Life With Dignity: Dr. Charles Vialotti’s Reframing of Hospice Care

October 2, 2025

Meet Dr. Charles Vialotti. At the age of 80, he lives in a 20-bed hospice facility where he provides 24-hour care for patients and families. His unusual commitment (literally residing on-site at Villa Marie Claire, a nonprofit hospice in Saddle River, New Jersey) reflects a philosophy that has shaped his long career: hospice should be understood not as a passive step toward death, but as an active stage of life that offers dignity, choice, and quality of experience.

Dr. Vialotti, a radiation oncologist by training, has been a central figure in hospice development in northern New Jersey. When hospitalists and primary care physicians hesitate to refer patients until the final days, he argues, opportunities are lost. Pain control, symptom management, family counseling, and psychosocial support are not end-of-life luxuries; they are medical interventions in their own right, capable of improving the trajectory of a patient’s remaining time. In his words, hospice should be framed as “life with dignity” rather than the more familiar but misleading phrase “death with dignity.”

This reframing has been highlighted in national medical outlets in the past two years, including Medscape and ROI-NJ, Catholic Health World, and Steve Adubato’s “One-on-One” video segment, to name a few. Vialotti emphasizes that the language physicians use has direct consequences for patient care. “Death with dignity,” he notes, implicitly positions hospice as synonymous with imminent death, which discourages timely referral. “Life with dignity” redirects attention to the lived experience of patients and families, highlighting hospice as an active form of care rather than a passive acknowledgement of decline.

The clinical evidence supports this perspective. Multiple studies demonstrate that more time in hospice can reduce emergency department visits, hospitalizations, and ICU stays in the last months of life, simultaneously improving patient and family satisfaction with care — all while longer survival times are experienced.^1-11 Additionally, families often report better bereavement outcomes when hospice is introduced as a supportive resource well before the final days.¹² Vialotti’s insistence on earlier framing and referral aligns with the evidence base and has resonance for hospitalists and other physicians navigating referral decisions.

The question for referring physicians is practical. When a patient with advanced illness is no longer likely to benefit from disease-directed interventions, how should that reality be framed? Vialotti’s model suggests that hospice referral is not an admission of defeat, but a clinical intervention oriented toward maximizing quality of life. By shifting our language from “death with dignity” to “life with dignity,” we open the door to earlier referral, broader acceptance, and more meaningful patient outcomes.

For many physicians, Dr. Vialotti’s commitment may serve as both a challenge and an invitation. His decision to live among his patients is extraordinary. His call to reconsider how we talk about hospice is, however, practical and accessible to every clinician. In the end, the words we choose may determine whether patients experience hospice as an option of last resort, or as an opportunity to live their final months with dignity.

Avatar – Big Enough to Serve, Small Enough to Care

With nearly two decades of hospice and home health service to the Houston Metro, this locally owned healthcare agency has grown to be more than 150 caring professionals strong. Yet, every patient still has direct access to the agency owner. Now, just as in our first month of operation, every patient is made to feel welcome, included, heard, and valued. Please remember Avatar for your home health and hospice referrals.

References

Hamano J, Takeuchi A, Mori M, Saitou Y, Yamaguchi T, Miyata N, Shimizu M, Yamamoto R, Kimura Y, Kamiyama Y, Arai Y. Comparison of survival times of advanced cancer patients with palliative care at home and in hospital. Plos One. 2023 Apr 13;18(4):e0284147.
Murakami N, Kajiura S, Tanabe K, Tsukada K, Shibata K, Minabe Y, Morita T, Hayashi R. Discharge to home from a palliative care unit: impact on survival and factors associated with home death after the discharge: a cohort study. BMC Palliative Care. 2023 Nov 30;22(1):191.
Lai WS, Liu IT, Tsai JH, Su PF, Chiu PH, Huang YT, Chiu GL, Chen YY, Lin PC. Hospice delivery models and survival differences in the terminally ill: a large cohort study. BMJ Supportive & Palliative Care. 2021 Dec 15;14(e1):e1134-43.
Rice DR, Hyer J, Diaz A, Pawlik TM. End-of-Life Hospice Use and Medicare Expenditures Among Patients Dying of Hepatocellular Carcinoma. Annals of Surgical Oncology. 2021 Sep;28(9):5414-22.
Cheraghlou S, Gahbauer EA, Leo-Summers L, Stabenau HF, Chaudhry SI, Gill TM. Restricting symptoms before and after admission to hospice. The American Journal of Medicine. 2016 Jul 1;129(7):754-e7.
Lah S, et al. The association between hospice utilization and performance on publicly reported outcome measures. In A14. Advance Care Planning and Palliative Care: Patients to Policy 2016. American Thoracic Society.
Huo J, Lairson D, Du X, et al. Survival and cost-effectiveness of hospice care for metastatic melanoma patients. The American Journal of Managed Care. 2014; 20 (5): 366-373.
Teno J, Shu J, Casarett D, et al. Timing of referral to hospice and quality of care: Length of stay and bereaved family member’s perceptions of the timing of hospice referral. Journal of Pain and Symptom Management. 2007; 24: 120-125.
Schockett E, Teno J, Miller S, Stuart B. Late referral to hospice and bereaved family member perception of quality of end-of-life care. J Pain Symptom Manage. 2005; 30: 400-407.
Bradley E, et al. Depression among surviving caregivers: Does length of hospice enrollment matter? Am J Psychiatry. 2004; 161: 2257-2262.
Pyenson B, Connor S, Fitch K. Medicare cost in matched hospice and non-hospice cohorts. J Pain Symptom Manage. 2004; 28: 200-210.
Schockett ER, Teno JM, Miller SC, Stuart B. Late referral to hospice and bereaved family member perception of quality of end-of-life care. Journal of Pain and Symptom Management. 2005 Nov 1;30(5):400-7.