A Little KISS in Hospice


Even KISS fails.

If the acronym Keep It Simple, Stupid always worked, the staff assigned to introduce potential patients to hospice could successfully use bullet points to convey the basics. Like these three:

  1. The hospice team will not care for the patient all day and every day.
  2. Finding the right balance of helpful medications can take time.
  3. A chaplain is the second-most important member of the team.

Why these “headlines?” During a recent patient care meeting, all were referenced—within moments of each other—when discussing new admissions. Every hospice admit nurse will mention a version of those three (and much more) when introducing hospice care to patients and families. Written material, and links to online resources, will also be provided.

Providing information is easy.

During hospice care, understanding that information is rarely easy.

Let me “drill down” into these three . . . Read More →

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A Sacred Silence

Woman on the beach

“She loved the ocean more than flying,” he had once said to me.

Before meeting my new patient, I spotted her Ford Mustang. The well-kept red convertible was parked on the street, by her brother’s driveway.

The license plate frame declared: Fly Away!

While unsure it was her car on that first visit, the frame’s message was a solid clue. Based on the medical chart notes, she was a flight attendant in her early forties.

This was years ago when I worked as a hospice chaplain. Most of our patients lived in their homes. I recollect visiting her a half-dozen times. From our first awkward handshake to the final moment I sat beside her hospital bed in her brother’s living room, our patient-chaplain relationship had grown stronger. She learned to trust me. I certainly learned from her as she continued living and loving while cancer relentlessly destroyed her body. Even at my last visit, her short gray-blonde hair was stylish. Her make-up, aided by her sister-in-law, was impeccable.

She never spoke one word to me.

Though the cancer spread across her once-athletic body, it had started in her throat. Long before entering hospice, she’d the lost the ability to speak. Read More →

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Yes, Some Leave Hospice Care

The Seventh Seal

As with the stark chess game in Ingmar Bergman’s classic The Seventh Seal (1957), death doesn’t lose.

We got rid of a few people in hospice this week.

Oh, and several lovely, beautiful patients also died. More on death in a moment.

I attend several of my hospice’s interdisciplinary groups, which are usually called IDGs. They are weekly patient care meetings, a required review of those under the care of our agency. Since all patients in hospice much be reviewed by the hospice team—led by a physician—every 15 days*, we discuss and update the needs for everyone in the course of a typical month.

Some patients are relatively stable, and can go for weeks and months with minimal input.

There are “focus patients” with issues—family conflicts or finding the right medication dosages or ________ (fill in the blank)—that must be immediately addressed.

There are new admissions to discuss.

Quite a few patients need to be recertified. Is this patient still hospice appropriate? Every few months (there is actually a precise schedule), this question will be asked and answered. Hospice care is for those with an illness giving them six months or less to live. There are always patients that continue in care over six months. However, like everyone, they will be routinely reviewed.

With some, still alive and kicking, we bid adieu. Read More →

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