HJNO May/Jun 2021

Q&A 28 MAY / JUN 2021 I  HEALTHCARE JOURNAL OF NEW ORLEANS   How did hospice, as we know it, begin, and how has it evolved over the years? Allene Womack McCann, RN, MN: In 1967, Dame Cicely Saunders founded St. Christo- pher’s Hospice in London, the first hospice for terminally ill patients in the United King- dom. In 1974, the first hospice, Connecticut Hospice, was founded in the United States in Branford, CT, by two pediatricians and a chaplain. Hospice programs were mainly staffed by volunteers as it was not recog- nized by Medicare, Medicaid nor private insurance companies as a reimbursable service. Hospice was approved as a Medi- care benefit in 1986. Over the years, it has become recognized as a standard health- care option for any person who has a life- limiting illness and either whose treatment options are not effective or who has cho- sen to discontinue aggressive treatment. Today, hospice, as we know it, is comprised of an interdisciplinary team who address the physical, psychosocial and spiritual needs of the patient and provide support to the family. The goal is comfort, dignity and quality of life. Hospice today is provided primarily at the patient’s home, assisted living, group homes and long-term care facilities. Hospice provides equipment, supplies and medications related to the patient’s terminal diagnosis and are con- sidered palliative as opposed to curative. Are there misconceptions sur- rounding hospice? McCann: Please see sidebar on Hospice Myths vs. Realities. The misconceptions are one of the major reasons that most people shy away from hospice care. Tyra Valteau-Sorapuru, LCSW: There are many misconceptions surrounding hospice care. Many people’s viewpoint on hospice is that their loved one will die in days or weeks in our care. Another misconception is that the comfort medication used to man- age the patient’s pain and/or anxiety will be the cause of their death. Lastly, many folks seem to think that once you go on hospice care, you can never revoke it. These myths, in many instances, prolong patients’ and caregivers’ decisions to seek hospice care. I often find myself having to debunk these myths in laymen’s terms in order to calm clients’ fears about hospice. When is a patient ready to enter hospice care? McCann: When the patient has a prognosis of six months or less to live and the patient/ family choose comfort and palliative care versus traditional, aggressive care. Valteau-Sorapuru: A patient should con- sider entering hospice care when two cri- teria have been met: they have been diag- nosed as having less than six months to live and there are no further medical procedures that could assist in improving the patient’s condition. Even when these conditions are met, though, a patient still may not be ready to accept their diagnosis. In this case, a patient should be educated about what hospice care is really like and be given the respect to choose hospice care only when and if they are ready. Many times, patients referred to hospice care right after being discharged from a hospital and their fami- lies feel as if they are being rushed into a decision. It’s important to note that families can take their time when making their mind up about whether or not hospice care will be best for their loved one; anyone can request a referral for hospice care. In your experience, what attracts someone to end-of-life care as a profession? What attracted you? McCann: I think that people choose end- of-life care as a profession when they real- ize that medical science really can’t treat, cure and heal everyone. I think it becomes difficult for health professionals to see patients suffering and know that in a tra- ditional healthcare setting, they are limited in how they are able to control those symp- toms. Hospice accepts the fact that medical science and treatment can’t always help — that patients sometimes will get worse and die. The goal changes from treatment and curative to comfort, quality of life and dig- nity. What attracted me to end-of-life care, to hospice, includes all of the above also. Additionally, a big drawing card for me, personally, was having the opportunity to do one-on-one care with the patient and their family. Really, one patient at a time! The second biggest attraction for me was the wholistic approach. I love that hospice is not only physical care, but psycho-emo- tional and spiritual care also. It addresses the whole person. The last aspect of hos- pice care that won me over is the fact that hospice is the only discipline that considers the patient and their family as the one cli- ent. This is paramount, because although ALLENE MCCANN, RN, MN , director of Clinical Services of Guardian Angel Hospice in New Orleans, has been a hospice nurse for 20 years. She graduated from LSU Medical Center with a master’s degree in nursing with a specialty in gerontology. McCann is the patient care manager and one of the owners of Guardian Angel Hospice. She finds great fulfillment in helping patients and their families with achieving comfort, dignity and quality of life. By focusing on emotional and spiritual support, as well as physical comfort, she and her team provide comprehensive care to their patients.