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From Intervention To Palliation

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The term "hospice" was first used in 1967 by London physician Dame Cicely Saunders, OM, DBE, FRCP, FRCN, to designate home care for dying patients. Just 7 years later, in 1974, the first hospice in the U.S. opened in Connecticut, according to the National Hospice and Palliative Care Organization.

Since that opening, hospice has become an accepted alternative to dying in a hospital. The program, which allows people to die at home surrounded by family and loved ones, has moved from a little known alternative to a viable medical option.

But as the population ages and medical complications grow, another Connecticut healthcare provider has decided to turn around the traditional home care model. Masonicare Health Center, one of the state's providers of healthcare and retirement living communities for seniors, is now offering acute hospice care in a hospital setting.

In-hospital Hospice

"One of the advantages of having these patients in an acute care hospital setting is intervention. There are things we can do they are not able to do at home. And we have quite a few resources we can call on," explained Melinda Schoen, MSN, RN, vice president of nursing at Masonicare Health Center, Wallingford, CT. "We have put together an interdisciplinary team which focuses on hospice and we have created a separate area on the acute care unit (ACU) with dedicated rooms."

"Each room is set up so a family member can stay with them and we also have a family room where they can go to relax," added Linda St. Pierre, MSN, BSN, RN. "And those six beds are part of Masonicare's acute care unit so there is a physician there, 24 hours a day."

St. Pierre, regional director of hospice clinical services for Masonicare, said dedicated rooms make it easier to care for hospice patients and their families.

Sharon Pierpont, BSN, RN, agrees, adding in-hospital hospice has made it easier for everyone, including visiting nurses.

"Working with patients at home, you run into times when families can't manage or the people need a higher level of care than they can get at home," said Pierpont, who is now the hospice case worker for Masonicare Home Care and Hospice.

Until the dedicated unit opened, she added, the available solutions were not the best. "You either had to find a nursing home willing to take them or they stayed in the hospital."

New Territory

Logistical nightmares, like finding a bed coupled with a growing case-load, sparked the creation of the dedicated unit. But it was Masonicare's long-standing relationship with Connecticut VNA, the largest home health agency in the state, which helped move the initiative from idea to reality quickly.

Changing the name from Connecticut VNA to Masonicare Home Health and Hospice was the first step. Next came staffing. That was almost as easy as the name change. Hospice patients are cared for by the same nurses who work on the ACU.

It was an adjustment, but Kim Doerfler, RN, hospice specialty nurse, said her intensive care background helped.

"I did a lot of end-of-life care in an intensive care setting although it was a more imminent kind of care, removing people from life support and so on. I have experience with that," she said. Doerfler says that prior experience helped her work on the acute care side of the unit, as well as the hospice side, crossing between these roles on every shift and every day.

Fellow nurse, Frank Wendt, APRN, at Masonicare Health Center, whose work experience is similar to Doerfler's, echoes her opinion.

"I come from an acute care background too, and this is a natural transition. Sometimes your patients don't get better, and you need to transition them to end-of-life care."

But Wendt added, "It has also been a learning process as far as thinking as a hospice nurse - trying to get away from acute treatment and really focus on palliation."

From Intervention To Palliation

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