Published on December 11, 2017

Hospice: a way of living and a way of dying

Hospice: a way of living and a way of dying

Talking about dying can be a difficult conversation to have with your loved ones. When it becomes inevitable that it needs to happen, it’s good to know that there is an entire team of specialists who can help you.

Pamela McPherson, BSN, RN, CHPN, at Cape Cod Hospital and Erin McGee BSN, RN at Falmouth Hospital are liaisons for the Cape Cod Healthcare VNA of Cape Cod Hospice program. Their role is to have those conversations with patients and families when it comes time to make decisions about where and how they would like to live the end of their life’s journey.

Hospice is a program for people with a life-limiting diagnosis,” said McPherson. “It’s an illness that is probably going to take their life in weeks to months, rather than months to years. The focus is on the quality of life they can have in whatever time frame they have left.

McPherson and McGee work under the direction of VNA Hospice Director Sarah Endres. The team also includes Will Oosthuizen, RN, weekend liaison at CCH and FH, and floating liaison Diane LaValley, RN.

“Our task as hospice liaisons is to be good educators and champions for the fact that the sooner a patient enters hospice, the more benefits there are. One of the benefits, according to statistics, is that many live longer.”

[RELATED: A traveler’s last journey, with hospice help]

A study published in the Journal of Pain and Symptom Management found that “patients who choose hospice care can live an average of 29 days longer than similar patients who do not choose hospice.”

The researchers attributed this to three factors:

  • Patients who are weakened by treatment avoid the risks of overtreatment
  • Hospice increases oversight of care and monitoring. This includes coverage of medications by hospice that Medicare Part D may not cover and coordination of interdisciplinary care that is not usually covered by Medicare.
  • Studies have shown that psychosocial support may help to prolong life

The Hospice Conversation

When a patient or family asks for hospice information at the hospital, McPherson or McGee are the ones who have the conversation with them.

“I always start by asking the family to tell me what they know and what has brought them to this point,” said McPherson. She also asks them if the initial discussion came from them, the physician or the patient.

“It gives me a window into what I am dealing with,” she said. “I also give them the choice of asking questions before or after my talk.”

The liaisons explain that the focus of hospice is on the quality of life, making the patient comfortable and providing the care they need to keep them out of the hospital because of their weakened condition.

“Hospice is a way of living and a way of dying,” said McPherson. “We don’t come into your home to discuss death and dying unless you want us to. We come in to try to enhance the quality of your life, assess how you are feeling and do what we can to make your day better.”

“At least half of the patients coming on to hospice have accepted that they are going to die,” added McGee. “And they are ok with that. Their hope isn’t to get better, it is to be comfortable.”

The Hospice Program

While the hospice program does not provide 24-hour hands-on care in the home, they are only a phone call away when they are needed for questions or symptom management.

The Hospice team is comprised of specialized nurses, support staff, the person’s primary care physician, the hospice medical director and the family or friends who may be the caregivers in the home.

Should you or a loved one need hospice care, everyone on the VNA Hospice team has a role they all work together to provide what you may need.

  • Registered nurses manage the care, provide education and support to you and your family and make assessments
  • Medical social workers provide ongoing emotional and psychological support. They can also assist your family with financial needs, caregiver issues and alternative placement needs.
  • Home care aides provide personal care and do light housework
  • The spiritual coordinator/chaplain provides support and assesses for spiritual needs for you and your family
  • Physical, occupational and nutritional therapists who assess and follow-up to ensure your safety and independence.
  • Volunteers can provide companionship, do errands, provide respite care, play cards, take a life story or record your story on a CD. (Volunteers cannot provide personal care)
  • A bereavement program is available for your family following the first year after your death including telephone conversations, support groups, mailings and visits.
  • The medical director works with the hospice team, teaches and advises the team and consults with your physician.

While many choose to remain at home, it may not be possible in all situations, either because there is no family or caregiver, the family lives far away or it may be too difficult for the family to provide the care. The option of a nursing home placement is available.

The hospice team would continue to cover to oversee and pay for all the care in the nursing home, but the hospice benefit under Medicare does not cover room and board. The family or patient would be responsible for those costs. There is assistance available for room and board through Medicaid and the hospice medical social worker would to help with the paperwork and guide families through this process.

The Palliative Care Program

The VNA of Cape Cod has a “bridge” program that is for patients who are unsure of moving on to hospice when they may still be receiving chemotherapy, radiation for cancer treatment or other life-prolonging treatments for other illnesses.

The Palliative care program is set up to provide comfort and symptom management while the patient continues treatments and until they feel they are ready for hospice care.

“When we’re evaluating someone for palliative care, it is because we anticipate that they will be bridging over to hospice,” said McGee.

“Some just need a little more time to psychologically or spiritually to ease into hospice,” added McPherson.

The palliative care team are the same nurses, home health aides, social workers, therapists and volunteers who are members of the hospice team. Family and caregivers can call 24/7 with any questions or concerns.

While hospice can be a difficult subject to broach, the care given by a family during this end-of-life journey can be a gift to you and your family.

“I’ve seen some beautiful reconciliations between families and friends just before death,” said McPherson.

With the full resources of Cape Cod Healthcare, VNA Hospice is the highest-rated hospice on the Cape. For more information on Cape Cod Healthcare VNA Hospice, please visit or call 508-957-7710.