Q & AKay Furman QHow did you get involved with

Mission Waco?

AI wanted to work with the poor. We forget that there are people in Waco who are pret-

ty bad off. I thought I’d like to work at Mission Waco, but things didn’t work out until Jimmy Dorrell [founder of Mission Waco] spoke at my church. I decided I needed to go outside of the church, inside of the community, to see what was going on, so I signed up online and talked to the coordina-tor. I volunteer at the Meyer Center in downtown Waco where the people off the street often need psychological services. There are so many people in need and not enough hands. We stay busy.

QHow did you get involved with Meals on Wheels?

AMy pastor kept announcing from the pulpit that Meals on Wheels [at Woodway First

United Methodist Church] needed a coordinator. We had a crew but needed someone for paperwork and to be a spokesperson. I felt that it was something worthwhile to do. He was so relieved.

Q Does Meals on Wheels have another purpose besides serv-ing meals?

A People we give meals to want us to stay and visit. Human contact means as much to

them as food does. They’re lonely and I feel like the visit means the world to them. Some elderly people don’t have family nearby or know their neighbors very well. Usually just a few minutes of conversation will mean a lot to them. It blesses others and is so worthwhile.

QHow has Meals and Wheels given you purpose after your husband’s death?

AMy husband was a very good person. It was easy to love him and take care of him

because we were so close. He had a stroke in December 1995, so I took care of him. Since my husband’s death it’s always been important for me to do something that brings purpose and meaning. I have to get up and be at the church by 8. You can’t help but have structure. If you don’t have anything to do, you feel adrift. Meals on Wheels is worthwhile because I know the reactions of elderly people who get the meals. It’s not just a busy work thing.

“Human contact meansas much to them

as food does.”

QWhy should people volunteer?

AVolunteering brings a different kind of satisfaction than a job. You do it solely when you want

to with the satisfaction and the knowl-edge that you are helping people. You get a better idea of what you have. It’s not easy for most people, especially for those with physical handicaps or MR [mental retardation]. They have a differ-ent life than you do that is not always pleasant.

Q How has volunteering benefi t-ted your life?

A You get a lot more pleasure, satisfaction and joy for your-self in a way that nothing

else brings. It blesses others and is so worthwhile. I would recommend it to anyone with time to spare. It’s very fulfi lling.

Q How did you become interested in helping the poor?

A Way back in high school I always had empathy for folks that don’t have what I have.

I felt some kind of responsibility and wanted to help them so that they have dignity and respect. A lot of this came from my church background. I’ve always liked working with the poor. People with MR have no money. Most receive money from family or get $500 a month of Social Security if they’re lucky.

26

& Joanne Lux

with local volunteers

/ By Lela Atwood

-Joanne Lux

A Good Death

27

Mission Waco

Meals on Wheels

Story by Cody Winchester

Her decline was rapid. A doctor recommended discharge and home hospice care; Nina’s diagnosis was “adult failure to thrive/debility,” one of nine noncancer terminal diagnoses rec-ognized by all Medicare-certifi ed hospices. This meant, accord-ing to the doctor, that she had less than six months to live. Nina has been on hospice care for more than a year and a half now. Five months after her ordeal at the nursing home, she moved in with Lucy, who built her spacious brick home outside Axtell with patients like Nina in mind. All the supplies Lucy needs to care for Nina — diapers, pain medication, an oxygen machine, her bed — are supplied by Providence Hos-pice, one of eight Waco-based hospices and one of two that operate on a not-for-profi t basis. Additionally, a hospice nurse visits Nina once or twice a week. “It’s a blessing,” Lucy said. “Without them I don’t know how we’d do it.” The philosophy behind hospice care is often summed up as “care, not cure.” Teams of nurses, chaplains, social work-ers and volunteers work with terminal patients to maintain quality of life, providing things like pain medication, speech therapy, dietary counseling, help with housework, caretaker relief and, after the patient dies, bereavement counseling for family members. “Having people surround you, being in a caring environ-ment, being at home — but still having professional care? That’s a good death,” says Dr. Lacey Gillentine, who teaches a popular class on death and dying at Baylor University. The idea of hospice care, which dates to midcentury England, represents a cultural shift in our expectations about dying, Gillentine says. It used to be that you died at home, with your family, and people were more apt to view death as a nat-ural extension of life. Advances in medical technology meant that more dying people went to the hospital, where death is

hidden, remote, “cleansed of its organic blight,” as Sherwin Nuland, author of How We Die, puts it. Hospice offers patients and their families a greater measure of control, as well as a more holistic approach that helps mitigate the loneliness and anomie of death. “I think now we’re just trying to get back to those roots, and trying to get back a little of that comfort and control we once had,” Gillentine says. Despite this, more people still die in a hospital or nursing home than die in hospice or home care. And America is gray-ing: The population aged 65 and over is increasing at a faster rate than the population as a whole. The Census Bureau pre-dicts that a fi fth of the Texas population will be over age 60 by 2030. Hospices generally treat terminal patients of every age, but the majority are “natural” end-of-life cases (Providence puts its average patient age in the mid-70s). While the offi cial cause of death may be cancer or heart disease or pulmonary infection, with elderly people these are often merely proximate causes. In the end, our bodies simply wear out.

Providence is an affi liate of Community Hospice of Texas, the state’s largest hospice network, which sees patients in a 60-mile radius of Waco. In 15 years of doing busi-

ness, they’ve seen their average monthly patient census jump from around 90 to 231 in August. The average stay is 75 days. They treat mostly home-care and nursing-home patients — at present, they don’t have a freestanding inpatient hospice, though they do have rooms on reserve at St. Catherine Center — and as a nonprofi t they don’t turn away charity cases. Last year they provided $458,469 in charity care, and hospice staff say that number is increasing each year. In the two years he’s volunteered at Providence Hospice, 74-year-old Charles Koch has worked with close to 40 patients.

Nina Ferguson, 91, is resting in a hospital bed in her room in the home she shares with her friend and caregiver, Lucy Lupu. Nina is slender and frail — Lucy estimates her carrying weight at 95 pounds — but her eyes are bright and clear, and she thumps her chest defi antly when Lucy suggests she could be eating better. Lucy is talking about how, in early February of last year, Nina almost died. She had been staying in a local nursing home when she developed a sore on her

foot. She said the staff didn’t change the dressing for two weeks, and infection set in.

/ story by Cody Winchester / photos by Denton Ramsey

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He lives in Gholson but drives to Waco twice a week to see pa-tients for visits that last anywhere from 30 minutes to two hours. He stays as long as they want to talk, runs errands, sometimes just sits quietly with them. “All you can do is try to make it as easy and peaceful as you can, to see them through,” he says. It’s diffi cult, he says, to form relationships he knows before-hand will be cut short prematurely, but it’s helped him “see the good in people.” He was with Joe Harrison, an octogenarian with lung cancer, for three and a half months before he died last winter. Caring for Joe “touched me very deeply,” he later wrote. “We were his family,” he says. “He trusted me with every-thing he had.” Because Medicare stipulates that 5 percent of a hospice staff must be volunteers, Providence enlists the help of 35 people who, like Charles, provide respite for primary caregivers. “I don’t think that people realize how all-consuming taking care of somebody that has a terminal illness is, and the more that disease progresses, the more consuming that becomes,” says Sonya Rawlings-Aleman, the volunteer supervisor. Many Providence staff members have watched a friend or family member die, and although caring for a dying stranger is less personal than caring for a dying loved one, it’s always emotionally taxing. To cope, they meet regularly to remember former patients and hang “bereavement wreaths” on the offi ce walls. “It’s tough to say goodbye,” says Deborah Simox, a social worker. “There is a sense of loss.” Sometimes, as in Nina’s case, a pat-ient’s family is able to hire a full-time caretaker. More often, though, the task falls to a family mem-ber, often a grown child. Traditional fa-milial roles are reversed: Children feed their parents, bathe them, change their diapers. “It’s a whole new level of family dedication,” says Gillentine, the Baylor professor. Death, frequently, is a relief — for family members as well as for caregiv-ers and hospice staff. “You have to remember that when death happens, it’s not about the person who died, it’s about the people left behind,” Gillentine says. “It’s tough for them.”

Lucy, Nina’s caregiver, migrated to Texas from Romania in 1983. She is tender toward Nina, whom

she calls “mammy” and “sweetie pie” — stroking her hair, adjusting her blanket, offering a quick glass of ice water when her threadlike voice fal-ters. Lucy talks in complexly accented English but answers the phone in rapid-fi re Romanian. Her right index fi nger was severed at the fi rst knuckle when she blacked out while running a table

saw. It took about a year for Nina to warm up to her after mov-ing in, Lucy says. Both women were the fi fth of 13 children, and Lucy was married the same day as Nina’s son. (In another coincidence, Lucy’s daughter was born the same day as one of Nina’s granddaughters.) Lucy’s daughters watch after Nina when she has to visit her other patients; her 16-year-old, Deb-bie, sings to her. “We love each other very much,” Lucy says. Nina was “skin and bones” when Lucy took over her care, she says, but Lucy nursed her back to health on a regimen of rich foods: crêpes, lamb, chicken sausage, poppy-seed cakes. Now she brags about having a little fat on her belly, but she can’t get out of bed by herself anymore, and fl uctuating blood pressure causes her to pass out frequently. “Her heart feels young, you know, but it’s just her body being given up,” Lucy says. Although her greatest frustration is the loss of independence that accompanied her creeping infi rmity, Nina still fi nds delight in little things. Lucy planted a garden in the spring, and Nina took great pleasure in watching her work, offering suggestions and playing with the green beans Lucy placed on her chair tray. “I don’t want to be here, but I’m happy,” Nina says. Nina’s husband, Harold, has been dead for 13 years. Dur-ing World War II he lied about his age and joined the Army, a 14-year-old fi ghting in the Asian Theater. Nina says Harold fell ill in May of 1996 and, rather than suffer through a prolonged illness, shot himself. She looks down. Lucy begins to grow uneasy. “He learned early,” Nina says quietly.

Aside from its social benefi ts, hospice also offers a fi scal advantage, one the federal government recognized in 1983 when it made hospice a Medicare benefi t. In 2008,

for example, the inpatient Medicare charge for a hospital was

Nina Ferguson Lucy Lupu

Nina Ferguson talks about her friend-ship with her caregiver, Lucy Lupu.

$6,196 per day; for routine home hospice care, it was $149. No one at Providence would say specifi cally what they’d like

to see out of federal health care reform — at this writing, the Senate hadn’t yet reconciled its bills with the House version passed on Nov. 7 — but Director Tammera Ryan said that personally, she just wants to make sure they can still operate effectively.

“Let us take care of our patients,” she said. “Let us take care of our families.”

As hospice care for el-derly patients has become more popular, it has come to represent a greater portion of Medicare spending, a third of which now goes to terminally ill patients in their last two years of life. Last year the Medicare Payment Advisory Commission (MedPAC), a Congres-sional advisory agency, recommended cut-ting an abstruse component of the hospice benefi t known as the budget neutrality adjustment factor (soon after, Congress approved a temporary moratorium on the funding cuts).

They’re also pushing for a U-shaped pay-ment schedule in which Medicare outlays would decrease the longer the patient was on hospice care, then pay out an adjusted sum after their death. As it stands, Medi-care pays a per-diem rate that varies depending on the level of care needed. Patients must be recertifi ed for hospice eligibility at 90 days, 180 days, then every 60 days thereafter. This restructuring would especially affect patients who, like Nina, have been on hospice for a long time. According to a MedPAC report delivered to Congress in June, Medicare payments to hospices in-creased nearly 250 percent between 2000 and 2007. Much of this they attributed to patients staying on care longer. Nina says she’s not afraid of death, though she’s not ready to go just yet. The longest-living member of her family, she wants to make it to 100. “I don’t really have regrets,” she says. “I just didn’t do enough.” As Lucy fetches Nina’s glasses and places them carefully on her face, Nina blinks slowly, owl-like, and smiles broadly. Her voice is clear.

“I can tell you one thing: I’ve had a good life. A good life.”

and 2007. Much of this they attributed to patients staying on care longer. Nina says she’s not afraid of death, though she’s not ready to go just yet. The

$6,196 per day; for routine home hospice care, it was $149. No one at Providence would say specifi cally what they’d like

to see out of federal health care reform — at this writing, the Senate hadn’t yet reconciled its bills with the House version passed on Nov. 7 — but Director Tammera Ryan said that personally, she just wants to make sure they can still operate

Senate hadn’t yet reconciled its bills with the House version passed on Nov. 7 — but Director Tammera Ryan said that personally, she just wants to make sure they can still operate

represent a greater portion of Medicare spending, a third of which now goes to terminally ill patients in their last two years

sum after their death. As it stands, Medi-care pays a per-diem rate that varies depending on the level of care needed. Patients must be recertifi ed for hospice eligibility at 90 days, 180 days, then every 60 days thereafter. This restructuring would especially affect patients who, like Nina, have been on hospice for a long time. According to a MedPAC report delivered to Congress in June, Medicare payments to hospices in-creased nearly 250 percent between 2000 and 2007. Much of this they attributed to creased nearly 250 percent between 2000 and 2007. Much of this they attributed to

blinks slowly, owl-like, and smiles broadly. Her voice is clear.“I can tell you one thing: I’ve had a good life. A good life.”

“I can tell you one thing: I’ve had a good life.

A good life.”

30

- Nina Ferguson

Lucy Lupu helps Nina Ferguson into a chair.

Parents of Premature Babies Inc.www.preemie-l.org

Heart of Texas Autism Networkwww.hotautismnetwork.org

Baylor Autism Resource Center(254) 710-6222autism@baylor.edu

Rapoport Academywww.rapoportacademy.org(254) 754-8000

Methodist Children’s Homewww.methodistchildrenshome.org(254) 753-0181

Habitat for Humanitywww.wacohabitat.org(254) 756-7575

World Hunger Farmwww.worldhungerrelief.org(254) 799-5611

Waco Arts Initiativewacoartsinitiative.blogspot.cominfo@Wacoartsinitiative.org

Family Abuse Centerwww.familyabusecenter.org1-800-283-8401

Look Good…Feel Betterwww.cancer.org(877) 227-1618

Mission Wacowww.missionwaco.org(254) 753-4900

Meals on Wheelswww.mowaa.org(703) 548-5558

Providence Hospicewww.providencehospice.org(254) 399-9099

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Contact this issue’s nonprofi ts to get involved