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Case Study 3 – Palliative and End-of-Life Care

Click here to review the draft palliative and end-of-life care – interactive case study..

The following case vignette provides key concepts that could be considered when developing a plan of care for a patient who may require a controlled substance to manage their health concerns. As with any clinical situation, there are many patient variables that must be considered, including comorbid conditions, social determinants of health and their personal choices. You may choose to include different or additional health history and physical examination points, diagnostic tests, differential diagnoses and treatments depending on your patient’s context however this case vignette focuses on the aspects relevant to controlled substances.

Danny Kahan NP-Adult, specialty is palliative care Joshi Kamakani – 70 year old male with metastatic prostate cancer June Kamakani – patient’s wife Kelli Kamakani – patient’s 40 year old daughter

Danny is reviewing the patient history outside the house or in the car before visiting the patient.

Joshi Kamakani is a 70 year old retired engineer that the Palliative Care home care team and I have been looking after at home for the last two months. Joshi was diagnosed with inoperable prostate cancer three years ago and has been treated with ablative hormone therapy. Six months ago, Joshi started to have pain in his hips. His oncologist ordered a CT scan and found he had metastases in his ribs, pelvis and lumbar spine. Joshi and his wife June had a meeting with the team at the cancer centre and decided not to go ahead with any further cancer treatment. Our team has been involved since. June called me yesterday and asked me to make a home visit. Joshi has been having more pain this week and has been spending most of his time on the couch. He cannot get around without assistance and is very fatigued.

Joshi’s past medical history includes hypertension and reflux. He is taking Predisone 5 mg PO BID, Leuprorelin Depot 22.5mg IM every 3 months, hydrochlorothiazide 25 mg daily and pantoprazole 40 mg daily.

For pain, Joshi takes Morphine slow release 100 mg q12h and has not needed additional medication for breakthrough pain so far.

Takes place in the home. Patient is seen reclining on couch in first floor living room. Wife and daughter present.

Danny rings the doorbell and June lets him in.

June: Hi Danny. I’m so glad you’ve come.

Danny takes off his coat and shoes and walks into the living room. Kelli is sitting with her father who is covered up with a blanket on a couch in the main living area – he is awake but obviously drowsy. He smiles at Danny and holds out his hand. Danny shakes it a sits down in a chair opposite.

June: His pain killers just are not working any more – he’s uncomfortable when he is resting and it’s worse when he has to move around. It’s been happening for the last few weeks. He hasn’t had a fall but he is unsteady on his feet – especially soon after he get up. Joshi: I tried some acetaminophen from the drug store a few days ago but it really didn’t work. Kelli: Danny, you have to do something. He’s so uncomfortable. Danny: OK let’s talk about this a bit more. Joshi, were you sleepy after we increased the morphine 2 weeks ago? You were at 80 mg for each dose and now you are at 100 mg. Joshi: I was a bit sleepy for a few days and I had a bit of a weak stomach but that is gone now. I am a bit constipated though. Danny: when did you have your last bowel movement? Joshi: 4 days ago. Danny: OK we will have to address that today. I’d like to use the scale that I used at our last visit, it’s called the PPS, to assess your level of activity. ( Edmonton symptom assessment scale and Palliative Performance Score). Your PPS is 40% – last time I visited you were at 60%. June: yes, he is definitely having more trouble. I think the pain is preventing him from moving and that’s just making everything worse.

Danny: Joshi, your pain interference score tells me that the pain is severely interfering with your activity and I see that you are rating your current pain at rest at 6/10 and at 10/10 when you move. When I examined you, I did not note any changes from my last visit except for some new swelling over your left hip. June: Yes that’s where it is most sore – and before you ask, I am not going to the hospital for an xray. Kelli: Why can’t you just double his dose?

Danny [THINKS]: I will also add a bowel regime to address Joshi’s constipation and provide an order for a PRN anti-nauseant like metoclopramide or ondansetron. Joshi and his family will need to have education about the timeline of the peak benefit of the change in the regular dose, keeping track of PRN use, proper use of breakthrough medications (before care or any activity that causes pain), any other interventions we can include to help with his pain including adding other medications.

June: Danny, can I speak to you in private for a moment? June and Danny move to a private area of the house. Kelli and Joshi remain on the sofa. June: Danny, I have some concerns about having extra medication in the house and I need some advice on how to deal with this. My daughter had a real problem with drugs when she was in high school. She had to have treatment and as far as I know, she has been clean for the past 2 years. I have talked to her about having medication in the house and she tells me she’s not tempted but I really want to be sure we don’t have any incidents. I trust my daughter but I do worry that some things are beyond her control. Danny: Well June, it is always a good practice to have a plan for safe storage of medications. Here is some information about where you can purchase a locked box. I recommend you keep a key and have the hospice nurse take the other and have it numbered and controlled at the hospice office for the use of the nurses that care for Joshi. In the meantime, keep the medications in a place that you and Joshi can monitor and please keep a count of the medication in the containers and continue to write down when medication is given. June: Thanks Danny – I don’t want my daughter to think I don’t trust her. This should help.

Two weeks later – Danny is back in his office reviewing Joshi’s file with a Nurse Practitioner student…

Follow-up case question by Danny.

Student: Next up is Joshi Kamakani for review… Danny: Well, I’ve just been to see Joshi and his family. It has been two weeks since we increased his dose of morphine SR. We also added a neuropathic pain agent to help with his pain which has made him a bit more drowsy. He continues to take 20-30 mg breakthrough morphine/day and I noticed today that he has some myoclonus. Joshi’s pain is still in the moderate range with activity and now nausea is a problem.

Opioid rotation and opioid equianalgesia from NOUGG (McMaster Guidelines).

Danny: I think a rotation of opioid is the next step. Student: What medication should Danny consider and at what dose?

Danny: Joshi is using 270 mg oral morphine equivalents per day. To convert this dose to hydromorphone, the medication I have chosen to rotate to, we multiply by 0.2. Morphine 270 mg x 0.2 = 54 mg hydromorphone/day. We will want to convert 60% of the total daily dose so 54mg x .6 = 32mg. I want to give Joshi the new dose in a slow release form. It is most practical to provide Joshi with hydromorphone SR 15mg q12h and also provide him an additional 2-3 mg of hydromorphone immediate release for breakthrough pain. Providing him with the breakthrough dosing will be sure Joshi can have additional medication to help him until we are sure we have a stable, effective dose in 48-72 hours.

Learning Outcome

This interactive case study covered the following information:

• Opiate Titration
• Opiate Rotation
• Pain Assessment
• Assessment of adverse effects
• Safety Assessment
• Collaboration
• Family centred care

5 case studies: When is it time for palliative care versus hospice?

Never hesitate to say “I need help” if you’re struggling to cope with the pain and distress of a life-limiting illness. Hospice and palliative care providers are specially trained to hear your plea and will offer comfort, compassion and support.

“Just because you ask to speak with a palliative care or hospice care provider doesn’t mean you have to start service,” says Lisa Wasson, RN, clinical educator for HopeHealth.

Palliative care and hospice care are two different sets of services, although you might hear people use the terms interchangeably.

• Palliative care is for patients with a serious illness who are still receiving curative treatments, such as chemotherapy or dialysis. Palliative care providers offer medical relief from the symptoms or stress caused by either the illness itself or the treatment. They also help patients understand their options and establish goals of care.
• Hospice care is for patients with a life-limiting illness who have decided to stop curative treatments or have been given no further treatment options for cure or to prolong life. A full team of doctors, nurses, social workers, spiritual chaplains, hospice aides, grief support professionals and volunteers offer comfort and support to the patient and family.

To learn more about these differences, read The ABC’s of curative, palliative and hospice care .

5 case studies: Is palliative care or hospice care more appropriate?

Below are five fictional stories to give you a sense of when it could be helpful to ask for a palliative care or hospice care consultation. (Every medical case is unique, and only your health care provider can advise on your care.)

Case 1: An 86-year-old with Alzheimer’s disease is repeatedly hospitalized

Janet was diagnosed with Alzheimer’s disease nine years ago and lives at home in the care of her husband. She cannot make her needs known, is incontinent and depends on her husband to feed her. She has lost 20 pounds in six months and been hospitalized three times.

Palliative care or hospice? Janet would likely qualify for hospice care given how far along her disease has advanced.

Case 2: A man wishes to stop dialysis despite family’s wishes

Robert is 64 years old and has kidney failure, coronary artery disease and diabetes. He receives dialysis three times per week but wants to stop treatment. Today he was hospitalized after skipping two dialysis appointments. Robert’s family is concerned he is giving up, and they don’t know what to do.

Palliative care or hospice? Robert and his family need to get on the same page regarding his options and wishes. A good first step would be to ask a palliative care provider to guide that conversation with skill and sensitivity. Ultimately, Robert does have to the right to stop dialysis and choose hospice if he wishes.

“We deserve as much beauty, care and respect from the health care system at the end of life as we receive at the beginning when we are born” —Lisa Wasson, RN, CHPN

Case 3: A 30-year-old with breast cancer and her mother need support

Imani has undergone two rounds of chemotherapy and radiation for breast cancer. She has severe nausea and is losing weight due to poor appetite. Her mother, who works full time, is her primary caregiver.

Palliative care or hospice? Imani is actively fighting her disease with curative treatment and might qualify for palliative care. She would receive symptom management, support services to help her mother, and a conversation about her goals of care.

Case 4: A woman with autoimmune disorders battles depression

Cindy, age 52, has multiple autoimmune disorders, fibromyalgia pain and depression. She takes antidepressant medication, is self-isolating and cannot hold a job due to taking too many sick days.

Palliative care or hospice? Cindy is not a candidate for either palliative care or hospice care because she does not have a life-limiting disease. She still needs support, though, and would be referred to a case manager or social worker.

Case 5: A man with advanced ALS requests a do-not-resuscitate order

Carter has ALS, or amyotrophic lateral sclerosis, a progressive neurodegenerative disease. He has been hospitalized with infection five times and is on a ventilator. Carter is alert and told doctors he wants to return home and sign a do-not-resuscitate order (DNR). His family is upset about his decision.

Palliative care or hospice? While in the hospital, Carter can request to speak with a palliative care or hospice care provider to guide this sensitive conversation with his family. If he wishes to start hospice, a team will help him return home, tend to life-closure tasks and die in peace and comfort surrounded by his family.

Lisa Wasson hopes more patients and their families will seek to understand the benefits of hospice and palliative care. “We deserve as much beauty, care and respect from the health care system at the end of life as we receive at the beginning when we are born,” she says.

Questions about hospice care or palliative care? Contact us at (844) 671-HOPE or [email protected] .

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Hospice & Palliative Care

Online continuing education, learn anytime. earn credits. improve practice..

The MJHS Institute for Innovation in Palliative Care is pleased to offer free interdisciplinary palliative care webinars, live and on demand , delivered by frontline experts, typically offering 1.0 AMA PRA Category 1 Credit™ for Continuing Medical Education (CME), Nursing continuing education (CE), Social Work CE credits, Case Manager CCMC CE credits, and Music Therapy CE credits.

Our free interactive multimedia modules on Community-Based Palliative Care Program Development   and Caring for Holocaust Survivors With Sensitivity at End of Life   offer up to 9.75 CE credits.

Free pdf downloads now available: 15 palliative care professional factsheets and patient education handouts on 18 topics in English, Spanish, Haitian Creole, Arabic, French, and Russian.

Evidence-Based Advocacy for the Hospice and Palliative Care Clinician

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The Great Read

What deathbed visions teach us about living.

Researchers are documenting a phenomenon that seems to help the dying, as well as those they leave behind.

Credit... Photo illustration by Amy Friend

Supported by

By Phoebe Zerwick

• March 12, 2024

Chris Kerr was 12 when he first observed a deathbed vision. His memory of that summer in 1974 is blurred, but not the sense of mystery he felt at the bedside of his dying father. Throughout Kerr’s childhood in Toronto, his father, a surgeon, was too busy to spend much time with his son, except for an annual fishing trip they took, just the two of them, to the Canadian wilderness. Gaunt and weakened by cancer at 42, his father reached for the buttons on Kerr’s shirt, fiddled with them and said something about getting ready to catch the plane to their cabin in the woods. “I knew intuitively, I knew wherever he was, must be a good place because we were going fishing,” Kerr told me.

Listen to this article, read by Samantha Desz

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As he moved to touch his father, Kerr felt a hand on his shoulder. A priest had followed him into the hospital room and was now leading him away, telling him his father was delusional. Kerr’s father died early the next morning. Kerr now calls what he witnessed an end-of-life vision. His father wasn’t delusional, he believes. His mind was taking him to a time and place where he and his son could be together, in the wilds of northern Canada. And the priest, he feels, made a mistake, one that many other caregivers make, of dismissing the moment as a break with reality, as something from which the boy required protection.

It would be more than 40 years before Kerr felt compelled to speak about that evening in the hospital room. He had followed his father, and three generations before him, into medicine and was working at Hospice & Palliative Care Buffalo, where he was the chief medical officer and conducted research on end-of-life visions. It wasn’t until he gave a TEDx Talk in 2015 that he shared the story of his father’s death. Pacing the stage in the sport coat he always wears, he told the audience: “My point here is, I didn’t choose this topic of dying. I feel it has chosen or followed me.” He went on: “When I was present at the bedside of the dying, I was confronted by what I had seen and tried so hard to forget from my childhood. I saw dying patients reaching and calling out to mothers, and to fathers, and to children, many of whom hadn’t been seen for many years. But what was remarkable was so many of them looked at peace.”

The talk received millions of views and thousands of comments, many from nurses grateful that someone in the medical field validated what they have long understood. Others, too, posted personal stories of having witnessed loved ones’ visions in their final days. For them, Kerr’s message was a kind of confirmation of something they instinctively knew — that deathbed visions are real, can provide comfort, even heal past trauma. That they can, in some cases, feel transcendent. That our minds are capable of conjuring images that help us, at the end, make sense of our lives.

Nothing in Kerr’s medical training prepared him for his first shift at Hospice Buffalo one Saturday morning in the spring of 1999. He had earned a degree from the Medical College of Ohio while working on a Ph.D. in neurobiology. After a residency in internal medicine, Kerr started a fellowship in cardiology in Buffalo. To earn extra money to support his wife and two young daughters, he took a part-time job with Hospice Buffalo. Until then, Kerr had worked in the conventional medical system, focused on patients who were often tethered to machines or heavily medicated. If they recounted visions, he had no time to listen. But in the quiet of Hospice, Kerr found himself in the presence of something he hadn’t seen since his father’s death: patients who spoke of people and places visible only to them. “So just like with my father, there’s just this feeling of reverence, of something that wasn’t understood but certainly felt,” he says.

During one of his shifts, Kerr was checking on a 70-year-old woman named Mary, whose grown children had gathered in her room, drinking wine to lighten the mood. Without warning, Kerr remembers, Mary sat up in her bed and crossed her arms at her chest. “Danny,” she cooed, kissing and cuddling a baby only she could see. At first, her children were confused. There was no Danny in the family, no baby in their mother’s arms. But they could sense that whatever their mother was experiencing brought her a sense of calm. Kerr later learned that long before her four children were born, Mary lost a baby in childbirth. She never spoke of it with her children, but now she was, through a vision, seemingly addressing that loss.

In observing Mary’s final days at Hospice, Kerr found his calling. “I was disillusioned by the assembly-line nature of medicine,” Kerr told me. “This felt like a more humane and dignified model of care.” He quit cardiology to work full time at the bedsides of dying patients. Many of them described visions that drew from their lives and seemed to hold meaning, unlike hallucinations resulting from medication, or delusional, incoherent thinking, which can also occur at the end of life. But Kerr couldn’t persuade other doctors, even young residents making the rounds with him at Hospice, of their value. They wanted scientific proof.

At the time, only a handful of published medical studies had documented deathbed visions, and they largely relied on secondhand reports from doctors and other caregivers rather than accounts from patients themselves. On a flight home from a conference, Kerr outlined a study of his own, and in 2010, a research fellow, Anne Banas, signed on to conduct it with him. Like Kerr, Banas had a family member who, before his death, experienced visions — a grandfather who imagined himself in a train station with his brothers.

The study wasn’t designed to answer how these visions differ neurologically from hallucinations or delusions. Rather, Kerr saw his role as chronicler of his patients’ experiences. Borrowing from social-science research methods, Kerr, Banas and their colleagues based their study on daily interviews with patients in the 22-bed inpatient unit at the Hospice campus in the hope of capturing the frequency and varied subject matter of their visions. Patients were screened to ensure that they were lucid and not in a confused or delirious state. The research, published in 2014 in The Journal of Palliative Medicine, found that visions are far more common and frequent than other researchers had found, with an astonishing 88 percent of patients reporting at least one vision. (Later studies in Japan, India, Sweden and Australia confirm that visions are common. The percentages range from about 20 to 80 percent, though a majority of these studies rely on interviews with caregivers and not patients.)

In the last 10 years, Kerr has hired a permanent research team who expanded the studies to include interviews with patients receiving hospice care at home and with their families, deepening the researchers’ understanding of the variety and profundity of these visions. They can occur while patients are asleep or fully conscious. Dead family members figure most prominently, and by contrast, visions involving religious themes are exceedingly rare. Patients often relive seminal moments from their lives, including joyful experiences of falling in love and painful ones of rejection. Some dream of the unresolved tasks of daily life, like paying bills or raising children. Visions also entail past or imagined journeys — whether long car trips or short walks to school. Regardless of the subject matter, the visions, patients say, feel real and entirely unique compared with anything else they’ve ever experienced. They can begin days, even weeks, before death. Most significant, as people near the end of their lives, the frequency of visions increases, further centering on deceased people or pets. It is these final visions that provide patients, and their loved ones, with profound meaning and solace.

Kerr’s latest research is focused on the emotional transformation he has often observed in patients who experience such visions. The first in this series of studies, published in 2019, measured psychological and spiritual growth among two groups of hospice patients: those who had visions and a control group of those who did not. Patients rated their agreement with statements including, “I changed my priorities about what is important in life,” or “I have a better understanding of spiritual matters.” Those who experienced end-of-life visions agreed more strongly with those statements, suggesting that the visions sparked inner change even at the end of life. “It’s the most remarkable of our studies,” Kerr told me. “It highlights the paradox of dying, that while there is physical deterioration, they are growing and finding meaning. It highlights what patients are telling us, that they are being put back together.”

In the many conversations Kerr and I have had over the past year, the contradiction between medicine’s demand for evidence and the ineffable quality of his patients’ experiences came up repeatedly. He was first struck by this tension about a year before the publication of his first study, during a visit with a World War II veteran named John who was tormented throughout his life by nightmares that took him back to the beaches of Normandy on D-Day. John had been part of a rescue mission to bring wounded soldiers to England by ship and leave those too far gone to die. The nightmares continued through his dying days, until he dreamed of being discharged from the Army. In a second dream, a fallen soldier appeared to John to tell him that his comrades would soon come to “get” him. The nightmares ended after that.

Kerr has been nagged ever since by the inadequacy of science, and of language, to fully capture the mysteries of the mind. “We were so caught up in trying to quantify and give structure to something so deeply spiritual, and really, we were just bystanders, witnesses to this,” he says. “It feels a little small to be filling in forms when you’re looking at a 90-something-year-old veteran who is back in time 70 years having an experience you can’t even understand.” When Kerr talks about his research at conferences, nurses tend to nod their heads in approval; doctors roll their eyes in disbelief. He finds that skeptics often understand the research best when they watch taped interviews with patients.

What’s striking about this footage, which dates back to Kerr’s early work in 2008, is not so much the content of the visions but rather the patients’ demeanor. “There’s an absence of fear,” Kerr says. A teenage girl’s face lights up as she describes a dream in which she and her deceased aunt were in a castle playing with Barbie dolls. A man dying of cancer talks about his wife, who died several years earlier and who comes to him in his dreams, always in blue. She waves. She smiles. That’s it. But in the moment, he seems to be transported to another time or place.

Kerr has often observed that in the very end, dying people lose interest in the activities that preoccupied them in life and turn toward those they love. As to why, Kerr can only speculate. In his 2020 book, “Death Is but a Dream,” he concludes that the love his patients find in dying often brings them to a place that some call enlightenment and others call God. “Time seems to vanish,” he told me. “The people who loved you well, secured you and contributed to who you are are still accessible at a spiritual and psychological level.”

That was the case with Connor O’Neil, who died at the age of 10 in 2022 and whose parents Kerr and I visited in their home. They told us that just two days before his death, their son called out the name of a family friend who, without the boy’s knowledge, had just died. “Do you know where you are?” Connor’s mother asked. “Heaven,” the boy replied. Connor had barely spoken in days or moved without help, but in that moment, he sat up under his own strength and threw his arms around her neck. “Mommy, I love you,” he said.

Kerr’s research finds that such moments, which transcend the often-painful physical decline in the last days of life, help parents like the O’Neils and other relatives grieve even unfathomable loss. “I don’t know where I would be without that closure, or that gift that was given to us,” Connor’s father told us. “It’s hard enough with it.” As Kerr explains, “It’s the difference between being wounded and soothed.”

In June, I visited the adult daughter of a patient who died at home just days earlier. We sat in her mother’s living room, looking out on the patio and bird feeders that had given the mother so much joy. Three days before her mother’s death, the daughter was straightening up the room when her mother began to speak more lucidly than she had in days. The daughter crawled into her mother’s bed, held her hand and listened. Her mother first spoke to the daughter’s father, whom she could see in the far corner of the room, handsome as ever. She then started speaking with her second husband, visible only to her, yet real enough for the daughter to ask whether he was smoking his pipe. “Can’t you smell it?” her mother replied. Even in the retelling, the moment felt sacred. “I will never, ever forget it,” the daughter told me. “It was so beautiful.”

I also met one of Banas’s patients, Peggy Haloski, who had enrolled in hospice for home care services just days earlier, after doctors at the cancer hospital in Buffalo found blood clots throughout her body, a sign that the yearlong treatment had stopped working. It was time for her husband, Stephen, to keep her comfortable at home, with their two greyhounds.

Stephen led Banas and me to the family room, where Peggy lay on the couch. Banas knelt on the floor, checked her patient’s catheter, reduced her prescriptions so there were fewer pills for her to swallow every day and ordered a numbing cream for pain in her tailbone. She also asked about her visions.

The nurse on call that weekend witnessed Peggy speaking with her dead mother.

“She was standing over here,” Peggy told Banas, gesturing toward the corner of the room.

“Was that the only time you saw her?” Banas asked.

“Do you think you’ll be seeing her more?”

“I will. I will, considering what’s going on.”

Peggy sank deeper into the couch and closed her eyes, recounting another visit from the dead, this time by the first greyhound she and Stephen adopted. “I’m at peace with everybody. I’m happy,” she said. “It’s not time yet. I know it’s not time, but it’s coming.”

When my mother, Chloe Zerwick, was dying in 2018, I had never heard of end-of-life visions. I was acting on intuition when her caregivers started telling me about what we were then calling hallucinations. Mom was 95 and living in her Hudson Valley home under hospice care, with lung disease and congestive heart failure, barely able to leave her bed. The hospice doctor prescribed an opioid for pain and put her on antipsychotic and anti-anxiety medicines to tame the so-called hallucinations he worried were preventing her from sleeping. It is possible that some of these medications caused Mom’s visions, but as Kerr has explained, drug-induced hallucinations do not rule out naturally occurring visions. They can coexist.

In my mother’s case, I inherently understood that her imaginary life was something to honor. I knew what medicine-induced hallucinations looked and felt like. About 10 years before her death, Mom fell and injured her spine. Doctors in the local hospital put her on an opioid to control the pain, which left her acting like a different person. There were spiders crawling on the hospital wall, she said. She mistook her roommate’s bed for a train platform. Worse, she denied that I loved her or ever did. Once we took her off the medicine, the hallucinations vanished.

The visions she was having at the end of her life were entirely different; they were connected to the long life she had led and brought a deep sense of comfort and delight. “You know, for the first time in my life I have no worries,” she told me. I remember feeling a weight lift. After more than a decade of failing health, she seemed to have found a sense of peace.

The day before her death, as her breathing became more labored, Mom made an announcement: “I have a new leader,” she said.

“Who is that?” I asked.

“Mark. He’s going to take me to the other side.”

She was speaking of my husband, alive and well back home in North Carolina.

“That’s great, Mom, except that I need him here with me,” I replied. “Do you think he can do both?”

“Oh, yes. He’s very capable.”

That evening, Mom was struggling again to breathe. “I’m thinking of the next world,” she said, and of my husband, who would lead her there. The caregiver on duty for the night and I sat at her bedside as Mom’s oxygen level fell from 68 to 63 to 52 and kept dropping until she died the next morning. My mother was not a brave person in the traditional sense of the word. She was afraid of snakes, the subway platform and any hint of pain. But she faced her death, confident that a man who loves her daughter would guide her to whatever lay ahead.

“Do you think it will happen to you?” she asked me at one point about her dreaming life.

“Maybe it’s genetic,” I replied, not knowing, as I do now, that these experiences are part of what may await us all.

Phoebe Zerwick, the author of “Beyond Innocence: The Life Sentence of Darryl Hunt,” is a North Carolina-based journalist. She teaches journalism and writing at Wake Forest University, where she directs the journalism program. Amy Friend is an artist in Canada whose work focuses on history, time, land-memory, dust, oceans and our connection to the universe.

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What Are Palliative Care and Hospice Care?

On this page:

What is palliative care?

What is hospice care.

• What are some similarities and differences between palliative care and hospice care?

Many Americans die in facilities such as hospitals or nursing homes receiving care that is not consistent with their wishes. It’s important for older adults to plan ahead and let their caregivers, doctors, or family members know your end-of-life preferences in advance. For example, if an older person wants to die at home, receiving end-of-life care for pain and other symptoms, and makes this known to health care providers and family, it is less likely he or she will die in a hospital receiving unwanted treatments.

If the person is no longer able to make health care decisions for themselves, a caregiver or family member may have to make those decisions. Caregivers have several factors to consider when choosing end-of-life care, including the older person's desire to pursue life-extending treatments, how long he or she has left to live, and the preferred setting for care.

Palliative care is specialized medical care for people living with a serious illness, such as cancer or heart failure. Patients in palliative care may receive medical care for their symptoms, or palliative care, along with treatment intended to cure their serious illness. Palliative care is meant to enhance a person's current care by focusing on quality of life for them and their family.

Who can benefit from palliative care?

Palliative care is a resource for anyone living with a serious illness, such as heart failure , chronic obstructive pulmonary disease , cancer , dementia , Parkinson's disease , and many others. Palliative care can be helpful at any stage of illness and is best provided soon after a person is diagnosed.

In addition to improving quality of life and helping with symptoms, palliative care can help patients understand their choices for medical treatment. The organized services available through palliative care may be helpful to any older person having a lot of general discomfort and disability very late in life.

Who makes up the palliative care team?

A palliative care team is made up of multiple different professionals that work with the patient, family, and the patient's other doctors to provide medical, social, emotional, and practical support. The team is comprised of palliative care specialist doctors and nurses, and includes others such as social workers, nutritionists, and chaplains. A person's team may vary based on their needs and level of care. To begin palliative care, a person's health care provider may refer him or her to a palliative care specialist. If he or she doesn't suggest it, the person can ask a health care provider for a referral.

Where is palliative care provided?

Palliative care can be provided in hospitals, nursing homes, outpatient palliative care clinics and certain other specialized clinics, or at home. Medicare , Medicaid , and insurance policies may cover palliative care. Veterans may be eligible for palliative care through the Department of Veterans Affairs . Private health insurance might pay for some services. Health insurance providers can answer questions about what they will cover.

Visit the National Hospice and Palliative Care Organization website to find palliative care near you.

In palliative care, a person does not have to give up treatment that might cure a serious illness. Palliative care can be provided along with curative treatment and may begin at the time of diagnosis. Over time, if the doctor or the palliative care team believes ongoing treatment is no longer helping, there are two possibilities. Palliative care could transition to hospice care if the doctor believes the person is likely to die within six months (see What does the hospice six-month requirement mean? ). Or, the palliative care team could continue to help with increasing emphasis on comfort care .

For more information, check out NIA’s article on Frequently Asked Questions About Palliative Care .

Increasingly, people are choosing hospice care at the end of life. Hospice care focuses on the care, comfort, and quality of life of a person with a serious illness who is approaching the end of life.

At some point, it may not be possible to cure a serious illness, or a patient may choose not to undergo certain treatments. Hospice is designed for this situation. The patient beginning hospice care understands that his or her illness is not responding to medical attempts to cure it or to slow the disease's progress.

Like palliative care, hospice provides comprehensive comfort care as well as support for the family, but, in hospice, attempts to cure the person's illness are stopped. Hospice is provided for a person with a terminal illness whose doctor believes he or she has six months or less to live if the illness runs its natural course.

It's important for a patient to discuss hospice care options with their doctor. Sometimes, people don't begin hospice care soon enough to take full advantage of the help it offers. Perhaps they wait too long to begin hospice and they are too close to death. Or, some people are not eligible for hospice care soon enough to receive its full benefit. Starting hospice early may be able to provide months of meaningful care and quality time with loved ones.

Where is hospice care provided and who provides it?

Hospice is an approach to care, so it is not tied to a specific place. It can be offered in two types of settings — at home or in a facility such as a nursing home, hospital, or even in a separate hospice center.

Read more about where end-of-life care can be provided .

Hospice care brings together a team of people with special skills — among them nurses, doctors, social workers, spiritual advisors, and trained volunteers. Everyone works together with the person who is dying, the caregiver, and/or the family to provide the medical, emotional, and spiritual support needed.

A member of the hospice team visits regularly, and someone is usually always available by phone — 24 hours a day, seven days a week. Hospice may be covered by Medicare and other insurance companies. Check to see if insurance will cover the person’s particular situation.

It is important to remember that stopping treatment aimed at curing an illness does not mean discontinuing all treatment. A good example is an older person with cancer. If the doctor determines that the cancer is not responding to chemotherapy and the patient chooses to enter into hospice care, then the chemotherapy will stop. Other medical care may continue as long as it is helpful. For example, if the person has high blood pressure , he or she will still get medicine for that.

Source: www.nhpco.org/palliativecare/explanation-of-palliative-care .Copyright © National Hospice and Palliative Care Organization. All rights reserved.

Although hospice provides a lot of support, the day-to-day care of a person dying at home is provided by family and friends. The hospice team coaches family members on how to care for the dying person and even provides respite care when caregivers need a break. Respite care can be for as short as a few hours or for as long as several weeks.

What are the benefits of hospice care?

Families of people who received care through a hospice program are more satisfied with end-of-life care than those who did not have hospice services. Also, hospice recipients are more likely to have their pain controlled and less likely to undergo tests or be given medicines they don't need, compared with people who don't use hospice care.

You may also be interested in

• Exploring frequently asked questions about hospice care
• Learning about different care settings at the end of life
• Reading about making care decisions at the end of life

Sign up for caregiving tips from NIA

For more information about hospice and palliative care.

NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center 800-438-4380 [email protected] www.nia.nih.gov/alzheimers The NIA ADEAR Center offers information and free print publications about Alzheimer’s and related dementias for families, caregivers, and health professionals. ADEAR Center staff answer telephone, email, and written requests and make referrals to local and national resources.

Alzheimers.gov www.alzheimers.gov Explore the Alzheimers.gov website for information and resources on Alzheimer’s and related dementias from across the federal government.

CaringInfo National Hospice and Palliative Care Organization 800-658-8898 [email protected] www.caringinfo.org

Center to Advance Palliative Care 212-201-2670 [email protected] www.getpalliativecare.org

Hospice Foundation of America 800-854-3402 [email protected] www.hospicefoundation.org

Education in Palliative and End-of-Life Care 312-503-3732 [email protected] www.epec.net

Visiting Nurse Associations of America 888-866-8773 [email protected] www.vnaa.org

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

Content reviewed: May 14, 2021

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Regulatory Lessons Learned from One Family’s Hospice Experience – Resource

In 2022, CMS shared one family’s hospice experience as a part of a presentation at the NHPCO Annual Leadership and Advocacy Conference CMS Update. As a result, NHPCO developed a video case study and discussion guide based on this family’s hospice experience to dispel myths of hospice care.

The video and discussion guide can be used as in-service education, as education for new staff, and as part of a hospice’s ongoing evaluation of compliance with the hospice regulations and assurance of quality hospice care. We urge hospices to use this case study as a learning experience and as a Quality Assessment Performance Improvement (QAPI) topic.

Each of the issues discussed in the case study are addressed by hospice professionals in detail. The excerpts below can be used individually or in combination to help educate hospice staff. For example, nurses may be interested in Excerpt #1: Nursing and Aide Visits and Excerpt #3: Family Calls on an Almost Daily Basis. For more educational suggestions and target audiences, please refer to the discussion guide below.

One Family’s Hospice Experience – A Case Study Video

• 0:00 – Introduction and Case Study
• 12:55 – Excerpt #1: Nursing and Aide Visits
• 17:03 – Excerpt #2: No Continuous Home Care
• 21:23 – Excerpt #3: Frequency of Nursing Visits
• 27:45 – Excerpt #4: Family Calls on an Almost Daily Basis
• 36:03 – Excerpt #5: Patient Can No Longer Swallow – Medication Challenge
• 43:39 – Excerpt #6: Haldol Not Working
• 48:50 – Excerpt #7: Number of Inpatient Care Days
• 56:34 – Hospice Physician GIP Documentation
• 1:02:05 – Excerpt #8: Call to Action
• 1:05:25 – Final Reflections

Regulatory Lessons Learned from One Family’s Hospice Experience Discussion Guide

© 2024 National Hospice and Palliative Care Organization

Eagle’s Eye View: Blood Pressure and PAD, Leadless Pacemakers, Palliative Care and Heart Failure

Mar 13, 2024   |   Kim A. Eagle, MD, MACC

In this week’s View, Dr. Eagle covers various blood pressure parameters and their predictability for peripheral arterial disease (PAD) and complications, then explores the five-year outcomes of leadless pacemakers. Finally, Dr. Eagle discusses the role of palliative care in the spectrum of treating patients with heart failure.

• Kim Eagle, MD, MACC keaglemd

Your browser doesn't support HTML5 audio. Here is a link to the audio instead.

Clinical Topics: Arrhythmias and Clinical EP, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Implantable Devices, Acute Heart Failure, Cardiovascular Care Team

Keywords: Ankle Brachial Index, Blood Pressure, Peripheral Arterial Disease, Cardiac Resynchronization Therapy, Pacemaker, Artificial, Heart Failure, Geriatrics, Palliative Care, EaglesEyeView

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Home palliative care capacity to rise 50% by end-2025: Ong Ye Kung

SINGAPORE – With a rapidly ageing population in Singapore, more people are being given the opportunity to die in the comfort of their homes.

To help them do so, home palliative care capacity will be increased to 3,600 by end-2025, up by 50 per cent from the current 2,400.

“By then, we would have almost doubled the home palliative care capacity from the point of announcing the new measures,” Health Minister Ong Ye Kung said at the official opening of Tan Tock Seng Hospital Integrated Care Hub on March 19.

When the National Strategy for Palliative Care was launched in July 2023, home palliative capacity was around 2,000 patients. This number is expected to increase to 2,800 by the end of 2024.

Inpatient and day hospice capacities are also expected to rise by around 15 per cent and 12 per cent, respectively, by 2025. This translates to a total capacity of about 300 inpatient beds and 140 day hospice places.

“I know capacity expansion is not a simple matter. It is not just about having more funding, but also adequate skilled manpower, equipment and effective management oversight,” Mr Ong said.

“Nevertheless, the needs are rising, the work is urgent, and I hope our providers, especially those delivering home palliative care, can move as fast as you can to fulfil the wishes of as many patients as possible.”

Currently, patients who wish to die at home face difficulties not only in getting their hands on medical equipment, but also the high cost of setting them up at home.

To help smoothen the transition, the Ministry of Health (MOH) is rolling out its new Equipment Rental Scheme, where public hospitals will help make it easier to rent home equipment, instead of having the families deal with rental companies themselves.

MOH has set aside $23 million for three years – from 2024 to 2027 – to implement this scheme, and more than 12,000 patients are expected to benefit.

Under the scheme, which will be launched in October, a compassionate discharged patient receiving maximum subsidies can pay about $100 to rent two pieces of equipment for a week.

These can include a hospital bed and an oxygen concentrator, which would have cost more than $2,000 if families were to buy them.

Mr Ong said his ministry will be monitoring the scheme and study how best to continue providing such support in the long run.

As Singapore prepares to become a “super aged” society, MOH has also enhanced financing for inpatient palliative care, home palliative care and day hospice care significantly.

Since February 2024, the lifetime MediSave withdrawal limit has been removed for all home palliative and day hospice patients who use their own MediSave.

The MediShield Life daily claim limits for inpatient palliative care have also been raised from $250 to $460 for general care, and from $350 to $500 for specialised care.

Under the 2023 National Strategy for Palliative Care, MOH also announced that the palliative care subsidy framework would be enhanced from the fourth quarter of 2024, where all Singapore citizens would receive subsidies of at least 50 per cent regardless of their monthly per capita household income.

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What is Palliative Care?

P alliative care is a healthcare approach that aims to provide comfort and improve the quality of life of people diagnosed with a serious or life-threatening disease such as cancer, heart failure or Parkinson’s.

Beyond symptom management, palliative care involves the coordinated effort of a group of professionals, including social workers, therapists, nutritionists and spiritual leaders. This team provides patients and their loved ones with the resources and guidance to manage the physical, emotional and spiritual burdens of the disease.

Read on to learn more about palliative care and its benefits.

Table of contents

Definition of palliative care, what is included in palliative care, types of palliative care, who needs palliative care, where to get palliative care, does medicare cover palliative care, how to get palliative care, what is palliative care faqs.

Palliative care is a treatment strategy that helps patients manage the symptoms, stress and discomfort of a serious illness. It also supports the patient’s family or caretakers in an effort to improve the quality of life of all involved.

Administered by a team of palliative care providers, this care extends beyond medical treatment to encompass physical, psychological and spiritual support. This approach is beneficial for a patient’s overall well-being because it alleviates symptoms such as nausea, fatigue or difficulty breathing. It also teaches them how to cope with depression, anxiety or other illness side effects.

While palliative care shares similarities with hospice care, they are not the same. Anyone diagnosed with a serious illness can receive palliative care, whereas hospice care seeks to offer comfort and support to people nearing the end of life and their loved ones.

Palliative care specialists offer patients symptom relief, social support, education and care planning. These services supplement the patient’s primary treatment to help them and their family navigate the added care needs and responsibilities of managing a serious illness.

Symptom relief

Physicians and nurses can answer questions about treatment and offer advice on how to manage symptoms such as pain, nausea, vomiting, constipation, fatigue and shortness of breath.

Palliative care also includes assistance from social workers, therapists or spiritual advisors to help manage anxiety or depression. These services may also be available to caretakers or family members who may have concerns or questions about treatment.

Social support

As managing a serious illness can put a strain on both patients and caregivers, palliative care also helps patients create and manage a support system. A palliative care team can refer a patient to support groups or other community resources where patients can meet others facing similar challenges.

Support groups in particular provide a space where patients can receive emotional support, share experiences and exchange strategies for coping with their particular illness and its side effects.

Palliative care specialists connect patients with groups or programs that teach them more about their condition and the resources available to them. That knowledge gives patients a sense of control over their care; it can help them manage their current symptoms and understand how the illness will develop over time.

Care planning

Through care planning, patients and their physicians collaboratively develop a long-term care plan that aligns with the patient’s preferences regarding treatment options, care settings and length of care.

Care planning may include spiritual guidance from a chaplain or other spiritual leader who can offer support or advice on how to handle the spiritual concerns that arise from having a serious illness. Patients can also be referred to financial advisors to help them plan and manage the costs of care not covered by insurance or Medicare.

Palliative care encompasses three aspects: physical, psychological and spiritual care.

• Physical care encompasses pain and symptom management. To alleviate and manage pain, physicians may prescribe medication or treatments such as massage or physical therapy. Patients may also be referred to a nutritionist who can help them create a diet plan to address their symptoms.
• Psychological care helps individuals navigate the psychological and emotional challenges of managing a disease. Treatment includes therapy and social work geared towards helping the patient and their family manage stress and develop mental health coping skills. Mental health professionals may also encourage the patient to attend group therapy, where they can meet others going through similar situations.
• Spiritual care focuses on offering the patient spiritual support, be it religious or secular. This support can involve helping people explore their values and concerns through attentive listening or guiding them through meditation or prayer.

Palliative care is for any individual facing serious, chronic or life-threatening illnesses, regardless of their age or the stage of their disease. Patients who need palliative care may be experiencing symptoms such as pain, discomfort or stress.

Patients can receive palliative care at a hospital, nursing home, outpatient clinic, assisted living facility and even at home. However, care settings may also depend on the resources available in that person’s community and what their insurance, Medicare or Medicaid cover.

Medicare covers palliative care services individually, but not as a single service under the umbrella term “palliative care.”

Palliative care services generally fall under Medicare Part B. This includes coverage for medical equipment and supplies as well as counseling, physical therapy, social work and dietary management. Other palliative care services covered by Medicare include doctor and nursing services (under Part A) and prescription drugs for symptom management and pain relief (under Part D).

However, treatment options such as massage therapy or at-home custodial care (where the patient receives assistance with daily activities such as eating, bathing and dressing) are not covered. If you’re seeking coverage for this type of care, we suggest you look into long-term care insurance .

To learn more about what is covered in your area, consult your doctor and check Medicare coverage details for your state.

How long will Medicare cover palliative care?

The length of non-hospice palliative care under Medicare will depend on the person’s treatment and care needs, as Medicare coverage benefits don’t run out.

As mentioned above, Medicare doesn’t cover palliative care as one service. Instead, individual care services may be covered under Part A, B, or D of Medicare. This means coverage details vary depending on the part of Medicare that covers each service.

For example:

• Under Medicare Part A (doctor and nursing services), patients have to pay a deductible each benefit period for inpatient services along with a daily coinsurance after 60 days.
• Medicare Part B (counseling, physical therapy and social work) covers 80% of services (with 20% coinsurance), but only after patients meet the annual $240 deductible.
• Prescription drug rules under Medicare Part D also require that patients meet an annual deductible before transitioning to standard copays.

For patients enrolled in Medicare Advantage, coverage and out-of-pocket costs will depend on the terms of their plan.

A good first step if you’re considering palliative care is to talk to your doctor, as you’ll likely need a referral for the different services this type of care comprises.

Make sure you understand your illness and the curative treatments available to you. This can help you design a care approach that aligns with your values, beliefs and the quality of life you’d like to have.

In this process, you should also start discussing future care planning with both your physician and loved ones. Once you’ve settled on a care approach, contact providers in your area to schedule an appointment.

What is the difference between palliative care and hospice?

Is palliative care covered by medicare, how much does palliative care cost per day, who qualifies for palliative care, summary of money’s what is palliative care.

Palliative care is a form of comprehensive care for people with a disease such as cancer, multiple sclerosis, Parkinson’s disease or heart failure. This type of treatment approach includes physical, psychological and spiritual care to help patients and their families manage the symptoms and stress brought on by the illness.

Patients can receive palliative care in hospitals, nursing homes, care facilities, inpatient clinics or at home. However, the cost of care will depend on what their insurance plan will cover. Medicare recipients receive coverage for palliative care under standard Medicare guidelines but as separate components rather than a comprehensive service.

© Copyright 2024 Money Group, LLC . All Rights Reserved.

This article originally appeared on Money.com and may contain affiliate links for which Money receives compensation. Opinions expressed in this article are the author's alone, not those of a third-party entity, and have not been reviewed, approved, or otherwise endorsed. Offers may be subject to change without notice. For more information, read Money’s full disclaimer .

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The Ministry of Health announced the additional capacity in an update on the 2023 National Strategy for Palliative Care. (Photo: iStock)

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SINGAPORE: Singapore is on track to add another 1,200 home palliative care places by 2025, the Ministry of Health (MOH) said on Tuesday (Mar 19).

This is a 50 per cent increase from the number of places currently available and will bring the total number of home palliative care places to 3,600, MOH said in an update on the 2023 National Strategy for Palliative Care .

Inpatient hospice capacity and day hospice capacity will also be increased by 15 per cent and 12 per cent respectively to 300 inpatient beds and 140 day hospice places by 2025.

The national strategy was launched last July to expand and improve palliative care in Singapore and enable more people to "fulfil their wish to pass on with dignity and comfort". This is as as the country prepares to become a "super aged" society

To better support the families of patients who wish to pass on at home, MOH will introduce an equipment rental scheme (ERS) to provide affordable and timely access to equipment such as hospital beds and oxygen concentrators.

"Currently, patients who wish to pass on at home face difficulty obtaining timely access to equipment due to unreliable equipment supply, inadequate support to navigate the equipment rental options and high rental cost," MOH said.

"Home palliative care providers also face challenges coordinating the administrative and logistical arrangements to meet the short turnaround time for equipment delivery."

Set to be launched in October this year, the scheme will provide eligible palliative care patients with subsidies to offset the cost of equipment rental for home-based care.

All eligible palliative care patients with a prognosis of one year or less will receive subsidies of at least 50 per cent, regardless of their monthly per capita household income, MOH said.

"Subsidies will be applied to the cost of weekly equipment rental, essential consumables and delivery," the ministry added.

MOH has set aside S$23 million (US$17.1 million) for the scheme, and it is expected to benefit more than 12,000 Singaporeans on home palliative care over the next three years.

MediShield Life insurance coverage, claim limits to be reviewed amid rising healthcare costs

Fulfilling, not 'depressing': Meet the volunteers and nurses who choose to provide end-of-life care

Daily Cuts - Expanding on our national strategy for palliative care

In February, the MediShield Life daily claim limits for inpatient palliative care were raised from S$250 to S$460 for general inpatient palliative care, and from S$350 to S$500 for specialised inpatient palliative care, MOH said.

The lifetime MediSave withdrawal limit was also removed for all home palliative and day hospice patients who use their own MediSave.

MOH added that it had also standardised and streamlined "compassionate discharge" processes across all public hospitals. A compassionate discharge allows a dying patient to spend their final days at home.

"More resources have also been made available for clinicians and caregivers to facilitate the compassionate discharge process. In addition, more hospital staff have been trained to manage compassionate discharge," MOH said.

"With this, we expect patients to experience smoother discharges, and their families to be better supported in the process."

Compassionate discharge practices used to be different across hospitals and even across departments in a hospital, Health Minister Ong Ye Kung said in a speech on Tuesday.

As part of its efforts to "empower more Singaporeans to live well and leave well", MOH said it is working with partners to raise awareness of palliative care.

"Together with the Ministry of Social and Family Development and Public Service Division, MOH launched the 'Plan Today' campaign to raise awareness of pre-planning and end-of-life matters through roadshows and mobile clinics in different parts of Singapore," the ministry said.

"There are also ongoing efforts with stakeholders such as the Singapore Hospice Council (SHC), to engage the public to normalise conversations on death and dying."

SHC has trained more than 80 ambassadors to advocate palliative care.

"The implementation of the National Strategy for Palliative Care is a multi-year effort and will require all stakeholders to play their part," said MOH.

In his speech at the official opening of the Tan Tock Seng Hospital Integrated Care Hub, Mr Ong said he hoped that more doctors, nurses and healthcare professionals could be trained in palliative care.

"Dying is a natural process, not a disease," he said.

"It takes different skill sets to manage this process in a way that minimises pain and maximises quality of life by bringing comfort in the face of suffering, dignity in the midst of vulnerability and compassion during life's most delicate moments."

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Calls to end the restraining of prisoners receiving palliative care

by Medical Journal of Australia

There are urgent calls to abandon the restraining of prisoners receiving palliative care, with the ongoing practice blamed on the Australian justice and health systems colliding.

Prisoners receiving palliative care in Australia, either in a hospital or a palliative care unit, may still be subject to prison policies regarding restraint even though care is being provided outside of a prison environment, experts say.

"Health care professionals involved in caring for hospitalized prisoner patients [have] described a 'seemingly opaque system' around the protocols and points of contact for removing shackles," wrote Lara Pemberton from the Biomedicine Discovery Institute at Monash University and colleagues in a Perspective, published in the Medical Journal of Australia today.

The processes for getting the shackles removed from a restrained prisoner is also "time-consuming and deliberative—time that a dying person may not have," Pemberton wrote.

In some jurisdictions in Australia, health care staff must follow formal pathways "to request a review of a patient's risk assessment."

While palliative care for prisoners is in the spotlight this week, there are again calls for prisoners to no longer be excluded from Medicare and Pharmaceutical Benefits Scheme (PBS) subsidies.

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• Staged Operas
• Collections
• Links & FAQ
• DMITRY KORCHAK Playlist 57 great video clips

FULL DMITRY KORCHAK Playlist 57 great video clips

Information on the Performance

• Work Title: DMITRY KORCHAK Playlist   
• Composer: various   
• Libretto: various     Libretto Text, Libretto Index
• Venue & Opera Company: various  
• Recorded: various
• Type: Staged Opera Live
• Singers: Dmitry Korchak
• Conductor: various   
• Orchestra: various  
• Stage Director:   
• Costume Designer:   

Information about the Recording

• Published by: OoV   
• Date Published: 2023   
• Format: Streaming
• Quality Video: 3 Audio: 3
• Subtitles: nosubs   
• Video Recording from: YouTube      FULL VIDEO

ADDITIONAL INFORMATION ON THIS PERFORMANCE

Dmitry Korchak (born February 19, 1979 in Elektrostal/Moscow Oblast) is a Russian tenor and conductor.

Korchak received his musical education at the Moscow Choral Academy. In 2004 he won prizes at the “Francisco Viñas” International Singing Competition in Barcelona and at the Plácido Domingo Operalia International Competition in Los Angeles.

As a singer he has appeared at La Scala in Milan, the Vienna State Opera, the Berlin State Opera Unter den Linden, the Paris Opera Bastille, London’s Covent Garden and New York’s Carnegie Hall. He has collaborated with artists such as Daniel Barenboim, Riccardo Chailly, Plácido Domingo, Lorin Maazel, Zubin Mehta and Kent Nagano.

From 2017 to 2020, Dmitry Korchak was Principal Guest Conductor at the Novosibirsk Academic Opera and Ballet Theater, where he directed his own festival, and Guest Conductor at the Mikhailovsky Theater in Saint Petersburg.

Korchak has made several guest appearances at the Kissinger Sommer, the Salzburg Festival and the Rossini Festival in Pesaro, where he also worked as a conductor. Korchak also worked with the Bavarian Radio Orchestra and the Chicago Symphony Orchestra, among others.

Comment ( 1 )

Thank you for this, he’s brilliant!

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News from non-English countries

"They fell to the ground with screams": Russian Guards fired at children single near Moscow - there is a casualty

2023-08-20T20:58:57.477Z

Highlights: In Russia, in the city of Elektrostal (Moscow region), during demonstrations, Rosgvardia soldiers began shooting at spectators with children from machine guns with blank cartridges. One child received serious damage from a rebounded cartridge case. In the video, a child can be heard crying and screaming violently. It is also interesting that Russia recently arranged a solemn farewell to Vladimir Shestakov, convicted for the murder of a child, who became a mercenary of PMC "Wagner" and was liquidated in the war in Ukraine.

In Russia, in the city of Elektrostal (Moscow region), during demonstrations, Rosgvardia soldiers began shooting at spectators with children from machine guns with blank cartridges.

So far, one injured child is known.

This was reported by the local Telegram channel of the Cheka-OGPU.

"Small children were clutching their heads screaming and falling to the ground. Not without injuries. The child received serious damage from a rebounded cartridge case," the report said.

One of the witnesses to the incident posted a video. It was her child who was shot by the Russian Guards. In the video, a child can be heard crying and screaming violently.

After the woman realized that her child had been wounded, she called her husband and doctor.

Meanwhile, Russian occupier Ivan Alekseev in the war in Ukraine after a drunken quarrel killed his colleague and tried to cover up the crime, saying it was the work of "Ukrainian saboteurs."

It is also interesting that Russia recently arranged a solemn farewell to Vladimir Shestakov, convicted for the murder of a child, who became a mercenary of PMC "Wagner" and was liquidated in the war in Ukraine.

• The suspect in the murder of a military volunteer was released from custody
• They will teach "patriotism": Russians in the occupied territories launch cadet classes
• Russia has created another training ground near Mariupol: how many soldiers are in the city

Source: tsn

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