Central Coast VNA And Hospice Care: A Case Study

A person’s life can end at any age. They can depart quickly or slowly. End of life care, also known as palliative care, is the care of patients that are not only in their final hours or days but the patients with a terminal illness that has become incurable. End of life care takes into mind what the patient desires so it is recommended that they consider an advanced care plan also known as an advance directive and living will. These documents allow the patient to formulate decisions on the future of their care if, at any point, they cannot vocally express themselves.

Caring Hospice is a company that will provide nursing care to patients that are terminally ill. The ultimate goal is to insure the patient is kept as comfortable as possible while maintaining dignity during the dying process. This company will send registered nurses to the patient’s home for routine physical assessments, medication teaching and administration, education about terminal diseases and the dying process. The nursing staff will also create and maintain appropriate plans of care for the multi-disciplinary team to provide holistic care to the patient.

Death is inevitable. It is one of the only certainties in life. Regardless, people are often uncomfortable discussing death. Nyatanga (2016) posits that the idea of no longer existing increases anxiety and emotional distress in relation to one’s mortality. Because of the difficulty in level of care for end-of-life patients, the patient and the family often need professional assistance for physical and emotional care. Many family caregivers are not professionally trained in medicine, and this is where hospice comes into play. Hospice aims to meet the holistic needs of both the patient and the patient’s family through treatment plans, education, and advocacy. There is a duality of care to the treatment provided by hospice staff in that they do not attempt to separate the patient’s care from the family’s care. Leming and Dickinson (2011) support that hospice, unlike other clinical fields, focuses on the patient and the family together instead of seeing the patient independent of the family. Many times in hospitals, the medical team focuses solely on the goal of returning the patient back to health in order for them to return to their normal lives. They do not take into account the psychological and spiritual components of the patient’s journey and the journey that the family must take as well. For treatment of the patient, Leming and Dickinson agree that hospice does not attempt to cure patients, and instead concentrates solely

1.1 Caring for patients at the end of life is a challenging task that requires not only the consideration of the patient as a whole but also an understanding of the family, social, legal, economic, and institutional circumstances that surround patient care.

Caring for patients at the end of life is a challenging task that requires not only the consideration of the patient as a whole but also an understanding of the family, social, legal, economic, and institutional circumstances that surround patient care.

Many terminally-ill patients give up hope when treatments are no longer available to help them and hospice care is given to them as an option. However, hospice care has proven itself to provide the best quality care for the last six months of the dying. The purpose of hospice is to provide the best care for terminally-ill patients at the end stage of their lives. Hospice offer services to support too many aspects a patient’s life such as medical, legal, spiritual care. Hospice includes art therapists, music therapists, and certified chaplains on the palliative team.

Rather, the hospice staff and the patient understand the patient is going to die and no further treatment options are available. Therefore, hospice care centers direct their attention towards providing a dignified ending to a patient’s life by delivering comfort and emotional support through a palliative care approach designated to alleviate pain and emotional distress. For example, at Hospice of Dayton, each patient residing at the care facility is provided their own room where their family is able to stay with them and the patient is able to receive the pain management and emotional support they need to die a little closer to peace and security. Additionally, at Hospice of Dayton, there are full-time doctors, nurses, counselors, and religious support-staff that provide patients the physical treatment they need to minimize their pain, as well as the emotional support they need to live the last moments of their life with dignity and emotional well-being. Most importantly, Hospice of Dayton because of its volunteers. Volunteers provide the invaluable service of listening, crying, and laughing with those who may not necessarily have someone to spend time with, while they undergo their long, arduous, and painful experience of

No caretaker would leave their loved one in a facility with rude, unqualified, untrained, or even outnumbered staff members. This consideration is something Superior Residences of Brandon prides itself on, and with good reason to. The training of the staff at Superior Residences is top notch – the employees must undergo 16 hours of training prior to employment, obtain a certification in CPR, participate in monthly employee meanings, obtain certification in Alzheimer’s Level 1 and 2, and continuing education courses provided by the state. Also unique to this facility, all employees are cross-trained and are certified Resident Aides (RA’s), which means they can approach any worker, for example a janitor, with a question or need and that employee would be able to assist (Andrew, J., personal communication, October 28th, 2016). As Jill Andrew’s stated, there are at least 4 RA’s in the building at all times for 70 residents, and although there are no nurses required under the license, they do have 5 nurses on staff. Another principle unique to Superior Residences was their dual licenses, having both an Extended Congregate Care license, which allows residents to age in place (Andrew, J., personal communication, October 28th, 2016) and a Limited Nursing Services license, which enables the facility to provide a select number of nursing services.

Palliative care, somewhat similar to Hospice care, focuses on relieving or preventing suffering from a life altering illness. The goal for both Palliative and Hospice care is to provide the best possible quality of life to

Today, I shadowed at the Linda E. White Hospice House. This building is brand new and was opened earlier this year. The purpose of hospice is to keep patients comfortable as they near the end of life. The Linda E. White Hospice House features seven suites for patients and their families. Each room includes a patient bed, a pull out sofa, a restroom, a separate guest room with a bed, and access to an outdoor labyrinth. These amenities are meant are accommodate the patient’s family and also keep the family and patient at peace.

HCC provides special care services for individuals who are terminally ill through a coordinated system of care and is facilitated with a team of nurses, social workers, spiritual counselors, and providers that are dedicated to the belief that quality of life matters. HCC provides services that are grouped and fall under the umbrella of Palliative care, Hospice care, and Bereavement care. These services that they offer mainly include: home health aide, counseling, medical social services, medical supply services, nursing services, occupational therapy, physician services, physical therapy,

Hospice is a component of palliative care. A person does not necessarily have to be dying in order to see a palliative care specialist. This is where the service is often underutilized in the hospital. In the 18 months I have been a nurse, I have cared for many patients with chronic illnesses who have dealt with symptoms that have severely impacted their quality of life. Most of the time, it seems as though the patient’s care providers are interested in treating the patient’s acute problems. My experience has been that the symptoms are often overlooked or are being treated in a manner that is to the dissatisfaction and discomfort of the patient.

The concept of hospice care in the United States has continued to evolve over the past three decades. Initially met with great skepticism and mistrust by the general population and the medical community, hospice services and care are now considered a valuable resource and venue of care for those suffering from a terminal illness and for their families. The choice of hospice services and the approach of palliation of symptoms, comfort care, and the end of life can be difficult for a patient and family. The many issues that surround the concept of hospice care may cause the patient and family feelings of great sadness, grief, anticipatory grief, anger, defeat, loss, and many other complicated and gut wrenching thoughts and emotions (Chi Ho Chan & Fong Tin, 2012). With the support of the hospice care providers the patient and family have the opportunity to spend quality time together and share their thoughts, concerns, reflect on the past, and most importantly to communicate final good-bye’s and potentially seek closure to any remaining unresolved issues.

People today are living longer than their forebears. By 2030, an estimated 72 million people of the U.S. population will be older than 65 years old and an estimated 9 million people will be older than 85 years old (Heinle, McNulty, & Hebert, 2014). Most adults will live with at least one chronic illness until they die (Heinle et al., 2014). Palliative care (PC) is specialized care that ensures that patients with any illness and their families achieve the best quality of life by addressing physical, intellectual, emotional, spiritual, and social needs (NHPCO, n.d.). Once considered a highly specialized, separate subspecialty of medicine, PC is now considered a healthcare priority by the National Priorities Partnership (Meier, 2011). PC is proven to improve clinical and financial outcomes and can be utilized simultaneously as curative care. However, despite the growing number of chronically ill people, the supply of PC specialists “falls short of what is necessary to serve the population in need” (Kelley & Morrison, 2015).

End-of- life care, as defined by NIH Senior Health (2012) is “. . . the broad term used to describe the special support and attention given during the period leading up to death, when the goals of care focus on comfort and quality of life”. There are different ways to provide end-of- life care for older people. One way is though hospice. It is a service for patients who are nearing the end of life wherever the patients are: at home, in a nursing home, or in a hospital (Mayo Foundation for Medical Education,2016). In addition to medical care, the hospice team may address emotional and spiritual needs, social services, nutrition, and counseling for both the patient and the family. According to National Hospice and Palliative Care Organization in 2014, in