Russell Murray Hospice Clinical Supervisor Missy Ellard provides holistic and palliative care that helps patients make their final journey on their own terms.

by Traci Chapman, staff writer
It takes great strength to deal with the finality that is hospice – to provide treatment not likely to provide recovery, to see the pain and suffering of patients and their family. It’s also rewarding work, a chance to help make that patient’s final journey one of peace, warmth and comfort.
“Hospice care can be difficult, of course, it takes something special to do this,” Russell Murray Hospice Clinical Supervisor Missy Ellard said. “I believe hospice work is a calling.”
That calling is something Ellard knows well. While she has worked in other nursing specialties, the Yukon RN has always come back, both to the type of work she loves and the company she said epitomizes the best of care and value that hospice brings to its patients and the people who love them.
Ellard did not start out as a nurse. For 10 years, she worked at the old Western Electric, later AT&T, facility. But, times changed for the industry and despite a strong and active labor union, she and many others were laid off.
“I always wanted to go into nursing,” Ellard said. “I’ve always seen getting laid off as a God thing, just what was meant to be.”
That outlook meant what many people would see as a step backward Ellard saw as an opportunity – and she jumped at it. It was in her early 30s that Ellard attended Redlands Community College and Southern Nazarene University, obtaining Associates of Applied Science and Bachelor of Science Nursing degrees.
In 1994, with school behind her, Ellard was ready to follow her new path and find her first nursing job. She learned about Russell Murray Hospice, then an El Reno hospice provider, and found a home – in the process becoming the first nurse RMH hired straight out of school.
“I worked as a staff nurse, as a case manager, I loved the work and the people I worked with, but after a time I wanted to try something new – I just really wanted to get other experience, so I branched out,” Ellard said.
That decision led her to a variety of experiences – working in home health and in a doctor’s office. She worked as a nurse for Canadian County Department of Human Services, making home visits to conduct patient assessments and evaluations, determining their qualification for Medicaid programs, including hospice referrals.
Ellard also used her skills for Oklahoma DHS Developmental Disabilities Services, responsible for health assessments at four Oklahoma City metropolitan area group homes. There, she recommended therapy, dietary consultations, wound care and other necessary services – but, as much as she enjoyed the work, something was missing, she said.

“I missed hospice care, I love hospice care,” Ellard said. “I had family members who were being served by Russell Murray, and I realized just how much I missed working here.”
So, she was back – Ellard said she realized she was home, exactly where she belonged. She was named clinical supervisor in Russell Murray’s now home office – while El Reno remained its base, the not for profit now had offices in Kingfisher, Weatherford and Oklahoma City.
Patients are not always what one might imagine someone needing hospice care might look like, Ellard said. The five nurses she directly supervises also provide physical assessments to at-risk children, like those taken to Canadian County Youth and Family Shelter – children who have had their lives completely disrupted, with parents or guardians who could be incarcerated or are facing severe addiction or other problems.
For those patients who are facing an imminent end to their life, Ellard and her nurses are committed to using every resource at their disposal to make any time that individual may have left the best it can be – and that is something different for each patient, she said.
“The thing about hospice care, about palliative care, is it’s truly holistic, something that provides not only relief from physical conditions, but encompasses everything to improve the quality of life for the patient,” Ellard said. “It’s the one area of nursing you can truly practice holistic care.” That might mean incorporating spiritual guidance or comfort, or it might involve finding a way to bridge an estranged family relationship; it could be making it possible for the patient to do something they’ve always dreamt of or simply ensuring they’re comfortable as they live their final days.
“Some of our patients want to fight their disease every single minute, as long as they possibly can, and we help and encouragement them with that,” Ellard said. “Others just want to be comfortable, to spend their time with their families or their friends, and we follow their lead on that, as well.”
No matter a RMH patient’s beliefs, needs or approach to their condition, they do have one thing in common – they are never turned away due to financial considerations, Ellard said.
“If a patient qualifies and desires hospice care, we do not turn patients away based on their reimbursement status,” she said. “Many hospices, even not for profit hospices, have a ‘quota’ of non-reimbursable patients and will decline patients if they don’t have a payer source – RMH has never done that.”
That approach has helped spur the company’s growth, which includes not only Ellard and her five-member nursing staff in El Reno, but a total of 25 full-time RNs and LPNs, as well as several per diem PRN nurses, across RMH’s four offices. That staff serves about 100 patients throughout the Oklahoma City metropolitan area and an approximately 75-mile radius surrounding each of its offices at any given time.
“Everybody deserves to die with dignity – to me, if we can bring peace, if we can bring comfort, we help them to do that,” Ellard said. “It’s that mission, it’s that ability to be a part of that – well, that’s the reason this was my first job, and I want it to be my last.”

INTEGRIS broke ground on the health care system’s first micro-hospital. The ceremony was take November 1st at 10 a.m. at 3391 S. I-35 Service Road in Moore. While the event was held at one location, it signified and celebrated all four of the micro-hospitals INTEGRIS plans to build in Central Oklahoma.
Last October, INTEGRIS officials announced they would be working with Emerus to open small-scale, fully licensed inpatient hospital facilities in different quadrants of Oklahoma City, to bring high-quality care closer to home. “We want to provide local neighborhoods with more choice and convenience when it comes to health care,” said INTEGRIS President and Chief Executive Officer Bruce Lawrence. “Our micro-hospitals will offer 90 percent of the medical services many patients and families will ever need.”
Emerus is the nation’s first and largest operator of such hospitals and is a nationally recognized, innovative leader in the delivery of emergency, inpatient, and diagnostic health care. Each joint venture facility will be open 24-hours a day, seven days a week and will be equipped to respond to almost any medical issue a patient may present with; including those that may be life threatening or require complex, critical care.
“The benefit of these facilities is two-fold,” stated Emerus Chief Executive Officer Craig Goguen. “While they help relieve emergency rooms at large comprehensive hospitals by treating the non-emergent needs that can overcrowd such institutions; they are also quickly accessible to stabilize and in many cases even treat truly emergent patients in their own neighborhood when time is of the essence. We’ve seen it in every community we’re a part of, these hospitals make a huge difference in people’s lives.”
Emerus operates similar facilities across the country in places like Dallas, Denver and Houston. The INTEGRIS micro-hospital in Moore will total about 50,000 square feet and will include an emergency department, inpatient unit, laboratory, and imaging services as well as medical offices for physicians and other health care providers.
The new facility will offer expanded health care to the community with compassion, efficiency and excellence, while maintaining the highest standards for quality, safety and service.
All four INTEGRIS micro-hospitals will house between eight and 10 inpatient beds for observation and short-stay use, and include a similar number of emergency treatment and triage rooms, along with primary and specialty care physicians, diagnostic and other outpatient clinic services.
The three other planned locations are in Northwest Oklahoma City, Far West Oklahoma City and Del City. The Moore facility is scheduled to open in early 2019 and the remaining locations should be up and running by the end of that year. Additional INTEGRIS micro-hospitals could be on the horizon in the future.

Providers at the clinic include: (top L-R) Sarah Cox, DO; Misty Hsieh, MD; (bottom L-R) Cerissa Kay, DO; and Lara Rodkey, ARPN-CNP.

Mercy continues to fulfill the promise of expanding health care services in south Oklahoma City with the opening of a new family medicine and pediatric care clinic at 1060 SW Fourth St. An official blessing with ribbon cutting is scheduled at 4 p.m., Tuesday, Nov. 4.
“We’re always looking for ways to better care for and cater to our patients,” said Di Smalley, Mercy regional president in Oklahoma. “Mercy already has a strong presence in north Oklahoma City and Edmond. We’re ready to provide that same level of patient care to those in south Oklahoma City and the surrounding communities.” The clinic includes family medicine physicians Sarah Cox, DO; and Misty Hsieh, MD; pediatrician Cerissa Key, MD; and Lara Rodkey, APRN-CNP. Imaging and lab work are also offered at the clinic. The newly constructed 11,800-square-foot clinic includes 24 exam rooms with space to accommodate an additional four providers as health care needs in the community grow.
Clinic hours are 7:30 a.m. to 5 p.m. Monday through Friday.
All providers are accepting new patients. For an appointment, call 405-378-5491.

Dear Savvy Senior,
What are the eligibility requirements to get Medicaid coverage for nursing home care?
Caregiving Daughter

Dear Caregiving,
The rules and requirements for Medicaid eligibility for nursing home care are complicated and will vary according to the state where your parent lives. With that said, here’s a general, simplified rundown of what it takes to qualify.
Medicaid Eligibility
Medicaid, the joint federal and state program that covers health care for the poor, is also the largest single payer of America’s nursing home bills for seniors who don’t have the resources to pay for their own care.
Most people who enter nursing homes don’t qualify for Medicaid at first, but pay for care either through long-term care insurance or out-of-pocket until they deplete their savings and become eligible for Medicaid.
To qualify for Medicaid, your parent’s income and assets will need to be under a certain level that’s determined by their state. Most states require that a person have no more than about $2,000 in countable assets that includes cash, savings, investments or other financial resources that can be turned into cash.
Assets that aren’t counted for eligibility include their home if it’s valued under $560,000 (this limit is higher – up to $840,000 – in some states), their personal possessions and household goods, one vehicle, prepaid funeral plans and a small amount of life insurance.
But be aware that while your parent’s home is not considered a countable asset to determine their eligibility, if he or she can’t return home, Medicaid can go after the proceeds of their house to help reimburse their nursing home costs, unless a spouse or other dependent relative lives there. (There are some other exceptions to this rule.)
After qualifying, all sources of your parent’s income such as Social Security and pension checks must be turned over to Medicaid to pay for their care, except for a small personal needs allowance – usually between $30 and $90.
You also need to be aware that your parent can’t give away their assets to qualify for Medicaid faster. Medicaid officials will look at their financial records going back five years to root out suspicious asset transfers. If they find one, their Medicaid coverage will be delayed a certain length of time, according to a formula that divides the transfer amount by the average monthly cost of nursing home care in their state.
So if, for example, your parent lives in a state where the average monthly nursing home cost is $5,000 and they gave away cash or other assets worth $50,000, they would be ineligible for benefits for 10 months ($50,000 divided by $5,000 = 10).
Spousal Protection
Medicaid also has special rules for married couples when one spouse enters a nursing home and the other spouse remains at home. In these cases, the healthy spouse can keep one half of the couple’s assets up to $120,900 (this amount varies by state), the family home, all the furniture and household goods and one automobile. The healthy spouse is also entitled to keep a portion of the couple’s monthly income – between $2,030 and $3,022. Any income above that goes toward the cost of the nursing home recipient’s care.
What about Medicare?
Medicare, the federal health insurance program for seniors 65 and older, and some younger people with disabilities, does not pay for long-term care. It only helps pay up to 100 days of rehabilitative nursing home care, which must occur after a hospital stay.
Find Help
For more detailed information, contact your state Medicaid office (see Medicaid.gov for contact information). You can also get help from your State Health Insurance Assistance Program (see ShiptaCenter.org), which provides free counseling on all Medicare and Medicaid issues.
Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.

A little more than 10 years ago, Jason Hasty, then the physical education teacher at Putnam City’s Western Oaks Elementary School, was a dedicated runner. If he wasn’t running in local races, he was training to run in those races. He wondered. Why couldn’t Putnam City host a race?
Flash forward to today, and it turns out the district can do just that. On the morning of Saturday, Nov. 11, more than 1,000 runners and walkers are expected to take part in the 10th annual Putnam City Cancer Classic, a 5k and 1-mile fun run that raises money for cancer research at Oklahoma Medical Research Foundation (OMRF). The 5k starting gun will sound at 8:30 a.m., while the fun run begins at 10 a.m. The event will be held at Wheeler Park, 1120 S. Western.
Registration for the 5k race is $30. Registration for the fun run is $15. Runners and walkers can register and pay online at www.pccancerclassic.com or register the morning of the event at Wheeler Park.
Hasty says the race has come a long way.
“That first year of the Putnam City Cancer Classic I was nervous. I didn’t know a great deal about hosting a race. But it worked, and it’s gotten better and better every year. The community shows up and has a good time. Everyone who takes part knows it’s a great event which benefits a great cause, cancer research at OMRF,” says Hasty.
Last year’s Cancer Classic raised about $9,700 for cancer research. It’s just one component of a larger cancer fund drive. For 42 years, Putnam City has worked with OMRF in the battle against cancer. Using everything from pajama days, school carnivals, soccer games and powder puff football, district students, parents and staff have raised more than $3.5 million to support OMRF’s cancer research efforts. Putnam City’s donations have purchased a vast array of sophisticated laboratory equipment, including centrifuges, microscopes and incubators, and also established an endowed chair at OMRF, the Putnam City Schools Chair in Cancer Research.
“The Cancer Classic is a fun event, but more importantly, everyone who takes part is taking personal action in the fight against cancer,” says Stephanie Treadway, the principal at Western Oaks Elementary School who is chair of Putnam City’s Cancer Fund Drive.

The Board of Health (Board) met at 7 p.m. today in emergency session and accepted the resignation of the Oklahoma State Department of Health (OSDH) Commissioner, Terry Cline, Ph.D., effective immediately. Dr. Cline has served as the OSDH Commissioner since June 2009. The Board appointed Director and Secretary of Finance, Preston Doerflinger, as Interim OSDH Commissioner. Director Doerflinger will assume his new responsibilities on October 31, 2017.
The resignation of Commissioner Cline came on the heels of information received by the Board that OSDH is faced with an immediate financial loss predicated upon multiple years of over-expenditures and fiscal mismanagement. In addition to Commissioner Cline, the Board acknowledges the resignation of Julie Cox-Kain, OSDH Senior Deputy Commissioner, effective immediately.
“The Board takes these matters very seriously and is prepared to take all steps necessary to ensure that OSDH continues its important work in the area of public health” said Board President Martha Burger.” Burger wants to assure the employees that the Board is committed to the critical work they perform for the citizens of Oklahoma.
OSDH is taking steps to address the problems head on and put OSDH back on sound financial footing. In addition to steps previously taken to address the shortfall, OSDH signed an engagement letter today for a special audit by the Oklahoma State Auditor and Inspector’s office to address the issues that have led to the current financial situation.

By John D. Doak, Oklahoma Insurance Commissioner
Currently, more than 678,000 Oklahomans are enrolled in Medicare. Are all of those beneficiaries getting the proper coverage at the most affordable price based on their respective budgets? Unfortunately, the answer is likely no but there is a solution available during the Medicare Open Enrollment period.
The Medicare Open Enrollment period runs from Oct. 15 through Dec. 7. During this time, beneficiaries can review their current medical and prescription drug coverage, as well as explore new options available to them that could provide better coverage at a reduced cost.
Did you know that last year there were 20 different prescription drug plans available to Medicare beneficiaries ranging in price from $17 to $166 a month? Most people would likely pick the cheaper option to save money. However, sometimes the cheaper option isn’t always the best option. For example, what if a beneficiary were to enroll in the cheaper plan option only to find out that a particular medication he or she was prescribed isn’t covered under the cheaper plan? In that scenario, it would mean that the cheaper plan wouldn’t cover any of the costs for that drug, which would result in the beneficiary having to pay the full price for that medication. Ultimately, the beneficiary in that situation could actually wind up spending twice as much or more for his or her drug costs that year.
Here are some other considerations for Medicare beneficiaries to think about each year:
* Did your physician prescribe a new medication for you in the last year?
* If so, will your current prescription drug plan cover that new medication or is there another drug plan available that will cover it and could help save you money?
* Have you noticed that the monthly premium or co-pay amount for your current drug plan, which does cover all of your prescribed medications, has increased significantly?
With so many different Medicare plans available, each with different monthly costs, co-pays and drug lists, how do you make the best decision for yourself?
That’s where the Medicare Assistance Program (MAP) at the Oklahoma Insurance Department comes in. MAP is a grant-funded program that offers free, unbiased counseling to Medicare beneficiaries concerning their different options for Medicare coverage. MAP counselors are available to meet with seniors in-person or on the phone to answer questions about original Medicare, Medicare supplement insurance, Medicare Advantage plans and Medicare prescription drug plans. Within that, MAP counselors can help Oklahoma seniors evaluate their current coverage and explore the options available to them for the coming year.
Last year, MAP counselors helped Oklahoma seniors save, on average, an estimated $2,100 per person. In addition, MAP can help Oklahoma seniors living on fixed incomes in applying for financial assistance to cover their medical and/or prescription drug costs.
There are trained counselors across Oklahoma available to assist and provide a more personal approach to Medicare coverage counseling. Please call 800-763-2828 to find a counselor near you.

Oklahoma Medical Research Foundation scientist Hal Scofield, M.D., said patients demanding antibiotics from health care providers has contributed to the growing problem of antibiotic resistance.

The world is running out of antibiotics.
In a new report from the World Health Organization, research showed that too few new antibiotics are being developed to counter the growing threat of infections that are resistant to currently available antibiotics.
“Antibiotic resistance is one of the biggest and fastest-growing health crises facing our planet,” said Oklahoma Medical Research Foundation immunologist Hal Scofield, M.D. The CDC estimates that 23,000 Americans die each year from infections that don’t respond to standard treatment with antibiotics. And this number is only going up.
Antibiotic resistance occurs when a bacteria, fungi, or parasite is no longer curable by medicines previously able to treat them. For example, if you give a patient antibiotics and it kills 99.9 percent of the bugs that are causing the disease, the 0.01 percent that survive can become superbugs that are resistant to the medication.
“This happens routinely, and we know it’s going to continue until protocols are established in medicine to minimize it,” said OMRF President Stephen Prescott, M.D., a physician and medical researcher. “Unfortunately there are a lot of forces working in the other direction.”
The primary cause for the surge in superbugs is excessive use of antibiotics. According to the CDC, healthcare providers write 47 million unneeded antibiotic prescriptions each year in the U.S. alone. “It’s routine for antibiotics to be prescribed for conditions that they can’t treat, things like sore throats, colds and other viral infections,” said Prescott.
Scofield emphasized that patients also bear some responsibility. “People often demand antibiotics from their healthcare providers in situations where they won’t help,” he said. “And for a variety of reasons—including the desire to please patients and to receive high customer-satisfaction ratings—the providers often reluctantly accept.”
Finding ways to administer antibiotics only when needed is important, said Prescott. But so is proper usage by patients once the drugs are prescribed. “This means never skipping doses or stopping treatment early, even if you feel better,” Prescott said.
He added that the use of antibiotics in animals like chickens, cattle and pigs may also be a culprit. “The drugs speed the animals’ growth and how much meat they have on them, but they are also very likely contributing in a significant way to the rapid rise of superbugs,” he said.
The new WHO report states that 51 antibiotics and 11 natural medical products are in development, but the fear is that it won’t be nearly enough, because many won’t make it all the way through trials to enter the market. The WHO also warns that many are only short-term solutions, as well, because most are just modifications of existing treatments.
“People in Oklahoma need to realize this isn’t a rare thing that only happens in third-world countries. It’s occurring all over,” Prescott said. “It’s a real problem and it’s not one that will be easily solved. There are big, wholesale structural changes that need to happen.”

On Tuesday, November 7, 2017, Oklahoma City’s Brightmusic Chamber Ensemble will present its second concert of the 2017-18 season, “Masterworks for Three,” featuring chamber works by eighteenth- and nineteenth-century composers, all of whom wrote extensively in the genre. The Ensemble will present trios by Mozart, Mendelssohn and Brahms. The Mendelssohn trio is one of his most popular chamber works and is recognized as one of his greatest. The sweetly-melancholic Brahms trio commemorates the death of his mother earlier that year and was the last chamber work he would write for the next eight years. All three compositions on the program of this Jeannette Sias Memorial Concert are masterworks by three of classical music’s greatest masters. The works on the program are: Wolfgang Amadeus Mozart, Piano Trio in G Major, K. 564 (for violin, cello and piano) Felix Mendelssohn, Piano Trio No. 1 in D Minor, op. 49 (for violin cello and piano) Johannes Brahms, Horn Trio in E-flat Major, op. 40 (for horn, violin and piano).
Brightmusic musicians performing are: Gregory Lee (violin), Meredith Blecha-Wells (cello), Kate Pritchett (horn) and Amy I-Lin Cheng (piano)
The performance will take place at 7:30 pm on Tuesday, November 7 at St. Paul’s Cathedral, 127 NW 7th Street (at Robinson). Individual concert admission is $20 per ticket. Children, students and active-duty military personnel are admitted free with ID. More information about this concert is available on Brightmusic’s website at http://www.brightmusic.org.

Support Groups Help Caregivers Manage Stress
Oklahoma City, OK – Sunbeam Family Services, through its Caregiver Fundamentals Program (CFP), will host support groups for individuals who are caring for a senior adult or grandparents who are raising grandchildren. The CFP program is in partnership with Areawide Aging Agency and provides caregiver education, respite and support groups.
Although caring for a loved one can bring feelings of satisfaction, caregivers often feel tired, overwhelmed, stressed, isolated and burned out. One of the tools Sunbeam offers is support groups throughout Oklahoma, Cleveland, Canadian and Logan counties. According to AARP, Oklahoma has more than 600,000 caregivers.
“Support groups provide caregivers a safe place to talk to other caregivers, ask questions, voice concerns and needs. It’s also a setting where they gain knowledge about resources available in the community to help them build confidence in their journey as caregivers,” said Taprina Milburn, Senior Care Manager.
Sunbeam offers the following free caregiver support groups in Oklahoma County:
For Grandparents Raising Grandchildren:
Educare OKC Grandparent Support Group, 500 SE Grand Blvd. Oklahoma City, OK – Second Thursday of each month, 11:30 a.m. to 1 p.m.
Midwest City Grandparent Support Group Fountain Brook, 11510 SE 15th Street, Midwest City, OK – Third Tuesday of each month, 6:30 p.m. to 8 p.m.
For Caregivers:
Sunbeam Family Services 1100 NW 14th Street, Oklahoma City, OK – Last Tuesday of every month, 12 to 1:30 p.m. (Lunch is provided)
WovenLife Oklahoma 701 NE 13th Street, OKC, OK – Fourth Wednesday of every month, 12 p.m. to 1:30 p.m. (Lunch is provided)
Excell Hospice & Home Health
1200 SW 104th, Oklahoma City, OK – Second Tuesday of every month, 12 p.m to 1:30 p.m. (Lunch is provided)
If you are interested in attending or for more information about Sunbeam’s Caregiver Fundamentals Program, call 405.609.8939 or tmilburn@sunbeamfamilyservices.org.