Caring for Hospice Patients

and Families
What Aides Should Know

Amy Olshever, LCSW

olshever@verizon.net
Learning Objectives
 The learner will understand hospice philosophy of care

 The learner will understand their role as part of the

hospice team

 The learner will recognize signs of healthy and

unhealthy coping

 The learner will understand strategies for healthy

coping
Hospice

Dame Cicely Saunders, 1976

“You matter because you are you, and you matter to the end
of your life. We will do all we can not only to help you die
peacefully, but also to live until you die.”
Hospice Care
 Hospice provides medical, emotional and spiritual care
to promote and enhance comfort and quality of life for
patients, their families and caregivers

 “Family” in hospice is defined by the patient and can

include whoever is important and significant to the
patient
Hospice Care: Philosophy of Care
 Comfort
 Dignity
 Respect
 Hope
 Dying is part of the normal process of living
 Affirms life but neither hastens nor postpones death
 Quality of Life
 Core Aspects of Hospice
 Patient/family focused
 Interdisciplinary
 Provides a range of services:
• Interdisciplinary case management
• Pharmaceuticals
• Durable medical equipment
• Supplies
• Volunteers
• Grief support
The Hospice Interdisciplinary Team

Bereavement Social
Specialist
Worker

Nurse Home
Patient Health
& Aide
“Family”
Spiritual Physician
Counselor
Volunteer
Hospice Admission Criteria

 General
• Life-limiting illness, prognosis is 6 months or
less if the disease takes normal course
• Live in service area
• Consent to accept services
Some Myths about Hospice
 Hospice is a place.
 A patient needs Medicare or Medicaid to afford hospice
services
 Patients can only receive hospice care for a limited amount
of time.
 Hospice is only for patients with cancer
 Hospice is just for the patient
 Hospice provides 24-hour care
 Hospice means you have given up hope
When Death is Near
 There may be physical & emotional changes

 Each person’s dying process is unique unto them

 No one can fully predict what it will be like or exactly

when it will occur

 Team members are available to visit and provide

consultation or evaluation as a patient’s status
changes
Common Signs & Symptoms of
Nearing Death
 Withdrawal
 Appetite Changes
 Elimination Changes
 Breathing Changes
 Changes in body temperature
 Mottling of extremities and dependent areas
 Changes in other vital signs
 Confusion & Disorientation
 Restlessness & Agitation
 Increased Pain
 Terminal Secretions
Pain Management

• Morphine Sulfate (Roxanol)

• Use a pain score
• Caregiver Concern
Terminal Agitation

• What does it look like?

• Ativan ( lorazepam)

• Haldol (haloperidol)

• Unidentified or untreated pain

Other Ways to Manage Terminal
Agitation

 Evaluate auditory and tactile stimuli and

patients individual need
 Distraction with music, holding hand for some
 Elimination of excessive stimulation for others
 Monitor for safety
Management of Terminal
Secretions

 Positioning

 Suctioning

 Medication

 Caregiver distress
Interdisciplinary Interventions
 Comforting presence of Hospice Team Members
 Pet Therapy
 Massage Therapy
 Music Therapy
 Education and support for family and facility caregivers
supports
 Vigil Volunteer
Components of Culture
• Ethnicity
• Race
• Gender
• Age
• Religion and spiritually
• Sexual orientation
Things to pay attention to:

• Awareness of your own culture and

worldview

• Your Attitude towards cultural differences

• What Knowledge do you have of different

cultural practices and worldviews

• Do you have Cross-cultural skills?

 19

Healthcare Providers’ Struggle

 Death Anxiety

 Cumulative Loss

 Grief

HOM/IOG ©
 Healthy Coping
Attitudes
Be gentle with yourself
Be aware of the body’s
need for rest and nutrition
Cry when needed
Expect landmines—
moments of painful
realization the death of your
loved one
Actions
Spend time with others to
decrease feelings of isolation
Find support in family, friends
and support groups
See medical doctor for any
new or unusual symptoms
Maintain a regular schedule
Avoid unrealistic goals and
expectations
 Unhealthy Coping
 Use of drugs or alcohol
 Suppression of feelings
 Isolation
 Eating excessively or not enough
 Lashing out at others
 Denial
THANK YOU FOR ALL YOU DO!!!
 QUESTIONS?