End of Life - Who Makes up a Hospice Team?

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Sally Smith:  Welcome to Age to Age.  I’m Sally Smith.  Let’s talk.  Today, we have my friend, Dr. Angus Baker, with us, who is the medical director of Hospice of Charleston.  Angus also spent thirty years in the community as a physician in hematology and oncology, and we are lucky to have him with us today.  Thank you, Angus.


Dr. Angus Baker:  Thank you, Sally.


Sally Smith:  One of the things I wanted to ask you today, and as I’m beginning to understand, Hospice is a real team approach.  In reading some things for today’s talk with you, Angus, I was so stunned by the variety and depth of services offered.  I mean things like support for the caregiver, counseling, spiritual guidance, medication, doctor visits.  I mean, it was just unbelievable.  I would love to ask you, through these goals of providing quality of life and a peaceful, comfortable end of life support for the loved ones of the dying, how does this happen?


Dr. Angus Baker:  It happens through a team.  I couldn’t be done by any one person, or one profession.  The magic and beauty of Hospice care is the interdisciplinary team.  It works both in consultation with each other and in the home, or wherever the patient happens to be.  The team, primarily, you don’t want to leave anybody out, the four groups that are working on patient care every day, usually include a nurse, a Hospice nurse, Hospice social worker, Hospice chaplain, and Hospice physician.  In addition to those core members of the team, that are almost always involved, we also have the patient and the family members.  They’re core members of the team as well.


We also have home health aids who provide personal care in the home of all different types.  We have volunteers.  A key aspect of Hospice care, that we couldn’t do without, are the volunteers that work with Hospice, either helping the Hospice professionals do their work or helping patients in their homes, or wherever they happen to be.  So, volunteer work is extremely crucial to Hospice care.  We also have people that aren’t involved every day, with every patient, such as physical therapists, pharmacists, maybe professional counselors, maybe speech therapists, etc. 


There are also administrative aspects to Hospice care, the team that really helps make Hospice care happen.  One little example, I always remember how important it is, there was a study one time of oncologists, cancer treatment doctors, compared to Hospice doctors about burnout, and who became just overwhelmed by the job and couldn’t do it anymore.  It’s more common for oncologists, for Hospice doctors, even though Hospice doctors deal more, every day, with end of life issues.  And the reason they thought this was because of the team support helping the doctor to do an even better job, and get through the tasks and the stresses of this work, whereas oncologists might be a little less supported by a big a team.


Sally Smith:  That’s such an interesting thought.  I read an article, years ago, about the effects of the simple act of holding hands with someone, and what people were able to do holding hands.  It’s such a simple thing.  The team idea is, you’re not in this alone, you know, we’re all working toward the same goals.  It’s probably very sustaining.  I’m not surprised.  Now, I’m interested, this team that you’re talking about, except for the volunteers who, as you say, are pivotal, the rest of these people, the chaplain, everybody, are they on the Hospice staff?


Dr. Angus Baker:  Yes.


Sally Smith:  They work for Hospice?


Dr. Angus Baker:  They might be part-time in some agencies.  They might be full-timed in a lot of agencies.  The bigger agencies will have one or more full-time chaplains, a number of social workers, bereavement counselors, physical therapists, either part-time or full-time.  All these different people are represented.  And if they’re not full-time available in the Hospice agency, they’re contracted by the Hospice agency to become available when they’re needed. 


Sally Smith:  Well, I’m really inspired by the fact that every one of them has criteria.  Let me ask you this, this team that you’ve got here, what hours are they available?  Is this a 24-hour commitment?


Dr. Angus Baker:  That’s a good question.  Twenty-four hours, seven days a week.  If a person has an emergency at home, at 2:00 AM, and they call the Hospice nurse, we’ll be in touch with them and more than likely we’ll make a visit to the home at 2:00 AM.


Sally Smith:  And the pain management, and symptom management, this comes through physical therapy and your own staff pharmacist, or your part-time pharmacist?  A problem develops, and they come in and analyze it?


Dr. Angus Baker:  Yeah.  Our nurses are really called case managers.  The nurses are on the phone, there’s a national Hospice pharmacy, called Hospice Pharmacy, that we contract with to provide all the medicines for our patients, and to provide expertise.  They’ve got doctors in pharmacy, PhDs in pharmacy, available to them 24 hours a day.  Our nurses, at 2:00 AM, can call this agency and talk to a pharmacist about what they think that patient ought to get next, thereby being helpful to the physicians and nurses.  And it’s almost always an evidence-based recommendation that works real well.  Sometimes we know the patient better than the pharmacist does, and we know that we might want to do something a little bit different, for whatever reason.  But the pharmacist is definitely part of the team in that way.


Sally Smith:  Well, what sounds beautiful in that scenario is that you have a Hospice pharmacy, a central place, so you’ve got all these questions coming into a central place where they’re used to dealing with it. 


Dr. Angus Baker:  Right.


Sally Smith:  And you’re buying your drugs in bulk.  That must help your costs tremendously.


Dr. Angus Baker:  It does.


Sally Smith:  I wondered how you were able to do that.  I see that in some instances you even provide medical equipment.  Would that be through the same sort of contractual agreement?


Dr. Angus Baker:  In most cases, we provide medical equipment and, very commonly, hospital beds, wheelchairs, bedside commodes, oxygen, all these things.


Sally Smith:  Wow.  And they would go back to Hospice to be used again?


Dr. Angus Baker:  Well, yeah.  What we do is contract through a medical equipment supplier to provide all of that. 


Sally Smith:  I understand, yes.


Dr. Angus Baker:  So, if we call right now and say that someone needs a hospital bed by 5:00, they’ll have a hospital bed by 5:00.


Sally Smith:  And so then, you pay their bill?


Dr. Angus Baker:  Yes.


Sally Smith:  They deal with the bed, and what comes home, and what doesn’t.


Dr. Angus Baker:  Right.


Sally Smith:  Now, I see, in there, it can get very detailed.  You even provide personal care, like bathing.


Dr. Angus Baker:  Yes.


Sally Smith:  And nutritional advice.  Is this something that volunteers would help with, or the nurses?


Dr. Angus Baker:  Well, usually not.  Actually, we have a large number of home health aids who are often trained in hospital care, or nursing home care, and certified, and give baths, or help patients with cleaning up their environment, or whatever they need.  It’s often one of two hours a day.  It might commonly be three days a week, but for some patients, it’s every day.  The nurse and/or the home health aid can also help with colostomy management, and catheter management, and stuff like that. 


Sally Smith:  It’s so complicated, and so fascinating that you’re able to coordinate it.  It’s just a big puzzle full of a lot of different pieces that are probably changing over time too.  Every week is different, every day is slightly different.


Dr. Angus Baker:  It is.  Can’t you see, though, how one person can’t do all of this?


Sally Smith:  Oh, absolutely.


Dr. Angus Baker:  Having this team involved is really key.


Sally Smith:  Well, also, what you get is better care, and you get a better product.  You get a better result, and a happier one, all the way around.

Two final questions:  One, with these different people, the aids, the volunteers, the chaplain, all of them, about how many would be on the staff of Hospice?


Dr. Angus Baker:  It depends on how many patients you have.  I think Hospice of Charleston has something like 135 employees right now, and they have somewhere around 200 patients at home, and somewhere around 15 patients at the Hospice of Charleston patient center.


Sally Smith:  Well, I had a friend, through some volunteer work I did earlier in my life, that was a Hospice volunteer and found it extremely rewarding.  In closing, is there something that you identify as a unique characteristic, or a particularly strong character trait, that seems to draw people to the Hospice team, wanting to be part of this Hospice team and give this gift to people at the end of their life?


Dr. Angus Baker:  Well, they’re people who definitely want to make a difference, in a personal way, for the people that they serve.  And, certainly, they’re people who are not terrified or bothered by the naturalness of death and life. 


Sally Smith:  Well, you know, the other thing, in the sixth-month period, is the personal ability to make a connection, instead of different doctors and different nurses.  I bet some of those nurses and volunteers develop some very close relationships with their patients that are very meaningful.


Dr. Angus Baker:  You said something about giving to them, but we really, everybody who works in end of life care feels that we get more back from our patients than we could ever give.  It’s a wonderful interaction, wonderful connection with people.


Sally Smith:  What a beautiful thing to say.  I’m really excited to have had this opportunity to talk to you about Hospice.  It’s a beautiful thing you’re doing, as far as what I’m hearing.


Dr. Angus Baker:  It’s a privilege to be there.


Sally Smith:  And I’m glad somebody like you is giving it its full time, and they are lucky to have you. 


Dr. Angus Baker:  Thanks.


Sally Smith:  I want to thank you so much for coming and spending this time with us.


Dr. Angus Baker:  My pleasure.


Sally Smith:  You can come back again when I think up more questions.


Dr. Angus Baker:  Okay.


Sally Smith:  I also want to thank my producer, Betsy Reeves, and our Web Administrator.  Thanks to all our listeners for joining us.  We welcome your suggestions and comments on our website.  This is Sally Smith, Age to Age, saying good-bye and wishing you courage and joy on your journey.  We are all connected.


If you enjoy listening to Sally Smith, you can buy her book, The Circle.  It’s the story of how she personally responded to her mother’s journey with Alzheimer’s disease.  It’s a wonderful gift of hope for anyone with a parent with dementia.  Just click on Sally Smith’s name under the Health Professionals tab on the Podcast home page.  All profits support research at the Center on Aging.  Thanks.

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