TAHLEQUAH DAILY PRESS — End-of-life issues and aging pose conundrums for even the closest family.

Questions abound. Should we find a nursing facility? How long will Mom be able to live alone? Dad wants to die at home with his family around him, but how do we make that happen?

Tahlequah has become a popular retirement area, and with that, the home health and hospice industry has grown by leaps and bounds.

The area is home to several different types of health care facilities, from nursing homes to retirement communities to home health care agencies and hospices.

One of the newest facilities is the Cherokee Nation Elder Care PACE program, a federal program designed to keep elders living in their homes, connected with their communities and out of nursing home facilities. The PACE center consolidates the services of an adult day health center, primary care office and rehabilitation facility into a single location.

“My catch-phrase to anyone who thinks we’re a nursing home or adult day center is ‘we’re similar, but different,’” said Ben Stevens, CNEC program director. “We provide team-based care management. The interdisciplinary team consists of a full-time physician, clinical nurses, physical therapist, occupational therapist, adult day center nurses, activities director, dietitian and transportation director.”

Cherokee Elder Care is the first PACE program in Oklahoma and the first to be sponsored by an Indian tribe.

For those who are either unable - or unwilling - to leave home, home health or hospice may be the better choice.

Carter Home Health Care has been serving the Tahlequah community 20 years and added hospice 16 years ago. Carter is the only Joint Commission on Accreditation of Health Care Organizations (JCAHO) certified home health operation in the state.

Penny Gifford, hospice professional services coordinator for Carter, believes that, alone, is beneficial to those seeking aid.

“JCAHO is a company that certifies hospitals,” said Gifford. “We go through the same stringent laws and audits as hospitals.”

According to Gifford, hospice deals with terminally ill, and home health is designed to rehabilitate a patient over a short period of time.

“With hospice, we come in to help maintain end-of-life issues, pain management and help provide quality of life,” said Gifford. “The time a person has left doesn’t matter, as long as it’s quality time.

Gifford chose her line of work after her mother sought hospice care 10 years ago.

“What drives me is, I feel everyone has right to choose and know what [his or her] rights are as an individual when it comes to choosing health care,” said Gifford.

“It’s my job to provide a voice for those who have none. I believe terminally ill patients can be completely and totally cared for in the home just as well as in the hospital. Hospice keeps the family close to the patient, where when they’re in the hospital, the family is basically estranged.”

Gifford relayed her own story about her mother, who became increasingly incapacitated and was hospitalized.

“She became agitated and was difficult to deal with in the hospital,” said Gifford. “As a result, she was often sedated. It finally got to the point where we knew she would be cared for better at home. When that was no longer an option, we moved her to a nursing home, where she had constant care and was able keep her family near.

“That’s when I grew as a person. My mom died where she wanted to be, in a nursing home. This is what I want to provide for other people - good days.”

Gifford said a hospice can maintain and manage the pain as well as a hospital, and that all patients have a choice.

While hospice is generally for people who are in the last six months of their lives, they often live longer.

“You don’t get put on hospice to end your life, but to live your life,” said Gifford. “It’s not a sign of giving up. We encourage people to do things to maximize the time they have.”

Gifford is very compassionate about being an advocate for the people.

“I feel like this is what God put me on this earth to do – provide information about home health and hospice and options,” she said. “Hospitals are for sick people who are going to get better, but when someone is unable to care for themselves, they become frightened. It’s my goal to help rid patients and families of fear so they can enjoy their lives.”