Insight to Hospice Care
Presenters:
Wendy McCarty-Director CHI Health at Home-Dickinson
Tami Christianson-MSW, Bereavement & Volunteer Coordinator
CHI Health at Home-Dickinson
Common Misconceptions
Regarding Hospice

Hospice is where you go when there is nothing more a
doctor can do.

To be eligible for hospice, I have to be in the final stages
of dying.

Quality care at the end of life is very expensive.

If I chose hospice care, I have to leave my home.

Families are not able to care for people with life limiting
illnesses.

Hospice care is only for cancer patients.

Hospice is just for the elderly.

There is no hospice in my area

After the patient’s death, hospice care ends.2
Kay’s Story
It’s helping her live
her life until she dies.
-Julie Opdahl
3
When Do I Call Hospice?
CHI Health at Home offers complimentary
informational visits to help clients & their
families learn more about hospice.
*Unexplained significant weight loss
*Worsening of disease, despite treatment
*Difficult to control symptoms
*Multiple health concerns
*Recurrent hospitalizations or emergency
room visits
4
Hospice Focuses on Life
When you have a life-limiting illness,
CHI Health at Home offers compassionate,
expert care that helps you to live each
day to the fullest.
Once the decision has been made to stop
curative treatment, the focus is on
attainable comfort rather than
unachievable cure.
5
While end-of-life is obviously
an extremely difficult part of
the life cycle, it also
provides special
opportunities—to strengthen
relationships, to put one’s
affairs in order, to find
spiritual peace
6
Hospice Comes to You
When surveyed, more than 90
percent of Americans said they
would prefer to die in their
own homes, yet more than
two-thirds die in hospitals and
nursing homes.
7
Hospice is not a place; it is a
comprehensive program of
services that come to the
patient.
We want the patient to be as
comfortable and alert as
possible, spending precious
time with their loved ones in
familiar surroundings whether
a private home, Assisted Living
Center or Nursing home.
8
Hospice Serves All
The Medicare hospice benefit
covers all expenses related to the
terminal illness, including
medications and equipment.
Hospice care also is covered under
Medicaid, some private insurances
and by the generosity of our
donors.
9
CHI Health at Home provides
care to everyone regardless
of ability to pay. We are
very grateful of the
generosity and support of
the communities we serve.
10
Hospice is Expert Medical Care,
but with a Different Goal
The shift is from cure to
comfort. CHI Health at Home
clients work with a special
team of health professionals
with expertise in palliative
care—a medical specialty
devoted to relieving pain and
managing symptoms, not to
curing a disease.
11
New Rules for end
of life care
Barbara Karnes-RN
New Rules for end of
life cares-Discussion

Withdrawal from the world and people

Decreased food intake

Increase in sleep

Going inside self

Less communication

Mental changes

Physical changes
13
Hospice Cares for the Client &
Their Loved Ones
When a person is diagnosed with a
life-limiting illness, everyone
involved experiences periods of
stress, uncertainty, doubt, fear and
confusion. CHI Health at Home
treats them and their loved ones—
family members being whomever
the person determine is “family”—
as a single unit of care.
14
Hard Choices for Loving
People
Living Will
 Advanced Directive
 Do Not Resuscitate (DNR)
 Life Sustaining Measures

15
Hospice is on call 24 hours a day
and 7 days a week
Aside from regularly scheduled
home visits, the patient can always
talk by phone to nurses who are
trained to assess unexpected
situations. Our staff can answer
their questions, ease their mind.
When the situation warrants, a
nurse can come to the home at any
time, day or night.
16
Hospice Regards Death as Part
of the Continuum of Life
CHI Health at Home neither
prolongs life nor hastens death.
We provide personalized
caregivers, education and a
caring community to enable the
family to make end-of-life a time
of peace and support.
17
Hospice Respects Patient
Decisions
The patient may not be in control
of their illness, but they are in
control of their care. CHI Health
at Home professionals provide
the information they need to
make informed, thoughtful
decisions.
18
Because the nature of dying
is unique, it is always our
goal to be sensitive and
responsive to the special
requirements of the
situation. We want the
patient and their loved ones
to remain in charge of their
lives as much as possible.
19
Hospice is a Team of
Compassionate, Expert
Health Professionals
The hospice team includes
primary care physician,
hospice medical director,
registered nurse, certified
nursing assistant, social
worker, spiritual coordinator
and trained volunteers.
20
With our range of
expertise, CHI Health at
Home can address the
entire range of end-of-life
issues, taking a
tremendous weight off
the patients and their
loved one’s shoulders.
21
Hospice Includes Your
Doctor
The primary care physician will
continue in their role managing all
treatment orders and plans
recommended by the hospice team.
Registered nurses will keep the
physician up-to-date with the needs,
even when the patient is unable to
make visits to the clinic.
22
Hospice Means Having a
Coach
A good coach teaches, supports and
demonstrates. Caring for a loved one at
home involves learning many new skills.
CHI Health at Home team members are
excellent teachers. Whether it is learning
to manage a pain pump, bathing your
loved one or delivering medications, the
staff will be there give you the confidence
they need to provide excellent comfort
care.
23
Hospice Helps with Talking
About Difficult Issues
End-of-life presents many concerns
that need to be addressed. Whether it
be medical management, living
arrangements or family dynamics,
these needs tend to intensify during a
crisis. CHI Health at Home team
members can help open the lines of
communication and work towards a
goal that our client has voiced as
important to them.
24
Hospice is an Opportunity to
Attend to End-of-Life Concerns
End-of-life can be a very special time for the patient
and their loved ones. With pain and symptoms under
control, you can focus on various issues including:

Life review: time to reflect and take inventory of
your life

Saying goodbye

Completing your advance directives

Completing unfinished emotional issues

Spiritual search for meaning in one’s life

Spending precious time with those you love
25
Hospice Means Flexibility
The patient is never “locked
in” to CHI Health at Home;
they can opt out of hospice
care at any time. Sometimes a
patient’s condition improves
enough that treatment again
becomes an option.
26
Hospice patients are not
necessarily bed-ridden either.
Thanks to expert pain and
symptom management, we have
patients who have been able to
go deer hunting, take a special
trip and attend a family event or
even visit a cherished place;
take a walk in the park.
27
Hospice is Help with Grief
For the patient and their loved
ones, the grief process begins with
the terminal diagnosis, as everyone
begins to contemplate the many
losses ahead. The CHI Health at
Home social worker and staff help
to process this “anticipatory grief”.
After death, we offer bereavement
services-home visits, phone calls,
support groups, mailings and
education-for 13 months
28
Grief and Loss
 Death
is normal and natural

Everyone of us is going to die-none
of us are promised another day

Grief has physical sensations-We
feel and we hurt

Grief brings with it fear. We are
reminded of how little control we
seem to have over our lives
29
Stages of Grief
-Denial
-Anger
-Bargaining
-Depression
-Acceptance
30
Journey of the Heart
Finding Healing After Loss

Provides group members to share their thoughts,
hopes, feeling, and beliefs to that the group is
pulled more closely together in an atmosphere of
trust that enhances learning and promotes
healing.

CHI Health at Home offers grief & loss group 3-4
times a year

Good Grief group is an ongoing grief group that
meets monthly for social outing.
31
Another benefit of hospice
bereavement care: Caregivers
often find the grieving process
less complicated after having
been intimately involved in the
end-of-life progression.
We at CHI Health at Home are here
to help.
32
How to talk to a
Grieving Person

Understand that Grieving takes time

Keep in touch no matter what

Don’t use platitudes or comparisons

Use these two simple phrases to keep
communication channels open

When to talk about the deceased person
33
Comments from families that
received Hospice & Bereavement
Services

Mom’s 13 ½ months in your Hospice care was
fantastic! *Your organization & your individual
staff are nothing short of angels her on earth.

You are a God sent nurse for our family!

We have a special place in our hearts for Tami &
Astro. Thank you for all of your love and support.

Thank you for all of the love and care for Mom &
Grandma.

You were considered his angels & you were!

You all are so patient and kind. What would we do
with out caring, loving people like yourself that
34
put their lives on call for others.
And then I realized that to
be more alive I had to be
less afraid, so I did it. I
lost my fear and gained
my whole life.Author unknown
35
Additional Information Available to
you at:
http://chiathome.com/
36