This article appeared in a November 2007 issue of the Dodgeville Chronicle.

Hospice wraps a cloak of comfort around the dying

by Jean Berns Jones

At the most difficult time families can imagine -- while one of their own is going through the process of dying -- compassionate hospice workers can come through the door of their home and shower them with comfort, care and support.

This is the simple philosophy of hospice. To relieve pain and provide physical, spiritual and emotional support to the dying patient and their family.

At Uplands Hills Health Home Care & Hospice in Dodgeville, the 20-member hospice team is composed of registered nurses and certified nursing assistants, a support therapist, social worker, chaplain and medical director. It is their goal at this time of pivotal change for the family, to ease and facilitate the transition for each member and for the family unit as a whole.

Linda Kosharek, CNA (left) and Sharon Ryan, RN stand by the bedside of a patient. Both are members of the hospice team at Upland Hills Health.

“Hospice is a philosophy of caring for people at the end of life, supporting the family both before and after the death and having them experience death with dignity and a sense of peace,” said Deanna Wilson, Director of Community Care Services at Upland Hills Health. Wilson’s position, which she assumed last August, also includes overseeing Upland Hills’ Home Care and Nursing Home services. As an RN of 22 years who also has experience as a licensed nursing home administrator, hospice director, and home care supervisor, Wilson seems a perfect fit for the job.

Another key component of hospice is the approximately 35 members of the community who serve as volunteers. Often referred to as “angels of mercy,” these people provide respite visits for caregivers, donate meals, help with transportation and other services to lighten the family’s burden and brighten their spirits.

Although being a hospice volunteer sounds like a heart wrenching job, “It’s a very fulfilling thing to do,” said Joyce McPhail, Director of Nursing at Upland Hills Health. “The volunteers love what they do; they’re just such special people.”

Shirley Sigg, a hospice volunteer from rural Hollandale, agrees. “It’s a pleasure to be able to do something to help someone when they are under stress,” she said. “It’s been a wonderful experience. I get more out of it than the person on the other end.”

“Death is a hard thing to deal with. We all know it’s coming but no matter when it comes it’s hard on the family, and just to be able to be there to comfort them somewhat...it’s very rewarding,” she added.

Hospice service in Iowa County was initiated as Lifeline Community Hospice at the Dodgeville hospital in 1982, and became Medicare and Medicaid Certified in 1994. The name was changed when Memorial Hospital became Upland Hills and the hospice now serves patients in six counties.

Emergency services are available 24 hours a day, seven days a week. Hospice pays for all medications and any needed equipment related to the terminal illness.

Hospice normally involves no cost to the patient. It is paid for by Medicare, Medical Assistance, and most insurance companies. If someone has no payment source, a sliding fee scale may be used or in rare cases the service may be provided without reimbursement. Family Care will also pay for hospice in counties that have CMO funding.

It is available to terminally ill people who are no longer seeking curative treatment and whose life expectancy is measured in months rather than years. A patient may have any terminal illness such as cancer, heart disease, chronic obstructive pulmonary disease, renal failure, Alzheimers, stroke or AIDS.

For non-dying patients, Upland Hills Home Care also provides RNs on call for assistance around the clock, seven days a week. They provide a wide range of skilled nursing services.

JoAnn Meade gives a hug to her husband, Raymond, who is a hospice patient being cared for in their Hollandale home.

With growing technology and because patients are now kept in the hospital for shorter periods, “There has been a huge difference in the complexity of issues we treat in the home,” explained Joyce McPhail, Director of Nursing. “Patient’s families are doing more independently. We teach them things like IVs, tube feeding, and self catheterization.”

“There are family members doing things that they probably never, ever thought they were capable of doing,” Wilson added, “and without the support they wouldn’t feel confident and strong enough to do it.”

“A lot of family members are very fearful of caring for someone in the home, but the loved one really wants to die at home,” added Patti Richgels, Hospice RN. “Sometimes just by doing some simple training and with support of the staff, they end up being able to care for that person until death. And it’s such a rewarding thing to know they were able to meet that person’s wishes and needs at that time.”

“And to know that their family will be supported after their death. I think that’s so important for the patient,” McPhail said. Hospice provides bereavement services for the family for up to a year after the death.

Early enrollment in hospice, rather than last minute decisions, are highly recommended. The time allows for training, stress reduction, and the chance to develop relationships so family members can receive the full potential of their hospice experience.

Hospice patients always have the option to change their minds if they decide to go into a facility.  The hospice has contracts with about 16 area hospitals, nursing homes and assisted living facilities, allowing team members to continue caring for patients and families as before. Last month the Home Care Department took over operation of the Lifeline program from a private company. The program allows patients to wear monitors to contact responders if they need help.

The department has also received a grant to receive ten Telehealth monitors for placing in patients’ homes. The monitors relay health data to a computer at the hospital so patients may do routine testing without leaving their homes.

One of approximately 20 hospice patients now being served is Raymond Meade of rural Hollandale. He and his wife, JoAnn, became connected with hospice in mid-February, 2006, when Raymond was told he had six months to live. That was almost two years ago, and JoAnn believes he is still with her due to the quality of his care.

“He has had such tender loving care from a wonderful support group,” JoAnne said. “Hospice comes into our home and they don’t take over, but they become part of the care team and do what they can to relieve pain and give Raymond the quality of life he deserves.”

Raymond has been linked with the Veterans Administration Hospital in Madison since 2005 when he was evaluated for effects from Vietnam. JoAnn, an RN, and Raymond, an engineer, had shortly before retired and built a new home in Hollandale, planning to travel. Their plans were dashed with Raymond’s diagnosis of a progressive neurological disorder related to dioxin (“agent orange”).

“It was my wish to care for him in our home,” JoAnn said. “If I could get the equipment and the support, I knew I could do it. But I knew I could never do it alone. Because of his level of care, it would be an around the clock task and impossible for one person.”

“All of the hospice nurses have exceeded my expectations, and we have two wonderful volunteers who come so I can get our for groceries and appointments,” she added.

Shown at Upland Hills Health Nursing and Rehabilitation Center are (l-r) Patti Richgels, Hospice RN; Joyce McPhail, Director of Nursing; and Deanna Wilson, Director of Community Care Services.

“Raymond and JoAnn both made a decision to be home together, and we try to make that possible,” explained RN, Sharon Ryan. “Working in hospice is more than rewarding. It’s a privilege to do it and to work with people in this stage of life -- to help them to mend relationships, make choices, and realize that every stage of life is beautiful.”

With Raymond’s diagnosis, the Meades were referred to the Palliative Care Team at the VA Hospital, who have worked closely with Upland Hills Hospice. The VA has provided a hospital bed, Hoyer lift, special chair and other supplies. Now Raymond has lost his speech and has been non-ambulatory since January, 2006.

“My biggest blessing is that he is alert and can communicate with his eyes and lips,” JoAnn said. “Even through his body won’t work, he is very aware of his surroundings.”

When their daughter and friends visit, everyone is seated in the living room near Raymond’s bed, which faces the country view through large windows. His granddaughter, Bernadette, climbs into bed and cuddles with him, along with their small dogs.

Through hospice, JoAnn says she learned about anticipatory grief and experienced a transformation in mindset. Now she tries to use the knowledge to help other family members and friends as they also travel the journey of separation and grief.

“I have received a lot of information that helps me to live in the minute and get what joy there is out of each day,” she explained. “It puts our focus on living. If you want to be together like we do, you accept things on the terms you have.”

“It’s just amazing for me to see all these people who come into our home. It’s not a job to them. It’s beyond that,” she said. “They are all here to help us with our long good-bye.