Hospice Doctor Remembers His First Patient, His Grandfather

Dr. Jorge Rivero, Medical Director for Hospice Care of the West. photo by Scott Weisgerber

Dr. Jorge Rivero’s inspiration to care for seniors started when he was a medical student keeping his grandfather comfortable at the end of life. Yet today, Dr. Rivero, now a Medical Director for Hospice Care of the West, recalls what brought him the most joy at the bedside with his grandfather were the captivating journeys into his past. His grandfather shared sensory rich stories of running a factory that made chili products and seasonings in Lima, Peru. Today, his family history lives on in his memories.

Equally memorable was his grandfather’s stubbornness in taking his medications or going to the doctor. He hated being in the hospital so Dr. Rivero accepted the challenge of dealing with most of the urgent care at home. He earned his grandfather’s trust and respect by taking time to listen to his stories, which translated to subsiding the stubborn behavior and following doctor’s orders.

With nearly three decades dedicated to geriatric medicine, Dr. Rivero uses the gift of listening to help his patients be comfortable and thrive in life’s second half.  In addition to serving as the medical director at Hospice Care of the West, he has a bustling group practice, Senior Care Medical Associates, in South Orange County. Part of his mission in ensuring his patients are comfortable, peaceful and happy in the last months of their

life is to transition them into hospice care, which is managed by an interdisciplinary team of experts specializing in end of life.  Along with his medical expertise as a hospice doctor, he collaborates with a nurse, social worker, spiritual care coordinator and volunteers to support and care for patients and their families at home instead of in a hospital toward the end. In addition to making house calls with patients, he meets with the hospice team weekly to manage the hospice patients’ care.

Before his group practice with Senior Care Medical Associates and becoming a medical director for Hospice Care of the West, he served on the faculty at University of California, Irvine where he cared for a large senior population that opened a window to understanding the inner workings of hospice. He noticed that when he referred patients to Hospice Care of the West and made the decision to be the attending doctor in the care, the nurses always collaborated with him on symptom management for his patients. He began to see the benefits of hospice care improving the quality of life for his patients and their families at home.

Doctors referring their patients to hospice care can choose to be the attending doctor, which means overseeing the plan of care. Alternatively, they can transfer their patients’ care to the hospice medical director. Dr. Rivero says many doctors choose not to be the attending doctor in hospice care and he feels this is a missed opportunity to show their commitment and continuity of care. He says in some cases, patients and families could feel like they are being left during the transition into hospice. Though this is not the case, as a medical director at Hospice Care of the West, he visits the patient’s home if there is no attending doctor and eases the transition into hospice. Patients and families often are so relieved to be home after a long stint in hospital. They are grateful when he and the hospice nurse arrive to take over their care. Though he enjoys these home visits, his wish is to see more doctors continue care

and sign on as the attending doctor in hospice care. This choice he believes will broaden the awareness and improve acceptance of hospice care in the medical community.

Though every patient and family is different, he has come to realize that discussing hospice as an option earlier, rather than later, helps all involved to make the transition when the time has come smooth. He takes the time to explain that he can no longer improve the patient’s function with aggressive medical treatment and that they’ve reached the point of considering a course toward making the patient as comfortable as possible. In his experience, hospice gives the patients and their families a chance to recognize the decline in function while seizing the opportunity to come together to celebrate the patient’s life and preserve family history before it’s too late.