The elderly man was tied to his hospital bed, screaming, with tubes protruding in multiple directions. To then third-year medical resident Dr. George Hennawi, the scene was not only frustrating, but would prove life-changing.
The day Hennawi walked into the man’s hospital room, Hennawi had no plans to focus his career on the care of those at the end of their lives. Rather, he had recently signed up for a different fellowship. But the view that greeted him in that room that day would stick with Hennawi and become the catalyst that would change his career, and ultimately shape the future of geriatric medicine in Baltimore.
“I felt we need to do better for older adults. We are so focused on illness that we forget what matters to people. So much of the time we forget about the humanity in medicine,” he said from his office at the Center for Successful Aging at MedStar Good Samaritan Hospital in Baltimore City, where he serves as director.
Started in 2013 under Hennawi’s leadership, the Center for Successful Aging works to provide comprehensive care for adults generally age 65 and older, some of whom are approaching the end of life, by employing what is known as person-centered care, or care that places the person rather than the disease first.
Hennawi said his vision was to create a place where older adults could get all of their services in one location from a team — that includes nurse practitioners, doctors, social workers, pharmacists, physical therapists, community health workers and specialists — which creates a plan of care based on the desires of the patient.
Dr. George Hennawi
For patients at the Center, care starts with a question: what matters to you?
It is a simple question, but one that Hennawi said not all providers ask. However, at the Center, the question drives every patient’s care.
“We create plans based on what matters to the patient,” he said, be that spending more time with family, continuing to work, maintaining independence, traveling the world, staying alive at all costs, or simply enjoying ice cream in bed. “If we understand early on what the patient wants, we can build proper support, education, emotional management and infrastructure to achieve it.”
Working with older adults often involves preparing and planning for the end of life. It also requires having conversations and asking questions that disease-centered care often neglects to ask. Person-centered care is not the norm in medicine, so some of Hennawi’s work involves building relationships with other providers to spread awareness of person-centered care and how to shift to that model. He said MedStar is also working to open a second Center for Successful Aging at its hospital in Olney, Md.
Assisting the elderly and particularly those with complex needs through support to both the patient and their caregiver is something the Center does every day. The Center engages patients in conversations about their values and preferences, and provides education and support to caregivers. Collectively, this helps the team provide appropriate resources and interventions that lead to better health and successful aging in place, as well as allows those nearing the end of their lives to live their final days full of hope and experience a peaceful, dignified death.
“I can’t say some people don’t go through bad experiences, but the majority of folks that are prepared and are supported in the right way, will not have a ‘bad’ death,” he said.
In his years of experience caring for the elderly, Hennawi said individuals nearing the end of life tend to fear two things: suffering and being a burden on their families. And while few fear death itself, most desire to take their last breath at home.
Unfortunately, despite advances in Hospice and palliative care — the former which supports patients with terminal illnesses through both in-home and in-patient care, the latter which manages pain and works to make patients comfortable — Hennawi said most people don’t access Hospice or palliative services in a timely manner, often waiting until the last days of life. Additionally, he said there is generally a lack of understanding about both.
The Center for Successful Aging cares for adults who are, on average, 85 years of age and who have significant medical, functional, and social needs. The Center is frequently involved in end-of-life care, sometimes working with patients to define their care at the end of life years in advance.
For those who pass, the Center hosts an annual Remembrance Gathering where the families can gather and share memories of their loved ones and celebrate their lives. Often, these families thank Dr. Hennawi and his team for educating, supporting and guiding them throughout their loved one’s final days and for the steps taken to ensure their loved one’s wishes for a peaceful death in their preferred location were honored.
Despite the cutting-edge approach to care and services offered by the Center to ensure comfort, compassion and a patient-centered focus, Hennawi said he has still been asked by a few patients to aid in their death.
“I respect people’s wishes. I believe in a person’s right to decide how they live their life and how they die, but actively aiding in their death is against what I believe,” Hennawi said.
Hennawi’s work has shown that there is hope at all stages of the aging process, including at the end of life. The Center has proven that through person-centered care, individuals can choose the direction of their life in the final years, months and days, and die with peace and dignity on their terms.
“There is nothing more rewarding to me than supporting people to live the quality of life that they choose and allowing them to have a dignified and peaceful death,” he said.
To learn more about the Center for Successful Aging, CLICK HERE.