Promoting Excellence : A University-Affiliated Geriatric Practice

School of Nursing and School of Medicine
University of North Carolina–Chapel Hill
Chapel Hill, North Carolina

Martha L. Henderson, MSN, MDiv, DrMin, GNP

Martha L. Henderson Martha Henderson practices as an adult nurse practitioner and geriatric nurse practitioner through the Program on Aging at the University of North Carolina–Chapel Hill (UNC). A self-proclaimed “end-of-life care facilitator,” she helps fill the health care and communication gaps often faced by the chronically ill elderly. Henderson is a Project on Death in America faculty scholar. Her special area of expertise is advanced care planning. Her doctoral dissertation, Beyond the Living Will, explores results from a study showing that discussing end-of-life preferences lowered death anxiety in a sample of retirement community elderly.

Generally, the patients Henderson serves have fallen through the cracks, being ineligible for home care and hospice, and have advanced chronic illness, such as end-stage heart and lung disease, dementia or cancer. Because their prognosis and trajectory for dying is fairly uncertain, they may not meet hospice’s six-month criterion. In addition, many of Henderson’s patients do not see themselves as terminally ill. Henderson also cares for people who home health won’t see because they can’t meet the strict criterion of being homebound.

Delivering the Basics
Henderson provides five basic services. She calls in professional colleagues as needed to ensure that these services are available:

  • Assessment: Henderson assesses the patient’s function and the adequacy of current living arrangements, including caregiver support.
  • Symptom management: Henderson does what is necessary to ensure that chronic illness is treated at the maximum level possible and/or that comfort care, including drug therapy, is provided. She also asks patients what is most important to them and how they want to use their limited time and energy.
  • Advanced care planning: Henderson defines advanced care planning as a “process in which people begin to think about their mortality, what’s important to them and how they want to die.” She helps her patients write an advanced care plan, including appointment of a surrogate decision maker and the completion of an advanced directive, if that is what they desire.
  • Emotional, social and spiritual counseling: Henderson helps patients deal with their own grieving and letting go of life. She may treat depression or anxiety with medication and counseling. Henderson also helps people come to terms with dying, which often involves listening, praying and reading scripture. She may make a referral to a pastor, priest or rabbi to help the patient maximize his or her own resources for spiritual support.
  • Continuity, coordination and communication: Henderson stays with a patient and family from admission until the patient dies. “This means that every time the patient changes settings, they have a familiar face—a care provider who knows them medically and personally,” she explains.

Referrals to Henderson come from hospice, primary care providers, friends, nursing colleagues and through UNC’s Program on Aging. The amount of care given depends on patient need. Some of Henderson’s patients are stable and require only monthly visits. When patients are unstable or actively dying, however, Henderson may see them frequently or may refer them for hospice care.

Henderson is supported by the UNC’s Department of Medicine, which donated 20 percent salary for her position to care for chronically ill adults who don’t qualify for hospice or home care but need additional assistance to improve their quality of life. Although Henderson has had the financial support of the Program on Aging and the UNC Department of Medicine, the lack of full reimbursement for her time through Medicare Part B makes long-term support for her position an uncertainty. Currently, she receives reimbursement for about 50 percent of her time. Thus, some of her “behind the scenes” telephoning to family and physicians, work with the family and coordination of services is not reimbursed.

Focus on Education
Henderson speaks, consults and conducts workshops throughout the United States. She teaches physicians, nurses and other health professionals how to help their patients prepare for death. Her advanced care planning facilitator course is designed for those who want to learn how to talk to people about what they want at the end of life. She and her colleagues have developed a worksheet to guide an advanced care planning discussion in the primary care setting. She also consults with hospice providers. In addition, Henderson is helping to educate other nurse practitioners about end-of-life care through participation in palliative care efforts of the American Academy of Nursing and in her role as chair of the End-of-Life Care Task Force for the American College of Nurse Practitioners.

Personal Reflection
“I do everything possible to keep patients comfortable and help them fulfill some of their dreams,” she explains. “I try to help them find joy within the confines of their illness.”

“Our evidence of success is the satisfaction of patients and families,” Henderson says. “Each family completes an evaluation after the death of their loved one. These evaluations are always very good and show the family’s gratitude.” Physicians also seem satisfied with Henderson’s efforts to improve patient care. “As long as I keep communicating with doctors about important changes in their patients, they are always very appreciative of the care I provide,” she notes.

Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying persons and their families. Visit for more resources.

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