Art Buchwald's parting shot.

Any humorist or comedian likes to have a parting shot. In Art Buchwald's case, his parting shot was actually a shot in the arm for the hospice industry. Buchwald was, of course, the syndicated newspaper columnist who for decades offered a humorous take on politics and personal life. His clinical history was somewhat unusual, although perhaps not so much so for long-term care providers who are used to the odd ups and downs of geriatric health. Having admitted himself to a Washington, D.C., hospice last year after deciding against dialysis for his failing kidneys at age 80, he ended up signing himself out of the hospice after five months. His condition had improved sufficiently for him to live at home and even write a book about the experience (Too Soon to Say Goodbye). He eventually did pass away January 17.

What was noteworthy about the man who, throughout his writing career, had needled the most powerful men in the world, including Presidents Eisenhower through Bush 2, is that he had nothing but good to say about his hospice experience and about hospice in general. He called his five-month stay in the hospice the "best time of my life," and made it his stated goal to have "hospice" become a household word.

It isn't quite yet, and for a variety of reasons--and not just because many Americans simply haven't tuned into the concept. Hospice has not been explained much to Americans diverted by other things but, more to the point, it has not been an easy fit for many nursing homes. Although it would seem to be a natural for facilities accustomed to seeing residents become terminal and die, the formal hospice approach--particularly that supported by Medicare--comes laden with administrative and financial challenges. Contractual relationships with hospice providers are strictly regulated, adequate Medicare and Medicaid (for the dually eligible) reimbursement is not a certainty, and developing close teamwork between facility and hospice staffs can pose difficulties.

And yet, when all is said and done, what better way to foster a facility's caring image--and reality--than to provide a warm, attentive, even humorous environment for a resident's final days. Art Buchwald was said to have conducted on ongoing, if quiet, party during his hospice days. He may not necessarily have been alluding to institution-based hospice care alone in his praise for the experience, but the spirit of his parting shot still applies. He left this world with a smile, and for that reason alone, nursing homes may well want to review their opportunities in this field.

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BY RICHARD L. PECK, EDITOR-IN-CHIEF