Series on Hospice Care

I wrote a three-part series on hospice care in Franklin County, Mass., where I work. I think many of us have the same impression about hospice -- that these services are for people right before they are going to die. While this can be true, people often utilize hospice services months and sometimes years before death. And, even some come out of hospice care and live for many more years. The goal is to improve their quality of life and to make them more comfortable when they have a life-limiting illness or are just getting old.

Here is the first article that I wrote. Mary Tirrell and I became good friends and I visited with her after the story published. Sadly, Mary passed away on Sunday. I saw her the week before and her health had taken a turn for the worse.

I feel so lucky that I got to know her and we became friends.

Published on Jan. 31, 2010
(Picture above is Mary Tirrell)

TURNERS FALLS -- Mary Tirrell has one goal: to make it to her 84th birthday on Jan. 27.
Even with her health deteriorating, and recently at a rate quicker than before, the talkative and witty Tirrell has stayed steadfast to that goal.
Tirrell, now a mere 84 pounds, was diagnosed with chronic obstructive pulmonary disease in September 2009. Soon after, she joined Hospice of Franklin County -- a decision that she credits for making her life better as her health started to fail.
Tirrell said her health would be a "mess" if it wasn't for hospice and that she would have to go to a nursing home.
"I am afraid if I go to a nursing home, I would never leave," she said, as she sat in a rocking chair in her living room, with a blanket covering her frail body.
The hospital suggested that she look into hospice.
Since her diagnosis, she has gone from about 140 to 84 pounds.
Tirrell, who has clear blue eyes and always sets her hair in curlers, says she gets tired quickly, has trouble breathing and feels weak often. In recent days, these symptoms have gotten worse and she says she has been doing less during her days. She is also wearing a nasal cannula more often, which is a device used to deliver oxygen.
Her nurse, Michelle Rogalski, visits Tirrell once each week. Her nurse sorts out her seven different medications into a plastic container and checks on Tirrell's overall health and is there to help manage any symptoms of her disease and old age.
Because of her nurse's care, Tirrell says that she is able to sleep much better at night.
"I love my hospice nurse," she said.
Hospice delivers all of Tirrell's medications. Hospice volunteers also come to sit with Tirrell and simply talk with her for a few hours.
"They are wonderful," she said. "I love when the woman comes to see me she goes places and tells me about them I used to go places."
"I look forward to people coming to see me," she said.
Tirrell says that she plans to stay on hospice "until the end."

Hospice of Franklin County offers an array of services and quality health care with a focus on comfort and quality of life when cure is not an option.
Sometimes the local hospice is called in for people when they have only hours to live, but often, they work with patients that have been using their services for months, if not for a year or more.
Patients get to pick what services they want, which include nursing care, with on-call service 24 hours a day, seven days a week; pain symptom management; emotional and spiritual support; medical social services; home health aide service; volunteer services, like someone who will run errands or sit and talk with a patient; home delivery of prescriptions, medical supplies and equipment related to a hospice diagnosis; physical, occupational, dietary and speech therapy, complimentary therapies, like Reiki, music therapy and massage therapy; and bereavement support.
A daughter's help
One of Tirrell's daughters, Betty Merchant, who is a certified nurse's assistant, comes to her mother's one-bedroom apartment every day for at least three hours. She helps prepare her meals, gives her a shower and buys groceries for her mother.
As her mother's health continues to deteriorate, she is now arranging to have someone with her mother at night for a few hours to help her with dinner, undressing and taking her medications. She will take on at least one of the night shifts and her other siblings will fill in the rest of the days.
An aide from Franklin County Home Care Corp. comes weekly to help clean the house and do laundry.
During the day, Tirrell likes to sit in her rocking chair, positioned in the corner of her small living room. There she crochets, reads historical romance novels and plays games, like Scrabble, on her computer and responds to e-mails. But, lately, she has been spending the majority of her day resting, as her strength has continued to fade.
She doesn't leave her apartment often, but sometimes her daughter takes her out to local craft shows and pizza restaurants, where she likes to get an individual-sized pizza.
"I used to cook," she said, as she looked at her daughter in her tiny kitchen, preparing a meal for her mother. "I am teaching her to cook."
Tirrell worked as a cook at Smith College, ran the kitchen at Charlene Manor Extended Care Facility and owned her own bakery in South Deerfield.
Not being able to cook makes her feel awful. "It makes me feel worse than anything."
But, on a day when she was feeling better than usual, she made homemade macaroni and cheese to share with her daughter.
"I don't want to eat anything," said Tirrell. "Hospice told me to have four small meals."
Mother and daughter often pick out new recipes and Merchant prepares the dish for her mother. Recently, she made a casserole, which Tirrell thoroughly enjoyed.
This year, Tirrell and some of her family had Christmas at her apartment in Sunrise Terrace. She lived in the Keith Apartments with her husband, Fred Tirrell Jr., until he died in 2002. Then, she moved to her current apartment. She has seven children, two boys and five girls. One of her daughters died from colon cancer in 2005. Tirrell was born on Deerfield Street in Greenfield. She had a brother and sister, both of whom are deceased.
Family support
Hospice doesn't just benefit the patient, it has also helped Tirrell's family by teaching them what her symptoms mean and what to expect in the future as her health continues to worsen.
Merchant said, when she first heard her mother was going on hospice, she was scared because she thought it meant her mother's death was imminent. But, that wasn't the case.
When Tirrell first decided to use hospice services, employees from the organization met with all of the family members. For her family, she said the education and information have made it easier for them to watch their mother's health start to fail.
"If she passed away in the next couple of months, because I have worked with hospice and know the end result, I think I will be more accepting."
"I have also been able to spend more time with my mom and I really like that," she said.
She said she was so nervous before hospice came into the picture, especially when her mother would be ill or have a fall. "We didn't always know how to handle the situation."
Now, if a situation arises, "we call hospice," she said.
When asked if hospice had improved her mother's quality of life, she didn't hesitate when she said "definitely."