Hospice Care

One in three patients with advanced cancer spend their final days in hospitals receiving costly, aggressive treatments they may not want, according to a major national study released Tuesday. Researchers at the Dartmouth Atlas of Health Care, whose work on hospital spending has been cited by the Obama administration, reviewed a sample of 20% of Medicare beneficiaries nationwide with advanced cancer who died between 2003 and 2007, including patients at 65 California hospitals.

It was 3 a.m. in Las Vegas in May 1972. Thomas Austin Preston Jr., better known as Amarillo Slim, had won the main event at the World Series of Poker less than two hours earlier, and there he was looking for a game -- any game. "As long as it's for real money," the tall and lanky professional gambler in the anteater-hide cowboy boots told a Times reporter, pushing his pearl-gray Stetson toward the back of his head. "Seems like a feller ought to be able to get a game like that -- something interesting, you know -- in a town like this here," he said.

Over the last 25 years, the number of Americans turning to hospice for end-of-life care has climbed dramatically -- from 25,000 in 1982 to 1.45 million in 2008, as more and more people choose to spend their final days in the comfort of home or a patient facility with a home-like environment rather than in a hospital pursuing aggressive treatments. During the last decade, Medicare reimbursements for hospice have also risen, allowing more hospices to open without relying on fundraising for survival, says Christy Whitney, chief executive of Hospice and Palliative Care of Western Colorado in Grand Junction.

Santorum's theology Re "The over-the-top Santorum," Editorial, Feb. 21 Rick Santorum's attempts to explain away his use of the word "theology" as a generic word meaning "belief system" might fly if he had left out the Bible tie-in. That inclusion, coupled with his repeated campaign promises to weaken the separation of church and state, argues that he is a nimble, slick guy who has at least two faces: the tea party evangelical and the moderate family guy. The Times wrote that Santorum "should perhaps have realized that accusing the president of embracing an unbiblical 'theology' would be interpreted as a nod" to the canard that President Obama is a Muslim.

Thank you for your editorial supporting the conclusions of the Orange County Grand Jury report that recommends the establishment of hospice care in Orange County. The need is immediate and will increase substantially over the next decade. It now costs $150 per day per patient in a hospice facility, as opposed to $1,200 per day in an intensive care hospital unit. Our Hospice Orange County steering committee is building an organization to fund and operate a facility that will provide quality, compassionate care for terminally ill patients and give comfort and financial relief to their families.

I would like to commend Pearl Jemison-Smith for her passionate description of hospice care for terminally ill patients ("Hospice Brings Dignity to Process of Dying," Commentary, Dec. 1). As a cancer-care specialist, many of my patients have benefited from the personalized care given by all members of the hospice team to control pain and other symptoms. However, the comment I hear most often from patients and families receiving hospice care is, "Why didn't I know about hospice earlier?"

Jenny McGlinchey's June 2 letter praising the hospice nurse was indeed a gesture from the heart. For the past 10 months, our household has been enveloped in the tender care of an array of professionals from hospice. I wouldn't know which one to thank. They all deserve equal acknowledgment. When my husband was discharged from the hospital, still gravely ill, our doctor suggested the hospice home care service for terminal cases. Thus we came under the umbrella of this service.

"I'm not sick; I'm only dying," a friend told Dr. William Lamers Jr. The man had inoperable cancer and wanted to go home to die, but his doctor wouldn't let him out of the hospital. It was the early 1970s, when most people with incurable illnesses died in a hospital, in a lonely room, attended by doctors and nurses with no specialized knowledge of the dying patient's emotional and physical needs. There was no system for caring for the dying at home. The experience opened Lamers' eyes to a major failing of the healthcare system.

Rep. Charlie Norwood, 65, is leaving Washington to receive hospice care at home in Augusta, Ga., forgoing further treatment for lung cancer that has spread to his liver. Norwood's spokesman, John Stone, said the seven-term Republican was not resigning from Congress, but was going home to be with his family.

In response to the article written by Archbishop Roger M. Mahony (Opinion, March 30), "An Archbishop's New Hospice: Hands-On, by Gospels Example," the hospice community is grateful for the archbishop's response to the need for care of the AIDS patient. We also recognize the remarkable work done by Mother Teresa of Calcutta offering desperately ill people comfort and solace in their last days. Hospice care has been provided in the United States for 11 years and has been bringing a quality of life and comfort to all who are faced with a life-threatening disease.

"I'm not sick; I'm only dying," a friend told Dr. William Lamers Jr. The man had inoperable cancer and wanted to go home to die, but his doctor wouldn't let him out of the hospital. It was the early 1970s, when most people with incurable illnesses died in a hospital, in a lonely room, attended by doctors and nurses with no specialized knowledge of the dying patient's emotional and physical needs. There was no system for caring for the dying at home. The experience opened Lamers' eyes to a major failing of the healthcare system.

The cancer that started 11 years ago has now ravaged the body of Freddie Ramos. It attacked a kidney first, then a lung, and the 57-year-old family man knows that death waits in the near distance. He's not ready to go, he says, but he's prepared. "Living in fear of death is no way to live," Ramos told me in the living room of the Los Feliz home he shares with his wife, Robin, and their daughters Bailey and Maya. INTERACTIVE: Share your story A Santana concert poster hangs on the wall, Hollywood Bowl, 2002, and a Diego Rivera art poster is nearby.

There was a cake with my mother's name spelled out in buttercream, small gifts and a song. The guests included 20 men and women suffering from Alzheimer's disease and dementia who lived in the secure wing of my mother's new home — a nicely appointed assisted living facility with art on the walls, gentle hands, crafts and music. After my mother started a fire in her hilltop wood-and-glass house, locked her caregiver out of the bathroom and began pushing dollar bills through the paper shredder, my brother and I surrendered to the concept of assisted living.

Both emails arrived the same day. One came from a reader with a picture attached of a very fancy sporty convertible parked across a white-and-blue painted handicapped space directly in front of a blue handicapped sign outside a Bank of America in Playa del Rey. The emailer said it was Andrew Bynum 's car. "Does he care about the Laker image," she wanted to know, "and respect for the people of Los Angeles?" Maybe she was mistaken; another 7-foot-giant driving a fancy sporty convertible around as if he owns the town.

Doc Rivers agreed to a five-year contract extension that would not only give him another run at an NBA title as coach of the Celtics, but also could keep him in Boston to help rebuild the franchise when the Big Three era is done. "I think Doc is the best coach in the league. So it's great for us," General Manager Danny Ainge said. "There's nobody I'd rather have as my coach than Doc. " Rivers' contract was set to expire — he had an option for next season — and he said after the Celtics were eliminated by the Miami Heat on Wednesday night that he was "leaning heavily" toward coming back.

The "do not resuscitate" paperwork was posted on the refrigerator door. I passed it every time I made my way from my mother-in-law's bedroom to her kitchen, to sort through the basket crammed with pill bottles for the medication she wanted. I kept track of what I parceled out in a "meds log" mounted on the counter. The scribbled notations of family members reflect our efforts at "comfort care" ? dull her pain, quiet her cough, tamp down her anxiety ? and chronicle cancer's deadly encroachment.

The Livingston Memorial Visiting Nurse Assn. will hold a training course for hospice care volunteers beginning Thursday and running until May 19 at the LMVNA office at 1996 Eastman Ave., Suite 101, in Ventura. The course will be held from 6 to 9 p.m. Monday and Thursday evenings. Class size is limited and registration is required. The cost of participation is $25. Volunteers will be trained by professionals in the health care and counseling fields.

Congressional Republicans are coming under growing criticism for their opposition to a bill that would provide medical care for Sept. 11 attack responders and survivors, including ailing police officers and firefighters. As advocates press for Senate approval, Republican resistance to the measure has grown increasingly untenable. After the Sept. 11 attacks, the GOP fashioned itself as the party that celebrated the heroism of the Sept. 11 workers, but now is seen by many as stalling the healthcare of last resort.

One in three patients with advanced cancer spend their final days in hospitals receiving costly, aggressive treatments they may not want, according to a major national study released Tuesday. Researchers at the Dartmouth Atlas of Health Care, whose work on hospital spending has been cited by the Obama administration, reviewed a sample of 20% of Medicare beneficiaries nationwide with advanced cancer who died between 2003 and 2007, including patients at 65 California hospitals.