Medical staff with LifeFlight air ambulance service and Eastern Maine Medical Center in Bangor wheel a stroke patient inside the hospital in this 2001 BDN file photo. Credit: BDN file photo

A nonprofit group that wants to improve the quality of end-of-life health care for rural Mainers who are seriously ill or have advanced frailty is trying to get people to simply talk more about the topic.

The Maine Hospice Council and Center for End-of-Life Care hopes that a $200,000 grant from a New York foundation that promotes improvements in nursing care will find ways to make it easier for such patients in the Ellsworth, Greenville and Jackman areas and their families to have these types of conversations with their doctors.

The three areas are the focus of the grants because they represent varying degrees in rural Maine of how much end-of-life care medical orders are used, said Kandyce Powell, Maine Hospice Care’s executive director. Ellsworth and Blue Hill have a relatively high rate of use of such doctor-approved orders, Greenville has about an average rate, and Jackman has a relatively low rate.

By comparing the areas, the Maine Hospice Council hopes to learn more about how to encourage conversations between rural patients, their families and doctors, Powell said. After learning more about what promotional strategies might work, or what challenges there are, Maine Hospice Council likely will pursue specific strategies to make sure seriously ill patients and those in advanced frailty throughout Maine are getting the care they want, she said.

“We’re trying to get the lay of the land here,” Powell said.

The money from the Rita & Alex Hillman Foundation is being split between Maine Hospice Council and National POLST, which is based in Washington D.C., with the Maine group getting $83,000 and the national organization getting the rest. POLST is an acronym for “physician orders for life-sustaining treatment.” They are medical orders signed by a patient’s doctor that spell out what kind of medical treatment that patient wants as part of their end-of-life care.

POLST orders are different from advanced directives in that they are signed by physicians and they spell out what kind of medical treatment the patient wants, Powell said. Advance directives merely indicate who will speak on a patient’s behalf if that patient is incapacitated, and carry no weight in determining what sort of medical decisions should be made.

Of the $200,000 overall grant, $136,000 is being used to fund staff time at National POLST and Maine Hospice Council on the project; $18,000 is going toward technical and conference support, supplies and travel; $28,000 is for consultants; and another $18,000 is set aside for incidental expenses.

One significant hurdle that the council already knows has to be addressed in rural parts of Maine is the physical distance that often exists between where patients live and where their doctors are based. Telehealth, in which patients communicate with doctors via private video conferencing, has helped connect physicians with patients who live on remote offshore islands, and can help connect them with patients in far flung hamlets as well, Powell said.

“The transportation issues in Maine are staggering,” she said. “Telehealth is one answer to that. We need more broadband coverage.”

Bill Trotter

A news reporter in coastal Maine for more than 20 years, Bill Trotter writes about how the Atlantic Ocean and the state's iconic coastline help to shape the lives of coastal Maine residents and visitors....