Hospice

[RkyMtnHigh 0]

Perhaps it is easiest to describe what Hospice is not.

Hospice is not "giving up";
Hospice is not a place; it is a system of care;
Hospice is about living out your final days to fullest and in comfort.

I work at an inpatient hospice facility and to debunk the myths:

Hospice doesn't require DNR (do not resuscitate)
Hospice doesn't speed up or slow down the dying process;
Hospice is not a place. It is a system of care that can be brouth to the patient where they may be at home or the inpatient facility,
Hospice is more than cancer patients. There are all ages and conditions that include HIV, AIDS, breast cancer, liver cancer, colon cancer, COPD, etc.;

What I do there is to enhance the quality of care delivered to patients/families, maximize program and family resources, and encourage community participation in delivery of hospice care. Provide patient, family and caregiver support services according to experience and training, and in compliance with HIPPA and company policies. Serve the program in any needed capacity in areas such as patient care, bereavement care, administrative support, program development and community relations and education.

I bring in slinkies, rubix cubes, SuperFly Screaming Monkeys, or whatever to make their day just a little different than the day before and to bring a smile to the patients' faces. Even if all I do is bring crushed ice to some, it's a level of compassion that I want to express.

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[enflyt 0]

and thank God for people like you

[Shell666 0]

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and thank God for people like you

What she said.
Love you Rocky. But you know that.

'Shell

[RkyMtnHigh 0]

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and thank God for people like you

I'm not looking for ANY kudos here via this post. I'm just clarifiying the role of hospice. It did start out as a depressing place to be, yet over time, I realized that some have lived out their purpose here. We have patients from as young as in late 30s to 90 yrs old. All types of medical conditions. Every time I go there it seems like a new list of patients. They call me the "funny weekend lady". Sometimes I pop in during the weekdays to say "hello" if I'm in the area for my fulltime job, and bring a few things to cheer them up or change the mood, but it means a lot to me to be there and do what I can to "help".

Dealing with the family members is the most challenging of the role. If you understand the stages of grieving then you can handle that part as well.

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[Brittentay 0]

the work you do is very admirable.

we had an at home hospice caregiver with us when my grandfather passed, and it really was a huge comfort. he let us know when it was time. and he prepared us in a way we could never have done ourselves. my grandfather grew to love him. and so did we.

thank you for what you do.

[RkyMtnHigh 0]

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the work you do is very admirable.

we had an at home hospice caregiver with us when my grandfather passed, and it really was a huge comfort. he let us know when it was time. and he prepared us in a way we could never have done ourselves. my grandfather grew to love him. and so did we.

thank you for what you do.

I just got the call from the manager of the hospice this week for me to transfer from the inpatient unit to homecare which would include running errands, reading their mail to them, reading to them, keeping them company, etc while the family caregiver is away getting their own errands done. I'm okay with the transition. If that is where they really need me then that's what I'll do.

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[BillyVance 34]

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and thank God for people like you

What she said.
Love you Rocky. But you know that.

Ditto.

"Mediocre people don't like high achievers, and high achievers don't like mediocre people." - SIX TIME National Champion coach Nick Saban

[PROGRESSIVE 0]

I'm currently living in a nursing home due to a hang gliding accident (which you have read my post on). Its disgusting how familys drop off there love ones here and visit them on rare occasion, or in some cases not at all. The people here just whither away. Moaning, groaning, crying. I hate it here!

Hospice is compassionate and caring, which is refreshing to see and hear about.

Pete

[jenfly00 0]

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Hospice doesn't require DNR (do not resuscitate)

This, I don't understand.

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"O brave new world that has such people in it".

[Stacy 0]

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This, I don't understand.

It's because hospice allows patients to make their own decisions about care. We can't force anyone to sign a living will, DNR, or POA form. We can advise them and give the pluses/minuses on each side of everything, but we cannot force them to sign anything. The patient and family design their own care program.

I've been working full time in hospice for 6 years now and now am working my way "up" the line. I started visiting patients as a creative arts therapist, moved into running the volunteer program and now I oversee the 9 employees who run the volunteer programs in our service area. It's reqarding work, but hard work.

Hospice is amazing becuase again teh patients and families dictate exactly what they want, what they don't and that is end of story. Services at non-profit hospices are provided regardless of any ability to pay.

[popsjumper 2]

All you people....

You want to do something that makes a real impact on others lives? Support and participate in the Hospice program.

Those people are angels.

My reality and yours are quite different.
I think we're all Bozos on this bus.
Falcon5232, SCS8170, SCSA353, POPS9398, DS239

[wmw999 2,114]

Hospice is wonderful. They help people, and their families, work on living until the point of a peaceful death. My mother, and my ex-husband's father both used hospice for just a few days each, and it was well worth it just for those few days.

Wendy W.

There is nothing more dangerous than breaking a basic safety rule and getting away with it. It removes fear of the consequences and builds false confidence. (tbrown)

[masterrig 1]

I've seen Hospice in action and there is no way, I could say enough good about their program. They were there, with my mom, before she passed, a neighbor, dying from the results of smoking, a father-in-law, dying from the results of smoking and so-on. Where, did they come from and do so much good?


Chuck

[eeneR 1]

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All you people....

You want to do something that makes a real impact on others lives? Support and participate in the Hospice program.

Those people are angels.

I am going to echo what popsjumper said....

Until you are there you have no idea. Hospice care makes such a difference. While my mom was in a hospice unit the whole family was around, thing is we would make a point to chat with other families there etc. We are all there for the same reason. The other thing, they let me bring one of my dogs into the unit. Nikita would come with my daily and after visiting with my mom for a little bit we would make our rounds to all the rooms.

It got to the point that the elevator would open and the nurses station would announce "Nikki is here"

She is not a "Dumb Blonde" - She is a "Light-Haired Detour Off The Information Superhighway."
eeneR
TF#72, FB#4130, Incauto

[jenfly00 0]

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This, I don't understand.

It's because hospice allows patients to make their own decisions about care. We can't force anyone to sign a living will, DNR, or POA form. We can advise them and give the pluses/minuses on each side of everything, but we cannot force them to sign anything. The patient and family design their own care program.

I've been working full time in hospice for 6 years now and now am working my way "up" the line. I started visiting patients as a creative arts therapist, moved into running the volunteer program and now I oversee the 9 employees who run the volunteer programs in our service area. It's reqarding work, but hard work.

Hospice is amazing becuase again teh patients and families dictate exactly what they want, what they don't and that is end of story. Services at non-profit hospices are provided regardless of any ability to pay.

So, if you had a hospice patient (not a DNR) heading toward impending renal failure, systolic blood pressure of 60, conjunctiva pale enough to approximate a hemaglobin of 6, lungs filling up with fluid, gasping for breath and a marked decrease in level of consciousness ...what would be done?

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"O brave new world that has such people in it".

[Nightingale 0]

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So, if you had a hospice patient (not a DNR) heading toward impending renal failure, systolic blood pressure of 60, conjunctiva pale enough to approximate a hemaglobin of 6, lungs filling up with fluid, gasping for breath and a marked decrease in level of consciousness ...what would be done?

Whatever the patient and the family wanted done. Hospice gets people thinking and making decisions about this stuff in advance...

[kbordson 8]

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So, if you had a hospice patient (not a DNR) heading toward impending renal failure, systolic blood pressure of 60, conjunctiva pale enough to approximate a hemaglobin of 6, lungs filling up with fluid, gasping for breath and a marked decrease in level of consciousness ...what would be done?

Whatever the patient and the family wanted done. Hospice gets people thinking and making decisions about this stuff in advance...

Agreed... Luckily Hospice understand that there's more to a patient than just a set of vitals and change in level of consciousness. The patient and family has to understand their initial diagnosis (ovarian cancer vs. end stage renal disease vs. .....) They are educated on what they might expect (progression of disease process, pain/bowel changes, treatment for palliation/pain options.) That person is managed so that he/she is comfortable and in control for as long as possible. In your hypothetical situation... the pulmonary edema is very scary to the patient (the sensation of not being able to breathe, drowning is horrid) He/She might be given something to try to take the fluid off the lung... even if it kicks the kidneys a bit. Or some morphine might be given for relaxation (and yes... I know you noted decreasing level of consciousness... but you can have less consciousness and still pain). The family and pt hopefully will have discussed situations like this and thought of possible ways to make that person last few minutes/hours/days as painfree and comfortable as possible.

(edit to clarify that although my reply was to Nightengale, I was also posting to the the other question as well)

[jenfly00 0]

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So, if you had a hospice patient (not a DNR) heading toward impending renal failure, systolic blood pressure of 60, conjunctiva pale enough to approximate a hemaglobin of 6, lungs filling up with fluid, gasping for breath and a marked decrease in level of consciousness ...what would be done?

Whatever the patient and the family wanted done. Hospice gets people thinking and making decisions about this stuff in advance...

Agreed... Luckily Hospice understand that there's more to a patient than just a set of vitals and change in level of consciousness. The patient and family has to understand their initial diagnosis (ovarian cancer vs. end stage renal disease vs. .....) They are educated on what they might expect (progression of disease process, pain/bowel changes, treatment for palliation/pain options.) That person is managed so that he/she is comfortable and in control for as long as possible. In your hypothetical situation... the pulmonary edema is very scary to the patient (the sensation of not being able to breathe, drowning is horrid) He/She might be given something to try to take the fluid off the lung... even if it kicks the kidneys a bit. Or some morphine might be given for relaxation (and yes... I know you noted decreasing level of consciousness... but you can have less consciousness and still pain). The family and pt hopefully will have discussed situations like this and thought of possible ways to make that person last few minutes/hours/days as painfree and comfortable as possible.

(edit to clarify that although my reply was to Nightengale, I was also posting to the the other question as well)

Not to belittle the great work bringing comfort to those at the end of life, but this is not hospice care in any historical sense...it's hospice care with broader parameters to qualify for more medicare dollars.

Hospice care is end of life care with the entire focus being on comfort, dignity and freedom from pain. While I am in full agreement with treatment for comfort (e.g. diuretics and morphine for the CHF), "whatever the patient/family wants" is not appropriate for hospice, but then American hospice is a different breed of cat.

You state, "The family and pt hopefully will have discussed situations like this". In true hospice, they absolutely will have discussed and agreed to what will be done.

American 'hospice' has broadened their acceptance parameters to qualify for more medicare dollars. Not to say they do not do good work, but 'coding' a hospice patient?!?!?!?! Would you transfuse them? Would you start dialysis? How about an organ transplant?

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"O brave new world that has such people in it".

[Stacy 0]

I can't answer your specifically medical questions- I'm not in the medical end. I'm in the psychosocial end. What I can say is that you cannot make a family sign a DNR or anything. Period. You also cannot deny them care because they wouldn't sign it. It's about choices. Yes, most families will have been spoken to by a professional from the team about the inevitable choices that will come up. Unfortunately sometimes we get a referral from a hospital, etc that is just too far along in the dying process for us to do everything we need to do. Getting the patient comfortable is the number one priority.

Some things are not cut and dry. For example, feeding tubes. For someone with end stage alzheimers that is bedridden and has a feeding tube and the "feeding" isn't really being absorbed, yes discontinuing it may be best. For a cardiac patient who has a tube as a result of something else and is otherwise alert, oriented, able to be fairly independent- stopping a tube feeding si ridiculous.

Unfortunately hospice deals with a lot of issues that aren't easily able to have a "yes" or "no" answer. We do our best to educate about the options and let the families decide. It IS different than the typical medical model. That is what is usually most appreciated by the families.

I'm sorry that Jenfly disagrees. Until you sit through a training class no one really understands the complexities involved with the care we give. We take culture, religion, and belief systems into consideration as well. You would be surprised how much those things come into play. What may seem obvious and common to you or I may not to someone whose belief system dictates otherwise.