Hospice care is a form of palliative care that focuses on pain and symptom relief, comfort and quality of life. Services are provided by a specialized medical team and generally available to those with a life expectancy of six months or less. We believe that we are all entitled to care that relieves pain and symptoms without prolonging life, nor hastening the end of life. We believe that each person, each family, is unique and that hospice care can help give meaning and quality to a patient’s final days and to family members or friends who are providing care.
The medical team is an interdisciplinary team of specialists including nurses, social workers, spiritual counselors, home health aides, volunteers and our own Medical Director who works with both the patient’s primary care physicians, and the patient and family itself.
Where is Hospice Care Provided?
You stay in the comfort of your own home in familiar surroundings, and Hospice Maui specialists tend to you there as often and as long as needed.
Who is Eligible?
The basic criteria for our services are:
- Prognosis of six months or less*
- Must live in our service area (Maui Island, except the Hana region)
- Must not be pursuing curative or life-extending measures
- Must have adequate caregiving in place**
Cancer, ALS, Stroke and HIV/Aids patients have all been served by Hospice Maui. We also provide services to patients with end-stage diseases such as Alzheimer’s and Dementia, Parkinson’s Disease, Cardiovascular disorders, Renal, Liver and Lung Diseases.
Early intervention with Hospice Maui care can lead to improved pain and symptom management, and much greater quality in the remainder of a patient’s life, regardless of how long that might be.
*No one can accurately predict how long someone might have to live, even skilled medical professionals. There are times when a patient’s condition stabilizes to a point where they may be discharged from Hospice Maui. Similarly, if a patient lives beyond the initial six-month prognosis, they can continue to receive services as long as their doctor re-certifies that they are still terminally ill.
**While we don’t have a requirement that someone have a 24 hour caregiver at the time of admission, they must have a solid plan for caregiving that can be implemented when we determine that the patient is no longer able to care for his/her daily needs. Sometimes that means just a few days of care, and sometimes that means months.
Who Pays for Care?
Hospice services are covered by major insurers such as HMSA, Kaiser, Medicare and Medicaid, but the reimbursement does not reflect our actual costs. There is always a shortfall between the daily cost of services rendered and the amount received from nurses. Plus, we provide hospice care to all those who are eligible regardless of whether they have insurance or whether they have the ability to pay. When there is no source of payment, we use funds from community donations to help cover the cost of care.
What is Not Covered?
Treatment that focuses on a cure or extending life, and diagnostic procedures that are not needed for comfort care.
Who Refers for Hospice Care?
Anyone can make a referral: physicians, family members, patients and friends can call us.
Our Intake Coordinator will gather information and contact the physician to ensure that hospice care is appropriate. Then a nurse and social worker will schedule a home visit to explain services, assess the specific needs, and answer any questions. Patients are brought on to our service as expeditiously as possible.
Stories from Our Patients
Remembering Duke Enomoto July 10,1936 - February 26,2008
Gulstan Napoleon Toshisuke Enomoto, Jr., known as Junie to his siblings, Uncle Junie to nieces and nephews, Toshi to his schoolmates and then in adulthood, just plain Duke. He once said his father should have kept it simple and just named him Sue.
A real son of the islands who loved all things Hawaiian, Duke was the second of 11 children born to Toshi and Anne Enomoto. Following graduation from St. Anthony he spent some years away from Hawaii in the Air Force, graduating from college and working for the Federal Government. He returned to Hawaii as a government employee to audit the University of Hawaii at Manoa, and a few years later he became Director of Administrative Services at Maui Community College. Duke ran a tax consulting business for 35 years and was still an MCC employee up to just a month prior to his death.
Duke was diagnosed with lung cancer in March 2006 and given 4 months or longer to live. Following a frank talk with his doctor, wife Rowena, and family members, Duke decided against treatment. Rowena told Duke at the time that she would support him 100% in whatever he decided.
Duke personally called Hospice Maui some months before utilizing our services in order to determine exactly what it was we would provide. One of our teams visited Duke and Rowena and was surprised at Duke's vigor and health. He was still working at the time, doing yard work and other chores around the house. Later that year when our nursing and social worker team got to know him they realized that, as in all things pertaining to this transition, Duke wanted to know what he and Rowena should expect, and to be as prepared as possible.
Rowena and Duke shared a great love. Although they met when they were older and neither had been looking for a new relationship, they packed a lifetime of love, happiness, spirituality, song and joy into 15 wonderful years. Rowena said, "We were best friends that loved each other deeply and found such joy in just being together". One of Rowena's favorite memories took place about a year after Duke's diagnosis when they were doing heavy yard work and loading a truck in the backyard. A sudden downpour left them both totally drenched, soaked to the skin. Instead of fretting about the rain and the mess, they laughed joyously and hugged each other.
In September of 2007, Hospice Maui was invited into the Enomoto's home. Social Worker Merlyn Hanada, and Nurses Gitti Crespo, Luciana Baccarat, Donna Kroetsch, Monika Bechert and Sandy Viloria, had the privilege of assisting Duke and Rowena as he faced the most mysterious and awesome transition of his well-lived life. Duke was a very spiritual person and said to Rowena just a few months before he died, "Just think, I'm going to get to see what we've all been wondering about all our lives." He was totally accepting, totally welcoming and knew he was going home to God.
Rowena said Hospice Maui services were so inspiring "not only because the personnel were perfect in everything they said and did, but that they also came in with so much love and compassion for the family." She stated that "hospice work was a calling, not a service, and the nurses became like their family." Rowena also said that the two years she and Duke shared during his death and dying were a tremendous gift to both of them and she will never be the same again. Rowena's cousin Carmela who was with Duke during his final moments, was so moved by the experience and the quality of compassionate care by the hospice team, that she just completed Hospice Maui's Spring 2008 Volunteer Training Class.
Duke and Rowena were both singers with beautiful voices and met when they were singing. Shortly before Duke's death, Rowena asked him how he would come back to her. "Easy," he said, "In a song." And he has, many, many times.
27 November 2007
The purpose of this letter is to express my mana'o relative to my pending death. My name is Gulstan "Duke" Enomoto, 71 years old, Maui born and raised.
On March 12, 2006 I was officially notified by my oncologist that I had a cancerous lesion in the center of my left lung consisting of squamous non-small cell cancer cells, and because of the size of the lesion, removal by surgery was not recommended. Chemo and radiation therapy were recommended.
I asked my oncologist how much time I would have if I did not take any treatment and he informed me I could die within four months or longer.
After serious discussions with my wife, children and siblings, I decided not to take any treatments. My decision was based on my trust and love in Akua-- The High Source. By completely placing my life in Akua, I have been blessed with continued quality of life since my decision. The fact that I am still alive is a clear revelation to me of Akua's love and mercy. I am not afraid of dying, fully knowing I am dying, because I know that when my time comes, it will be because Akua is calling me Home.
I pray that by sharing my mana'o, the reader will seriously think about the specific situation. It is not easy for anyone to face the reality of being told they have a terminal illness. Like me, the person is faced with a range of emotions from fear, hope, anger, despair, and depression.
This range of emotions is natural, since the person has never faced this situation before. I believe, however, there is a way to meet this crisis in a logical manner. One, from the time a person is born they realize their life will end in death. By facing this reality, realistically, the person must conclude their time is coming to an end earlier. If the person has experienced in his/her lifetime a religious or spiritual relationship than this is the best time to reconnect with your religious beliefs and seriously take the necessary action to resolve all of the emotional issues. Like me, you will feel the peace of Akua and be fully comforted in Akua's love.
Me ke aloha Pumehana,
-- Uncle Dukie
Mary Crockford October 18,1930-March 27, 2009
I was diagnosed with Chronic Lymphocytic Leukemia in 1995. The leukemia did not affect my life for years. I was able to travel all over the world, conduct children’s tours at a botanic garden, and have a busy, happy social life.
However, about 3 years ago I began to have serious health problems. I had a six day stay in a hospital after lung surgery, and another five day stay when I picked up a bacterial infection. For the first time, I needed six months of chemotherapy. The chemo knocked down the CLL temporarily but also left me with little energy.
Two years later I moved to Maui to be near my son, Scott. The leukemia had worsened and I needed monthly chemo treatments plus monthly blood transfusions, IVIG injections and shots. I did this for a year but, after much thought, I made the decision that I did not want to continue with the treatments.
I signed up with Hospice Maui. Beginning with my first visit with hospice workers I felt safe. My biggest fear had been that I would end up in a hospital, full of tubes, being kept alive artificially. Now I can relax and take what comes knowing that I am in caring hands.
My oncologist told me that I did not have much time left so I asked my two sons on the mainland to visit me. When others heard of my situation, my granddaughter, sister, nephew and close friend and her daughter also decided to come to Maui during a two week period. I think I got an enormous adrenalin boost from all the excitement, and I felt and looked well the whole time. I was pleased that the last time many of the people I love saw me, I looked like my old self and not like a sick old lady.
One night, all of the them were here at the same time along with Maui family and friends. We had a pizza picnic at Kamaole Beach Three. It was an amazing evening and I sometimes felt that I was attending my own funeral even though I was alive and able to hear all the nice things that people were saying about me. It was incredibly heartwarming. I was also able to meet with individuals and small groups for lunches, dinners, conversations and much laughter. It was a joyous time and gave me an enormous sense of peace, happiness and completion.