H O S P I C E

H O S P I C E
A Compassionate Service

THE HOSPICE MODEL

Utilizes a team-oriented approach to medical
care.

Offers excellent pain management and symptom
control

Offers physical, emotional and spiritual support to
the patient/family

Support Is tailored to each patient’s unique needs

Relies heavily on the support of many trained
volunteers

Compassionate Bereavement support is offered to the
patient’s family or loved ones for at least a year after the
death of the patient.

Type and Number of Hospices in
the USA in 2010

Free
Standing
2278
Home Health
Agency
Based
578
Hospital
Based
531

Free Standing Hospice
A Free Standing Hospice is independently owned
and offers complete hospice services – Home
Care, Inpatient Care and Bereavement Support.

Home Health Agency Hospice
Owned by a Home Health Agency, usually for-profit,
and they contract with a free standing hospice or
hospital based hospice for inpatient services.

Hospital Based Hospice
Provides a small designated inpatient unit or selected
scattered inpatient beds with a palliative care team
that services the entire hospital. The hospital will also
have a small home care agency to provide home care.

US Government mandates ALL hospice
care MUST be primarily home care
with limited use of inpatient beds.

In the UK and Ireland vast majority of hospice care
provided in free standing hospice inpatient building.

Free Standing Model of Hospice
My talk today will be focus on the Free Standing
Model of Hospice Care.

Here is a picture of two free standing hospices that are
very different from each other.

The Hospice at the Texas Medical
Centre, Houston, Texas

The Hospice at the Texas Medical Center, also known
as Houston Hospice, was founded in 1980 and was
one of only 4 hospices in the United States at that
time.

It has a large home care service that offers hospice
care to over 200 patients a day.

Medical students and Residents from Baylor College
of Medicine and from University of Texas Medical
School rotate through the hospice as do nursing
students from 3 nursing schools, social workers from
2 universities, and ministers from the community.

Zen Hospice Project
San Francisco, California

Zen Hospice Project was founded in 1987 as a service
offered by the monks and students at the San
Francisco Zen Center. Initially, it brought services to
indigent cancer patients living in the streets or in
small residential hotels. Soon after, the AIDS epidemic
came to the forefront in San Francisco.

It was the first Buddhist Hospice in America.

In 1988, Zen Hospice Project began working in
partnership with Laguna Honda Hospital to offer
hospice services in an institutional setting.

Zen Hospice started offering person-centered care for
the dying at its residential Guest House, a renovated
Victorian Home across from the Zen Center, in 1990
and incorporated formally as Zen Hospice Project in
1992.

Over the years, it has become a haven for people who
are dying and their families, who had nowhere else to
turn.

8 Reasons for the Popularity of the
Free Standing model of hospice
Care

1
They only do hospice and palliative care. This means
they are never distracted by being part of a cure
oriented environment

2
The entire building is designed to be very
homelike and comforting with each patient room
carefully decorated to be more like a room in
your own home.

Patient Room

Hospice Social Area

3
There are gardens accessible for patients, families, and
staff to rest in and enjoy the flowers, birds, and trees.

Entrance to Garden

Garden area

Fountain in Garden

Azalea Garden

4
Pets are allowed to visit in the hospice and many free
standing hospices have a cat or dog or both that live
there and are free to roam from room to room. They
are called “Therapy Pets”.

5
All the staff are there because they have chosen to
work specifically with the dying and the bereaved.

6
All the staff – administrative, medical, pastoral, and
volunteers are all trained in care and support of the
dying/bereaved and see the dying (death) as our
greatest teacher.

7
Because there are no emergencies in hospice there is
a great sense of peacefulness and openness in a
hospice environment.

8
This view leads to profound and life changing insights
into the development of compassion and
unconditioned love.

The Hospice Inter-disciplinary
Team
The Hospice Interdisciplinary Team is the most
important component in a hospice. How the team
functions together can make the difference between
an excellent hospice and a mediocre hospice.

When a hospice is small The Hospice Team IS the
Patient Care Team.

The Patient Care Team
Hospice
Physician
Bereavement
Coordinator
Hospice
Nurse
The Patient &
Family
Volunteer
Coordinator
Clinical Social
Worker
Hospice
Chaplain

When the hospice grows larger The Hospice Team will
be made up of the directors of each disciplinary area.
This team will usually meet once a week.

The Hospice Team
Hospice
Administrator
Volunteer
Coordinator
Medical
Director
Patient & Family
Pastoral Care
Director
Nursing
Director
Social Work
Director

The Patient Care Team will meet every day. As the
hospice grows larger there may be many Patient Care
Teams within the hospice. Each team will cover a
specific geographic part of the service area.

The Role of Each Team Member

The Administrator
The role of administration on the team is that of the
enabler. They must understand the needs of
patient/family and caregivers and develop ways to
find and maintain whatever is needed to meet the
needs of both staff and patient.

Hospice Physician
The head of the medical component of patient
care team is always the physician. The physician
will treat patients in the Patient Care Centre and
will also make house calls if a patient is being
supported in their own home.

Hospice Physician with Patient

Hospice Nurse
The Hospice Nurse is highly trained in palliative
care and works with the hospice physician as well
as with the other team members.

Clinical Social Worker
The Clinical social worker works closely with
patient/family dynamics and aids other members
of the team in discussions on how to deal with
certain situations that may arise or that have been
on-going within the family.

Chaplain
The Chaplain is available to patient/family if they
request spiritual support. The chaplain is also
available to staff members. Staff can become
closely involved with their patients and tend to
accumulate grief from the loss of all of the
patients in their care.

Volunteer Coordinator
Hospices rely on the help of many, many trained
volunteers. We use volunteers to help in the
office, as well as in patient’s homes and in the
Patient Care Centre. They do everything from
sitting by the bedside of a patient for hours,
reading to patients, running errands, flower
arranging, as well as help with fund-raising.

The Bereavement Coordinator
The bereavement coordinator steps in after the
death of the patient. Hospice continues to
support the family and loved ones for at least a
year after the death of the patient. We have
trained bereavement volunteers that work with
the bereavement coordinator to give support
wherever and whenever it is needed.

How the Hospice Team Functions

Meets daily to discuss patients needs – physical,
emotional, and spiritual. Also helps to ensure
that team members do not bring their own
emotional baggage into the care of the patients.

Physical pain can be powerful and dehumanizing, and
can create tremendous stress within the family. This
makes it important that we deal with their pain
immediately.

The medical component is the largest part of the
interdisciplinary team. Daily team meetings help to
ensure that hospice care remains balanced with the
emotional and spiritual support remaining as strong
as the medical support.

Admission of a Hospice Patient

All Patients must have a referral from a physician with a
prognosis of 6 months of less to live.

An appointment is made with patient/family to discuss hospice
care and to have admission form signed and witnessed.
The admission form states the prognosis and has a Do Not
Resuscitate statement.

Home Care
Admission:
• If it is a home admission patient is to be
cared for in their own home.
• Hospice nurse and social worker explain
hospice care to patient/family.
• Forms are always read aloud and then
signed by patient/witness. Copy left it
home.
• Nurse does physical exam of patient and
social worker talks with family.

When
they
return
to the
office:
• If patient needs pain/symptom management
hospice physician is scheduled to make a house
call.
• The nurse orders any medical equipment
needed in home. If medication is required it is
ordered and delivered.
• Nurse and social worker meet with the team to
discuss and make plan of care and schedule
visits.
• Referring physician is notified of admission by
hospice physician

Patient
Care
Centre
Admission
• Hospice physician/nurse make visit to patient’s
home or hospital room and explain hospice
service, have forms signed/witnessed.
• Physician evaluates medical needs of the
patient.
• Time of admission to PCC is determined and
ambulance transport scheduled. No sirens or
flashing lights.
• Patient arrives in ambulance, is greeted at front
door by nurse and taken to room.
• Shown social areas, nurses station and meet
various member of hospice team

Hospice accept all patients who are referred to us with
the required prognosis no matter what their financial
condition is or whether they have insurance or not.

Hospice Volunteer Program

Volunteers are an important part of the
interdisciplinary team working to “de-institutionalize”
the dying process and to help provide a more humane
system of care for the dying and their families.

Federal law requires that at least 5% of all hospice
patient care hours be provided by volunteers.

Volunteers offer many important services including:

Support for patients: This can include visiting, reading,
taking walks, writing letters, bringing in music,
supervising visits with pets, even massage therapy for
volunteers with the necessary skills

Respite and support for family members: Volunteers
can assist with shopping or household maintenance,
or allow family caregivers the opportunity to take
care of necessary errands and get some time away
from the house. Family members also appreciate a
visit from a compassionate friend who understands
what they are going through

Child care assistance: This can include help with
babysitting, picking up children from school or
providing necessary transportation to club meetings
or sporting events and practices. Volunteers have also
made invaluable contributions with family pet care.

Bereavement support: Hospice volunteers can work
closely with the hospice’s professional bereavement
staff in duties that range from assisting as a support
group facilitator to serving refreshments and helping
with mailings to clients and families.

Fund-raising and administrative work: A volunteer
with clerical skills can serve a hospice by helping in
the office with simple administrative duties.
Fundraising responsibilities can range from preparing
mailings or thank you letters to organizing fundraising
events and contacting possible donors.

To ensure that all volunteers are equipped for the
challenge of working with the dying, hospices require
that volunteers complete extensive orientation and
training sessions, as well as submit to a routine
background check. It’s important that volunteers
understand the history of hospice and are aware of
the specific ways their local hospices works to serve
the community.

DEATH OF A PATIENT

When a patient dies in hospice care we use “ritual” to
help ease the sense of loss of a loved one.

Home
Care
Death:
• We encourage close family members to
take part in washing and cleansing the
body.
• Light candles and burn incense.
• Prayers and/or meditation as they wait
for the removal of the body

Patient
Care
Centre
Death:
• Family members and patient care staff
wash and clean body.
• Light candles and burn incense in patients
room and allow family to sit quietly until
arrangements have been made to
remove body and/or until their religious
requirement have been met.

Patient Care Centre Ambulance
Entrance

Once body has been removed the room is cleaned and
the bed is made.
We then lay a rose on the pillow of the bed and no new
patient is admitted to this room for at least 24 hour.

BEREAVEMENT

Hospice is mandated to provide bereavement support
to family and loved one for at least one year after the
patient’s death

The Bereavement Coordinator has a team of trained
volunteers who continue to visit family members and
offer support.

Grieving children have a difficult time expressing their
grief and we have found that one of the best ways for
them to help them “talk” about their feelings is
through an art program developed for bereaved
children

We hold a memorial service for patients who have
died and family members, staff and volunteers attend.
Each patient’s name is read aloud and a family
member lights a candle in rememberance.

Chapel at Patient Care Centre

IN CONCLUSION

The mission of hospice is ALWAYS to provide
compassionate care to the dying and to their families.

Hospice is a flexible service and is designed to meet
the local needs. DO IT YOUR WAY.

Remember, Hospice is NOT a program, it is a SERVICE.

Hospice can change the lives of not only the people
that you serve, but also change the lives of you who
serve.
Death can be our greatest teacher.

Prince Sidhartha, before he became the Buddha,
saw old age, sickness, and death as the 3 heavenly
messengers. Two of my daughters died when they
were babies, and my 15 year old son was killed in a
gas explosion. Death was a heavenly messenger for
me. It made me question what life was all about
and it taught me that Now is the only that is real
and that it is forever. Years later I discover the
Buddha’s Here and Now Dhamma.

Let your work with the dying open your heart and your
mind to the importance of living your life fully – right
here, right now.
This moment right here, right now is timeless.

Right here, right now is the Dhamma and the
importance of Here and Now is one of the great lesson
that our work with the dying can teach us.

Those of us who are Buddhist chant in praise of the Buddha,
the Dhamma, and the Sangha. When we chant in praise of
the Dhamma we say:

Sandittiko – Apparent, Here and Now

Akaliko - Timeless

Ehipassiko – Encouraging investigation

Oppanayiko – Leading inward

Paccatam veditabbo vinnuhi ti – To be
experienced individually by the wise.

Hospice work is a path to
Compassion and a path to Wisdom.