HJNO May/Jun 2021

HEALTHCARE JOURNAL OF NEW ORLEANS I  MAY / JUN 2021 29 the patient is going through the dying pro- cess, so is the family. Hospice goals always address the patient and the family. What do you think makes a good hospice team? McCann: What makes a good hospice team is collaboration and respect of all members of the team. Each discipline on the hospice team is important and aids in the successful care of a hospice client. Some of the team members may have a more active role in certain cases and at different times, but the input of the team as a whole gives strength to the team. Working with a good hospice teammakes work enjoyable and satisfying. What are the biggest challenges you see from a patient perspec- tive, caretaker perspective and a family perspective when one enters hospice? McCann: I think that overall, for all per- spectives, one of the biggest challenges upon entering hospice is trying to under- stand what hospice really is. Trying to work through myths and getting clarification on what to expect from the hospice team is ongoing. Also, making the adjustment from normal, traditional medical care/treatment to a hospice plan of care is very difficult for many. Oftentimes, the patient, caregiver and the family feel as if they have “given up” by enrolling in hospice care. For the patient, I think that sometimes finding the right medication to help in symptom control can be challenging as hospice is prepared to adjust medications at a quicker pace than they have been used to. Although this can be challenging to some patients, this is a very welcome change for many. For the caregiver/family, adjusting to not taking the patient to the hospital every time some- thing changes or declines is often difficult. It can be challenging that as the patient’s condition declines, the caregiver/family has much more hands-on care. The hos- pice team spends much of its time teaching and supporting the family in providing that level of care. A great deal of education and support is necessary for both the patient and family. Valteau-Sorapuru: From the patient per- spective, the biggest challenge is acceptance of their hospice diagnosis and facing the reality that their condition will not change. The biggest challenge from the caretaker perspective is accepting the responsibil- ity of caring for the patient at home and allowing the patient to die with dignity. The biggest challenge from the family perspec- tive is accepting the patient’s decision to go through with hospice care and for all family members to be on the same page about their loved one’s end-of-life plan. End of life often brings drama to those involved. Are there com- mon experiences you see at this time, and how does a hospice worker or social worker deal with these issues? McCann: Some of the issues that are com- mon to many when dealing with end of life include the stages of dying that were identi- fied by Kubler-Ross: denial, anger, bargain- ing, depression and acceptance. Of course, people don’t always go through these stages in linear order; it’s very common for people to move in and through them. We also occasionally see fear — fear of the unknown as well as concern about the journey. The social worker, as well as the rest of the team, strives to meet each patient and family where they are. The mis- sion is to accept them as they are and work toward the goals of a peaceful and com- fortable death for the patient and adequate coping for the family. Valteau-Sorapuru: The issue surrounding hospice care that usually brings about the most drama is when not all family mem- bers of the patient are in agreement about hospice care being best for their ill rela- tive. Drama also often unfolds when fami- lies cannot settle on who has the right to be the spokesperson for a patient if the patient does not have the capacity tomake the deci- sion for him/herself. The role of a hospice social worker is to respect each person’s point of view around the death process and to bring calm to the storm. The social work- er’s role is to have the patient’s best interests in mind and to remind family members of that perspective. Another common experience that causes conflict is patient or family misunderstand- ing of comfort medication, such as mor- phine. Although a hospice nurse may edu- cate the patient and their family on the benefits of morphine, many families have a mentality that morphine will kill their loved one instead of recognizing how it can help soothe the terminal disease a patient may have. The social worker can put fami- lies’ anxieties at ease by sharing that the amount of morphine given to patients is TYRA VALTEAU-SORAPURU, LCSW , is a licensed clinical social worker based in New Orleans. She has worked in the social work field for 30 years and has been a hospice social worker for 11 years with Hospice Associates of New Orleans. Prior to working with hospice, she mainly worked in the nonprofit realm in many different capacities and has provided direct supervision to clinicians working in the field of social work.