Spring (Vol. 11, No. 1) - San Francisco General Hospital Foundation

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S a n F r a n c i s c o G e n e r a l H o s p i t a l F o u n d a t i o n N e w s
Palliative Care Service
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with the purpose of that room. She was there for several days before
she died.
“Even though she didn’t have family to be with her, she was
comfortable from a physical and emotional standpoint. Our staff
visited with her and held her hand. It was so powerful to see the high
quality of care someone could get, even when she was all alone.”
But usually people who receive Palliative Care Services are not alone.
“A person’s life affects those around them. Often the way that people
address illness is as a family unit,” says Kinderman. “Our service
helps families. People have been able to die here with their loved ones
around them.”
Epperhart recalls one patient who was taken out of the hospital’s
acute setting to live out her last days in a comfort care suite. Family
members were able to sleep in the room and be with her round the
clock.
“I went in late one night and saw about 20 family members around
her bed. They brought lots of food and were able to spend her last days
with her,” Epperhart says. “Four generations were there, including
great-grandchildren. It was important for the children to come to
a place that didn’t look like a hospital room. We gave this woman
respect and dignity, and she died as she lived, with people around.”
In addition to providing a space for family members to be, the
Palliative Care Service helps them communicate with medical teams
and connect with social service programs throughout the city.
“We have helped to fill in some significant holes for patients and
families,” says Kinderman. “Often after someone dies, there’s very
little structure in place to help support the family. We’ve been able to
provide support and continuity for families that are grieving and trying
to navigate a complicated system after their loved ones have passed.”
“Our goal is not only to provide excellent
direct patient care, but to share those
methods with other institutions.”
As with all SFGH programs, cultural sensitivity and competency are
critical components of the Palliative Care Service. Different cultures
bring different views and traditions to the end of life. A recent survey
found that, at the end of life, affordability of care is a top concern
for Asians and Latinos; for African-Americans the concern is about
finding providers who respect their culture; and treating pain and
discomfort is paramount for Caucasians.
“It’s so important to have awareness of different cultures,” says
Epperhart. “About 40 percent of our patients have limited English
proficiency. We work very closely with our interpreters. We have
to understand that in certain cultures it’s not the patient who’s the
decision maker. It can be the spouse or children. That’s part of their
tradition.”
Just as important is the spiritual component of the Palliative Care
Service. In February, chaplain Eric Nefstead joined the Palliative
Care Team.
“Part of human dignity is about making choices that are true to your
spirit. The work of our team is to try and help people do that,” says
Nefstead. “We listen to patients’ hopes and fears. As they give of
themselves, it helps us give of ourselves and then the world is freed of
some fear and pain. We can all recognize the joy of living even in the
sad moments of our dying or that of our loved one.”
Nefstead, who has been working in end-of-life care for 15 years, says
he wears two hats as the Palliative Care Service chaplain. First, he is a
clinician who works directly with patients.
“Many of the people we serve at San Francisco General have
experienced trauma in the form of poverty, immigration and
substance abuse. That can make them afraid and distrustful of
others,” he says. “As a chaplain, I can help them find their own voice
and desire amidst the bigger system.”
Regina Epperhart, MSW, Social Worker; Caroline Maroten, RN, NP;
and Anne Kinderman, MD, Director, members of the Supportive and
Palliative Care Service, SFGH discuss patient care strategies.
Nefstead is also a teacher in the SFGH Clinical Pastoral Education
program, training those who provide spiritual services at SFGH and
beyond.
“Part of what I teach theological students and religious leaders is how
to listen attentively to people near the end of their lives. As spiritual
leaders, we can help people discover their own spiritual resources as
they face the reality of their death,” he continues. “Then when our
students leave here, they can bring what they’ve learned to others in
other hospitals.”
In fact, just about every aspect of the Palliative Care Service is seen as
a teaching opportunity.
“Our goal is not only to provide excellent direct patient care, but to
share those methods with other institutions,” says Kinderman. “We
can show others around the world what people can experience at the
end of life.”
There is a strong practical element to palliative care, too. While over
half of Americans express a preference to die at home, only onequarter
do and approximately one-half die in a hospital. As a result,
end-of-life care is costly, consuming 10 to 12 percent of all healthcare
costs and the majority of Medicare expenditures in the year prior
to death. With palliative care, the most appropriate services are
provided to each patient, often instead of invasive and unnecessary
medical treatments.
While the Palliative Care Service is a recent addition to SFGH, it
is already receiving a warm reception. Early predictions were that
services would be provided to about 150 patients a year. At the time
of this writing (three months into its existence), the program has
already served more than 70 patients.
“In a short amount of time, we’ve been able to dramatically
improve the level of care that people receive at the end of life,” says
Kinderman. “That’s had a visible impact on patients, family and staff
across the hospital.”
“What’s great about working with the palliative care team is that
each person brings a spirit of appreciation for the fullness of life,”
adds Nefstead. “No one is just a doctor or nurse here. Everyone is a
humanitarian.”