PHOENIX, Ariz. - Medical schools teach students how to treat illness and injury, but typically spend little time on the specialized skills required for end-of-life care. Four years ago, Arizona's largest hospice agency, Hospice of the Valley, began training all Maricopa County internal medicine and family practice residents in "palliative care" - care that focuses on comfort, rather than cure, and usually comes into play when the patient can no longer be fully cured.

Dr. Gillian Hamilton, vice-president for education and innovation at Hospice of the Valley, says the program has been especially successful in teaching caregivers how to talk with patients approaching the end of life. A series of grants from the Virginia G. Piper Trust has allowed expansion of the training to include palliative medicine team members such as nurses, social workers, chaplains and hospitalists (who practice only in a hospital setting).

Hamilton says the training helps to overcome pre-conceived notions about palliative and end-of-life care.

"Here's one resident comment: 'I will be more aggressive about controlling end-of-life pain and not so hesitant about using higher doses of medications, if needed for adequate pain control.'"

The program teaches that hospice doesn't mean every patient is sickly and bed-ridden. Some hospice patients are still holding down jobs, Hamilton says.

"Saying that you might die in the next year doesn't mean 'I give up, there's nothing we can do.' It means 'Let's do everything we possibly can to have you live as joyfully as possible each day that you have.'"

Caregivers need to balance their desire to treat every condition a patient may have with what will improve that patient's quality of life and with what patients and their families actually want, Hamilton adds.




get more stories like this via email

A new national survey says one in five Americans 50 and older has nothing in savings for retirement.

Wisconsin workers young and old are being urged to take action now, to avoid added financial stress in their later years.

The survey results were issued by AARP this month.

Just affording basic expenses right now is a concern for many. But AARP Wisconsin's Communications Director Jim Flaherty said you don't want to be caught off guard when retirement nears.

He acknowledged that it can be hard for younger adults to plan that far ahead, when they're juggling expenses like student loan debt - or for older individuals managing costly medications, and higher grocery bills.

"A lot of times, because they're just trying to get by and they do have to live paycheck-to-paycheck," said Flaherty. "But this is one way to say, 'Hey, if you can live with a little less from your paycheck every week, that will sure grow.'"

Researchers note that 57 million Americans don't have access to a retirement plan through their work.

Wisconsin has not yet joined the list of states that have created state-operated retirement accounts, where employers and their workers can contribute money each pay period.

Supporters hope the issue is revisited next legislative session.

Flaherty said a combination of individuals being proactive and policymakers easing household budget pressure can hopefully put more people on a path toward a healthy retirement.

He said making progress can deter them from looking elsewhere to spend their golden years.

"Let's have an infrastructure that makes drugs affordable, that makes healthcare affordable, that makes retirement savings something that's part of their plan," said Flaherty. "And that'll keep Wisconsinites here."

And groups like AARP have encouraged Congress to address long-term stability concerns for Social Security, so that younger workers can anticipate full benefits.

Some Republican lawmakers have floated cuts, but senior advocates contend any solutions to make the program stronger should not be tied to deficit talks.

Oregon is working to address the state's digital divide with hundreds of millions of dollars in funding.

Infrastructure presents the largest challenges for connecting people in Oregon to high-speed broadband internet.

Nick Batz, director of the Oregon Broadband Office, said there are more than 170,000 residencies in the state with no or slow internet access.

"Our goal through the broadband office and with all our stakeholders throughout Oregon is to provide access to all 112,000 unserved locations and as many of the 60,000 underserved locations as we can," Batz explained.

The state has received federal funding from a variety of sources, including nearly $690 million from the Broadband Equity, Access and Deployment program, and more than $150 million from the Capital Projects Fund approved in the American Rescue Plan Act from 2021.

Oregon's Digital Equity Plan has also been approved and along with it, nearly $10 million in funding.

Bandana Shrestha, state director of AARP Oregon, said there was a time when high-speed broadband internet was considered a luxury.

"Now, it's such a big necessity for everyone, including for older adults," Shrestha pointed out. "Because we know that if you don't have connectivity, you're not going to be able to see your doctor when you want to. Telemedicine is not going to be possible."

Batz added his office is working to ensure every Oregonian can get on the internet.

"It is an interesting challenge," Batz observed. "Nothing has been done like this in Oregon's history of trying to get internet access to everybody. So, it's going to be quite the challenge and it's absolutely going to require participation from everybody to make this happen."

Nursing homes across South Dakota will soon receive a boost in support, as part of the most recent legislative session.

Facilities caring for Medicaid recipients are reimbursed by the state for some of the cost. Reimbursement rates have been calculated based on patient needs, occupancy and funds available in the state budget. Last year, the South Dakota Legislature increased the rate from about 75% to 100%.

House Bill 1167 now allows the Medicaid reimbursement rate to be adjusted annually, to keep up with inflation and other changes.

Erik Nelson, advocacy director for AARP South Dakota, is glad lawmakers are giving nursing homes attention.

"We have seen a number of nursing homes close in recent years," Nelson pointed out. "Financial considerations were a factor in that, along with workforce and some other issues."

Since 2019, 15 nursing homes have closed across the state, with six of the remaining 98 on a federal list of facilities not meeting basic standards of care. In addition to a lack of funding, the average staff turnover rate is 54%.

State lawmakers also approved the use of $5 million in American Rescue Plan Act funding toward expanding telehealth services in facilities including nursing homes, allowing patients to receive some health care services remotely.

Nelson noted telehealth is one way to supply needed support.

"For not only the residents, but the family caregivers that are supporting their loved ones in the nursing homes," Nelson emphasized. "And of course, the staff of the nursing home that's in the community."

Census data show South Dakota's population is aging and by 2030, one-fifth of residents will be older than 65.