Why Hospice is Good

When I was growing up I had never heard of hospice. When I was in nursing school it was mentioned only briefly. I didn’t learn anything about hospice until I started my second real home care job. I learned a couple of important things:

  • This patient is definitely not getting better
  • Never call 911
  • Try not to talk about it

Unfortunately, I didn’t really have any direction and these were just things that I figured out on my own (obviously). After a few years the agency I was with decided they wanted to open their own hospice. This was great because they hired people to train the staff and all of a sudden I had an expert at my fingertips.

I volunteered for extra training and I had the opportunity to learn more about the attitude of hospice. Sheila was the instructor and I really liked her. I liked how genuine she was and I felt her passion when she was teaching me things. She tried to teach me how to talk less and listen more. It was a shock when she told me that, and I am still struggling with it.

I still didn’t have a great understanding of what hospice was and why it was so great, but I definitely had gained some insight from Sheila.

When I started teaching classes to home health aides for orientation and inservices, hospice was one of the topics. It was in these classes that I started to perfect my “Why I love hospice” speech. I know Sheila told me to stop giving speeches but this was a really good one.

What is hospice? Hospice is an insurance benefit. In order to be eligible to get unemployment, you have to qualify. In order to get disability, you have to qualify. Hospice is an insurance benefit, like other insurance benefits you have to qualify for the benefit. There has to be a doctor that “signs off” on your medical needs in order for you to receive the insurance benefit. In order to qualify for hospice you have to have a doctor sign a paper that says; if your disease runs its normal course your life expectancy is six months or less. You agree to stop receiving curative treatments and not use 911 or the emergency room for treatment. Hospice is a BENEFIT. You get medications, medical supplies, 24 hour nursing support, weekly home health aide hours, access to clergy, therapists and volunteers. There are people who will read to you, sing to you and paint with you. It is interdisciplinary. If you qualify for hospice, you qualify for all of the benefits associated with it. It does not mean that you are somehow hastening death, or happy with the impending death. This we cannot control. What can we control? Pain, comfort and dignity. When you deal with hospice, you are dealing with experts. Yes, experts in “end of life”, experts in death. What a blessing to have a group of professionals who are experts in dealing with all the issues at this crucial time. If you have a problem with your heart, you see a heart specialist. If you have a problem with your lungs, you see a lung specialist. That is all hospice is. Death speacialists. And we, as the caregivers, have an awesome responsibility to provide guidance and support during this terrible time. Because it is probably the family’s first experience with hospice, the family looks to the caregiver for reassurance and support. Don’t refuse to take a hospice case because it is “hard” or “sad”. Be honored that you are invited into this family’s life during this very difficult time.

I often get choked up when I give this speech, and I have given it many, many times. I truly believe that caring for a hospice patient is an gift. It is a gift to the patient, and it is a gift to the caregiver. A couple of weeks ago I was taking care of a patient who was recently admitted to hospice. After we were finished discussing their services I looked at the patient and said, “Do you want me to cut your nails?” The wife emphatically said, “YES!” I was surprised that she wouldn’t do it herself, and I had never cut another adult’s nails in my life, but I realized that I was being given an opportunity to really care for this patient. His nails were gross. When I was done, they looked great.

I come from a long line of strong-opinioned, strong-willed, somewhat pushy women. These days I mostly tell it like it is. I try to be totally honest with my patients without hurting their feelings.

I have always tried to be honest with my children. I have learned (from my mother) to answer all questions matter of factly and in a way that the child will best understand. In my almost 19 years as a parent I have answered questions about sex, babies, circumcision, masturbation, viagra, pregnancy, abortion, relationships, abuse, pride in one’s body, eating healthy, breast milk, child birth, cesarian sections, death, burial…you get my point.

Recently my 18 year old daughter told me an acquaintance of hers has had a reoccurrence of his cancer. She told me that he is on hospice. She asked me if he has a chance of being ok. I told her no. 

At the home care company where I work I have treated more hospice patients in the past 3 months than I have in the past three years. I learn something new from each patient.

One daughter told me that all she wants is to get to talk to her father before he passes. I made sure to share that with the nurses caring for the patient and they knew to wake the daughter if the patient was having a moment of lucidity.

A wife recently told me that her husband just wants to die. I made sure to share that with the nurses caring for the patient and they knew to give the maximum medications that can be safely administered as per the doctor’s orders.

A son shared with me that his mother needs to be in charge. I made sure to share that with the nurses caring for the patient  and they knew to check with the patient regarding all care needs and issues.

These, and many other, patients taught me that each life (and death) is different. I always ask the client or their family member, “What are your priorities for care?”. I also ask them to let me know if there is anything else I can help them with, or do anything else for them. Inevitably, I am given the same answer.

“Please make them better”.

If only I could.

Lessons I’ve Learned:

  1. It sucks, but death is a part life. 
  2. Take the services that are available to you. 
  3. Don’t be afraid of the truth. 





6 Reasons Why Home Care?

Home care, visiting nursing, community nurse…we are called many things. But that doesn’t change what we do. Nurses who make home visits, regardless of what we call ourselves, are all the same and have the best nursing job on earth.

I became a nurse for many reasons (see my previous post for details). I knew I needed a job right away so I interviewed A LOT. It quickly became apparent that I had some problems. First of all, I couldn’t work nights, this was non-negotiable. I was a single mother, and I had no one to watch my kids. This made me very unattractive to hospitals. I also didn’t want to work on Shabbos (Saturday), also a problem. I needed reasonable hours and/or something close to home (see single mother excuse). I wasn’t discouraged while I was going to all of my interviews and not getting any offers, I knew something was going to come up.

It did.

I got an offer from a staffing company to work per diem at their flu shot clinics. Back in the old days before CVS and Walgreens started giving flu shots, they used to hire companies to staff flu shot clinics at their stores. I went to pharmacies and large businesses and gave many, many flu shots. One woman complained that I didn’t really give her a shot (I did). She said it didn’t hurt at all and therefore I must be lying about giving her the shot. I told her it didn’t hurt because I’m REALLY good at giving flu shots. She didn’t buy it. After that moment I changed my pre-shot speech. Instead of giving the usual list of possible complications and contraindications I added, “the shot may not hurt, but if you want it to, I can arrange that.”

Eventually I was offered a spot in a training program at a home care agency. It was a dream come true (thanks to Sammy and Aviva). The program offered in class training for several months and then orientation in the field and a gradually increasing workload to productivity. It was a challenging time and I made plenty of mistakes but I made it through. I learned quickly that I had the perfect job. I stayed at that job for three years and my next home care position for three years and am at my current position for one year. I NEVER want to leave.

When you see a hospital nurse she is really busy, focused and usually very serious. Home care nurses are always smiling, why is that?

My patients often ask me about my family and how many children I have. Then they all ask exactly the same question, “When do you relax?” “I’m relaxing right now”, I tell them. That is not a joke.

  1. Independence. 

No one was looking over my shoulder. That may sound like a bad thing when you’re a new nurse, but it wasn’t. I may not have done things perfectly right on the first try, but I figured things out. Coming to the solution on my own was very satisfying and exciting as a new nurse. I had a supervisor and case managers in the office who could sometimes answer my questions when I could get them on the phone, but I learned not to bother.

2. Flexibility

I don’t just see patients in their homes. I have done new employee orientation, HHA classes, chart audits, quality control, community lectures, staff education and competencies. Sometimes its nice to spend some times in the office.

I decide when to see each patient. If the patient isn’t available when I want to see them (most were, they were usually homebound) we would chose another option that worked for both of us on a different day/time. This meant that I could go home and eat lunch…or go out for lunch (which nurses get to actually eat?). It also meant that I could schedule doctor appointments for myself or my kids and plan my patients around that appointment…or my kids school play, or a teacher conference, or a trip to the mechanic to get an oil change, or the post office. How do working mothers get things done?

3. The patients

I can sit with my patient for an hour talking about; the photographs on their walls, the numbers on their arm, what they’re cooking on the stove, the work they did “before”, the origin of their last name, their garden, their dog, their paintings, their piano…Of course I discuss their medical history but only after we have made friends. Why would I do it any other way? If I do a good job and I ask the right questions, most of my home and health assessment has been completed before I ask any of the questions on my nursing assessment. My patients are happy to share personal details with me because they trust me. When I teach new nurses I remind them that we are a guest in the patient’s home. We must ask permission before we sit down or place our bag on a chair.

4. The stories

My patients share the stories of their lives with me. Stories of immigration, illness, happiness and sadness. They trust me with the stories that make them who they are. I have met some truly amazing people who have experienced truly wondrous things. I am always humbled by the gifts they give me in the form of memories.

5. The money

The money is comparable to hospital nursing and the opportunity for overtime is usually available depending on the type of agency you work for. Even if your agency does not have overtime availability you can work for other home care agencies per diem while you are working full time for another. I have done this and it has created quite a financial opportunity for me.

6. The nursing

I have treated a wide variety of health issues. No matter what you may hear, home care IS real nursing. Wounds, staples, trachs, PEGs, foleys, sutures, vents, amputations and many more.

I may see a patient two or three times, or I may see them daily for years. Either way I am invited into their life. In this environment I have the ability to help my patients make real changes and I have the honor of watching it happen.

11 Reasons Why I became a Nurse

1. The money.

One of the main reasons I chose nursing was because of the earning capability. I was in the middle of a divorce, had two small children and no career to fall back on. I figured that I would always have a job if I worked in healthcare. I hoped for job security. I know that the market has changed significantly since I graduated but I still believe this is true. I’m not embarrassed to admit this, it happens to be the truth.

2. The respect.

I have ALWAYS been proud to be a nurse. Even when the work is hard and the time is short I have always known that I am serving humankind when they are the most needy. My patients are always happy to see me. How could any other profession be more important or satisfying?

3. The thrill. 

The amazing feeling I get when I help someone, whether it was something big or small, is almost unmatched in my personal or professional life. I am often so excited that I want to shout from the rooftops.

4. The fun. 

Um. This is hard to explain if you aren’t a nurse, but take my word for it. Getting the foley in on the first try, getting the IV in on the first try, healing a wound, teaching someone a new skill, seeing a patient get better or bringing comfort to a patient or family member.

5. The friends. 

The people I have worked with since I became a nurse all hold a special place in my heart. The friendships and camaraderie is almost instantaneous. This is a special feeling I share with nurses even those I have only just met. Being a nurse is like being part of a huge extended family.

6. The experiences. 

The experiences I have had with my patients, their families and the other people I work with have shaped my life in a way I could not have imagined.

7. The options.

Being a nurse can mean many things. I can work with blood and guts or I can sit at a desk. I can work with children and then decide I want to work with the elderly. I can work full time, part time, summers only, shift work, occasional visits, or even from home. This is hugely attractive to me and to most people I’m sure.

8. The knowledge. 

Having the ability to save someone’s life is quite the useful talent. Knowing all the other stuff comes in handy also.

9. The people. 

I have met so many different people living completely different lives than my own. It is easy to live life in your small circle of friends and family and not realize that there are so many different types of people on this Earth that you may never get to meet or experience. I am so grateful for what I have, seeing how terrible some peoples’ lives are, its impossible not to gain perspective.

10. The stories. 

My patients share the most interesting stories with me. They often don’t want to talk about being sick so we talk about everything else instead. I have learned so much from these conversations-stories about the holocaust, about family, about all different types of professions. I have learned incredible things about strength and honor and even bravery. Of course I can’t tell any one else these stories, but take my word for it, they are amazing.

11. The stories. 

I have the best stories. I have a story for every disease you have ever heard of and several you have never heard of. Want to scare your kid into wearing a helmet? Not using drugs? Wearing a seat belt? Using sunscreen? Yup, got a terrible story for every scenario. Need a feel good story, got that too. Miraculous recoveries? Sure thing. Just let me know what you’re in the mood for and I will provide the entertainment or the inspiration, whatever you’re looking for.

Bottom line, I highly recommend nursing as quite the incredible profession. It has been for me.

Lessons I Have Learned

1. See 1-10