The Hospice Team:
Providing Palliative Care
The care of terminally ill patients is an evolving medical specialty that requires special knowledge, training, and skills. Hospice care is provided by an interdisciplinary team under the supervision of a registered nurse (RN). The team members consist of nine specialists in addition to the team physician. The nine and their functions are as follows:
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The Social Worker as a member of the team addresses the financial, housing, and emotional needs of the patient's caregivers at home.
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The Dietary Consultant functions to assure adequate and suitable nutrition, for example, for diabetes or patients with cachexia.
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The Chaplain offers spiritual help by working together with the patient's own religious guides. Hospice clinicians can now eliminate 90% of the dying person's physical pain, but holistic treatment by the Chaplain and hospice team is needed to address spiritual pain and avoid any thought by either patient or care-givers of resorting to assisted suicide. The Chaplain may rely on the team's volunteers for follow-up assistance.
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The Bereavement Counselor provides psychological support for the grieving family until up to 13 months after the patient's death in order to alert professionals to any serious depression and to help family members through the grieving process.
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Volunteers provide a responsive ear to the patients, read to them, offer transportation, do shopping, prepare meals, take care of plants and pets, and so forth, depending on the patient's needs. They can devote more time to individual patients than can the nurses and professional caregivers and can even offer respite care for several hours so that the constant family caregivers can be freed from time to time to lead their own lives.
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Physical therapists help in safe positioning and movement and generally in making the patient more comfortable, as well as to facilitate the patient's maximum level of physical and psychological independence through energy conservation techniques and safety measures.
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Speech therapists deal with cerebral vascular accidents (CVA), tracheotomies, laryngetomies, and various neurovascular diseases.
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Home health aides, known as Certified Nursing Assistants (CNAs), provide personal care and assist with activities of daily living. Under the supervision of the RNs they are the frontline eyes and ears of the hospice team.
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| 9. |
The pharmacy specialist provides service, education, and information about medications, reviews the medication regimen, and participates in the IDT meetings.
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The tenth member of the team is the hospice physician or Medical Director, who serves as a resource for the hospice in all its work. He certifies the need for services, advises on the Plan of Care, and signs all verbal orders. The hospice physician provides guidance on revising policy and procedures and serves on the hospice's advisory committees and governing board.
In many cases, the patient continues with his or her own personal doctor, so that the hospice physician functions as a clinical advisor to this doctor. In other cases, the patient's doctor turns the patient over entirely to the hospice physician. In all cases, the patient or the patient's representative has the final authority over the entire hospice team's program of care. |
