VNA Hospice liaisons offer in-hospital end-of-life care

One of the unique things about Visiting Nurse Association of Cape Cod Hospice and Palliative Care is that the VNA Hospice has a hospice clinical liaison embedded in both Cape Cod Hospital and Falmouth Hospital. Their role is to educate patients about how to make their end of life as comfortable as possible, while also honoring their wishes to live their last days in a manner they choose.

“One of the first things we’ll say when we go in with a patient is, ‘What is important to you? What are the things that you value? And let’s see if hospice can help you achieve those goals,” said Cape Cod Hospital hospice liaison Pamela McPherson, RN. “Because this is a point in people’s lives when they feel like all of their choices are being taken away from them,”

“They just received the worst news in the world and it’s like now I have no choices left to make. What we try to have people see is there are choices you can make. You can choose how you want to live for the next couple of months. Not how you want to die, but how you want to live before you die.”

Falmouth Hospital liaison Diane Lavalley, RN, said that when she asks patients those questions, there are two big themes that she hears from them. Most are concerned about their family members. Parents are afraid to be a burden on their children. Married people are worried about what will happen to their spouses after they’re gone.

“And the big one is, ‘I don’t want to be in pain,’” she said.

The Education Piece

A big part of their job is educating people – both patients and the hospital staff. Lavalley emphasizes to doctors, case managers and nurses that it is better to talk to patients earlier than later. Both she and McPherson ask their hospital’s staff to refer patients with terminal illnesses about six months before the anticipated death.

“We do a lot of informational visits, spending a lot of time with patients and families, talking about hospice services and how it could benefit them – not necessarily at that moment but anytime it is an option going forward, if they are dealing with a terminal illness,” Lavalley said. “It’s not a commitment. It doesn’t mean that you’re going to die this week, but it’s important to know now what services you can have down the road.”

If the patient does choose and qualify to have hospice service with the VNA on discharge from the hospital, the liaisons do all of the legwork to make it happen for them so that when they leave the hospital everything is set up for them when they get home.

The informational visits are never a one-time meeting, McPherson said. They occur over a few days so the patient and family can get to know them and build trust so it can be a seamless transition back home. One of the biggest misconceptions about hospice is that the nurses will be in the home 24 hours a day. The nurses are available 24 hours a day, if needed, but the actual caregiving is done by the family or a privately hired nurse.

“Truly an Honor and a Gift” to Work with Hospice Patients

Both McPherson and Lavalley have been working with different hospice groups for many years. McPherson has been working with hospice in general for 27 years and as the hospital liaison for 10 years. She had previously been a critical care nurse but took 10 years off to stay at home and raise her children. She decided to become a hospice nurse after her 20-year-old babysitter, who lived across the street, developed a brain tumor.

“We were very, very close to her family,” McPherson said. “My husband was actually the pastor of the church and we were a tight-knit community. Her mom was my husband’s secretary so we were really close.”

Hospice was not only there for the girl’s family but also for friends like the McPhersons who spent a lot of time at the house.

“I saw how they just took care of everything,” she said. “They were there in the middle of the night. They brought equipment and they were so kind. It was my first exposure to hospice and I said if I go back to work, that’s what I want to do because they are caring for people at their most vulnerable moments and making such a difference for this family.”

About a year later, she did just that and after 27 years, she can’t imagine doing anything else.

Lavalley began working as a hospice nurse in Western Massachusetts about 20 years ago. At the time she worked as a per diem field nurse with hospice while also working at a local hospital as a maternity nurse.

“I had both ends of the spectrum,” she said. “What you don’t realize is really how similar it is. You are assisting people coming in and going out and it definitively is a time when everybody needs that kind of help.”

Lavalley stopped doing the hospice work when her mother needed a caregiver. Then the small hospital she worked for closed. In addition to losing her job, she lost both of her parents in the same year. At that point she decided to fulfil her lifelong dream of moving to Cape Cod. She’s been a hospice hospital liaison for eight years.

When she was a field nurse, she saw that there were lapses in care and education about hospice services so she loves her job as a liaison because she can help address that need.

“The most rewarding part of my job has always been being able to be that help, that support system for people,” Lavalley said. “I’ve always said right from the get-go that people letting me in at this time in their life is truly an honor and a gift. It just is. I always walk away thinking they gave me more than I could ever give them in just being open and including us in their world because it’s a very, very tender and difficult time.”