SCHEDULE CHANGE

See handout for detailsOct 27

12:30 -13:00 Review Midterm and Test 2 – New schedule and requirements

October 2811:30 – Midterm Due

November 3Test 2 – Guest speaker write ups DuePresentations and game pal test Due

Providence Hospice End Of Life Care in the Community

Jane Brandes MSNDirector Providence Hospice

HOSPICE PHILOSOPHY OF CARE

Hospice provides support and care for persons in the last phases of a terminal disease. Hospice recognizes that the dying process is a part of the normal process of living and focuses on enhancing the quality of remaining life. NHPCO 2012

A BRIEF HISTORY OF HOSPICE

• Hospice can be traced back to medieval times referred to as a place of shelter and rest

• 1948 Dame Cicely Saunders began her work with terminally ill

• 1967 first modern hospice opened in London “St Christopher’s Hospice”

• 1974 First Hospice Program in the US opens in Connecticut

“PROVIDENCE HAS BEEN PROVIDING HOSPICE SINCE THERE WAS HOSPICE IN THIS COUNTRY”-RICK WARREN

• 1979 Providence is a demonstration project site

• Housed in old PPMC library with a small inpatient unit

• Average Census of 5-10 patients (Current Average is 400)

• Mid to late 80’s St Vincent's Hospice started • Struggle as West Side physicians thought it

would bankrupt the system• Director was the only nurse had to take call 24

hours a day and then make visits in the middle of the night with her children

……We have come a long way

WHO IS ELIGIBLE FOR HOSPICE?

Someone with a <6 Month Prognosis and is covered by Medicare part A or most commercial insurances.

Common Examples of End Stage Illness:

• Cancer• Heart Disease• Pulmonary Disease• Dementia

THE HOSPICE TEAM

• Personal physician • Board-certified

hospice and palliative medicine physicians and nurse practitioners

• Hospice nurses • Social workers

• Pharmacists • Chaplains • Hospice aides • Volunteers • Bereavement

support staff

HOSPICE SERVICES

• 24 hour availability• Counseling services• Physical and Occupational Therapy for safety• Medical supplies and equipment• Medications for control of symptoms• Respite and Inpatient care

HOSPICE SERVICES

• Hospice services are provided in the patient’s home.

• It may be a private residence, an assisted living community, an adult care home, or a residential or intermediate care community.

COMPLIMENTARY THERAPIES

• Music Thanatology• Massage• Acupuncture• Animal-assisted

therapies

THE PHASES OF DYING

• Each person is unique and approaches death in their own way, the following is a broad guideline of what one may experience.

ONE TO THREE MONTHS BEFORE DEATH

• Withdrawal from people and activities

• Communicating less

• Eating and drinking less

• Sleeping More

ONE TO TWO WEEKS BEFORE DEATH

• Disorientation and confusion

• Use of symbolic language and talking to people not present

• Physical changes: not eating, taking little or no fluids, decrease in blood pressure and pulse

DAYS TO HOURS BEFORE THE DEATH

• Sleeping most of the time

• Surge of energy Restlessness• Difficulty Swallowing• Changes in Skin Color• Rattling breath sounds

MINUTES BEFORE THE DEATH

• Shallow breath with longer pauses

• Mouth Open• Unresponsive

BEREAVEMENT CARESUPPORTING THE FAMILY AFTER A LOVED ONE PASSES

ON

• During Hospice Care: Anticipatory Grief and Grief assessment

• After the loved one Passes on: 13 months of Bereavement Services

BEREAVEMENT SERVICES

• 13 Month Grief Support

• Mailings about Grief Support

• Grief Support Classes and Groups

• Grief Counseling

• Child and Family Grief Support

• Camp Erin• Referrals for Long

Term Counseling • Twice Yearly

Memorial Services for family, friends, caregivers.

RESOURCES!

• Providence Hospice 503-215-CARE• Web:

http://oregon.providence.org/patients/programs/providence-hospice

• http://www.oregonhospice.org/

Thank You!