Last Hospice Article

GREENFIELD -- When many people think about hospice care, they think it is only for people who have days to live.
But, that's not the case at Hospice of Franklin County -- a nonprofit hospice that currently serves about 40 patients in the Franklin County area and has a staff of about 35.
Sometimes the local hospice is called in for people when they have only hours to live, but often, they work with patients who have been using their services for months, if not for a year or more.
"Many people think that hospice is only for the last few days or the last week of life," said Executive Director Terry Gaberson. "Although we can certainly help patients referred that late, they aren't able to take advantage of the full range of services. Patients can receive hospice care as long as they continue to qualify, some have received hospice care for year or more and some have recovered and graduated from hospice care."
She said for patients who are not seeking "aggressive, curative therapy," hospice provides the education, support and service they need to "gain some control and choice over how they will live the rest of their lives."
"Much of this work is based on relationships, and it takes time to build those along with the trust that is so important at this vulnerable time," she said. "Most of our hospice families say they wish they'd known about hospice sooner, and that before signing on they thought that hospice meant you only had a few days to live."
Gaberson said many people have the perception that hospice is just for cancer patients, but that isn't true. Gaberson said there are many illnesses that meet the criteria for hospice care, and someone doesn't necessarily need a diagnosis. Someone's health could be deteriorating just because of old age.
"Some people think that hospice care is just about dying, that we're the ones you call when there's nothing left to be done to treat an illness," she said. "This is high quality health care with a focus on comfort and quality of life when cure is not an option and most chronic illnesses such as heart failure, or chronic lung disease eventually fall into this realm."
Hospice of Franklin County offers many services, including nursing care, with on-call service 24 hours a day, seven days a week; pain symptom management; emotional and spiritual support; medical social services; home health aide service; volunteer services, like someone who will run errands; home delivery of prescriptions, medical supplies and equipment related to a hospice diagnosis; physical, occupational, dietary and speech therapy, complementary therapies, like Reiki, music therapy and massage therapy; and bereavement support.
"It's a sensitive subject to bring up; we have a very hard time talking about death and end-of-life planning in this country," said Gaberson. "When a person with advance illness requires more and more hospitalizations, their treatments become less effective, and they want to remain home and comfortable as much as possible, it's a good time to talk with their physician about what kind of care they want and review options for getting that care."
If someone chooses hospice care, his or her physician does need to confirm that he or she qualifies, she said.
When people are accepted into hospice, they can pick and choose what services they want to use. Referrals and information requests come from people seeking services, family members, physicians, nurses, social workers, case managers, discharge planners and friends. Free informational services are offered to those considering hospice services. The hospice benefit is covered by Medicare, Medicaid, HMO's and most private insurances. No one is turned away for inability to pay.
The Hospice of Franklin County's board of directors was established in August 2004. On Sept. 9, 2004, its organization was incorporated as a free-standing, independent, nonprofit.


A team
The staff at the Hospice of Franklin County are a team, and as this unified group they offer "quality and compassionate health care for people facing life-limiting illnesses."
"For a holistic approach to care, supporting emotional, spiritual and physical needs, it's important to take in the perspective from all disciplines on a regular basis. Not all team members are in direct contact with every family, however they each weigh in, pointing out family strengths and help problem solve as we work with each case," said Gaberson.
Jean Footit, a social worker, goes to the patients' homes to provide information and assess the situation. It is her job to find out what the patient's needs are. Footit offers the patient and his or her family support and education, so everyone knows what to expect as their loved one's illness progresses.
Footit and the other social workers also help some of their patients apply for MassHealth and other services for low-income residents like fuel assistance and additional support offered by local organizations, like Franklin County Home Care Corp.
Jenn Bete-Brown is a spiritual counselor at the local hospice organization. For some, she coordinates clergy visits. For others, she is someone they can talk to about their spirituality and what has been important in their lives. When doing the initial assessment, patients' spiritual needs are determined.
Hospice nurses' primary responsibilities include symptom control, pain control and disease management. Janice Fisk, who worked as a hospice nurse for years and now works as the organization's clinical director, said the nurses also assess a patient's medication and are the liaisons between the patient and their family and their physician. Hospice patients don't have to change doctors or stop seeing their own doctor. Some local doctors still make home visits.
The nurses typically visit their patients once a week, but as someone's condition changes or worsens, they will increase their visits. Nurses are on call 24/7.
Hospice aides typically visit patients more frequently, usually once a day, and their major responsibility is their patient's personal care. They assist with medications, teach both the patient and family what will happen as a disease progresses and will assist with hygiene needs, like helping their patients shower.
Their patients are typically in their 80s or are older, but in the last few years, they have had patients who have been in their 20s, 30s and 40s.
In this line of work, the hospice staffers have to frequently face death, but many don't dwell on that.
"My focus is in the moment, we can still laugh and play," said Mary Lee, a hospice aide. "They are alive until they are not."
"To live up until the moment of our death is what we support people doing," said Bete-Brown.