Hospice care includes a diverse range of services and forms of medical care. The care is done through daily activities to minimize the stress for patients and their families. Among its major responsibilities, the interdisciplinary hospice team manages the patient’s pain and symptoms. They also assist the patient with the emotional, psychosocial, and spiritual aspects of dying.
The interdisciplinary team provides the necessary drugs, medical supplies, and equipment, and they instruct the family on how to care for the patient outside of the hospice. In addition, they deliver special services like speech and physical therapy when needed. They also make short-term inpatient care available when pain or symptoms become too difficult to treat at home, or when the caregiver needs respite. And lastly, they provide bereavement care and counseling to the surviving family and friends of the patient.
A Great Team Can Make the Difficult Time Easy
Hospice care has diverse aspects and it requires a wide range of services. A multi professional health team works together in caring for the terminally ill patient. They develop and supervise the plan of care in conjunction with all of those involved with the care. The interdisciplinary team considers all aspects of the family unit, providing support to both the dying patient and to the caregiver. The family is included in all decisions and care planning because the care provided is patient-centric.
Every hospice should have a doctor of medicine or osteopathy. They are known as the medical director and they assume the overall responsibility for the medical component of the hospice patient’s care program. The act as a consultant for the attending physician, and they serve as a mediator between the interdisciplinary team and the
attending physician. The medical director plays a major role in creating successful teamwork.
Every hospice should have a registered nurse who coordinates the implementation of the plan of care for each
patient. They are in charge of performing the initial assessment, admitting the patient to the hospice program, and developing the plan of care along with the interdisciplinary team. The nurse coordinator also ensures the plan of care is being followed, and they coordinate the assignments of the hospice nurses and aides, facilitate meetings, and determine the methods of payments. The nurse coordinator is vital in controlling the quality of care.
Social workers evaluate and assess the psychosocial needs of the patient. They assist with community resources and filing insurance papers. They also support the patient and caregiver with emotional and grief issues. In addition, social workers assist with counseling when communication difficulties are present. The role of social workers helps in bridging the gaps between the patient family and the hospice company.
Spiritual coordinators must have a seminary degree but can be affiliated with any church. The spiritual coordinator is the liaison between the spiritual community and the interdisciplinary team. They assist with the spiritual assessment of the patient, and they work closely with the family to maintain their beliefs. They also develop the plan of care regarding spiritual matters. In addition, they assist the patient and caregiver in coping with fears and uncertainty. Lastly, they assist with funeral planning and performing funeral services. This role is very important for maintaining the public image of the hospice company.
The volunteer coordinator must have experience in volunteer work. They are responsible for assessing the needs of the patient and caregiver for volunteer services. They provide companionship, caregiver relief through respite care, and emotional support. Volunteers may read to the patient, sit with the patient, or do grocery shopping or yard work. Volunteers can improve the quality of life by spending more time on things, which are not directly related to medical care.
This position requires a professional who has experience in dealing with grief issues. They assess the patient and caregiver at admission to the hospice program and identify risk factors that may be of concern following the death of the patient. They follow the plan of care for the bereaved caregiver for at least a year following the death. They may also provide counseling or refer to other counseling resources.
Every hospice should have a pharmacist who must be a licensed pharmacist and must be available for consultation on the drugs the hospice patient may be taking. The hospice pharmacist evaluates for drug-drug or drug-food interactions, appropriate drug doses, and correct administration times and routes. The pharmacist is holds a key role in preventing medication errors, and providing patient counseling related to the medication errors.
The dietitian consultant should be a licensed medical nutritional therapist (LMNTs), and should be available for consultations and for diet counseling. The hospice nurse does nutritional assessments at admission; if nutritional problems are noted, the patient may be referred to an LMNT. This role is very important to improve the quality of life of the hospice patient.
Hospice aides should be certified nurse assistants who are supervised by the hospice nurses. They are responsible for following the plan of care developed by the interdisciplinary team. They assist the patient with bathing and personal care. They may also assist the patient/caregiver with light housekeeping services.
Other Service Providers
The hospice team may also have some other professionals if needed, which may include following positions:
- Physical therapist
- Speech-language pathologist
- Occupation therapist
These positions are not for rehabilitative services, but may be necessary to assist with improving the quality of life and care for the patient and caregiver.
The Hospice’s Responsibility After a Patient’s Death(Bereavement Period)
Hospice care does not end once the patient dies but usually continues for at least 1 year with bereavement support. Even though the family feels they have prepared for the death, facing the future without the person who died is difficult. The hospice staff also goes through a grieving period for each patient who dies. Each hospice provides support to their staff with support meetings and time to vent their feelings and to heal. This role of the hospice is vital to keep society stable and healthy after losing the people who have had an affect on people’s lives.
Ethical Issues in Hospice Care
Hospice care is complicated as it involves many ethical decisions throughout the care from the period of the enrollment of the patient to the end of their care. Ethical issues when dealing with hospice patients include withholding or withdrawing nutritional support, the right to refuse treatment, and do not resuscitate (DNR) orders. It is hoped that the patient’s wishes are made known in advance, such as a living will or an advance directive, or that a durable power of attorney has been appointed. It is imperative that the nurse is aware of the organization’s ethical policies and procedures so that any questions and concerns may be addressed appropriately and correctly.
Quality Care at the End of Life
It is the patient’s right to receive the quality care at the end of their life. Feedback from family members, patient, and employees, through surveys and inspections can be used as sources to develop and improve future hospice plans. It is extremely important to have a quality assurance program in place to minimize errors.
Hospice Performance Reports
The National Summary of Hospice Care published the following reports, which can be helpful in determining hospice performance.
NHPCO Performance Measure Reports:
NHPCO members also have access to
national-level summary statistics for the following NHPCO performance measurement tools:
- Patient Outcomes and Measures (POM)
- Pain relief within 48 hours of admission (NQF 0209)
- Avoiding unwanted hospitalization
- Avoiding unwanted CPR
- Family Evaluation of Bereavement Services (FEBS)
- Survey of Team Attitudes and Relationships (STAR)
Job satisfaction (hospice-specific)
- Salary ranges
- Provider-level results