“No one’s doing a good job with end-of-life care,” asserts Matt Loscalzo, director of patient and family services in the oncology center. “Not even the Buddhists. So far, not one academic medical center has designed a broad initiative that cuts through all divisions and integrates research, education and clinical programs. No one has figured out how to pay for it, how to support it and integrate it into overall care.”
To bring up the level of care for the dying, a few major foundations are focusing resources on this endeavor. Chief among them is philanthropist George Soros’ Open Society Institute and its Project on Death in America (PDIA), which supports professional practices and education related to end-of-life and bereavement.
Loscalzo is working under just such a grant to prepare family members to become caregivers during the period just prior to death. Meanwhile, pediatrician Nancy Hutton is one of only three dozen or so PDIA faculty scholars in the United States, an elite group developing mentoring and other programs at leading medical centers to teach staff skills for working with end-of-life patients and their families. Hutton, who established a primary care service for babies of HIV-positive mothers at Hopkins, is receiving $70,000 for up to three years to put together a comprehensive model of end-of-life care for children with HIV and AIDS.
Great Britian is about a decade ahead of the us, but as funding sources for such initiatives multiply, hospitals throughout the nation are beginning to develop programs in palliative care. A few, like Northwestern, have both a consult service and an inpatient unit. Beth Israel in New York City is one of the first to establish an entire department of pain and palliative medicine.
With the palliative care committee here now clearly in the spotlight and permeating every part of the Hospital, “Hopkins,” says Loscalzo, “has a unique opportunity to grab the brass ring by creating a model program.”