01/18/05

LC050118

Val Zavala>> Tonight on Life and Times --

Hospice care is meant to comfort dying patients, so why do
people wait until their final days to use it?

Marguerite Hirsch>> Here we all hug each other and we show our
love. In a hospital, it's just a business to them. It's a job.

Val>> And then, where can you go to see the world's greatest
dramas performed by classically trained actors? Why, Glendale,
of course, on the stage of "A Noise Within".

All that and more straight ahead on tonight's Life and Times.

Life and Times is made possible through the generous support of
the L.K. Whittier Foundation dedicated to improving the quality
of life by supporting innovative endeavors in the fields of
medicine, health, science and education.

And by a generous grant from Jim and Anne Rothenberg.

Val>> It can make the end of life more dignified, more
comfortable and more compassionate, so why do so few American
families take advantage of hospice care? And why do they wait
until the last minute to put a loved one in hospice? Well, it
has to do with our doctors, our Medicare policies and families
themselves. Stephanie O'Neill Noe met one family in the Valley
that's making some big decisions.

Stephanie O'Neill Noe>> For ninety-four year old Marguerite
Hirsch, this San Fernando Assisted Living facility is home.
Hirsch, who is in poor health, moved here in November and plans
never to leave for a hospital stay no matter how ill she
becomes.

Carol Rees>> "You've been doing really good. You've really
improved since the last time I saw you."

Marguerite Hirsch>> "Yes."

Carol Rees>> "Yes, especially in your spirits."

Stephanie O'Neill Noe>> Hirsch, who has a serious heart
condition, is among the nearly one million terminally ill
Americans who annually opt out of traditional medical care and
are instead embracing the lesser-known option of hospice.

Carol Rees>> The goals of care are not for a cure in the
physical sense. You don't have the hope of getting better, but
you have the hope of having a good life.

Stephanie O'Neill Noe>> Carol Rees is a hospice nurse for
VITAS, one of nation's oldest and largest hospice providers.

Carol Rees>> We try to diminish or minimize as much as we can
the suffering that people endure and make the experience as
positive as possible. But if you have decided that you would
rather live a normal life without having to be poked and prodded
and going into the doctor every day or on a machine for three
hours a day or permanently, then we're here for you.

Stephanie O'Neill Noe>> Those who choose hospice receive care
from teams comprised of nurses who visit as needed, a doctor who
oversees care, home health aides who assist in daily tasks like
bathing, social workers who provide counseling and clergy who
offer spiritual guidance. Patients like Hirsch are provided
basic care at their home such as medication to ease suffering
and pain, but they are not given life-prolonging procedures.
However, Rees says, the patient can decide at any time to go
back to traditional medical care.

Carol Rees>> I tell people you turn over every rock. You have
a right to rescind your hospice. There's nothing marrying you
to this program. You can change your mind in an instant and we
will refer you back to your doctor and make sure everything is
in place. If you come into hospice and, oh, you here about
something, you can change your mind and come back when you're
ready, when you find out that either it worked, it's wonderful,
or it didn't work and welcome back.

Stephanie O'Neill Noe>> Still, Rees says, many people fear the
idea of hospice. Is there a stigma associated with hospice?

Carol Rees>> A lot of times, the first thing that people feel
uncomfortable with us coming is because here they come, that
means I'm dying. Whereas, you're living. You're still alive.
We're here to help you live. That is the hardest thing for the
families to come to grips with is to allow themselves to keep on
living while they're still alive, and the patient, but it works
out really well with the team that we have.

Nancy Griffin>> Let's face it. Our culture doesn't have a very
open and honest attitude towards dying. It's been a taboo
subject. Families don't talk about it.

Stephanie O'Neill Noe>> Nancy Griffin is the West Coast editor
of the American Association of Retired Persons Magazine which is
working to improve the availability of hospice care in the
United States.

Nancy Griffin>> With high technology and the orientation of
doctors to always try to extend the lives of their patients,
it's very hard for those patients and doctors and their families
to find that point where, you know, enough pain has been
endured, enough attempts have been made to save the life and to
just say, okay, what we want to do now is to allow the patient
to go home and enjoy comfortably the last days or weeks or
months of the patient's life.

Stephanie O'Neill Noe>> What's more, in order for a patient to
qualify for hospice coverage, two doctors must declare they have
six months or less to live, something many physicians are
hesitant to do. That's in part why fewer than half the number
of people who qualify for hospice care actually receive it.
Instead, a majority of the terminally ill die in hospitals.

Nancy Griffin>> There are a number of factors for why it's not
larger, which include physician training. Physicians are
trained to cure patients rather than to administer palliative
care and help them die in a comfortable way. It includes
attitudes of families who think that hospice means giving up and
they don't want to let go and admit that the patient is going to
die.

Stephanie O'Neill Noe>> Moreover, many Americans remain unaware
that both Medicare and most private insurance policies provide
full coverage for the service. That was welcome news for
Hirsch's daughter, Louise Kares. She says that, without the
service, these last months of her mother's life would be far
more difficult for everyone.

Louise Kares>> I would worry a lot more. I was always worried
about her before. Now I know there's someone around that will
take care of her. I can go on vacation for a couple of days and
not worry about her all the time.

Carol Rees>> We come in and do her blood pressure every week,
we check her medications, we make sure that she's getting her
needs met. Not just her physical needs, but her emotional
needs.

Carol Rees>> "Now the last time I was here, you were wanting to
be able to have more independence. Has that happened? Do they
pretty much let you get up and walk around as you choose?"

Marguerite Hirsch>> "Yes."

Carol Rees>> "Okay. So are you happier now?"

Marguerite Hirsch>> "Yes."

Carol Rees>> "Good, excellent."

Stephanie O'Neill Noe>> Dr. Paul Diehl of West Hills says he
learned nothing about end of life care in medical school.
Trained as an internist, he spent the first half of his career
working solely to cure patients of their ills. Today he devotes
a large portion of his practice to hospice care.

Dr. Paul E. Diehl>> The ability to have someone when they're in
their last days to be able to go home, to be what I call in
their castle with their things, with people that hold them the
dearest and to be able to do that and support them, I think, is
an absolute. You know, the idea of going to a hospital to spend
your last days, I mean, I'm sorry, I myself when I'm at that
door, you know, I want to be taken care of just the way that
these people are being taken care of through hospice.

Stephanie O'Neill Noe>> Unlike Hirsch, many who qualify for
hospice don't get it until they're on the verge of dying and,
while hospice can still make them comfortable, patients benefit
far more when they enter the program much earlier.

Marguerite Hirsch>> Well, I know I wouldn't get the care or the
loving. That's what's important, the loving. Here we all hug
each other and we show our love. In a hospital, it's just a
business to them. It's a job, you know, the care helpers. Once
in a while, they show a little compassion, but mostly I feel
it's their job, which is good too, but we all need that extra
little hug. I love all you girls.

Carol Rees>> "I know. We're lucky."

Stephanie O'Neill Noe>> For Life and Times, I'm Stephanie
O'Neill Noe.

Carol Rees>> "(Laughter) Am I going to have to give you a
tissue?"

Marguerite Hirsch>> "No."

Kcet.org is the place to look for the very latest on Life and
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Toni Guinyard>> Prepare to make some sacrifices. California
Governor Arnold Schwarzenegger has unveiled his budget plan to
fix what he calls a broken system. We spoke with political
analyst, Sherry Bebitch Jeffe, who says the stage is now set for
a political fight that could test the governor's popularity and
the power of the initiative process.

Sherry Bebitch Jeffe>> What we see in the budget is a true
statement of priorities and, as far as I can tell, his
definition of special interests is everybody who disagrees with
him. The teacher's union, the labor union. My goodness, you
could make the argument children because the teacher's union is
saying he's really kind of decimating the educational --

Toni Guinyard>> -- wait a minute, Sherry. Aren't you being a
little harsh here on Governor Schwarzenegger? We're looking at
a state with this huge budget deficit. Cuts have to be made.

Sherry Bebitch Jeffe>> That's true. Oh, absolutely. And the
question is, where are those cuts going to be made? Do you
close tax loopholes? Do you look at certain taxes that are
across the board that might be more fair, if you will? Do you
look at what it means to tinker with Proposition 98, the
education funding initiative? I'm not saying that he's wrong.
He's doing what every politician does in taking care of his
supporters. But the message that goes out there, rightly or
wrongly, is that he's honing in on Democratic constituencies.

I'm shocked that a Republic governor would hone in on Democratic
constituencies, but again he was elected in part because he
promised to bring bipartisan cooperation to Sacramento, and
lately it's been missing. The people who voted to recall Gray
Davis and to put Arnold Schwarzenegger in the governor's office
voted for him because he pledged to change things, to turn
things around, to do things differently, to blow up the boxes,
he said.

Quite frankly, I don't think voters care how he does it. The
message they sent was to get in there and help us out and we
don't care how you get it done. They perceive that the ends
justify the means and, if indeed at the end of all of this, he
does what he promised and reins in spending and balances the
budget and makes the government more accountable, the people who
voted for him, his coalition, will be happy.

Toni Guinyard>> Where does this leave elected officials who
happen to be Democratic? Because we're looking also at an
initiative process with the governor saying, hey, this is where
my strength is and you can't fight me on this because I have the
support of the people.

Sherry Bebitch Jeffe>> Number one, it's not only legislators
who are Democrats. The question is, where does this leave the
legislature and the legislative process? The way I like to
portray it is, in Arnold's world, Arnold is the governor, the
voters are his legislature and the legislature is, by and large,
irrelevant. He takes what he wants done to the ballot and
that's where he really does have clout.

What are the Democrats doing now? They're threatening to do the
same thing with issues that they care about, with legislation
that the governor had vetoed, like the minimum wage, like the
driver's license bill. What we're going to see, if we're not
careful and if the voters want it, quite frankly, is government
being fought out totally at the ballot box. We're fairly close
to that now. With the budget process and with all the ballot
box budgeting that's gone on over the years, it shouldn't be
surprising that we're sort of one step away from a plebiscite
legislature.

Toni Guinyard>> I'd like to focus a little on the issues raised
in the area of education. In the state of California, about
forty percent of the budget goes to education. The governor is
not saying, wait a minute, we have to make some big cuts there.

Sherry Bebitch Jeffe>> It was the voters who approved
Proposition 98 which thought up the formula by which K through
12 education is protected. It's interesting to me. He says
don't trust the special interests. Trust the people. It is the
people who brought us ballot box budgeting to begin with. It is
the people who said, yes, we want to protect education. It is
the people who said we want to put some funds aside for
transportation, for infrastructure. It is the people who passed
Proposition 13 which started us on this road to ballot box
budgeting. So the governor is now saying trust the people, but
make sure it's my stuff that is voted on and approved.

The average Californian hasn't yet focused on the budget
problem. I mean, they're out there. There is so much going on
under any circumstance and the voting public really doesn't
focus on what's happening until what's happening begins to
threaten them. Quite frankly, the education formulas that are
being bandied about affect those who are in public schools and
they tend to be poorer, more minority, more Democratic, less
able to fund educational alternatives and less likely to vote
and certainly less likely to vote Republican.

Governor Arnold Schwarzenegger>> "Ignore the lobbyists, ignore
the politics and trust the people."

Sherry Bebitch Jeffe>> I watched the state-of-the-state address
and Schwarzenegger filled the screen. He never looked at the
legislators, hardly ever. He looked right at that camera and
talked to the people. Then came the Democratic response and the
two legislative leaders, Speaker Fabian Nunez and the Senate
President Pro Tem Don Perata, looked for all the world like a
high school cable access show.

They didn't have the media skills that Schwarzenegger developed
not only because he ran a media campaign and represents
everyone, a statewide very visible constituency, but because he
had nurtured them through his acting career. Legislative
leaders have a different constituency and they still haven't
gotten television and that makes a difference. I'm not saying
that this was good. I'm not saying this was bad, Toni. I am
saying that this influences public opinion.

Toni Guinyard>> Well, Sherry Bebitch Jeffe, we will continue
looking at what happens in Sacramento and what Governor Arnold
Schwarzenegger does. Thank you so much for spending a little
time with Life and Times.

Sherry Bebitch Jeffe>> My pleasure, Toni. Good to see you.

To send a comment or a question to our program, you can reach us
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Val>> They're a one-of-a-kind theatre group dedicated to
keeping the classics alive. They're called "A Noise Within".
That's a stage direction from Shakespeare's "Hamlet". They're a
topnotch theatre group based in Glendale, but they've performed
around the world. So how do you keep Shakespeare alive on stage
in this "Lion King" kind of world? We find out in this piece
produced by Donna Branch.

Geoff Elliott>> "A Noise Within" began in 1991. My wife, Julia
Rodriguez Elliott, and myself and the third founder, Art Manke,
all three of us trained at the American Conservatory Theatre in
San Francisco. Once we all graduated from that program, we
realized that there wasn't a great deal out there in terms of
what we had trained to do. So we decided to produce a
production of arguably the greatest play every written,
Shakespeare's "Hamlet". That's where it all began. That fall
of 1992, we began doing three plays in rotating repertory and
things have grown and here's where we're at today.

Julia Rodriguez Elliott>> I think we were so successful early
on because it was clear that there was a void that was being
filled. There was a lack of high quality classical repertory in
Los Angeles. Not just Los Angeles, but Southern California and
the nation for that matter because "A Noise Within" is really
only one of a handful of companies on this continent that are
still working in that kind of tradition of classical repertory
with a resident company. So I think that the response was
because of the high quality of the work and the fact that this
type of work isn't being done.

Geoff Elliott>> The kind of material that we do, there are
inherent challenges in terms of producing it, in terms of
performing it, in terms of directing it. You do need to be
trained to do it. It's an athletic event really for an actor.
That's the reason why, when you go to a classical, intensive
training program like the American Conservatory Theatre, you
work on your body, you work on your voice, you work on your
speech and, of course, you work on your mental ability to be
able to wrap yourself around these classical texts.

[Film Clip]

Geoff Elliott>> It's as if you're standing on the shoulders of
giants of world literature and you're looking out over the
future. These people wrote these plays hundreds of years ago,
but they're so relevant to what we do today. They're so about
us. They're about passion. They're about life. They're about
death. They're about love and hate and these things that we
deal with every day, and that's really what it's all about.
When people come here and they see a fine actor performing in
Shakespeare, it becomes clear to them almost immediately. When
an actor on stage knows what they're doing and they're trained
to do what they're doing, an audience member generally can drink
that up.

Julia Rodriguez Elliott>> We're very excited about a
collaboration with the Los Angeles Philharmonic. We performed
last summer opening the new shell at the Hollywood Bowl. They
performed Mendelssohn's "A Midsummer Night's Dream" and we
performed William Shakespeare's "A Midsummer Night's Dream".

>> "Hi-diddly-dee, an actor's life for me."

>> "I'm waiting to have my face transformed by a makeup artist.
I transform my character. I become Puck."

>> "Go away, go away, go away."

>> "Oh, we're friends. This is no shame in the theatre."

Geoff Elliott>> "This is the first audience we've had, the
orchestra. The orchestra (laughter) is our first audience and
we won't have another audience until we have eleven thousand
people tomorrow night."

Julia Rodriguez Elliott>> It's very exciting and the last time
that this was done was in 1934. It was a Max Reinhart
production. I think that's the last time that there's been this
kind of a collaboration, so it's very exciting.

[Film Clip]

Julia Rodriguez Elliott>> Our mission is to produce quality
classical repertory theatre and tied to that mission is
education. Our focus has always been about bringing kids to the
theatre. We work with a lot of teachers who incorporate it into
their curriculum because so much of what we do is literature-
based, so these kids are reading it in the classrooms and what
better way to complete that experience than to bring them to
actually see the plays, these plays that were not intended to be
read. They were intended to be seen and heard.

Geoff Elliott>> For all but one of the years that we have been
in existence, we have been here in the former Masonic Temple
building and it wasn't designed to be a theatre. So through a
lot of blood, sweat and tears -- and some blood, really -- we
created a theatre out of this particular room, but it's not
designed to be a theatre. So it's very difficult to do what we
do, particularly because we're a rotating repertory theatre
which means that every three or four days we have to break down
a set, haul it off of this stage, put another set up and it's a
lot of labor, very difficult.

[Film Clip]

Geoff Elliott>> We also, a number of years ago, began to sell
out. Many times we've had waiting lists. We've had to let
people go and not see the show because we didn't have room for
them, so we've got to expand. We have been working with the
city of Glendale and we're working together on a piece of
property here in Glendale to build a building on, to be able to
expand, to be able to fully realize the different programs here
that we have to offer, that we can more fully develop, to be in
a facility that I think this company really deserves. Not only
will we be a cultural destination for people in this area and
throughout California, but it will allow our outreach programs
and our educational programs to expand. We will have classroom
space to do the things that we're doing now, but be able to do a
great deal more of it.

Julia Rodriguez Elliott>> Certainly in terms of what we do
here, it is a community. It's an opportunity for people to come
together and commune and share ideas and experiences even in the
way that our theatre is set up. We perform three-quarter
thrust, which means that you have audience members on all three
sides. So people are really engaged and are experiencing these
plays together, not just with the actors, but with each other.
As my husband, Geoff, often says, you know, when you come to see
a play, you're going to see that particular experience in that
moment in time and it will never be the same. It will just be
that experience for that particular group of people in that room
at that time and then it's gone and on to the next one.

[Film Clip]

Val>> Our thanks to Donna Branch of Glendale TV and the
Glendale Arts and Culture Commission for that piece. And that's
our program. I'm Val Zavala. For everyone at Life and Times,
thanks for watching. We'll see you next time.

Life and Times was made possible through the generous support of
the L.K. Whittier Foundation dedicated to improving the quality
of life by supporting innovative endeavors in the fields of
medicine, health, science and education.

And by a generous grant from Jim and Anne Rothenberg.

Val>> Next time on Life and Times --

The little airport that could. Right now, it's just offering
one flight a day, but is Palmdale ready to take off?

>> The airlines say we'll bring in flights when we see
revenues, when we see people traveling in and out of that
airport. The traveling public says we'll fly in and out of that
airport when we see the flights that we want.

Val>> That's next time on Life and Times.