Written by Sister Jo Ann Trama, for Journey, a publication from the Immaculate Heart of Mary Center in Scranton, Pennsylvania
Hospice care has been evolving since the 11th century with care for wounded and dying Crusaders. The first hospice opened on the Greek island of Rhodes. Hospices over the centuries were established in France, the United Kingdom, Australia, Ireland, Israel, Scotland, Argentina, Hong Kong, Uganda, the United States, and many other countries. The focus and mission of hospice has evolved too. Palliative care for the terminally ill person is the major focus of hospice. Hospice professionals also provide care in the areas of psychological, emotional and spiritual comfort, as well as support and education to family members, significant others, and extended family members.
I was new on the CareGivers America (CGA) hospice team in January 2012. The team is interdisciplinary including a doctor, RNs, LPNs, social workers, a chaplain, a bereavement coordinator, and volunteers. A hospice has an executive director, a clinical director (usually an RN), a medical director (an MD), and also a clinical supervisor who is an RN. Medicare (that pays for hospice services) requires that social workers have a Master of Social Work degree, and our hospice requires our chaplain to have a Master of Divinity degree. All volunteers go through twelve weeks of training prior to seeing any patient or caregiver.
Every patient in hospice has an RN who is the patient’s case manager. The patient and the patient’s primary caregiver can accept or refuse services of the social worker, chaplain, and/or volunteer.
Mentoring in hospice is evident in our teamwork through our educating and coaching each other and keeping each other continuously updated on the status of our patients and the needs of caregivers.
Team members mentor but also ask for coaching in areas that may be out of the scope of expertise. Team members respect each others’ insights and observations so as to address possible medication adjustments or medical equipment needs of the patient. Sometimes an additional face-to-face visit with a patient or caregiver to offer support or education is the best response at a difficult moment in the end-of-life journey.
Mentoring is a personal, relational process. It occurs among the hospice team members and envelops each patient, caregiver, and family as we move together through palliative care. The work of hospice is to provide a peaceful end-of-life transition for patients. This work and mentoring for many has a spiritual dimension.
During the admission process, the social worker will ask the patient if there is someone who was dear to them who has died and who will “come for them” at the end of their life. Some patients respond readily, others need time to ponder this question. To mentor a peaceful death, the hospice team assures the patient and the caregiver that spirits are not hallucinations or medication effects. We have seen patients fix their gaze at a definite place in their room, have heard patients speak to whomever they see, and watch the patient reach out to go with the one whom they are seeing.
As helping with a birth is deeply emotional and a “Creator” event, so is mentoring a person back into the Creator’s hands.
The hummingbird is the symbol of our hospice. The hummingbird is able to fly backwards, teaching us that we can look back on our past but not dwell there. Hummingbirds can teach us courage to move forward and they can remind us to forever seek out the good.
Sister Jo Ann serves as a social worker with CareGivers America Hospice in Clarks Summit, PA.