Crossroads University - Caring for the Caregiver - Understanding Your Loved One’s Hospice Team

Understanding Your Loved One’s Hospice Team

Caring for the Caregiver

Crossroads University

Caring for the Caregiver

Understanding Your Loved One’s Hospice Team

By Sally Drummond, RN, CHPN

The most important people of the team

Hospice providers understand that few people are ready for death and you and your loved one may be feeling this exact way. This is why much of the focus of a hospice care team is in helping prepare families and patients emotionally and spiritually for this inevitable event – wherever you are in the process.

Hospice will surround you as the caregiver and the patient with a team experienced in providing end-of-life care. The team consists of professionals from multiple disciplines who not only address the physical distress associated with dying; they address all needs associated with the dying process. The goal is to create a safe environment and make your loved one comfortable by assisting the patient with self-determined life closure all the while helping you and the family cope with and grieve the loss of your loved one.

Hospice care is patient-centered, patient-directed because the needs of the patient and family drive the activities of the hospice team. You, your loved one and family are the primary and most important members of the hospice team.

Roles and responsibilities of the team

The primary care physician is responsible for identifying the patient’s need for hospice and making the referral for hospice services.

Primary Care Physician

The primary care physician is responsible for identifying the patient’s need for hospice and making the referral for hospice services. The physician is encouraged to remain involved as a member of the patient care team, and to actively participate in the hospice plan of care.

This role is an important one as you and your loved one may value the relationship you have with your physician and consider her/him a trusted care provider. By your physician staying involved, this will create a better transition to hospice and overall experience for your loved one and you as the primary caregiver.

The hospice medial director provides an oversight of patient care and support to the hospice team.

Hospice Medical Director

The hospice medical director provides an oversight of patient care and support to the hospice team. The hospice medical director attends an interdiscplinary team (IDT) meeting to discuss the plan of care by assisting in establishing goals, and providing active participation in decisions regarding patient care.

As needed, the hospice medical director is available to consult with your loved one’s primary care physician regarding her/his care issues.

The registered nurse case manager coordinates the plan of care with the primary care physician and hospice medical director.

Registered Nurse Case Manager

The registered nurse case manager coordinates the plan of care with the primary care physician and hospice medical director through initial and ongoing nursing assessments. The nurse will make visits to your loved one two to three times a week, or more as needed, to ensure that all distressing symptoms are effectively palliated and that your loved one and your family’s needs are being met.

The RN provides supervision of all care provided by the licensed practical nurse and home health aides, and coordinates care with the other members of the hospice team to ensure that your loved one and the family’s psychosocial and spiritual needs are met.

The hospice social worker provides initial and ongoing psychosocial assessments of your loved one and establishes a 
                                    psychosocial plan of care.

Social Worker

The hospice social worker provides initial and ongoing psychosocial assessments of your loved one and establishes a psychosocial plan of care. The social worker will normally see your loved one and family one to two times a month to provide emotional support and ensure everyone’s psychosocial needs are met. You, your loved one, any family member or a member of the IDT can request additional psychosocial visits as needed.

The social worker can provide guidance to your loved one and yourself with topics such as helping with a Do Not Resuscitate (DNR) order, assisting with finding financial or community resources, and if needed making arrangements for nursing home placement or transfer to an inpatient care facility. The hospice social worker can also provide you and your loved one with counseling during times of crisis.

The hospice chaplain provides initial and ongoing spiritual assessments of your loved one and family and provides interventions as needed.

Chaplain

The hospice chaplain provides initial and ongoing spiritual assessments of your loved one and family and provides interventions as needed. The chaplain visits one to two times a month or more often as needed if you, your loved one or member of the IDT requests. If relevant, the hospice chaplain coordinates care with your loved one’s community spiritual care provider.

The care provided by the hospice chaplain is more spiritual in nature than religious. Spiritual care is aimed at addressing the existential issues commonly experienced in the dying process. Care by the hospice chaplain is non-denominational; no attempts will ever be made at proselytization. The chaplain can, if requested by your loved one or family, officiate the funeral.

The bereavement counselor assesses the grief of your family and can provide bereavement services for up to a year.

Bereavement Counselor

The bereavement counselor not only supports and guides you as the caregiver through the bereavement period after your loved one has passed away, but can help your loved one personally work through the grief associated with her/his declining health and eventual death.

The bereavement counselor assesses the grief of your family and can provide bereavement services for up to a year, or longer, after your loved one passes away. Your loved one may find great comfort in knowing that her/his family will continue to receive the support of the hospice team after she/he is gone.

The home health aide will assist your loved one with personal care needs and you with light housekeeping.

Home Health Aide

The home health aide will assist your loved one with personal care needs and assist you with light housekeeping. They can also teach you and other family members correct and safe methods for providing personal care to your loved one.

When required, the services of the aide are highly valued by patients and families. The home health aide supplements the care provided by the nurse case manager. Their role will inevitably become invaluable in the comfort of your loved one.

The hospice volunteer provides companionship and support to your loved one and the family.

Hospice Volunteer

The hospice volunteer provides companionship and support to your loved one and the family. All hospice volunteers are required to attend volunteer training at the hospice and must follow a volunteer plan of care.

The volunteers frequently perform needed errands and light housekeeping for you and your loved one. Medicare requires that 5% of all hospice care hours (in the entire agency) are to be provided by hospice volunteers.

Taking comfort in hospice

There are many aspects of hospice care that impact the quality of life your loved one and the family will experience. Early hospice intervention is the best way to help you and your loved one begin the difficult journey ahead. The more the entire family understands what the teamwork of hospice can do, the more comfortable everyone will be during the end-of-life process.

References

  1. “Hospice and Primary Care Physicians: Attitudes, Knowledge, and Barriers.” Karen Ogle M.D. American Journal of Hospice and Palliative Medicine Vol. 20, No. 1, pp 41-51 (2003).
  2. “Palliative and End of Life Care: Clinical Practical Guidelines” 2nd Ed, Kuebler, Kim K.; Peg Esper, Deborah E Heidrich, Pg 29, Elseiver Health Sciences, ISBN.
  3. “Unplugged: Reclaiming our Right to Die in America.” Colby, William H., pg 210 Amacom Division American Mngt Assn. ISBN 0814401600, (2007).