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The comfort of home

Photo by Josh Miller/Sierra Sun Tahoe Forest Hospice nurse Lorna Tirman checks Margaret Brown's heart rate in Brown's living room on Tuesday.
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Ninety-three-year-old Margaret Brown had to see her daughter become a hospice patient before she became one herself.Brown is a quick-witted grandmother who lives with her son-in-law, Dean Klingerman, in Glenshire. While Klingerman is at work five days a week, a hospice health aide and volunteers come by.When hospice first came into Brown’s life, she was dispirited because of her daughter’s death.”It’s kind of bad to be my age and lose a daughter – your only child,” Brown said. “That’s when I hit rock bottom.”Shortly after her daughter’s death, Brown’s doctor recommended her for hospice because of a medical condition. Visits from volunteers and her health aide have made all the difference to Brown. They bathe her, organize her closet so she can reach her clothes, and talk to her about the pain of losing her daughter.They even threw her a party for her 93rd birthday.

“You’ll never find anything better,” Brown said, glowing while viewing photos from her party. “Everyone has been so good to me.”Tahoe Forest Hospice is a program that allows terminally ill patients to die comfortably at home. They do it all for their patients: home visits, spiritual and bereavement counseling, social services. They also provide medication, equipment and supplies.”If they didn’t have a community hospice program, they would be forced to be dying in the hospital rather than at home,” said Director Eileen Knudson, who helped start Tahoe Forest Hospice in 1999. “It takes nine months to come into this world, and it takes time to leave. People leave a stage of doing to a stage of being, and we’re here to help with that end-of-life process.”Because of all its services, Tahoe Forest Hospice is an expensive program. They won’t turn down anyone who needs them within a 4,900-square-mile area. Knudson estimates that 15 percent to 25 percent of Tahoe Forest Hospice’s cases are uncompensated or charity care. This includes patients without insurance and patients who aren’t old enough for Medicare.In fact, Medicare doesn’t even begin to cover the cost of hospice care. And even when reimbursements are added from private insurance, MediCal and Medicaid, medical insurance pays less than half of Tahoe Forest Hospice’s bills.The result is a program that relies heavily on its 60 or so volunteers, its Truckee and Kings Beach thrift stores, and donations.That still leaves a 12 percent revenue shortfall, which is paid for by Tahoe Forest Hospital.

“The challenge with reimbursement is that there’s not enough and there’s nothing we can do about it. You only get so much,” Knudson said.Knudson’s goal is to sustain her program, without needing the hospital’s financial help. Through the community’s support – via volunteers, donations, and hospice thrift store shoppers – Knudson believes hospice can become a self-supporting program.Comfortable at homeEighty percent of the nation’s elderly population would prefer to die at home rather than in the hospital, said Tahoe Forest Hospice nurse Lorna Tirman.”I think a lot of it comes down to routine,” Tirman said. “When you talk about comfort, it’s not just a nurse giving someone a pill. The comfort comes from being at home.”



For Tahoe Forest Hospice’s patients, comfort also comes from the companionship of hospice workers, who deal with people facing death on a daily basis.”I just learn so much from these people,” Tirman said. “Not very many of us get to spend time with someone who’s looking at the other side. I feel very honored by that.”Hospice works best when nurses are able to come into the picture early because of their familiarity with medications patients need, Tirman said. Too often, patients don’t seek hospice because it’s an admission that death may be near.”Sometimes we get called and we have two days. It’s hard; it’s a scramble,” she said.Then there are patients like Margaret Brown, who it appears will be with hospice for a while.As Brown viewed photos of her 93rd birthday party – pictures of Brown surrounded by hospice volunteers, of Brown in a birthday crown – one of her hospice volunteers, Pat Kerstulvich, asked “Didn’t we have fun?””Oh yes, we sure did,” Brown said.


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