Meeting with Hospice, 20 Oct

Dad, Ruth, See-Ing, King, Lang, Hong, Richard, Joan, Cara, Jonathan and I met with Kelly Powers, an admissions representative of Community Hospice. She explained the Hospice philosophy of providing care and comfort measures, including pain and symptom management. Hospice is not meant to be life-prolonging. Hospice patients do not receive IV fluids. In Grandma's case, the care that would be continued would be breathing treatments, oxygen, and pain medication. There are three Hospice options: inpatient care, outpatient care at a skilled nursing facility, and outpatient care at home (Dad's house). Patients such as Grandma who have recently received acute care go to one of the three inpatient Hospice facilities until they are stabilized, at which point they transition to outpatient care. However, if a patient is experiencing what Hospice staff call a "measurable decline", they can stay in the inpatient facility. One of the signs of measurable decline is reduced intake of food and water. Given this, there is a strong chance that Grandma will not ever transition to outpatient care. Some of the advantages of Hospice care include good patient/nurse ratio (1:4-6) and expertise in end-of-life care. Visits are allowed around the clock. (The hospital has visiting hours that they have been compassionately ignoring for us.) The inpatient Hospice closest to Dad's house is right here at Shands, where Community Hospice leases space in another building. We were able to visit and see a vacant room, which has a comfortable chair that pulls out into a bed, soothing paint colors, and diffuse lighting. In case a second visitor wishes to stay overnight, a cot can be brought into the room. The space is about a third larger than Grandma's current room. The facility (which is called the Morris Center and can accommodate 17 patients in private rooms) offers laundry facilities for visitors, a community kitchen with a coffee maker, fridge, and microwave, and a den with TV and DVD player. Hospice is staffed by medical doctors, physician's assistants, nurse practitioners, nurses and nursing assistants. Besides medical staff, each patient has a social worker who assists the patient and family in a variety of matters.