The Hospice Team
Primary Care Givers
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Administrator:
As director of the hospice office, the administrator is responsible for the operational and financial aspects of hospice care that includes the hiring of staff, the negotiation of vendor contracts that provide auxiliary services to hospice patients, and the management of day to day procedures.
Admission Nurse:
An admission nurse is a registered nurse who makes the first patient visit, determines the appropriateness of the patient for hospice services, and completes the hospice admission. Often the admission nurse is the first hospice contact with the patient and family.
Attending Physician:
The patient’s physician is often the one who has written the medical order for hospice services, and sometimes they remain as the primary care physician for the patient. Throughout the hospice experience, medical care continues to be prescribed by the patient’s attending physician. The case manager works directly with the patient’s attending physician keeping him/her informed of the patient’s condition and any change of status. Also, the attending physician prescribes medication needed to keep the patient comfortable.
Bereavement Coordinator:
Bereavement is the period following the death of a patient when grief and loss is experienced. Bereavement services begin the day a patient is admitted to hospice service and care is provided for 13-months after the death of a patient to family members or caregivers. The Bereavement Coordinator is trained to offer grief support through phone calls, letters, support groups, and personal visits.
Case Manager:
Skilled Registered Nurses trained in pain and symptom management provide hospice care to patients. Case managers monitor the patient’s condition, provide education to patients and caregivers, and inform the hospice team of patient status and needs. The case manager offers medical equipment (DME) and pain management medication as needed for comfort care. A hospice nurse is available 24-hours a day, 7 days a week to patients and caregivers.
Certified Nursing Assistant (CNA):
CNA’s provide for the patient’s personal care (dressing, bathing, shaving, etc). Their hands of service keep the patient clean and groomed, which provides comfort and dignity for the patient and offers support and education to the family and caregivers. CNA’s may assist with feeding the patient, when needed. Because of the frequency of contact with the patient (personal care needs are determined by the case manager and the family’s requests), the CNA sometimes becomes the strongest emotional contact with both the patient and family.
Chaplains:
Chaplains offer spiritual care in accordance with the wishes of the patient and family, often coordinating with the patient’s clergy or religious leader. Hospice chaplains are trained to focus on the patient and family’s spiritual needs and are experienced in discussing end-of-life issues. Chaplains are available to assist in funeral planning and may be involved in the bereavement care. Chaplains do not evangelize but rather
support the patient in his/her own end-of-life journey.
Community Relations Representative (CRR):
A CRR educates families, physicians, and medical staff about the benefits of hospice services for patients and families. A CRR is involved in community events to educate and promote awareness of hospice services. Sometimes, a CRR is the first hospice contact for the patient and family.
Medical Director:
A Medical Director certifies that a patient is hospice appropriate based on diagnosis and prognosis. He/She serves as a liaison with attending physicians and case managers for hospice patients; sometimes the Medical Director becomes the hospice patient’s attending physician. The Medical Director attends interdisciplinary team meetings (IDG), reviews patient care plans, and adapts pharmacology orders to the patient’s change of status, as needed.
Patient and Family:
The patient, family, and caregivers are the center of all hospice care. Patient care begins when the patient makes decisions about what they want hospice care to be for them (which may include staying at home, moving to a healthcare facility, or dying in an inpatient unit). The hospice team listens and responds to the patient’s needs, concerns and requests. Each discipline offers resources to the patient and family to help maintain comfortable palliative care through the end-of-life.
Social Workers:
Hospice social workers conduct psychosocial assessments and provide counseling, education, and other skilled interventions to enhance patient and family coping. They are knowledgeable about financial and community resources and often link patients and families to sources of practical assistance. Hospice social workers support patients and families throughout the grieving process and routinely assess the bereavement risk of family members. Social workers assist patients with advance care planning, including designating health care or financial powers of attorney and making decisions about Do Not Resuscitate (DNR) orders. Social workers advocate for patients’ selfdetermination and attempt to honor patients’ wishes about end-of-life care whenever reasonably possible. They assess the strengths of the patient and their family system and incorporate these positive components into the individualized hospice care plan.
Volunteer Services:
Trained, certified hospice volunteers provide unique services to patients and families, often determined by the “gifts” of the volunteer as well as the needs of the patient or family member. In the home and healthcare centers, volunteers offer companionship for the patient that often translates into a connection with a patient’s roommate and the staff at the facility as well. Sitting and visiting with a patient, taking them outside for a stroll in a wheelchair, reading to a patient, providing music, taking magazines and flowers are all examples of comfort care that volunteers provide faithfully. In the home setting, volunteers may also offer respite care for the caregiver (time away from the patient for an appointment, shopping, or rest). Volunteer services are based on patient need and request as assessed by the Volunteer Coordinator.