Hospice care can be a light in a time that might feel dark, scary, and overwhelming. Hospice is best defined as the care of a person and their family through the entire end-of-life process, including some period of time after the patient has passed away. A hospice care team consists of medical professionals, therapists and volunteers. Family members are also considered team members, as they often are the primary caregivers.
The primary goal of the hospice team is to ensure that adequate and appropriate medical, emotional and spiritual care for the dying individual is being provided. The team communicates frequently to ensure that any changes in the patient’s condition are addressed with adjusted care plans and that no services are duplicated. Some clients will not need constant monitoring by all members of the hospice team. The team and its members are selected on a case-by-case basis and individually tailored to ensure that the patient’s needs are met at all times.
A Medical Director or Hospice Physician is in charge of overseeing how the Team interacts and is responsible for coordinating all facets of care. The Hospice Physician is considered to be the coordinator of all care for each and every patient in the hospice facility or being cared for by the hospice organizations staff. They also have very specific additional duties for each new case. One of the most significant duties is the creation and maintenance of a written care plan. A care plan outlines every detail of the patient’s care, including how team members should respond when certain situations arise. The care plan will show all medications and therapies, including the possibility of increased pain control as the patient’s condition progresses. The care plan also details the expected results of each intervention or medication, and anticipated goals or reevaluation dates. A hospice Physician also certifies a terminal illness for a patient or their family, allowing the pursuit or continuation of certain government or medical benefits. Most insurance companies require a certification of terminal illness to qualify for admittance to a hospice facility or for at-home hospice care. Finally, the Hospice Physician is charged with assuring that any predetermined arrangements or requests for care are honored by the hospice team.
Other physicians will be involved in the patient’s care as well. Depending on the nature of the patient’s condition, specialists will also visit. If a patient has cancer, oncologists or radiation therapists may be part of the team. Quite often, a patient or family member will request that a personal family physician be part of the hospice team. This often allows a comfort level for the family and patient due to the familiarity with the family physician, and the family physician can help to bridge any discomfort while the hospice team is established.
Nurses also play a very important role in the hospice team, and truly spend the most time providing one-on-one care and treatment to the patient. Hospice facilities employ a variety of nurses, and each has a specific role for the care of a patient. Registered nurses specializing in hospice care provide higher level nursing care and can provide some bedside procedures. They will maintain intravenous medications and monitor care. Licensed Practical Nurses provide more basic direct care, such as basic monitoring or companion duties, while Nurse Assistants may assist with patient hygiene and dressing, assistance with feeding, basic transport within the facility, and companion care. The nurses providing care for the patient work together to fully care for the patients’ needs. All nurses work under the supervision of a physician or specialist, and are an invaluable resource for the patient and their family.
Physical, Occupational, or Speech Therapists may be part of the hospice team if the patient’s condition warrants their involvement. Oftentimes, as a patient’s condition changes, additional support may be needed to help facilitate basic self-care or feeding, and therapeutic intervention may help maintain the patient’s independence for as long as possible. Worsening or changing conditions can cause speech difficulties or increased pain or stiffness. Therapy to target these issues can greatly improve a patient’s feelings of self-confidence and provide some level of pain control as well. Maintaining a routine that is as close to ‘normal’ as possible is always a goal within hospice care.
Social Workers & Chaplains
To ensure the patient and their family’s spiritual and emotional needs are net during and after the hospice process, Licensed Social Workers and Spiritual Counselors or other Clergy will be part of the hospice team. In the event of more intense intervention, a Psychiatrist may be called in for a consultation, or sessions with a Psychologist may be interwoven with the patient’s medical care. Since grieving is such a complex process that each individual handles differently, these caregivers may be called in on an as-needed basis, or may not be called until after the patient passes and the family requests support.
Some hospice teams consider any family or friend direct caregivers to be part of the team as well, since they have the closest relationship with the patient and will be best suited to notice subtle changes in the patient’s behaviours and condition. Family caregivers often are present around-the-clock and can immediately notify the appropriate team Member.
Finally, of great value to the patient and entire team are specially trained volunteers that can assist with any tasks or comfort care that the patient or family might need. If a family caregiver needs to step away for any reason, a volunteer can provide companionship to the patient. A volunteer can also run errands for the family or help with household chores. With the strain of caring for a dying family member, this type of basic or respite care can be priceless.
The goal of a hospice care team is to work seamlessly together during a stressful time to provide the best care for the patient and their family, in a way that both honors the patient and provides the highest level of quality care. Working with providers certified in hospice care can ensure that the patient’s wishes can be honored while supporting the entire family circle.