Dr. Val FarmerDr.Val
Rural Mental Health & Family Relationships

Bringing Hospice Care To Rural Communities

January 15, 1996

Many terminally ill people choose to die at home with the support of hospice volunteers and professionals. I have found hospice people to be dedicated, caring and special.   A rare thing in our society - hospice care is a cutting edge movement that is also cost efficient. Not just for terminally ill elderly cancer patents, the hospice program is for all life-threatening illness - young people and children too.

The goals of a hospice: A hospice offers a different view of dying. By accepting the reality of an impending death, care is directed toward pain relief and symptom management for the comfort of the patient. Physicians forgo aggressive and intrusive treatments that detract from the quality of life.

Hospice care is delivered in family friendly and less costly environments such as at home, nursing homes or hospice inpatient units. Home is home. The patient and the family are more relaxed in the privacy and comfort of their own surroundings. They have more independence and can pursue personal goals with greater ease. Life is more normal.

A hospice offers service and support to family members. Families share in the responsibility of treatment planning and care. Nurses provide care in the home and train family members on how to help in that care.

Volunteers provide needed assistance, serve as confidants as needed and give family members a break from the ongoing demands of care. Care is compassionate, spiritual and practical. The family also receives bereavement care after their loved one has died.

When is a hospice appropriate? The biggest frustration for hospice providers and the family members they serve is that physicians and families wait too long before requesting hospice care. Once families understand how wonderful the program is, they often wish they had participated sooner.

Physicians are trained to cure and heal - to try to do everything to prolong life. When traditional medical treatments no longer work, physicians need to shift their attitude to providing comfort and pain control. This is a difficult transition.

No physician enjoys the heart4o-heart talk about the reality of death, either with the patient or the family. Sometimes they unnecessarily delay the conversation about a hospice. Families can take the initiative by asking their physician about hospice care.

Once the patient is in a hospice, the physician will have many more eyes and ears to monitor the patient. Symptom relief can be much more timely and effective.

Patients and families appreciate the time for honest and frank conversations. There is time for preparation and new priorities. They set aside time for loving relationships, reconciliation, spiritual contemplation and for saying goodbyes. Hospice care maximizes that precious time together - not as a last resort but a different form of care.

Hospices in rural areas: A community can be organized with a supportive physician and enough nurses to

provide 24-hour on call service. There needs to be a core group of trained volunteers within a reasonable distance. A care network includes a cooperating pharmacy, a medical equipment supplier and the local hospital. Access to a local hospital is important for control of symptoms and respite care.

Rural programs are often linked to hospital-based hospice programs in the region. These programs reach out to rural communities to share their expertise and resources. They provide hospice training to the local rural community. These regional programs are usually accredited for Medicare eligibility. Local "ownership" and grass root support for the hospice are essential for success.

There is often a shortage of nurses in rural areas. Nurses traveling out to rural areas have learned to be super organized. Trips are planned for timely coordination with the family, supplier, pharmacy and physician. Nurses rely on four-wheel and front-wheel drive vehicles, cellular phones, pagers and fax machines. Communication is the key.

Nurses, social workers and volunteers blur and expand their roles when providing services to rural families. They are flexible to do whatever it takes to provide needed services. They train family members and neighbors to do key procedures. They give them the skills and equipment needed to deal with their worst fears and concerns. Help is one phone call away. Problems can be talked about and solved while the nurse is en route.

Besides the usual benefits of a hospice for the patient, rural families appreciate not having to suspend their lives completely to visit their loved one in a distant hospital. It is a lot less draining on the family. The hospice helps them keep a semblance of a normal life instead of being uprooted by their loved one's illness.

Hospices build on the strengths of rural families and communities to overcome the inconvenience of distance. Rural people are resourceful and caring. They know how to go the extra mile for a friend, neighbor or loved one. They take the time to learn important new skills while they provide loving support. They make hospice care in the home possible.

Special thanks to Dodie Brown and Barbara Vargo of the Hospice of the Hills, Rapid City and Mary Lou Dahms of the Hospice of the Red River Valley, Fargo for their assistance on this column.