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.