Hospice techniques
Hospice care coast to coast Thomas A. Welk, DMin (with contributions by Sandra L. Imes, RN, BSN; and Pam Burger, RN and Louise Marzyck)
Maxine Martin and her husband (hospice patient Lloyd) took full advantage of the hospice promise to,” help people live their final days with dignity and comfort among family and friends.” In their particular case, it took the cooperative efforts of three hospice programs scattered from coast to coast (almost) to make it possible for them to be “among family and friends.’ Their first contact with a hospice program was the one located in the middle of the country: Hospice Incorporated, with its administrative headquarters in Wichita, Kansas (a program that presently serves a five-county area in Southcentral Kansas). This was in December of 1989. Thomas A. Welk, DMin, is Director of Education, Hospice Incorporated, Wichita, Kansas. Sondra L Imes, RN, BSN, Hospice of Guernsey, Cambridge, Ohio. Pam Burger, RN, Louise Marzyck, Tn-Cities Chaplaincy Hospice, Kennewick, Washington.
The Martins’ determination to get assistance in order to make the most of the time left for Lloyd was already indicated during their first contact with hospice. As Maxine relates, “When Lloyd and I were told after his surgery that he was terminal we were devastated.” She called one of her daughters, an oncology nurse in Texas. “Our daughterdirectedus to request hospice care. The hospital social worker asked how far we lived from Wichita. I told her 25 miles. She responded, ‘Then we can help you.” A slight smile crossed Maxine’s face as she said this. She discovered later that in 1989 Conway Springs (theirhome in Sumner County)was not included in the hospice incorporated service area. “The social worker never did ask what town we lived in. I guess she just presumed that since we were less than 30 miles from Wichita, we would qualify.” Maxine quickly added, “We opened
The American Journal of Hospice & Palliative Care September/October 1992 Downloaded from ajh.sagepub.com at University of Manitoba Libraries on April 24, 2015
the door for Hospice Incorporated in Sumner County. Lloyd was so open with the factthathis cancerwas terminal. His openness made it possiblefor us to accept the help we needed. This, in turn, has made it possible for others in the community to accept the help of hospice during a terminal illness.” Thishelp was given not only in Kansas through Hospice Incorporated. The Martins had dreams that would have to include hospice support services in other parts of the country for the dreams to become reality. “Lloyd really wanted to visit his grandchildren in Ohio one more time,” Maxine explained. “He had to see the three boys.” Considering Lloyd’s condition, would it be possible for him to make this trip? The question was discussed by Hospice Incorporated staff at a patient review meeting. Some reluctance was voiced about the feasibility of the Martins making this trip. Challenges and potential obstacles were raised.
However, none of these obstacles were seen as being insurmountable. Specifically, it was pointed out, this was in line with the philosophy of hospice care. It was also seen as an opportunity to interact and cooperate with another hospice program, even though one was located a considerable distance from Southcentral Kansas. The Hospice Incorporated patient care coordinator was instructed to proceed with the necessary arrangements to make it possible for the Martins to go to Ohio. Contact was made with Hospice of Guernsey in Cambridge, Ohio. The willingness of the staff of Hospice of Guernsey to do whatever was necessary to accommodate the Martins during their stay in Ohio was outstanding.
Hospice of Guernsey Sondra L. Imes,RN, BSN On March 22, 1990 Lloyd Martin, a patient with Hospice incorporated (headquartered in Wichita, Kansas), and his w?fe, Maxine, arrived in New Concord, Ohiofora visit with their son, Jerry Martin, PhD. Prior to their arrival, Hospice of Guernsey in Cambridge, Ohio had been enlisted to provide services to the Martins during their stay in Ohio. The official transfer process from Hospice Incorporated to Hospice of Guernsey had been arranged without d~fficully.Lloyd Martin was thereby able to continue to utilize the Medicare Hospice Benefit. This guaranteed that hospice services would be coveredfor the Martins during their Ohio visit. The transfer took effect on March 26, 1990. Mr. Martin ~stay in Ohio was essentially uneventful from a medical perspective, although the on-call RN was accessed several times because ofconcern over increasing fatigue and some increase in memory loss and confusion. Primary care nurses Sandy Black and Rita Sampson visited three times.
Virginia Chappeleai LSW made one visit to offer support to the family as theyfaced theprospects ofthe terminal prognosis.
The willingness of the staffof Hospice of Guernsey to do whatever was necessary to accommodate the Martins during their stay in Ohio was outstanding. Jerry Martin stated he was pleased to have hospice only a phone call away in casehisfatherneededassistance. He quickly added, “Thefinal visit that my father made to Ohio would not have been possible ifwe wouldn’t have been able to transfer hospice care.” He added that his mother’s continued involvement with hospice in Southcentral Kansas, as a volunteer, has been an assurance to him. Final visits are important to hospice patients andfamilies in their questfor fulfillment and satisfaction in the last days oflife. The Martinfamily was able to take care ofa number of important details during their time together in Ohio. Hospice of Guernsey is pleased to have been able to cooperate with HospiceIncorporated to make this possiblefor the Martin family. Lloyd and Maxine returned to their home in Conway Springs, Kansas on April 9, 1990. A change ofdesignation was made, and the Martins continued to have available to them the Hospice Medicare Benefit, once again utilizing the services ofHospice incorporated. For Lloyd, however, it wasn’t enough just to be with family. Friends, with whom he could share some precious moments of life before death occuned, were also on the list. So in March of 1990 Lloyd and Maxine
decided to take another trip to Washington State to visit some longtime friends. Again, the question: Where would the support come from during their stay in Washington? And, once again, the answer was quickly found: a hospice program. Working withHospice of Guernsey in Cambridge, Ohio had been such a positive experience that there was no reluctance to enlist the services of a hospice program in the state of Washington. Contact was made with Tn-Cities Chaplaincy Hospice in Kennewick, Washington. The accompanying article by Pam Burger, then a nurse with TnCities Chaplaincy program, and Louise Marzyck outlines the technical details of how the more than 1600 miles between Wichita, Kansas, and Kennewick, Washington were spanned. A different set of circumstances in Washington required a different set of approaches than had been the case with Hospice of Guernsey in Cambridge, Ohio. The most significant difference was that Hospice Incorporated would continue to be financially responsible for the Martins’ care while in Washington. Communication between administrators and other team members quickly resolved the practical, technical and administrative questions. Details were completed by May 5, and the Martins were able to leave on their two-week trip for Washington with the assurance that help would be readily available for Lloyd should he need it during his stay there. —
Tn-Cities Chaplaincy Hospice Pam Burger Louise Marzyck In May 1990 Tn-Cities Chaplaincy Hospice had the privilege to be involved among a unique collaboration ofinterdisciplinary hospice team members. The uniqueness of this interdisciplinary team was that it spanned greater than 1600 miles and involveda
The American Journal of Hospice & Palliative Care September/October 1992
Downloaded from ajh.sagepub.com at University of Manitoba Libraries on April 24, 2015
working relationship between directors, patient care coordinators and registered nurses oftwo separate hospice facilities. The patient care coordinator of Hospice incorporated in Wichita~,Kansas contacted Tn-Cities Chaplaincy Hospice patient care coordinator to discuss the transfrr ofcare ofa hospice patient. She inquired about our ability toprovide services during the patient’s stay in this area. It was determined that Tn-Cities Chaplaincy staffwould be available to provide services, but since our agency had not been involved in such an arrangement before, the request was referred to our hospice director for approval. The directors of the two programs discussed the details of the proposed collaboration. Major issues for Tn-Cities Chaplaincy were: The need to receive, in advance, pertinent and current information regarding the patient; consentfor care and appropriate legal releases; assurance that the patient/family understand their options while in this area; and a current plan ofcare. Development ofaplan ofstrategy to handle any need for emergency care and/or hospitalizationfor the patient. As the patient would be 45 minutes away from our metropolitan area, a consulting physician located in the rural community was contacted by the family and agreed to attend the patient as needed. If the patient needed to be hospitalized, our small agency would not be able financially to absorb the costs ofsuch care and as “subcontractor” would not be able to provide hospice inpatient services. Hospice Incorporated assured us that they would retain full financial responsibility for
services the patient needed. Written agreements outlining the conditions listed above werefurnished by Hospice Inc. prior to the patient ~ visit. We agreed to call them at least once per week to keep them informed ofthe patient’s condition and care. Upon arrivalto Washington state, we made contact and confirmed that the patient tolerated his trip well and made arrangementsfor weekly home visits.
The uniqueness of this interdisciplinary team was that it spanned greater than 1600 miles and involved a working relationship between directors, patient care coordinators and registered nurses of two separate hospice facilities. During the first home visit and assessment, the patient’s condition was found to be stable. Patient and spouse were very well informed on diagnosis, medications, treatment plan and hospice philosophy. After observing the patient and his spouse with their friends, any doubt that we, as professionals, may have had regarding the patient’s ability or stamina to make this trip was dissolved. It was apparent this is where the patient wanted to be, and that his friends needed him to be here. To our amazement side trips to the ocean and mountains were part of his agenda. This patient’s philosophy of living each day to its fullest and his desire to spend quality time with his spouse and dearfriends prevailed. As scheduled, this patient returned to Kansas and the care of his primary
The American Journal of Hospice & Palliative Care September/October 1992 Downloaded from ajh.sagepub.com at University of Manitoba Libraries on April 24, 2015
hospice provider~Through this patient, we, as professionals, were reminded that due to the complexity of hospice services, we need to rely on our national network of team members and together work within our guidelines, but not necessarily our “state lines”for the enhancement of our patients’ and families’ lives. The collaborative effort of two hospice programs once again made it possible for the Martins to take full advantage of the hospice philosophy of living life to the full. As Pam and Louise point out in their comments, “This patient’s philosophy of living each day to its fullest and his desire to spend quality time with his spouse and dear friends prevailed.” Maxine Martin was brief, but enthusiastic, in her assessment of their trip to Washington: “Friends in Washington were overwhelmed at how hospice helped. How they would come out and check on Lloyd.” This was to be Lloyd’s final trip. On September 26, 1990, nine and one half months after his initial diagnosis Lloyd died in his home town of Conway Springs; in his home state of Kansas; while under the care of his original hospice, Hospice Incorporated. Maxine pointed out that Lloyd lived six months longer than what initially was expected. “Lloyd and I took each moment we had and lived it as fully as possible,” Maxine proudly stated. Maxine continues her involvement with Hospice Incorporated. She and several other volunteers from Conway Springs are weekly visitors to the Hospice Incorporated central office in Wichita (“To do little, ol’ chorey things”) and an enthusiastic spokesperson for hospice in Conway Springs and the surrounding area (nationwide!).D
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Hospice care coast to coast Thomas A. Welk, DMin (with contributions by Sandra L. Imes, RN, BSN; and Pam Burger, RN and Louise Marzyck)
Maxine Martin and her husband (hospice patient Lloyd) took full advantage of the hospice promise to,” help people live their final days with dignity and comfort among family and friends.” In their particular case, it took the cooperative efforts of three hospice programs scattered from coast to coast (almost) to make it possible for them to be “among family and friends.’ Their first contact with a hospice program was the one located in the middle of the country: Hospice Incorporated, with its administrative headquarters in Wichita, Kansas (a program that presently serves a five-county area in Southcentral Kansas). This was in December of 1989. Thomas A. Welk, DMin, is Director of Education, Hospice Incorporated, Wichita, Kansas. Sondra L Imes, RN, BSN, Hospice of Guernsey, Cambridge, Ohio. Pam Burger, RN, Louise Marzyck, Tn-Cities Chaplaincy Hospice, Kennewick, Washington.
The Martins’ determination to get assistance in order to make the most of the time left for Lloyd was already indicated during their first contact with hospice. As Maxine relates, “When Lloyd and I were told after his surgery that he was terminal we were devastated.” She called one of her daughters, an oncology nurse in Texas. “Our daughterdirectedus to request hospice care. The hospital social worker asked how far we lived from Wichita. I told her 25 miles. She responded, ‘Then we can help you.” A slight smile crossed Maxine’s face as she said this. She discovered later that in 1989 Conway Springs (theirhome in Sumner County)was not included in the hospice incorporated service area. “The social worker never did ask what town we lived in. I guess she just presumed that since we were less than 30 miles from Wichita, we would qualify.” Maxine quickly added, “We opened
The American Journal of Hospice & Palliative Care September/October 1992 Downloaded from ajh.sagepub.com at University of Manitoba Libraries on April 24, 2015
the door for Hospice Incorporated in Sumner County. Lloyd was so open with the factthathis cancerwas terminal. His openness made it possiblefor us to accept the help we needed. This, in turn, has made it possible for others in the community to accept the help of hospice during a terminal illness.” Thishelp was given not only in Kansas through Hospice Incorporated. The Martins had dreams that would have to include hospice support services in other parts of the country for the dreams to become reality. “Lloyd really wanted to visit his grandchildren in Ohio one more time,” Maxine explained. “He had to see the three boys.” Considering Lloyd’s condition, would it be possible for him to make this trip? The question was discussed by Hospice Incorporated staff at a patient review meeting. Some reluctance was voiced about the feasibility of the Martins making this trip. Challenges and potential obstacles were raised.
However, none of these obstacles were seen as being insurmountable. Specifically, it was pointed out, this was in line with the philosophy of hospice care. It was also seen as an opportunity to interact and cooperate with another hospice program, even though one was located a considerable distance from Southcentral Kansas. The Hospice Incorporated patient care coordinator was instructed to proceed with the necessary arrangements to make it possible for the Martins to go to Ohio. Contact was made with Hospice of Guernsey in Cambridge, Ohio. The willingness of the staff of Hospice of Guernsey to do whatever was necessary to accommodate the Martins during their stay in Ohio was outstanding.
Hospice of Guernsey Sondra L. Imes,RN, BSN On March 22, 1990 Lloyd Martin, a patient with Hospice incorporated (headquartered in Wichita, Kansas), and his w?fe, Maxine, arrived in New Concord, Ohiofora visit with their son, Jerry Martin, PhD. Prior to their arrival, Hospice of Guernsey in Cambridge, Ohio had been enlisted to provide services to the Martins during their stay in Ohio. The official transfer process from Hospice Incorporated to Hospice of Guernsey had been arranged without d~fficully.Lloyd Martin was thereby able to continue to utilize the Medicare Hospice Benefit. This guaranteed that hospice services would be coveredfor the Martins during their Ohio visit. The transfer took effect on March 26, 1990. Mr. Martin ~stay in Ohio was essentially uneventful from a medical perspective, although the on-call RN was accessed several times because ofconcern over increasing fatigue and some increase in memory loss and confusion. Primary care nurses Sandy Black and Rita Sampson visited three times.
Virginia Chappeleai LSW made one visit to offer support to the family as theyfaced theprospects ofthe terminal prognosis.
The willingness of the staffof Hospice of Guernsey to do whatever was necessary to accommodate the Martins during their stay in Ohio was outstanding. Jerry Martin stated he was pleased to have hospice only a phone call away in casehisfatherneededassistance. He quickly added, “Thefinal visit that my father made to Ohio would not have been possible ifwe wouldn’t have been able to transfer hospice care.” He added that his mother’s continued involvement with hospice in Southcentral Kansas, as a volunteer, has been an assurance to him. Final visits are important to hospice patients andfamilies in their questfor fulfillment and satisfaction in the last days oflife. The Martinfamily was able to take care ofa number of important details during their time together in Ohio. Hospice of Guernsey is pleased to have been able to cooperate with HospiceIncorporated to make this possiblefor the Martin family. Lloyd and Maxine returned to their home in Conway Springs, Kansas on April 9, 1990. A change ofdesignation was made, and the Martins continued to have available to them the Hospice Medicare Benefit, once again utilizing the services ofHospice incorporated. For Lloyd, however, it wasn’t enough just to be with family. Friends, with whom he could share some precious moments of life before death occuned, were also on the list. So in March of 1990 Lloyd and Maxine
decided to take another trip to Washington State to visit some longtime friends. Again, the question: Where would the support come from during their stay in Washington? And, once again, the answer was quickly found: a hospice program. Working withHospice of Guernsey in Cambridge, Ohio had been such a positive experience that there was no reluctance to enlist the services of a hospice program in the state of Washington. Contact was made with Tn-Cities Chaplaincy Hospice in Kennewick, Washington. The accompanying article by Pam Burger, then a nurse with TnCities Chaplaincy program, and Louise Marzyck outlines the technical details of how the more than 1600 miles between Wichita, Kansas, and Kennewick, Washington were spanned. A different set of circumstances in Washington required a different set of approaches than had been the case with Hospice of Guernsey in Cambridge, Ohio. The most significant difference was that Hospice Incorporated would continue to be financially responsible for the Martins’ care while in Washington. Communication between administrators and other team members quickly resolved the practical, technical and administrative questions. Details were completed by May 5, and the Martins were able to leave on their two-week trip for Washington with the assurance that help would be readily available for Lloyd should he need it during his stay there. —
Tn-Cities Chaplaincy Hospice Pam Burger Louise Marzyck In May 1990 Tn-Cities Chaplaincy Hospice had the privilege to be involved among a unique collaboration ofinterdisciplinary hospice team members. The uniqueness of this interdisciplinary team was that it spanned greater than 1600 miles and involveda
The American Journal of Hospice & Palliative Care September/October 1992
Downloaded from ajh.sagepub.com at University of Manitoba Libraries on April 24, 2015
working relationship between directors, patient care coordinators and registered nurses oftwo separate hospice facilities. The patient care coordinator of Hospice incorporated in Wichita~,Kansas contacted Tn-Cities Chaplaincy Hospice patient care coordinator to discuss the transfrr ofcare ofa hospice patient. She inquired about our ability toprovide services during the patient’s stay in this area. It was determined that Tn-Cities Chaplaincy staffwould be available to provide services, but since our agency had not been involved in such an arrangement before, the request was referred to our hospice director for approval. The directors of the two programs discussed the details of the proposed collaboration. Major issues for Tn-Cities Chaplaincy were: The need to receive, in advance, pertinent and current information regarding the patient; consentfor care and appropriate legal releases; assurance that the patient/family understand their options while in this area; and a current plan ofcare. Development ofaplan ofstrategy to handle any need for emergency care and/or hospitalizationfor the patient. As the patient would be 45 minutes away from our metropolitan area, a consulting physician located in the rural community was contacted by the family and agreed to attend the patient as needed. If the patient needed to be hospitalized, our small agency would not be able financially to absorb the costs ofsuch care and as “subcontractor” would not be able to provide hospice inpatient services. Hospice Incorporated assured us that they would retain full financial responsibility for
services the patient needed. Written agreements outlining the conditions listed above werefurnished by Hospice Inc. prior to the patient ~ visit. We agreed to call them at least once per week to keep them informed ofthe patient’s condition and care. Upon arrivalto Washington state, we made contact and confirmed that the patient tolerated his trip well and made arrangementsfor weekly home visits.
The uniqueness of this interdisciplinary team was that it spanned greater than 1600 miles and involved a working relationship between directors, patient care coordinators and registered nurses of two separate hospice facilities. During the first home visit and assessment, the patient’s condition was found to be stable. Patient and spouse were very well informed on diagnosis, medications, treatment plan and hospice philosophy. After observing the patient and his spouse with their friends, any doubt that we, as professionals, may have had regarding the patient’s ability or stamina to make this trip was dissolved. It was apparent this is where the patient wanted to be, and that his friends needed him to be here. To our amazement side trips to the ocean and mountains were part of his agenda. This patient’s philosophy of living each day to its fullest and his desire to spend quality time with his spouse and dearfriends prevailed. As scheduled, this patient returned to Kansas and the care of his primary
The American Journal of Hospice & Palliative Care September/October 1992 Downloaded from ajh.sagepub.com at University of Manitoba Libraries on April 24, 2015
hospice provider~Through this patient, we, as professionals, were reminded that due to the complexity of hospice services, we need to rely on our national network of team members and together work within our guidelines, but not necessarily our “state lines”for the enhancement of our patients’ and families’ lives. The collaborative effort of two hospice programs once again made it possible for the Martins to take full advantage of the hospice philosophy of living life to the full. As Pam and Louise point out in their comments, “This patient’s philosophy of living each day to its fullest and his desire to spend quality time with his spouse and dear friends prevailed.” Maxine Martin was brief, but enthusiastic, in her assessment of their trip to Washington: “Friends in Washington were overwhelmed at how hospice helped. How they would come out and check on Lloyd.” This was to be Lloyd’s final trip. On September 26, 1990, nine and one half months after his initial diagnosis Lloyd died in his home town of Conway Springs; in his home state of Kansas; while under the care of his original hospice, Hospice Incorporated. Maxine pointed out that Lloyd lived six months longer than what initially was expected. “Lloyd and I took each moment we had and lived it as fully as possible,” Maxine proudly stated. Maxine continues her involvement with Hospice Incorporated. She and several other volunteers from Conway Springs are weekly visitors to the Hospice Incorporated central office in Wichita (“To do little, ol’ chorey things”) and an enthusiastic spokesperson for hospice in Conway Springs and the surrounding area (nationwide!).D
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