Hospice Paper 2

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Hospice: An Overview, Page 2

An important part of hospice is that it involves a team-oriented approach to treating the patient and family. Instead of only doctors and nurses treating the patient, hospice provides a team of professionals and volunteers. This team of nurses, chaplains, social workers, physicians, counselors and volunteers strive to promote the well being of the dying patient and his/her family (TCH).

The first step of getting hospice is contacting a local hospice program through a local hospital or a physician. The second step is to get the physician's referral. In short, the referral confirms that the patient has a terminal illness and will not live more than six months. A hospice representative will then visit the patient the day of the referral; care is ready in the patient's home within two days of the referral. If the patient does not live at home, however, then hospice care will still be provided; hospice care is provided in the home, hospice facilities, hospitals or nursing homes (NHF).

During the first few days of the referral, the hospice team meets with the physician, patient and family. First of all, the team, patient and family appoint a primary caregiver. The primary caregiver, who helps make decisions for the patient, is usually a family member. But, the caregiver can also be a neighbor of friend. After establishing a primary caregiver, the hospice team works with the patient and family to figure out their priorities. For instance, they decide what sort of medication the patient will be on; when the best time is for nurses to come; and how involved they want the hospice volunteers. An important aspect of hospice is that it supports both the patient and the family. Because of this, a part of hospice is providing relief to caregivers who neglect their own needs when caring for the patient (NHF).

The team also develops a "plan of action." This plan is designed to meet each patient's needs for pain management and symptom control. The plan also outlines the medical and support services required: nursing care, personal care, social services, physician visits, counseling and volunteer services. It is important to note that volunteers are another special aspect of hospice care. Hospice volunteers are people from the community who have gone through extensive training to work with the terminally ill and their families. Volunteers may stay with the patient while the family runs errands or takes a break; or volunteers may run errands for the family. Volunteers essentially become an extended part of the family; they provide emotional support and companionship to patients and their families during a patient's last months. Furthermore, the "plan of action" identifies the medical equipment, medication and treatments necessary to provide high-quality comfort and care. For instance, if the patient is more comfortable in a hospital bed, which can be raised and lowered easily, then hospice will provide it. Also, if the patient needs any physical therapy or dietary counseling, hospice will provide those services (NHF).

The final step of hospice comes after the patient's death: bereavement support for the family. Bereavement support, also known as grief support, is offered to families for at least a year. Volunteers and hospice employees provide this support with phone calls, visits, written material about grieving and support groups (NHF). However, in addition to providing grief counseling in the form of phone calls, books and support groups, each hospice also may have its own unique kind of bereavement support. Liz Cozart, a hospice volunteer and bereavement coordinator in North Carolina, said her hospice has a special "Remembrance Day." Once a year, usually around the holidays, every family who has lost a loved one in the Transylvania County Hospice is invited to celebrate and grieve for the life of the patient. The main function of "Remembrance Day" is to allow families to grieve and heal together. The hospice chaplain gives a spiritual-not religious-sermon and then families light a candle in memory of the patient (Cozart).

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