Facing the Challenges of Hospice Care

Residential Care/Assisted Living was once considered the preferred place to live when relatively active seniors needed care.  However, an interesting phenomenon has occurred in that residents overwhelmingly fall in love with this model of care.  They move to the community, build relationships of trust with staff, age with them, and ultimately expect to die with them.

Hospice has evolved into an "expected" part of senor care.  While this expected care often provides a beautiful journey for both resident and care staff, it is not without challenges.  Three areas of common concerns for providers include:

1. Hospice Agency/Community Relationship

It is critical that the agency and community work in tandem.  There must be a mechanism in place to immediately address satisfaction with care.  When the relationship breaks down and there is impaired continuity of care, of course the resident pays the ultimate price.  Unfortunately, there have been occurances of hospice staff "bashing" the facility care and creating unrest. Clear communication can help avoid these painful situations.

2. Unrealistic Family Expectations

Denial, anger, and other emotions are not uncommon with family members when their loved one is dying.  The community must fully disclose care capabilities.  This is especially true in California, where medication management ca nbecome a significant challenge.  Service plan meetings can provide a positive avenue for families to be a part of the care process.  However, should family members be unrealistic about expected care, and then other options, such as in-patient hospice, may need to be explored.

3. Substandard Care

A Do-Not-Resuscitate Order only states to withhold resuscitative measures.  It does not in any way indicate that care should be withheld.  A resident on hospice deserves outstanding care measures.  Decubitus ulcers, etc. should be avoided in hospice care as with any other realm of senior care.  Occasionally care staff prefer to interact to interact less with a resident, due to their withdrawal process.  They may not even consciously do it.  Communities need to ensure care is always appropriately available and provide any necessary support services to direct care staff.

By and large end-of-life care in the residential setting is a meaningful and positive experience for all.  However, quality providers are alert to the challenges as well.