Repeatedly in our hospice experience we hear the question raised, “What can hospice provide which the nursing home does not provide?” It seems like a very logical question. Both the nursing home and hospice employ nurses, social workers, chaplains and C.N.A.’s. Professional people, who have the best interest of the resident in mind, coordinate the teams, and yet their focus may be different. Nursing homes are the second most highly regulated industry in the US: more regulated than either the airline or the nuclear industry. It is an exhausting job to take care of multiple residents’ needs of being fed, clean, safe and happy. They have regulated time frames, care requirements and a limited amount of resources to fulfill every resident’s needs in their facilities. Hospice can focus their attention to the special needs of the individual who has a limited life span.
The Hospice Team
The hospice core team consists of a nurse, certified nursing assistant, volunteer, chaplain, social worker, and medical director. The social worker performs the role of a counselor with the dying process of the resident, the residents’ family and extended family. They often spend time with small children, to assist them with understanding the impending death. The chaplain’s role is to establish or reconnect the resident with his or her own religious roots. This may be with the resident’s family’s religious affiliation, especially if the resident has moved to be closer to family members. The RN focuses much expertise on pain control and symptom management with the dying process. The nurse and hospice medical director, serve as a communication link between the resident, the family, physician, and attending physician. The issues addressed may include medication choices, determining the medical benefits of hydration or choosing not to artificially hydrate a person. The extension of the interdisciplinary team members include the C.N.A. who can spend extra time bathing, writing notes to friends and escorting the resident on walks. The volunteer can be a special friend, taking time to talk to or to read to the resident. The extra attention from the entire team promotes quality of life and dignity throughout the last moments of life. The entire team also supports the staff at the facility, in their grief, throughout the dying process. Hospice may also call in specialists such as a dietician or a therapist to meet the specialized needs of a dying person.
The Hospice Provides
Hospice provides all hospice diagnosis-related medication, including all pain control and symptom control measures. Additionally, hospice provides medical equipment and supplies, helpful to controlling symptoms. For example, in hospice we know that people who are dying often do not assimilate nutrition in the same way they used to and their skin breaks down much easier. Hospice can, when deemed necessary, provide for equipment that would prevent these skin breakdowns. Without hospice services, this would have to be paid for by the family. The facility must balance the need for equipment and supplies with what the family can afford to pay. Hospice is able to help meet most of these needs.
The Hospice Strives
Hospice strives to bring conclusion and acceptance to a person’s life process. The team provides support for the resident, and all of the caregivers, including the patients’ family, extended family and the staff of the nursing home.