Being in control is not a feeling we associate with dying. Yet, as anyone who has nursed a loved one through a terminal illness knows, the freedom to make even small decisions at the end of life can be the difference between dignity and despair.
James G. Kavanagh was an ex-Navy man - the kind of guy used to calling the shots. When the 87-year-old's prostate cancer metastasized, Kavanagh's family took turns caring for him in shifts so he could remain at home where he felt comfortable and in control.
"I slept on the floor next to his bed so I could help him if he needed anything in the middle of the night," says his daughter, Kathy Kavanagh.
When Kavanagh's pain got too intense to manage at home, his daughter was grateful that he could go to the Bruns House - a unique hospice facility that combines the best of top-notch hospital care and a home environment.
"We talk to patients. We ask them what they're afraid of," says Delisa Sanui, inpatient facility manager. "Often they're afraid they'll be in pain or they won't be able to breathe. We tell them what we can do and we come up with a whole plan. Then we put the plan into effect so they won't suffer, so they won't have pain."
"The most important thing is that they listen to the patient," says Kathy. "As long as the patient has a breath, he is in control."
In Kavanagh's final hours, the staff not only listened to him, they almost sensed his needs.
"The last night his pain level soared," says Kathy. "They worked so hard. There was this young nurse and, even though my dad was asleep, she noticed the tension in his expression. She sat by his bed and massaged above his eyes. She did that for an hour."
That's one example of the type of care for which the Bruns House is known. Founded in July 2004 by the Hospice and Palliative Care of Contra Costa, Bruns House was designed to provide another option, rather than a hospital or home care, to families caring for dying loved ones.
With typical hospice care, the nurses and staff go to the patient's home intermittently to provide medical and other care, but the patient's family and friends or hired caregivers are primarily responsible for the bulk of the patient's care.
"At the end of life, 24-hour round-the-clock care is often required, and it's really difficult for the family," says Sanui, who has 10 years of hospice experience. "When a family comes here, they can step back and be family. The nurses provide all the care, and we have a doctor who comes in daily so there is a lot of medical supervision and continuity of care.
"What I've really noticed is a huge difference is that the families are able to process their grief differently," she continues. "They're able to address end-of-life issues much better than they can do when they're at home, awake 24 hours a day providing all the hands-on care. It's a big issue, and here we spend a lot of time helping them go through the whole dying and grieving process."
The traditional alternative for an overwhelmed family or a patient who needs more intense pain management than can be provided at home is for the patient to be admitted to a hospital. While hospitals can meet medical needs, they aren't typically prepared to deal with the myriad of emotional and social needs of the dying and their families. Hospitals also have rigid rules about visiting hours, food allowed and no-pet policies that can be upsetting to patients and families already going through a stressful time.
"We wanted some place home-like for patients to go at the end of life where they could receive care (comparable to a hospital)," says Cindy Siljastrom, CEO of Hospice and Palliative Care of Contra Costa.
There are a few other similar hospice facilities in California, but Bruns House is the only place of its kind in the East Bay. Bruns House is named for Lt. George H. Bruns III of Lafayette whose family donated substantial funding for the house through the Lt. G.H. Bruns III Fund. It was established after Lt. Bruns died in 1967 while serving in the U.S. Air Force.
"It was definitely needed," says Siljastrom. "The first year we served 265 people."
Most of the patients' costs are paid by Medicare, Medical, or private insurance companies.
From the outside, the Bruns House looks like any other home on the residential block in Alamo. It's a cream-colored ranch house with green trim, lots of trees, and inviting chairs on the front porch. A welcome mat beckons the visitor inside to a comfortable living room with a big screen TV, a huge spotless white kitchen, and a garden in the back with a fountain, roses and a barbeque shaded by a trellis. There are six private, well-appointed rooms for patients.
The Bruns House is staffed with a registered nurse 24 hours a day, licensed nurses, a home health aid, a cook/housekeeper and social workers and chaplains who visit the home.
"The cook provides food for patients. Families can bring in their own food and cook, too," says Sanui. "Sometimes they want to gather and cook a big family meal together - maybe the patient's favorite meal or secret recipe. Little things like that can help families a lot.
"We try to make it a family affair. That's one of the biggest benefits here. Like a birthing center, this is a place for families who are having a dying experience. We treat the whole group together."
"I think one of the most important things about the Bruns House is that they don't just support the patient, they support the whole family," says Kathy Kavanagh. "The whole time I was taking care of (my father), my daughter role had completely evaporated. I was too busy being the caretaker.
"At Bruns House, I could relax and just sit by the bed and hold his hand. It took the terror away that I might have missed something that I wouldn't have known to do. That was the best gift they could give me."
Shannon Rightmire has such nice memories of her grandfather's last days there that she plans to volunteer at the Bruns House. "When you walk in there, it's your house, too," she says. "The people were so great. They treated him just like he was their grandpa. They would sit next to him and keep him company. My grandfather loved fried chicken, so they'd make that especially for him. He still liked his wine, so he had that, too."
Food preferences are one way that the House caters to patients. "They get what they want to eat. We don't worry so much about nutrition as we do what the patient wants," says Sanui. "They can eat chocolate cake three times a day, if that's what they want. They can drink wine or beer - anything they want they can have (with doctor's permission).
"One woman ate only chocolate ice cream. She was too ill to speak, but her eyes would light up when you asked her, 'Do you want some chocolate ice cream?'"
Bruns House also allows pets, which can be a great comfort to patients. "We've had cats and dogs visit. One lady was a little confused and would get agitated, but her family would bring her poodle and as long as he sat in her lap, she was fine," said Sanui. "One patient even had her horse visit her in the back yard!"
The staff is surprisingly cheerful, considering their work.
"The way I look at it when I come to work, is I'm going to make the dying process easier for someone today. I don't look at it like a patient's going to die today," says Sanui. "You can see someone peacefully slip away without pain or agitation. I know that I have the power in me to make that difference. To make sure they're not suffering; to empower them to make their own choices and take care of unresolved issues; to make sure they get to die the way they want to die."
Kathy Kavanagh believes that philosophy made all the difference for her father. "The care they gave him was just amazing. He felt safe," she says. "Like it was finally OK to give up and let go and stop charging through. He really went in a peaceful way."
<b>About Bruns House</b>
* Admissions: All admissions to Bruns House require a physician's order. Referrals are taken on a first-come, first-served basis. For more information, call 887-5678.
* Types of care at Bruns House
- Pain relief and symptom management: Skilled medical and nursing assessments and interventions to control symptoms such as pain, nausea, anxiety, shortness of breath, seizures or complicated wound dressings.
- Imminent death: The best care possible during the final phase of life.
- Transitional care: Teaching caregivers the necessary skills to prepare for discharge of the patient to home or an extended care facility.
Read the full story here Web Link posted Friday, September 30, 2005, 12:00 AM