Mar 25, 2008
Redding
Regional Hospice’s director talks about programs, services
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by Catherine Samose
A small group of residents joined Redding’s Cynthia Roy Squitieri, executive director of Regional Hospice in Danbury, on Feb. 27 at the Redding Community Center for a discussion of the services hospice offers. Ms. Roy Squitieri titled her presentation “Hospice — Enrichment at the End of Life.” She answered questions as they arose.
“We have two programs,” Ms. Roy Squitieri said. “Our pre-hospice program is for patients not yet ready for hospice but needing the services of a visiting nurse. They may need hospice soon, but are not there yet. They may not be emotionally ready. They may be actively seeking treatment for their illness.”
‘Cares at Home’
Ms. Roy Squitieri explained that the pre-hospice program is what is called Cares at Home. “The patient has to have a skilled need, something to be managed by a nurse for the Cares at Home program,” she said. “It’s for people who are homebound and being treated for a serious illness under the care of their primary-care physician. Cares at Home gets the same services as hospice, including spiritual care, volunteer services, and social work services.”
Ms. Roy Squitieri added that should anyone die while in Cares at Home, their survivors qualify for bereavement services through hospice’s Healing Hearts program.
End-of-life care
“The second program, our largest program, is our hospice program for patients with a six months or less prognosis who don’t need curative care,” Ms. Roy Squitieri said. “It’s always a delicate topic. What’s most important to know: Hospice is not a place. It’s a philosophy, the philosophy of managing symptoms and bringing comfort care to wherever the patient is. Essentially it’s bringing nursing services, home health aide services, social work services, spiritual care services, physical and occupational therapy, and the palliative-care management of symptoms. Volunteers are a core part of that.” The hospice patient must choose to be a part of it, she noted.
Hospice is for people who realize they are going to die. Palliative care relieves or lessens without curing.
“When a patient comes to hospice, we develop a plan of care,” Ms. Roy Squitieri said. “If a patient is in a lot of pain, a nurse may do a consultation to determine what pain medication the patient needs. She recommends something to the doctor, who will often agree. Then the patient becomes comfortable.” Sometimes emotional needs are greater than physical needs, she added.
Any medical equipment or prescriptions needed by a hospice patient are covered by hospice, Ms. Roy Squitieri said. “We cover all medications related to comfort and symptoms in a terminal illness,” she said. “Most of our patients have a comfort pack, a little box with small amounts of medications for different kinds of symptoms.”
24/7
Hospice is “24/7,” Ms. Roy Squitieri, explaining this is required by the law and Medicare rules. Medicare helps pay for hospice’s expenses, although donations through fund raising are key because Regional Hospice is non-profit and free to its patients.
“There is always a nurse available who will come at any time needed and may administer the medication in the patient’s comfort pack,” she said.
At times, a nurse’s presence is required 12 hours a day and an aide for the other 12 hours, Ms. Roy Squitieri said.
Dr. Robert Kloss, an oncologist and primary-care physician, is the medical director of Regional Hospice who takes care of the patients, Ms. Roy Squitieri said. Patients may retain their own doctors, but don’t have to. “Dr. Kloss co-signs all orders,” she said.
Grievance services
“A very important part of the services hospice offers are the grievance services provided survivors of the patient by our Healing Hearts program,” Ms. Roy Squitieri said. “People may say they were prepared for the death and don’t need Healing Hearts services. But in a few months, the trauma may hit them and they will come to us. We have the largest bereavement center of the 27 hospices in Connecticut.”
She said Regional Hospice does group and individual work and sees 120 people a week in its Healing Hearts program, and 80 of them are children.
“People should do some advance planning for their end of life and put it into writing,” she said. “Do you want advance life support? Do you want to be resuscitated? Let your family know what your wishes are.”
She said a patient in hospice may change his mind at any time. If a patient decides he wants more chemotherapy, he would be discharged from hospice. The patient may return whenever he’s ready and leave again if he wants to. And patients may be resuscitated while on hospice, if that is their wish.
Hospice
Ms. Roy Squitieri shared with her listeners that although hospice, which comes from the same linguistic root as “hospitality,” dates to medieval times when it meant a place of shelter and rest for weary or ill travelers on a long journey, hospice as we know it today came into being as recently as the 1960s.
Dame Cicely Saunders founded the first modern hospice in London in 1967. But first she introduced the idea of specialized care for the dying at Yale University in 1963. She said we should talk with the dying, and we should acknowledge people are dying. They should live fully till they die, and we should offer supportive care to people who are dying, she said.
Florence Wald, the dean of Yale’s School of Nursing, thought it was an amazing concept that should be formalized in this country, and she set out to do that.
Then, in 1969, Dr. Elisabeth Kubler-Ross wrote a best-selling book based on 500 interviews with dying patients. On Death and Dying identifies the five stages through which terminally ill patients progress. In her book, Dr. Kubler-Ross makes a plea for home care as opposed to treatment in an institution. She argues that patients should be given choices and be able to participate in the decisions that affect their destiny.
In 1974, Congress decided to provide federal funds to support hospice programs. In 1986, it created a Medicare hospice benefit.
“Hospice is for anyone, any age,” Ms. Roy Squitieri said. “We’ve had a three-year-old and a 101-year old. The average age is 74.”
© Copyright 2008 by Hersam Acorn Newspapers
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