At our weekly hospice team meetings, we review every patient’s current situation. This includes the various staff assigned to a patient’s care. It goes something like this:
What about Juan Lopez?
- Nurse . . . two to three times a week
- Social Worker . . . one to two times a month
- Chaplain . . . phone contact only
- Home Health Aide . . . declined
- Volunteer . . . one to two times a month
What about Mary Jones?
- Nurse . . . one time a week
- Social Worker . . . two to three times a month
- Chaplain . . . two to three times a month
- Home Health Aide . . . declined
- Volunteer . . . declined
Of course, the above names are fictional. In a typical meeting, the hospice where I work will talk in detail about scores of patients. We discuss the recent deaths and new admissions, along with all of the ongoing patients served in their homes or facilities. Every patient has a choice about which of their “team” provides direct support to them. However, every patient must be seen by a nurse, from as little as several times a month to (though rare) every day. It depends on the needs.
As we move through the patient’s names, I’m still surprised when the home health aide has been declined. With the two pretend patient examples I provided, I purposely had those fake patients refuse their home health aide. In fact, it happens quite often.
+ + +
What is a home health aide (HHA)? He will help get you bathed, maybe a sponge bath in your bed or assistance with a shower or bath in your bathroom. She will be with you when you go to the toilet. He may clean up the space around your bed, making sure the area is safe. If you need an additional hand with eating, she will be next to you. The HHA will often be internally asking . . .
- Does the patient need to be repositioned in the bed?
- Do the sheets need changed?
- Are there enough supplies of towels or adult diapers?
The HHA (in some hospices, it’s Certified Nursing Assistant or CNA), observes how bandages are doing, checks medication supplies, determines if catheters are properly working, and a whole lot more. While with the patient and caregivers, much of what an HHA sees and hears is conveyed to the case manager nurse.
The aides are present in the most vulnerable times, like with a patient taking a first bath after a long time in the hospital. They are alone with patients, supporting the “simple needs” that are no longer simple, and hearing fun (and sometimes sad) family stories.
Most hospice aides have seen patients die. If you’re a scared or unsettled family member, you’d want an aide by your side when your loved one has died. They will know what to do. They will know who to call. They will have a shoulder for you to cry on. A beloved’s death overwhelms us, even if we think we’re prepared. Every HHA has stories about helping a husband or parent or child survive into the next moment when a beloved’s final breath is taken.
What’s more important?
The medication that keeps your pain at bay? Thank the nurse for that.
The prayers the chaplain offers to have with you? Healing words can bring hope.
The social worker, holding your hand when you finally told your grandchildren that you were dying? Such a blessing to have support when speaking the worst news.
The help in transferring to the wheelchair so that you could journey outside to see your garden again? How gentle and encouraging the HHA was as he wheeled you into your yard.
All of those events matter. What’s the point of having pain controlled, if you literally can’t take the time to smell your roses?
+ + +
This week, in a meeting about a particular patient with a troubling concern . . . the HHA was present. Nurses, hospice administrators, social workers, and a chaplain were also there. We had complex issues to discuss. The patient, you see, had
- Demanded that only white people take care of her.
- Informed hospice he had the legal medical-aid-in-dying drugs and planned to die . . . soon.
- Refused to stop her chain-smoking around the oxygen tanks that assisted her breathing (but that could explode with any open flame).
- A granddaughter stealing pain medication and he was lying to protect the girl because she was the only one in the family that cared about him.
- Something even worse . . .
None of the above are true. Like the earlier patient names, I made ‘em up! Except that all represent concerns a hospice may confront when caring for fearful, stubborn, and wonderful people.
Next to me, this HHA, with all of the “powerful” staff in the room, had some of the best suggestions. Why? She knew the patient. She’d tended to his (or her) most basic needs. She’d listened to family stories and cried with her (or him).
Her words literally aided us in coming up with a good plan to better care for our patient.
If I had Harry Potter’s wand crafted from the finest holly or was a genie with three wishes to grant, I’d make sure every patient said “Yes!” whenever a home health aide was offered!
(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)
Image at beginning “borrowed” from the Minneapolis Star Tribune.by