patients and their families, teaching them how they can help manage symptoms at home. “For patients to continue meeting their goals of care, ongoing communication about their chronic illness with the hospice team is essential,” Dooley notes.
Some 16 months after the VNSNY cardiac hospice program began, the program’s admission rates are up—out of the 1,000-plus patients typically in VNSNY’s hospice program at any given time, between 160 and 170 are now receiving specialized cardiac care—and hospital readmissions for this group are down significantly. “The program has definitely improved quality of care for our cardiac patients,” says Dooley.
* The patient’s name has been changed for privacy.