HPCI Newsletter Spring 2019

LILIAN AND BENJAMIN HERTZBERG PALLIATIVE CARE INSTITUTE

PALLIATIVE CARE NEWSLETTER SPRING 2019

Authors-Turned-Caregivers Share their Stories of the Impact of Serious Illness The Hertzberg Palliative Care Institute brought together a panel of acclaimed authors last fall, inviting them to share their personal stories of caring for a seriously ill loved one and how palliative care supported them.

“When we think about health policy and medical coverage, we often think only about the patient. But when it comes to people with living with serious illness, we must include the caregivers at home, who need help as well,” said Dr. R. Sean Morrison, Ellen and Howard C. Katz Chair of the Brookdale Department of Geriatrics and Palliative Medicine. The Hertzberg Institute held the panel discussion, titled “Partners in Care”, to shed light on the caregiving experience.

Around 48 million Americans provide care to a seriously ill adult at home, spending an average of 20 hours a week in an unpaid, emotionally-draining job. One in three caregivers are in poor health, and 97 percent say they need more help. As the baby boomer generation ages, the nation is facing a shortage of caregivers. Increased public awareness and health policy reform will alleviate the caregiver shortage and burden.

Authors and caregivers Elizabeth Gilbert, Michael Ausiello and Jennifer Homans, PhD were joined on the panel by Dr. Cardinale Smith, Associate Professor of Medicine, Hematology and Medical Oncology, and Geriatrics and Palliative Medicine. The panel was moderated by Dr. R. Sean Morrison.

For Ms. Gilbert and Dr. Homans, palliative care was a key support for them in their role as caregivers – helping them to understand the course of their loved one’s disease and to cope in the darkest moments. Palliative care focuses on treating the symptoms, pain, and stress of a serious illness for patients and their families. It is appropriate at any age and at any stage in a serious illness, and unlike hospice, it can be provided alongside curative and all other appropriate medical treatments. “It truly is whole-patient care, and we offer the same support for loved ones,” Dr. Smith said.

Dr. Homans spoke of trying to write a book, care for her children and care for her husband, who was living with amyotrophic lateral sclerosis (ALS).

“Palliative care meant introducing someone else who could stand between all those whirling parts — this third person who was calm and could steady the ship for a moment,” she said. In contrast, Mr. Ausiello described the challenges of a caregiving experience without this added layer of support. ■

BROOKDALE DEPARTMENT of GERIATRICS AND PALLIATIVE MEDICINE

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Research Shows Greater Need for Palliative Care for Patient and Family Surviving spouses of people who die in the hospital incur higher medical costs in the year that follows than the spouses of people who die outside the hospital, according to a new study by Dr. Katherine Ornstein, Assistant Professor of Geriatrics and Palliative Medicine.

The study, published in August 2018 in the journal Health Services Research, showed that in the year after their spouses in-hospital death, surviving spouses were significantly more likely to have an emergency room visit or hospital admission, contributing to $3,106 higher Medicare spending. This increased Medicare spending continues into the second year after the spouse’s in-hospital death, the study found.

“The findings, while not proving causation, suggest that medical providers must consider the trauma involved when a loved one undergoes unnecessary hospitalization when living with serious illness” said Dr. Ornstein. “We need to think about how unnecessary and potentially burdensome treatments and hospitalizations impact families, and we need to think about how we can meet their needs.”

Palliative care teams specialize in the care of patients and families facing serious illness. These teams offer an

added layer of support and ensure that treatments are aligned with patients’ goals, care is provided in the setting of their choice – typically home, and that families are supported throughout the course of illness and bereavement. To mitigate adverse impacts like those in Dr. Ornstein’s study, the Hertzberg Palliative Care Institute advocates that all persons with serious illness and their families have access to high quality palliative care in all care settings – home, hospital assisted living, and nursing homes.

Dr. Ornstein is the Director of Research for the new Institute for Care Innovations at Home within the Brookdale Department of Geriatrics and Palliative Medicine. Her research focuses on the impact of financial and caregiving resources of vulnerable homebound populations.

The Institute for Care Innovations at Home is an epicenter of home-based care research and the official academic partner to Mount Sinai at Home.

The Institute provides the research infrastructure for all Mount Sinai at Home clinical activities and serves as a base for national and international research activities focused on Care Innovations at Home. ■

Lilian and Benjamin Hertzberg Palliative Care Institute Advisory Board Members Saskia Siderow, Co-Chair Susie West, Co-Chair Deborah Berg Beth Dannhauser Peggy Danziger Joseph Hertzberg

Lois Perelman-Gross Meryl Rosofsky, MD Stephen Siderow Jenny Steingart Dorothy Toran Zena Wiener

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CONTINUING A LEGACY:

The Hertzberg Institute Speakers Bureau In 1996, longtime friends communications Bette Kerr, EdD and consultant who Susie West established transitioned from a the Hertzberg Palliative career in financial Care Institute Speakers journalism as a result of Bureau, a volunteer her exposure to palliative program which sends care. Together with her Hertzberg clinicians husband, Stephen, she into diverse community joined the Hertzberg venues to educate Advisory Board in 2012, professional and lay and since 2016, she has Susie West and Bette Kerr groups about palliative served as Co-Chair of care and its the Advisory benefits. This year, Board with Mrs. after 12 years at West. the helm, Ms. Ms. Smolinsky Kerr and Ms. is a real estate West have chosen broker in New to focus on their York City with other volunteer a significant Saskia Siderow Jigi Smolinsky activities, background in enlisting Advisory publishing. After experiencing the Board Co-Chair, Saskia Siderow, and supportive care offered on the Wiener Hertzberg volunteer, Jigi Smolinsky, to Family Palliative Care Unit in 2017, she steward the Speakers Bureau. is eager to ensure that all patients and Through their dedication and families have access to the type of care guidance, Ms. Kerr and Ms. West have her family received. brought palliative care education “Palliative care and countless New to countless individuals in the New Yorkers are indebted to Bette and Susie York tri-state area. Active Hertzberg for their long legacy with the Speakers volunteers, Ms. Kerr is a practicing Bureau and so much more. It is hard doula for the Hertzberg Institute to imagine anyone else stewarding this at Mount Sinai Hospital, bringing incredibly important initiative, but I comfort and companionship to have great faith in and gratitude toward hospitalized seriously ill patients. Ms. Saskia and Jigi. I am humbled to have West co-chairs the Hertzberg Advisory the support of these four incredible Board and provides administrative women and of all of our volunteers at support for the Institute. the Hertzberg Palliative Care Institute.

Like Ms. West and Ms. Kerr, It is their work that truly makes a Ms. Siderow and Ms. Smolinsky difference,� said Dr. R. Sean Morrison, experienced palliative care firsthand Ellen and Howard C. Katz Chair of the through the illness of a loved one, Brookdale Department of Geriatrics and from that experience, developed and Palliative Medicine. a passion to educate all seriously If your organization would like a ill patients and their families. Ms. Hertzberg speaker, please contact us Siderow is a healthcare analyst and at (212) 241-1446.

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Provider Spotlight:

DR. EMILY CHAI

When asked why she chose to practice palliative care, Dr. Emily Chai will tell you that “while in training, my mentors, Drs. Diane Meier and Sean Morrison, modeled a type of healthcare that went beyond medical knowledge, a type of care that treats the whole person and their family called ‘palliative care’. When I saw the healing that occurred when we align patient and family values with the care they receive, I knew that was what I wanted to do.”

Dr. Emily Chai serves as the Vice Chair for Inpatient Services in the Brookdale Department of Geriatrics and Palliative Medicine, where she manages clinical operations across the Mount Sinai Health System and

oversees the educational and quality research programs. Two years after Dr. Chai joined the faculty in 2003, she was appointed Medical Director of the Hertzberg Palliative Care Institute. Under her leadership, the Institute as grown from a dedicated unit and one consultation team to two units, seven consultation teams and four outpatient practices across seven campuses.

“Dr. Chai is a remarkable leader.

She has grown with the department and manages to stay three steps ahead of the next change, steering our faculty, staff and patients with incredible wisdom, mentorship and compassion,” said Dr. R. Sean Morrison, Ellen and Howard C. Katz Chair of the Brookdale Department.

Creative Arts Therapy Explores New Mediums with Incredible Impact

Rennis Howell, III was a well-known figure in his community where he mentored younger generations, coached and organized basketball leagues, and devoted himself to giving back.

Mr. Howell, known for his positivity, generosity and humor, was proud of the life he lived and as his illness progressed, he sought one more opportunity to share wisdom with his family, friends and community. While receiving care on the Palliative Care Service last year, he worked with Creative Arts Therapist Lauren Smith and Child Life Specialist Nicole Wood to explore how this could be accomplished. Together, they created a 33-minute video in which, Mr. Howell gave direction for music, content and design. Per his request, the film was later played at Mr. Howell’s funeral.

“This was a unique therapeutic moment – Mr. Howell had a clear vision for how he wanted to share his legacy, and Creative Arts Therapy lent the perfect intervention for him to touch so many. It was a true highlight of my career,” stated Ms. Smith. The video of Mr. Howell’s final thoughts and ‘shout outs’ offered his friends and family reassurance, love and inspiration.

It also solidified his legacy and eased his final days.

Honoring Mr. Howell’s desire to use his experiences as education for others, Ms. Smith has proposed and been accepted to present this case at the 50th American Art Therapy Association Annual Conference in Kansas City, Missouri this fall.

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Missing from the Formulary of American Healthcare Dr. Albert Siu, Chair Emeritus of the Brookdale Department of Geriatrics and Palliative Medicine, delivered a passionate call to action for the American healthcare system in April.

“In American medicine today, we somehow manage to provide the most expensive care on the planet, yet we receive lackluster results, and do it in a way that is most unequal in terms of the outcome results,” said Dr. Siu in his remarks for the 23rd Annual Douglas West Memorial Lecture, titled Missing from the Formulary of American Healthcare.

Dr. Siu explained that the current state of healthcare is due to the evolution and incorporation of three core American values, which he described as “all noble and the right thing to do, but exceedingly difficult to reconcile.”

Dr. Siu suggests that to heal the US healthcare system, we need to better align our values of innovation and entrepreneurship, freedom of choice and equity with the medical needs of our population.

Innovation and entrepreneurship should be focused not only on the development of new technologies, but also on producing the highest quality care for all Americans. Healthcare providers should have both the latest innovative treatments at their disposal and the core knowledge and skills (such as pain and symptom care, effective communication, and care coordination) necessary for the effective treatment of serious and complex disease. Freedom of choice should be honored by giving Americans universal access to services

R. Sean Morrison, MD, AlbertSiu, MD and Susie West

such as palliative care, expert geriatrics care and at-home care.

Lastly, Dr. Siu implored the audience to recognize and “get serious about inequality.” He described the current state of medicine in which Americans are covered by a wide range of insurance companies and plans that vary considerably in both their costs and scope of coverage. The result of unequal medical coverage is unequal health outcomes, with the white and wealthy achieving the best outcomes and the socially vulnerable and poor obtaining the worst. These disparities can only be addressed by ensuring equal healthcare coverage for all.

Dr. Siu is a recognized expert and academic leader in aging and palliative care whose career has spanned academia, government and policy research. As the Ellen and Howard C. Katz Professor and Chair of the Brookdale Department from 2003 to 2017, he transformed the fields of geriatrics and palliative care and challenged traditional models of healthcare delivery. ■ To view the lecture, please visit www.mountsinai.org/palliativecare

Lilian and Benjamin Hertzberg Palliative Care Institute Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place, Box 1070, New York, NY 10029 Tel. 212-241-1446 • www.mountsinai.org/palliative

Fourth Century French Proverb

“To cure sometimes, to relieve often, to comfort always”

Spring 2019

PALLIATIVE CARE NEWSLETTER

Lilian and Benjamin Hertzberg Palliative Care Institute Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place, Box 1070 New York, NY 10029