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Hospice is an ever-evolving aspect of medical care

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Posted: Monday, November 4, 2013 12:14 am

FAIRBANKS — November is National Hospice and Palliative Care Month, a time to draw attention and raise awareness of this special kind of care.

Hospice care is a philosophy of end-of-life care that focuses on the comforting and care of a terminally ill patient’s symptoms. These symptoms can be physical, emotional, spiritual or social in nature. 

The concept of hospice as a place to treat the incurably ill has been evolving since the 11th century and first came into the United States in the 1970s in response to the work of Cicely Saunders in the United Kingdom. Since its arrival hospice care has expanded rapidly. 

In Fairbanks, we are fortunate that our hospice is supported by extensive volunteerism, with a medical team that places an emphasis on advocating for the patients’ needs to be met. 

Hospice care is available to patients of any age with any terminal diagnosis. Although most hospice patients are in treatment for less than 30 days, care may extend beyond six months if a patient’s condition continues to merit such medical care. Medical and social services are supplied to patients and their families by an interdisciplinary team of professional providers and volunteers who take a patient-directed approach to managing illness. 

Generally, treatment is not diagnostic or curative, but is based on what the patient and families goals are. In many situations hospice services are covered by Medicare and other providers.

Care may be provided in a patient’s home, skilled nursing facility, or assisted living facility. The goal of hospice care is to provide comfort to the patient and family. This can mean freedom from physical, emotional, spiritual and/or social pain. 

Hospices do not seek to hasten death, or extend life. Hospices provide care with an interdisciplinary team. This interdisciplinary team approach involves all members of our team working together towards the same goal, which in this case is determined by conversations with the patient and family. 

In this team approach, there often can be blending of the roles of the team so that the goals of patient care can be best met.

Team members include the hospice medical director, physicians, pharmacists, registered nurses, certified nurse’s aides, social workers, spiritual advisors and volunteers. The hospice medical director is a physician who provides support and guidance to the clinical staff providing care to the patient and family. 

The medical director may also provide medical care if the primary physician is unavailable or if the patient does not have a primary care provider. The hospice medical director is also required under Medicare to certify patients. 

The physicians involved in providing care may include the primary physician, who continues to provide valuable information about the patient’s medical history as well as continuing to see and treat the patient; specialists who have been treating the patient are also valuable in providing care and information so that the patient receives the best care possible.

Registered nurses (RN) are responsible for coordinating all aspects of the patient’s care and insuring symptoms (physical or otherwise) are being addressed and managed. The RN visits can vary widely, if the patient is experiencing few symptoms the visit may just be a short check-up. 

If a patient’s symptoms worsen the nurse will visit more often, make recommendations for changes in the course of treatment and provide support and education.

Every hospice patient is assigned a social worker who visits at the time of admission to hospice. The social worker function can vary from providing emotional support to patients and families to assisting with financial stressors. 

The social worker can be instrumental in connecting the patient and family with community resources. Lastly, if a patient is unable to be cared for at home the social worker will work to find a safer place for the patient to receive hospice care.

Our spiritual advisor also sees the patient and family at the time of admission. After the initial visit, the care provided is determined by the patient and family with input from the interdisciplinary team. The spiritual advisor is responsible for provide spiritually supportive counseling, life review and may connect the patient with clergy they are comfortable with.

The hospice aide is not a core service, in that it’s not required for every patient to receive care from an aide. This care is directly related to the patient’s situation and is often the one most depended on by the patient and family. 

The hospice aide typically visits 1-5 times per week providing personal care for the patient. Many times it is the hospice aide who develops the closest relationship to the patient, due to the frequency of the visits.

The pharmacist oversees the patient’s drug therapy, which includes filling prescriptions, monitoring for drug interactions and adverse reactions, anticipating problems and assessing the appropriateness of drug therapies in the context of patient-oriented goals.

Volunteers are a major part of hospice care in Fairbanks. They provide a variety of physical and emotional comforts to our patients and families, including respite care and companionship. Hospice volunteers also provide administrative support in our hospice office.

Hospice’s Fall Service of Memories — a ceremony to honor the lives of loved ones — will be held at 6 p.m. Nov. 19 at the Morris Thompson Cultural and Visitors Center. The public is welcome.

For more information about medical hospice services at Fairbanks Memorial Hospital visit www.fmhdc.com or call the Hospice office at 458-3090.

Kim Huffington is the Hospice Services Manager at Fairbanks Memorial Hospital. She has worked in the hospice field for more than 12 years and is a certified hospice and palliative care nurse.

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