Home Health and Hospice return to Alpine County

At the end of summer I joined a small group of women in helping a mutual friend take care of her friend who had been diagnosed with a life-limiting disease. When he decided to leave the hospital after eight weeks of treatments and a prognosis of 48 hours to live, our friend offered to look after him in her home.

Round-the-clock care was required and our small group was spread far too thin to provide adequate assistance. For one month our friends made a heroic effort to give high-quality care. During that time we longed to be able to draw on volunteers who could spell the primary care-giver by sitting with the patient and helping with cooking. We bewailed the absence of Home Health and Hospice services in Alpine County. We now visit the patient in a long-term care facility.

Unknown to us, Alpine County Public Health Officer, Dr. Richard Harvey, had been negotiating with Barton Hospital since May to restore these services which were withdrawn from the county about a year and a half ago because of the expenses of time and travel. In October, the Barton Board of Directors approved reinstating the programs on a trial basis until Jan. 1, 2011. They acknowledge that residents of this county use Barton Hospital; we are part of the hospital's service area. It costs more to readmit people to the hospital than to provide Home Health for them. Barton would like the programs to break even.

Home Health care offers professional and technical services delivered in the home. It can be used whenever a person needs assistance that cannot be easily provided by family members. Professional staff assess the patient and develop a plan of care. Home Health services include: rehabilitation services, wound care, I.V. therapy, education in diet, self-sufficiency and medications and diabetes and geriatric management. The Home Health team is made up of registered nurses, therapists, medical social workers, nutritionists and aides. There is 24/7 on-call nursing care.

Hospice care provides palliative care (relief of pain and symptoms) rather than curative care to those who are terminally ill and expected to live no longer than six months. The Hospice team includes: a medical director, the patient's physician, registered nurses, Home Health aides, therapists, dieticians, medical social workers, volunteers, bereavement counselors and spiritual counselors of the patient's choice. Hospice care is available to people wherever they live: private homes, Hospice centers, hospitals, nursing homes and other long-term care settings. The family or physician, with the permission of the patient, may initiate Hospice care.

In a recent survey of Hospice patients, five major needs were identified:

n Adequate treatment for pain and other symptoms and to feel awake, not drowsy, after medication.

n Avoidance of the prolongation of life.

n A sense of control.

n Not to burden the family.

n To strengthen relationships with loved ones.

Until the late 19th century most Americans took care of their dying family members. By the mid 20th century most people in the United States died in a hospital or a nursing home.

Death had become a medical event often with treatment continuing after death was inevitable. In 1967 Cicely Saunders established the first modern hospice, St. Christopher's near London, England. She experimented with offering pain medication "by the clock" rather than waiting for the pain to return. In 1968, Dr. Elisabeth Kubler-Ross published "On Death and Dying," challenging us to take a closer look at the American way of dying.

In this book Kubler-Ross asserts: "If a patient is allowed to terminate his life in the familiar and beloved environment, it requires less adjustment for him. His own family knows him well enough to replace a sedative with a glass of his favorite wine; or the smell of a home-cooked soup may give him the appetite to sip a few spoons of fluid which, I think, is still more enjoyable than an infusion."

Last Wednesday 11 prospective hospice volunteers gathered in the library meeting room to watch the first two hours of the training tapes. Kate Harvey, a local nurse, introduced the materials. She is currently studying to be a hospice nurse. At our next meeting we will be joined by chaplain from Carson Valley, who is our volunteer group's coordinator. He also runs "Memory Dish" bereavement groups every third Wednesday of the month and a Grief Support Program every other Thursday, both in the Valley. Call (530) 543-5832 for more information. Anyone interested in using the Home Health or Hospice program, call (530) 543-5581.

Thanks to Kate and Richard Harvey and to Alpine County Library for promoting the programs and training.