Terminally ill people who are nearing the end of their lives frequently express a fear of dying.
Sometimes the fear of dying is really a fear of dying in pain, according to Lane Beauchamp, a medical-social worker for 1st Choice Home Health and Hospice in Soldotna.
One of the goals of hospice is to achieve control over pain without impairing a patient’s alertness, and with the assistance of a hospice worker, “patients can voice their fears out loud, which is a big help,” Beauchamp said.
First Choice Hospice, which is approaching its third anniversary as one of only two Medicare-certified hospice providers in Alaska, works closely with the volunteer-based Hospice of the Central Peninsula, to coordinate comfort care to patients.
“Hospice provides comfort care for terminally ill patients and their family members,” said Mary Jensen, volunteer coordinator for Hospice of the Central Peninsula.
“(Hospice) offers social, medical, mental and spiritual assistance,” she said.
Besides helping people with the fear of dying, hospice workers help people who fear leaving their family financially stressed, or those who fear their death will cause emotional problems for their spouse or other loved one.
First Choice Hospice provides skilled hospice services, which must be initiated by a physician in order to be paid for through Medicare, according to Dr. Craig Doser, the company’s medical director.
In order to qualify for Medicare-provided services, patients also need to have a life expectancy of six months or less, Doser said.
First Choice also can arrange for payment of hospice services under other government plans, including Medicaid, Veterans’ Administration and the Native Health Service.
Anybody is eligible to receive the free volunteer services provided by Hospice of the Central Peninsula, with or without a doctor’s referral.
To meet the physical needs of the patient, hospice doctors and nurses provide pain and symptom relief, change the patient’s body position, give back rubs and attend to personal hygiene.
Although terminally ill patients may no longer be as active as they once were, hospice workers help them with social needs by listening to music with them, arranging for them to eat their favorite foods, seeing that they are well dressed and well groomed and arranging for them to share time with their family and friends.
“Our volunteers are trained listeners, and they can often help people decide which services they want,” Jensen said.
As an emotional assist to patients, Jensen said, “We help with the four gifts: Forgive me; I forgive you; Thank-you, I love you; and It’s OK to go.”
She said Hospice of the Central Peninsula also has a lending library containing numerous books on death and dying and on bereavement.
Spiritual needs of the patients are met by hospice workers and by a chaplain who is part of the hospice team.
Patients also may request that their own pastor or other spiritual leader be brought in to work with the team.
According to Randy Milliron, intake nurse of 1st Choice, the company has 10 registered nurses, two licensed practical nurses, three certified nursing assistants and one physician (Doser).
Milliron said the nurses go to the patients’ homes regularly to help with comfort care.
“We check them out from head to toe, check skin integrity, deliver equipment and supplies as needed and keep an ongoing record of the patient’s status,” she said.
Each week, with the patient’s permission, the nurses meet with the physician, the social workers and the spiritual leader to discuss the patient and what his or her current needs are.
If the patient eventually transitions to Central Peninsula General Hospital, the nurses will do follow-up visits to insure a continuity of care, according to Doser, who also works as an emergency room physician at CPGH.
“When the patient does pass away, the nurse will pronounce them dead,” Milliron said, eliminating the need for a police officer or Alaska State Trooper to do so.
A prearranged Comfort One order needs to be in place for that to happen, she said.
In the nearly three years 1st Choice has been a certified hospice provider, Doser said the company has served 92 clients.
Jensen said since Hospice of the Central Peninsula was established in 1987, volunteers have helped 30 people a year on average, and last year, served an all-time high of 50.
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