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PLEASANT VIEW -- In a Pleasant View home, a man lays in bed, the rich tones of a harp punctuated by the hiss of his oxygen supply.
Maurice Ames is dying.
Near his bed sits Chris Jones, her fingers dancing delicately across the strings and her lilting, breathy voice contrasting with the ethereal notes of the harp.
Jones and her harp are there as part of the hospice care Ames, 84, is getting. She is a certified music thanatologist -- someone who uses live music in end-of-life care to respond to the patient's physical and emotional issues.
Jones said it is "a contemplative practice with a clinical application, offered live and prescriptive for the individual."
During her time with Ames, the TV is turned off, cell phones silenced and chatter stops. A chorus of bongs, cuckoos and music are the only interruption, issuing from the many clocks in the house, a reminder of Ames' late wife's hobby.
Jones begins by checking vital signs -- the pulse, asking about pain and checking breathing.
"If I stop breathing, I'm dead," Ames joked.
As the music plays, he glances around the room, a slight smile on his lips. Red Skelton and John Wayne collections sit by the TV and railroad memorabilia is scattered around the room, traces of Ames' 44 years with Union Pacific.
Jones glances often at Ames to measure his response to the music. It all depends on the patient, Jones explained.
With someone as alert as Ames is that day, the music she chooses is more structured and grounding. With someone whom she calls actively dying, the music is meant to be releasing and less structured.
The music can reduce anxiety, relieve pain, help people sleep and provide several other health benefits, said Debbie Robertson, Applegate HomeCare and Hospice spokeswoman. These benefits are why Applegate has hired music-thanatologists for more than five years.
Ames' son, Jim Ames, said his father's health began seriously deteriorating about a month ago.
Jim's wife, Tammie Ames, said since Jones began playing for her father-in-law, his anxiety has gone down and the family has been able to reduce the amount of pain medication he needs.
"It's not half as much as it used to be," she said.
Robertson said having a peaceful moment to spend with a dying family member can be invaluable.
"Birth is a process. Death is a process," she said. "This helps us begin to think, in a quiet setting and a peaceful way, about them and their part in our lives."
As the population ages, more people are turning to hospice care at the end of their lives. This competition for care is creating a few problems but also increasing the number of services available.
As of 2008, more than 1 million Americans were using hospice through Medicare at a cost of nearly $12 billion per year, according to a MedPac report to Congress. By 2018, MedPac estimates the U.S. will be spending more than $23 billion on hospice care.
Of the people who could use hospice in Utah, nearly 70 percent, or 8,000 residents, do, which places Utah at the top nationwide in percentage of people who utilize hospice, said Dan Hull, executive director of Utah Hospice and Palliative Care Organization. Most states are between 30 and 40 percent, which is where Utah was 10 years ago.
The percentage is so high because more people have learned about hospice but also because there is a culture of acceptance around death in Utah, Hull said. Because many Utahns don't see death as a bad thing, he said people are more willing to admit they are dying and to use hospice.
Hull said the government saves $2,500 per person by using hospice rather than putting them in another care facility.
"The biggest cost for care is at end of life," he said. "If someone gets sick and goes to the hospital they can go through a lot of money."
As more people turn to hospice, the number of Medicare-participating hospices has risen as well. Most of that growth is in for-profit hospices. While non-profits and government hospices have remained about the same, for-profit hospices have gone from about 800 to 1,800 nationwide, according to a June 2009 MedPac report.
Because of that, people need to be very careful when choosing a hospice service for their family, Robertson said.
The hospice is given a certain amount of money per day, per patient from Medicare and has minimum standards to meet, she said. To maximize profits, some companies do only the minimum necessary -- cover medications and supplies and visit twice a month, she said.
Hospices compete by providing the best care, while staying in business. Unfortunately, residents don't know what to ask to be their own advocates, Robertson said.
People shouldn't be afraid to interview companies, she said. They provide a service and work for the person. Ask about number of visits a week, what will be paid for by the hospice, how often respite care is used and any other services above medication that are offered.
"These are Medicare benefits that their families have paid for," she said. "It's not for someone to direct them, but their power to decide."
She said people can also call the hospice and have their relative assessed, because they might qualify for hospice and not realize it.
Utah Hospice and Palliative Care Organization: http://www.utahhospice.org/
Applegate HomeCare and Hospice: http://www.applegatehomecare.com/Pages/Home.aspx
Music-Thanatology Association International: http://www.mtai.org/
