Latest news with #hospice
Medscape
6 hours ago
- Health
- Medscape
Nurse Practitioners Fill Gaps as Geriatricians Decline
On Fridays, Stephanie Johnson has a busy schedule, driving her navy-blue Jeep from one patient's home to the next, seeing eight in all. Pregnant with her second child, she schleps a backpack instead of a traditional black bag to carry a laptop and essential medical supplies — stethoscope, blood pressure cuff, and pulse oximeter. Forget a lunch break; she often eats a sandwich or some nuts as she heads to her next patient visit. On a gloomy Friday in January, Johnson, a nurse practitioner who treats older adults, had a hospice consult with Ellen, a patient in her 90s in declining health. To protect Ellen's identity, KFF Health News is not using her last name. 'Hello. How are you feeling?' Johnson asked as she entered Ellen's bedroom and inquired about her pain. The blinds were drawn. Ellen was in a wheelchair, wearing a white sweater, gray sweatpants, and fuzzy socks. A headband was tied around her white hair. As usual, the TV was playing loudly in the background. 'It's fine, except this cough I've had since junior high,' Ellen said. Ellen had been diagnosed with vascular dementia, peripheral vascular disease, and type 2 diabetes. Last fall, doctors made the difficult decision to operate on her foot. Before the surgery, Ellen was always colorful, wearing purple, yellow, blue, pink, and chunky necklaces. She enjoyed talking with the half dozen other residents at her adult family home in Washington state. She had a hearty appetite that brought her to the breakfast table early. But lately, her enthusiasm for meals and socializing had waned. Johnson got down to eye level with Ellen to examine her, assessing her joints and range of motion, checking her blood pressure, and listening to her heart and lungs. Carefully, Johnson removed the bandage to examine Ellen's toes. Her lower legs were red but cold to the touch, which indicated her condition wasn't improving. Ellen's two younger sisters had power of attorney for her and made it clear that, above all, they wanted her to be comfortable. Now, Johnson thought it was time to have that difficult conversation with them about Ellen's prognosis, recommending her for hospice. 'Our patient isn't just the older adult,' Johnson said. 'It's also often the family member or the person helping to manage them.' Nurse practitioners are having those conversations more and more as their patient base trends older. They are increasingly filling a gap that is expected to widen as the senior population explodes and the number of geriatricians declines. The Health Resources and Services Administration projects a 50% increase in demand for geriatricians from 2018 to 2030, when the entire baby boom generation will be older than 65. By then, hundreds of geriatricians are expected to retire or leave the specialty, reducing their number to fewer than 7600, with relatively few young doctors joining the field. That means many older adults will be relying on other primary care physicians, who already can't keep up with demand, and nurse practitioners, whose ranks are booming. The number of nurse practitioners specializing in geriatrics has more than tripled since 2010, increasing the availability of care to the current population of seniors, a recent study in JAMA Network Open found. According to a 2024 survey, of the roughly 431,000 licensed nurse practitioners, 15% are, like Johnson, certified to treat older adults. Johnson and her husband, Dustin, operate an NP-led private practice in greater Seattle, Washington, a state where she can practice independently. She and her team, which includes five additional nurse practitioners, each try to see about 10 patients a day, visiting each one every 5-6 weeks. Visits typically last 30 minutes to an hour, depending on the case. 'There are so many housebound older adults, and we're barely reaching them,' Johnson said. 'For those still in their private homes, there's such a huge need.' Laura Wagner, a professor of nursing and community health systems at the University of California, San Francisco, stressed that nurse practitioners are not trying to replace doctors; they're trying to meet patients' needs, wherever they may be. 'One of the things I'm most proud of is the role of nurse practitioners,' she said. 'We step into places where other providers may not, and geriatrics is a prime example of that.' Practice Limits Nurse practitioners are registered nurses with advanced training that enables them to diagnose diseases, analyze diagnostic tests, and prescribe medicine. Their growth has bolstered primary care, and, like doctors, they can specialize in particular branches of medicine. Johnson, for example, has advanced training in gerontology. 'If we have a geriatrician shortage, then hiring more nurse practitioners trained in geriatrics is an ideal solution,' Wagner said, 'but there are a lot of barriers in place.' In 27 states and Washington, DC, nurse practitioners can practice independently. But in the rest of the country, they need to have a collaborative agreement with or be under the supervision of another health care provider to provide care to older adults. Medicare generally reimburses for nurse practitioner services at 85% of the amount it pays physicians. Last year, in more than 40 states, the American Medical Association and its partners lobbied against what they see as 'scope creep' in the expanded roles of nurse practitioners and other health workers. The AMA points out that doctors must have more schooling and significantly more clinical experience than nurse practitioners. While the AMA says physician-led teams keep costs lower, a study published in 2020 in Health Services Research found similar patient outcomes and lower costs for nurse practitioner patients. Other studies, including one published in 2023 in the journal Medical Care Research and Review , have found healthcare models including nurse practitioners had better outcomes for patients with multiple chronic conditions than teams without an NP. Five states have granted NPs full practice authority since 2021, with Utah the most recent state to remove physician supervision requirements, in 2023. In March, however, Mississippi House Bill 849, which would have increased NP independence, failed. Meanwhile, 30 Texas physicians rallied to tamp down full-scope efforts in Austin. 'I would fully disagree that we're invading their scope of practice and shouldn't have full scope of our own,' Johnson said. She has worked under the supervision of physicians in Pennsylvania and Washington state but started seeing patients at her own practice in 2021. Like many nurse practitioners, she sees her patients in their homes. The first thing she does when she gets a new patient is manage their prescriptions, getting rid of unnecessary medications, especially those with harsh side effects. She works with the patient and a family member who often has power of attorney. She keeps them informed of subtle changes, such as whether a person was verbal and eating and whether their medical conditions have changed. While there is some overlap in expertise between geriatricians and nurse practitioners, there are areas where nurses typically excel, said Elizabeth White, an assistant professor of health services, policy, and practice at Brown University. 'We tend to be a little stronger in care coordination, family and patient education, and integrating care and social and medical needs. That's very much in the nursing domain,' she said. That care coordination will become even more critical as the US ages. Today, about 18% of the US population is 65 or over. In the next 30 years, the share of seniors is expected to reach 23%, as medical and technological advances enable people to live longer. Patient and Family In an office next to Ellen's bedroom, Johnson called Ellen's younger sister Margaret Watt to recommend that Ellen enter hospice care. Johnson told her that Ellen had developed pneumonia and her body wasn't coping. Watt appreciated that Johnson had kept the family apprised of Ellen's condition for several years, saying she was a good communicator. 'She was accurate,' Watt said. 'What she said would happen, happened.' A month after the consult, Ellen died peacefully in her sleep. 'I do feel sadness,' Johnson said, 'but there's also a sense of relief that I've been with her through her suffering to try to alleviate it, and I've helped her meet her and her family's priorities in that time.'
BBC News
a day ago
- Health
- BBC News
St Margaret's Hospice hosts crisis fundraiser amid £100k shortfall
People have two days to raise £100,000 to help keep a much-loved hospice afloat. A hospice has launched at 36-hour fundraising event in an effort to balance its budget in the wake of increasing demand and unexpected St Margaret's Hospice, in Taunton, has launched a 36-hour fundraising event in an effort to balance its budget in the wake of increasing demand and unexpected costs. Supporters have until Friday evening, to raise the money through crowdfunding. There will also be sponsored walks and art Hall, the hospice's fundraising manager, said: "Demand on our care is growing, costs are increasing, and funding is difficult to secure." It is thought the charity needs about £12m a year to run its services, but Ms Hall said centres all over the UK were facing "new challenges".She added the increase to National Insurance alone is costing an additional £300,000 this year, which was not part of the charity's initial budgets a year ago."That was something we didn't anticipate, and couldn't have known when we set the budgets," she other £200,000 shortfall from National Insurance can be covered by its network of shops and legacy donors. It is hoped from Thursday to Friday evening, the public, as well as a number of corporate partners, will raise the £100,000 it needs through the charity's fundraiser, which it has called Every Moment Hall said she is "confident" the hospice can reach its fundraising target, describing it as a "real challenge".There is also match funding available up to £50,000 which has been provided by "generous supporters".Supporters can donate online, or head into shops across the county.
Yahoo
2 days ago
- General
- Yahoo
Sterling hospice nurse, her 32 years of military service honored with 'Quilt of Valor'
Jun. 18—STERLING — For retired U.S. Air Force Lt. Col. Julia Ritz of Walnut, service has never been a straight line — it is a calling set upon a twofold path. Recently honored by the Quilt of Valor Foundation with a handcrafted quilt commemorating her 32 years of service in the U.S. military, Ritz reflects on a career shaped by dedication, sacrifice and a lifelong devotion to helping others. Now a hospice nurse with Rock River Hospice & Home in Sterling, Ritz's journey into military service began in 1989, when she took her oath in the U.S. Navy during the Gulf War. Although originally pursuing a commission as a naval flight officer, her career ultimately evolved through service in the Navy Reserves, Minnesota Air National Guard and the U.S. Air Force. "I listed first, and then I crossed over to the other side," Ritz said. "I just retired on April 12 this year after 32 years." Ritz's career included active duty at Hurlburt Field with Air Force Special Operations Command following the Sept. 11, 2001, attacks, as well as deployments to Kandahar, Afghanistan, where she served as director of operations for an Expeditionary Medical Evacuation Squadron, and later to Al Udeid Air Base in Qatar. "I was not a combatant — just medical," Ritz said. "But that was pretty extraordinary, being in Kandahar." Ritz retired as a lieutenant colonel but remains humble about her career. "I wish I had made it to full bird," Ritz said. "But it was never about me — it was about the people." Ritz said she was inspired to serve by a sword that her grandfather had with an anchor on it. Her father also served as an Army reservist. That same sense of purpose led Ritz to health care. "It was kind of selfish on my part," she said. "When I started, females didn't get to serve everywhere that they do today, and health care or nursing was where you had a kind of target." Ritz became a commissioned officer through health care, serving in the Medical Service Corps while also maintaining credentials as a nurse — and, outside the military, a pilot. Her path into hospice work began during the early days of the COVID-19 pandemic. "I had met a hospice nurse from Rock River [Hospice & Home] at Parkway Center in Sterling," Ritz said. "When the pandemic kicked off, they lost all their nurses. ... That's how I got involved." Ritz credits her colleagues at Rock River Hospice, where she continues to care for patients and their families in their final stages of life. "It takes a special person to work with hospice. It's not easy," Ritz said. "Kudos to Jacqueline, my [director of nursing] /administrator, and all the rest of the nurses there at Rock River. They're wonderful people." The transition from military medicine to hospice care came naturally, although not without challenges. "The military has helped me, but it's never easy when you lose somebody — that doesn't end," Ritz said. "We treat them like family, and that's how we handle things. That's the same with the military ... you take care of each other, and it's a family thing." The Quilt of Valor, presented by the national nonprofit Quilt of Valor Foundation, is a handmade tribute awarded to service members and veterans who have been touched by war. The organization's mission is to honor and comfort those who have served, doing so with the tangible gift of a quilt — each one stitched with gratitude and recognition for sacrifice. For Ritz, receiving the quilt held deep personal meaning. War, she said, had shaped much of her military life. "Unfortunately, it's been throughout my whole time in the service, off and on," Ritz said. "You figure the Persian Gulf, I was on NAS Pensacola on a beach and going through training, and that was my first taste of what could happen. And then, of course, 9/11 was devastating. ... We all went to the base ready to go." Ritz also acknowledged the personal sacrifices made along the way. "I have to thank my children, Elisabeth and Thomas Sullivan," Ritz said. "They endured years of sacrifice as a family, and I couldn't have done this life without them." As Ritz continues her work in hospice care, she still holds a dream of returning to the skies. "My goal before I age out is to go back to either corporate or cargo flying," Ritz said. "But that's another story." For now, the quilt that Ritz received is more than just fabric — it is a symbol of a life of service, woven with honor, compassion and resilience.
Times
3 days ago
- Health
- Times
Dr Anne Merriman obituary: doctor known as ‘mother of palliative care in Africa'
Dr Anne Merriman revolutionised palliative and end-of-life care in Africa after developing a cheap form of oral morphine with a Singapore hospital pharmacist. Originally mixed in a kitchen sink, it included a pound of morphine, a preservative and colouring: lighter doses were green; stronger ones, pink and blue. A bottle cost about $2, a fraction of the cost of western formulations. Universally known as 'Dr Anne', she said: 'It's easier than baking a cake.' She developed the pain-controlling recipe after seeing terminally ill patients discharged from hospital because 'nothing more could be done for them'. Many died at home in severe and prolonged pain. 'A wild, undisciplined schoolgirl' who became a nun and a doctor, Merriman founded the pioneering Hospice Africa Uganda (HAU) in 1993 at the age of 57. Palliative care was largely unknown in Africa when she started her work in Uganda. HAU has treated more than 35,000 patients and trained more than 10,000 healthcare professionals from 37 African countries in the so-called Merriman model. Tough, stubborn and charismatic, she conceded that her 'brash and insensitive ways' had offended people, adding: 'I find it amazing that God has used this blemish as one of my greatest strengths.' It enabled her, she said, to be 'a forceful and obsessive' advocate for hospice care and to stand up to older male doctors who claimed that morphine prescribing would promote drug abuse. In her book Audacity to Love, published in 2010, she wrote: 'In Africa, in particular, some men are more dominant than in the rest of the world and don't take well to a female doctor bringing in a new speciality. 'Even today in Uganda, considered to have the best palliative care in Africa, there are consultants who refuse to allow patients' pain to be treated with oral morphine, even though sometimes these patients are their own colleagues.' Calling herself a 'true Scouser', she was born in Liverpool in 1935, the third of four children of Thomas ('Toddy'), a primary school headmaster, and Josephine Merriman (née Dunne). A bright, questioning child, she wanted to become a Catholic priest like her older brother Joseph and later wrote: 'I could not understand such discrimination and I still feel the same way.' The catalyst for her passion for palliative care emerged in childhood when her 11-year-old brother Bernard died from a brain tumour. She later spoke passionately about the absence of palliative care for him. There were other signposts signalling a spectacular future in caring. At the age of four, after seeing pictures of sick African children in a magazine, she declared: 'I'm going to Africa to look after the poorly children.' Nine years later she saw a film showing the Irish head of the Medical Missionaries of Mary (MMM) riding around the Nigerian village of Anua on a bicycle. She told her mother and a nun at school that she wanted to join the order and did so at the age of 18 after leaving Broughton Hall Catholic High School in West Derby, Liverpool. Recognising a rich potential in the wayward, recalcitrant novice with disappointing exam results, MMM enrolled her in a three-year internship at the International Missionary Training Hospital in Drogheda, Ireland. She spent a further year in a medical laboratory before going to medical school at University College Dublin. As a young doctor Merriman worked in MMM hospitals in Nigeria and in Drogheda, Edinburgh and Dublin. After 20 years as a religious sister and missionary, she returned to secular life in Liverpool to look after her sick mother and to specialise for eight years in geriatric medicine. Increasingly concerned by patients dying 'without pain and symptom control', she followed the teaching of Dame Cicely Saunders (obituary, July 15, 2005), the founder of the modern hospice movement. Saunders created a new kind of hospice, St Christopher's in Sydenham, southeast London, combining compassionate care with medical care. But Merriman's vision of a hospice was not restricted to a physical building. Hospice care, she said, could be given in the most appropriate place, including the patient's home. It included emotional, social and spiritual support as well as pain control. This made pragmatic sense in Uganda where 90 per cent of the population are reported to live in rural areas where doctors are scarce. Uganda became the first African country to permit nurses and trained clinical officers (physician assistants) to prescribe morphine; and the first African country to make palliative care part of its health service. After her mother's death in 1981, Merriman worked in Calcutta with Mother Teresa whose order included a hospice; in Penang in Malaysia as an associate professor; and in Singapore as a senior teaching fellow. In 1990 she accepted an invitation to become the first medical director of the Nairobi Hospice, only to leave quickly because of 'bureaucratic interference'. A case history she published in Contact, a World Council of Churches journal, secured her future in Africa. Describing a terminally ill patient who had a pain-free, peaceful death, it attracted invitations from several African countries who wanted to develop palliative care services. She chose Uganda as it was emerging from 25 years of war and reeling under the HIV crisis. Archbishop Emeritus Desmond Tutu (obituary, December 27, 2021) said in 2018: 'Anne has created a uniquely African template of love, dignity, care and compassion for people.' Nominated for the Nobel peace prize in 2014 and appointed MBE, Merriman protested that 'caring for the dying is the lowest priority in healthcare because doctors are trying to cure, not to care'. She lived in a large house overlooking Lake Victoria with her 'family', including three housekeepers and 15 dogs, once led by Adam and Eve. When Eve died she declared that Adam was grieving and found him a new partner. A warm, welcoming hostess, she was renowned locally for her Tuesday night dinners where 12 or more guests would include local dignitaries, visiting specialists and overnighting donors and volunteers. But she could also, as she put it, create a frosty atmosphere in a tropical climate. In one notable case, she highlighted the tragedy of Robert, a terminally ill 12-year-old boy with a huge cancer, a Burkitt's lymphoma, on his face. Robert slept under a counter in his aunt's shop and Merriman regularly took him to the hospice for a change of scene. He grimaced in pain as they drove across the many potholes along the way. Merriman said: 'After his [Robert's] death, the President of the USA, Bill Clinton, visited Uganda … They levelled the road so he wouldn't get a bump on the bum. The Roberts of this world do not count. But Presidents do. How sick is that?' Anne Merriman, doctor, was born on May 13, 1935. She died from respiratory failure on May 18, 2025, aged 90
Yahoo
6 days ago
- Business
- Yahoo
How Iran's response to Israel's strike could shake up global markets — in 5 scenarios
How Israel's strike on Iran could affect the global markets largely depends on the scale, nature and duration of Iran's response. In the worst-case scenario, oil prices may surge to $120 per barrel, according to Lazard Geopolitical Advisory. Israel-Iran clash delivers a fresh shock to investors. History suggests this is the move to make. I'm in my 80s and have 2 kids. How do I choose between them to be my executor? These defense stocks offer the best growth prospects, as the Israel-Iran conflict fuels new interest in the sector My husband is in hospice care. Friends say his children are lining up for his money. What can I do? 'I'm 68 and my 401(k) has dwindled to $82,000': My husband committed financial infidelity and has $50,000 in credit-card debt. What now? Oil prices rose on Friday, with U.S. benchmark West Texas Intermediate crude for July delivery CL.1 CLN25 up 7.4%, near $73 a barrel, after climbing as high as $77.62 after Israel launched strikes on Iranian nuclear sites and military officials. Iran retaliated on Friday by launching dozens of missiles towards Israel, the Israel Defense Forces said. Stocks DJIA SPX COMP were sharply lower Friday, but the conflict's broader impact on global markets mostly depends on Iran's response, Lazard analysts noted. They put together a list of five potential response scenarios — with the most likely one being that Iran targets Israel directly, which may lead to an increase of $10 to $20 per barrel in oil prices and an increase to the cost of energy and goods in the region, the analysts wrote in a Friday note. It's also highly likely that Iran targets U.S. military or diplomatic assets in the Middle East, which may lead to an upward swing in oil prices to $80 or $90 per barrel, according to the analysts. That poses medium to high risks to global markets, they noted. In a more severe outcome, oil prices could jump to $85 to $105 per barrel if Iran attacks Gulf oil-and-gas infrastructure, which could lead to a rise in global inflation expectations. Such a scenario looks less likely to happen compared with the previous two, Lazard analysts said. The worst-case scenario, however, would be a disruption to or the closure of the Strait of Hormuz, a key shipping route for Middle East energy exports. Read: Why the Strait of Hormuz is now a major focus of worry for oil prices and the global economy That outcome, seen as unlikely, could lead to a surge in oil prices to up to $120 per barrel, potentially causing oil-driven inflation to reach crisis levels, the analysts noted. It also could cause severe disruptions to the global supply chain, they added. Still, even that scenario would most likely be short term, as it could trigger a U.S. military intervention to reinstate the shipping lanes, the analysts said. 'He failed in his fiduciary duty': My brother liquidated our mother's 401(k) for her nursing home. He claimed the rest. Walmart's stock looks like it's in trouble. What the chart says may come next. Why bonds aren't acting like a safe haven for investors amid the Israel-Iran conflict My friend wants me to join in a political protest. I'm worried about my job. Am I a coward if I say no? 'I am getting very frustrated': My mother's adviser has not returned my calls. He manages $1 million. Is this normal?
