School of Nursing and School of Medicine
Martha Henderson practices as an adult nurse practitioner and geriatric nurse practitioner through the Program on Aging at the University of North Carolina–Chapel Hill (UNC). A self-proclaimed “end-of-life care facilitator,” she helps fill the health care and communication gaps often faced by the chronically ill elderly. Henderson is a Project on Death in America faculty scholar. Her special area of expertise is advanced care planning. Her doctoral dissertation, Beyond the Living Will, explores results from a study showing that discussing end-of-life preferences lowered death anxiety in a sample of retirement community elderly.
Generally, the patients Henderson serves have fallen through the cracks, being ineligible for home care and hospice, and have advanced chronic illness, such as end-stage heart and lung disease, dementia or cancer. Because their prognosis and trajectory for dying is fairly uncertain, they may not meet hospice’s six-month criterion. In addition, many of Henderson’s patients do not see themselves as terminally ill. Henderson also cares for people who home health won’t see because they can’t meet the strict criterion of being homebound.
Delivering the Basics
Referrals to Henderson come from hospice, primary care providers, friends, nursing colleagues and through UNC’s Program on Aging. The amount of care given depends on patient need. Some of Henderson’s patients are stable and require only monthly visits. When patients are unstable or actively dying, however, Henderson may see them frequently or may refer them for hospice care.
Henderson is supported by the UNC’s Department of Medicine, which donated 20 percent salary for her position to care for chronically ill adults who don’t qualify for hospice or home care but need additional assistance to improve their quality of life. Although Henderson has had the financial support of the Program on Aging and the UNC Department of Medicine, the lack of full reimbursement for her time through Medicare Part B makes long-term support for her position an uncertainty. Currently, she receives reimbursement for about 50 percent of her time. Thus, some of her “behind the scenes” telephoning to family and physicians, work with the family and coordination of services is not reimbursed.
Focus on Education
“Our evidence of success is the satisfaction of patients and families,” Henderson says. “Each family completes an evaluation after the death of their loved one. These evaluations are always very good and show the family’s gratitude.” Physicians also seem satisfied with Henderson’s efforts to improve patient care. “As long as I keep communicating with doctors about important changes in their patients, they are always very appreciative of the care I provide,” she notes.