1. SCHEDULE CHANGE See handout for details Oct 27 12:30 -13:00 Review Midterm and Test 2 – New schedule and requirements October 28 11:30 – Midterm Due November 3 Test 2 – Guest speaker write ups Due Presentations and game pal test Due

2. Providence Hospice End Of Life Care in the Community Jane Brandes MSN Director Providence Hospice

3. HOSPICE PHILOSOPHY OF CARE Hospice provides support and care for persons in the last phases of a terminal disease. Hospice recognizes that the dying process is a part of the normal process of living and focuses on enhancing the quality of remaining life. NHPCO 2012

4. A BRIEF HISTORY OF HOSPICE Hospice can be traced back to medieval times referred to as a place of shelter and rest 1948 Dame Cicely Saunders began her work with terminally ill 1967 first modern hospice opened in London “St Christopher’s Hospice” 1974 First Hospice Program in the US opens in Connecticut

5. “PROVIDENCE HAS BEEN PROVIDING HOSPICE SINCE THERE WAS HOSPICE IN THIS COUNTRY”-RICK WARREN 1979 Providence is a demonstration project site Housed in old PPMC library with a small inpatient unit Average Census of 5-10 patients (Current Average is 400) Mid to late 80’s St Vincent's Hospice started Struggle as West Side physicians thought it would bankrupt the system Director was the only nurse had to take call 24 hours a day and then make visits in the middle of the night with her children ……We have come a long way

6. WHO IS ELIGIBLE FOR HOSPICE? Someone with a <6 Month Prognosis and is covered by Medicare part A or most commercial insurances. Common Examples of End Stage Illness: Cancer Heart Disease Pulmonary Disease Dementia

7. THE HOSPICE TEAM Personal physician Board-certified hospice and palliative medicine physicians and nurse practitioners Hospice nurses Social workers Pharmacists Chaplains Hospice aides Volunteers Bereavement support staff

8. HOSPICE SERVICES 24 hour availability Counseling services Physical and Occupational Therapy for safety Medical supplies and equipment Medications for control of symptoms Respite and Inpatient care

9. HOSPICE SERVICES Hospice services are provided in the patient’s home. It may be a private residence, an assisted living community, an adult care home, or a residential or intermediate care community.

10. COMPLIMENTARY THERAPIES Music Thanatology Massage Acupuncture Animal-assisted therapies

11. THE PHASES OF DYING Each person is unique and approaches death in their own way, the following is a broad guideline of what one may experience.

12. ONE TO THREE MONTHS BEFORE DEATH Withdrawal from people and activities Communicating less Eating and drinking less Sleeping More

13. ONE TO TWO WEEKS BEFORE DEATH Disorientation and confusion Use of symbolic language and talking to people not present Physical changes: not eating, taking little or no fluids, decrease in blood pressure and pulse

14. DAYS TO HOURS BEFORE THE DEATH Sleeping most of the time Surge of energy Restlessness Difficulty Swallowing Changes in Skin Color Rattling breath sounds

15. MINUTES BEFORE THE DEATH Shallow breath with longer pauses Mouth Open Unresponsive

16. BEREAVEMENT CARE SUPPORTING THE FAMILY AFTER A LOVED ONE PASSES ON During Hospice Care: Anticipatory Grief and Grief assessment After the loved one Passes on: 13 months of Bereavement Services

17. BEREAVEMENT SERVICES 13 Month Grief Support Mailings about Grief Support Grief Support Classes and Groups Grief Counseling Child and Family Grief Support Camp Erin Referrals for Long Term Counseling Twice Yearly Memorial Services for family, friends, caregivers.

18. RESOURCES! Providence Hospice 503-215-CARE Web: http://oregon.providence.org/patients/programs/p rovidence-hospice http://oregon.providence.org/patients/programs/p rovidence-hospice http://www.oregonhospice.org/ Thank You!