End of life care at Grace Cottage

Friday June 28, 2013

Since Governor Shumlin signed the Vermont "aid in dying law" last month, it has been noted in the Reformer that basically all of the hospitals in the state have decided to "opt out" from implementing this law. Opting out was an option detailed within the law. Most hospitals are developing policy and procedures to implement this law.

In this newspaper, over the past couple of weeks it was twice stated that a "hospital is a facility people come to for healing, and the intent of the law is not to make the hospital a place where people come to die." It is absolutely true, however, that at Grace Cottage Hospital in Townshend, where I have been an attending physician for the past 15 years, people do indeed choose to come to the hospital for end-of-life care. To die. As much as death is a part of life, many people and their families have chosen to use Grace Cottage Hospital at the end of their lives as a source of comfort, excellent nursing care and pain management.

The reasons for this are many. First, as people come to die, they usually become uncomfortable. Morphine sulfate is the standard of care to help relieve this discomfort. While available in concentrated drops through pharmacies and administered by patients and families through home hospice services, sometimes such pain management can be insufficient. Hence, some people are admitted to our hospital for improved pain management as they die.

Another reason why people may come to Grace Cottage Hospital for end-of-life care is that as people are closer to dying, they become much more immobile. It can be very difficult for family members to turn, clean and keep their loved ones comfortable. At Grace Cottage Hospital, while insurance companies and Medicare may not consider this a "skilled service," our nursing staff has time and time again demonstrated phenomenal skill in keeping people comfortable as they die just in repositioning them.

Others come to Grace Cottage Hospital at the end of their lives because it is too emotionally difficult for their family members to care for them at home, even with excellent hospice care in the community. Our staff is able to provide incredible TLC to patients and families. Family members can rest and take care of their own needs as their loved one is cared for here.

Some decide to come to Grace Cottage Hospital at the end of their lives because they have established relationships with their physicians over many, many years. They are confident that their needs and their families' needs are going to be met.

For many, although Grace Cottage Hospital is, after all, a hospital, it just feels like home to them. Over the years, they have come to know the nurses, the maintenance people, the housekeepers, the kitchen staff, etc. This hospital is genuinely part of their community - almost like an extended family.

Caring for people at the end of their lives and for their family and friends is something in which our hospital takes tremendous pride. At Grace Cottage, we provide lots of outstanding services: rehabilitation, emergency room services and primary care, to name a few. However, I think it is very fair to say that some of our reputation is actually staked upon our hospice room and the compassionate care delivered by our nurses and staff to relieve the suffering of our patients (and their families) at the end of their lives.

Obviously, we are not practicing "physician assisted suicide" here at Grace Cottage Hospital. The new law provides for an entirely different situation. Here at Grace Cottage Hospital, we will continue to be privileged to provide high-quality, compassionate, physician directed end of life care for patients and families in need of this very important service at the end of their lives.

Dr. Moss Linder received his medical degree from the University of Vermont in 1991. He completed a family medicine residency at Oregon Health Services University. Prior to joining Grace Cottage in 1997, he worked as a family physician at the Acoma Cañoncita Laguna Hospital in New Mexico. Dr. Linder is Board Certified in Family Medicine.


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