A coordinated approach to end-of-life care

Marie Nenna was a people person. She loved to sing, dance, volunteer in the community and especially, cook for her family. Even at age 86 and living in a memory care facility, nurses would tell you she was the friendliest person in the room.

“She really loved people,” says Philip Nenna of his mother. “When we were younger, everyone we knew wanted to come over and have dinner at our house. They knew they'd get a good meal,” he jokes.

Marie was diagnosed with Alzheimer’s disease eight years ago. Despite being in and out of the hospital over the past few years, she still loved to participate in activities and social events, Philip says.

In late September, staff at the memory care facility told Philip that his mother had been taken to Sharp Grossmont Hospital after an incident related to her condition occurred. He got a call from the emergency department (ED) later when her condition worsened.

“‘Your mom is here. You need to come because she may pass,’" Philip recalls the doctor saying to him. “It was shocking because we had just visited her a couple days earlier and everything was good.”

Choosing comfort and quality of life

Dr. Gregory Thomas, a hospice and palliative medicine physician at Sharp Grossmont Hospital, says Marie wasn’t able to communicate when she arrived at the hospital. She showed a serious decline in physical and mental ability.

Along with being very thin, these signs and the effects of the incident indicated a life expectancy of far less than six months, making her eligible for hospice.

“One of our goals in end-of-life care is to talk about patient values and not so much the obvious question of whether someone wants to live,” Dr. Thomas says. “Instead, we ask how patients want to live within the context of a disease or the situation that they're going through. It was important for us to communicate that with the family.”

Despite wanting to see her improve, Philip and his wife, Olivia, told ED physicians that his mother had been very clear she did not want to be resuscitated.

“I remember asking, ‘Is there anything we can do?’” Olivia says. “But because of her age and weight, anything they tried could be devastating to her body. They told us they didn't know if she had hours or days, but that it was about her quality of life.”

Coordinated care and compassion

“Nurses treated her with so much love while our family was together comforting her and preparing for what was next,” Philip says.

After one night in the ED, Sharp HospiceCare arranged for Marie’s transfer to its LakeView hospice home in nearby La Mesa, where she was cared for and given medication for pain management.

“It was a terrible time, but everything about hospice was great,” Philip says. “They lined everything up and were so helpful and caring. Anytime something changed, and we weren’t there, they would call and let us know what was going on.”

Dr. Thomas credits early and frequent communication across several teams for the quality care Marie received. He recalls that the ER physician had already started comfort-focused care based on the family's wishes before he became involved.

“The nursing staff assessed symptoms and appropriately managed them until the patient could be discharged from the ER,” Dr. Thomas says. “And Sharp HospiceCare staff were efficient in getting transportation set up to the hospice home. This approach allows us to deliver care that aligns the values of each patient and their family.”

Marie passed away three days later, surrounded by family. They say they’ll remember her for her strong will, even in her final days, and the care she had for others.

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