Interdisciplinary Care | Pediatric | Inpatient | Homecare | Pain Management and Symptom Control

Interdisciplinary Care Unique to Hospice

Like a tapestry woven with many different threads, care by The Connecticut Hospice, Inc. is an interplay of the skills of so many different professions. Within Hospice home and inpatient care, physicians, nurses, pharmacists, social workers, clergy, artists, volunteers, and consultants actively assist each patient and family in resolving the myriad of difficulties surrounding irreversible illness. It is the "team" approach - comprehensive, coordinated palliative care without gaps or overlaps - that truly distinguishes Hospice within the health care system.

In the inpatient building, each day begins with morning reports and chart rounds. At this time, nurses, physicians, and pharmacists discuss medication regiments, pain and other symptom control, and other issues related to patient care. After reviewing each patient's chart, the physician begins morning rounds on each patient. These daily meetings of the nurse, physician and other members of the team assure coordinated care. The weekly interdisciplinary team conferences resolve problems and plan care for the patient and family. In this way, team members learn from each other and reinforce each others' strengths. Team members also assess and refer patients to other disciplines as the need arises. Because irreversible illness has many ramifications, team care also includes the family.

The primary nurse initially assesses the patient and identifies problems and needs to be addressed. The nurse develops a custom-designed care plan and presents this to the rest of the interdisciplinary team. This occurs in both the home care and inpatient programs. The pharmacist, for example, provides patients and families with drug information, patient monitoring and patient counseling. An individualized approach to the design of all patients' drug regimens takes into account the unique characteristics and problems of each patient.

Pastoral Care

Pastoral caregivers provide spiritual support, upon request, with respect for individual values and beliefs. They work closely with community clergy whenever possible to assess the patient's and family's religious history and the ability to be supportive at this time. Hospital and home care clergy sit on the interdisciplinary rounds weekly and make daily assessments of referrals. A broad range of religious ceremonies are provided, including weekly mass, weddings, baptisms, bar mitzvahs, and more.

Social Work

Social Work is an integral part of the team approach. Hospice social workers help patients and families bridge communication breakdowns and deal with the reality of irreversible illness. Social workers also help arrange community and financial supports. The bereavement program, which offers support to the grieving family for up to one year, is coordinated by the Social Work Department.
Bereavement, a non-judgmental supportive set of practices, reminds families that there is no right or wrong way to grieve. Individual responses to loss are as unique as fingerprints. Multiple reactions to the multiple challenges faced by families after the death of a loved one require the most intensive training in education of the volunteers participating in these plans.

Arts

Hospice care affirms life and focuses on the quality of life. To this end, Hospice embraces and views the arts as an important component of care. As members of the team, artists assist patients and families in individual creative projects. They hold performances, coordinate changing art exhibits, and tend to flowers and plants inside the building and in outside patio gardens.

Dietary Department

The dietary department works closely with other members of the team to provide balanced, appealing menus for patients in the inpatient program and advice to families caring for their loved one at home. Dietary care includes dietary assessment and the preparation of special therapeutic diets, the preparation of nutritious foods presented in gourmet style, meeting individual dietary requests, and nutrition consultation for home care patients.

Volunteers

Volunteers have a nobility of character and a gentleness of soul which when combined with learning all of the nuances of The Connecticut Hospice, Inc. through a three-month orientation program, make them part of the Connecticut Hospice community. Many staff have said they could not perform as they do without the volunteers, and many patients and families have expressed their gratitude for the extreme kindness that brings so much comfort to those in need. Volunteers participate in both direct patient care and support functions at Hospice. Lay and professional volunteers provide a variety of services as part of the interdisciplinary team. They are "someone like me" to the patient and family - a listening ear, a friendly visitor, a fresh perspective - in a difficult time. Hundreds of volunteers, ranging in age from 16 to 94, support The Connecticut Hospice. Volunteers are divided into two broad categories: caregiving and program support. Caregiving volunteers have direct contact with patients and families, while program support volunteers give their time to departments in which there is no direct contact. Volunteers in both categories complete a period of orientation and/or training. Between October, 1999 and January, 2000, volunteers contributed a staggering 14,000!

 

Pediatric Care

Patients of all ages have always been a part of our program at The Connecticut Hospice. The Children's Place provides specialized inpatient care for infants and children. A similar pediatric program is offered under our home care plan.

The saddest thing about terminal illness is that it can strike children. Even harder to handle is the inability of family and friends to know what is best in the way of care and caring for the child so afflicted. Not only does the child suffer, but everyone around the child suffers, as well. There is a way to ease this suffering and the confusion that can go with it. A way to deal with all the issues parents of terminally ill children face on a daily basis is offered by The Children's Place.

The Connecticut Hospice, Inc. is rededicating its children's program as The Children's Place. It is designed to provide the necessary components of child and family care, including counseling to those who are in need. Because of our 10 years of experience in caring for children with advanced irreversible illnesses, we stand ready to provide a well-designed program of comprehensive care around-the-clock through our home care program and inpatient center:

• Physicians available all the time
• Pastoral counseling to aid with spiritual issues
• Continual involvement of social workers
• Bereavement counselors provide support
• Pharmacists assist with pain medication
• Artists stress personal fulfillment
• Dietary staff make meals enjoyable
• Volunteers add many special dimensions to caring...those little things that can ease a child's fears

Our Mission...

What We Do A commitment to caring, comfort, and counseling touches everyone and everything at The Children's Place. Our mission says it all:

The Connecticut Hospice shall provide quality, compassionate, and competent hospice care in Connecticut to patients suffering from irreversible illness, and to member of their families. Care shall be interdisciplinary in nature, shall allow for family decision-making and participation in care, and shall seek to enhance quality of life for as long as life lasts. With the full support of the philanthropic community, care shall be offered based on need rather than ability to pay. Bereavement care shall also be offered commensurate with need.

This mission is applied through our Home Care and Inpatient Programs. The Home Care Program keeps the child at home, a familiar, supportive environment close to family, friends, pets and favorite toys. Home care staff visit regularly, and are available around-the-clock. The plan of care is directed by the child's primary care physician.

The Incare Program offers a home-like environment, with personalized care provided by our full-time physicians and nursing staff. The child's room may be decorated to mirror his or her room at home. Visitors of all ages are welcome 24 hours a day, seven days a week and well-behaved pets may join the family and friends in cheering up the child.

Our Accomplishments

The Connecticut Hospice is proud of many significant accomplishments. Some of our key credentials are:

• Accreditation as a Hospital with Commendation by the Joint Commission on Accreditation of Healthcare Organizations
• Licensed by the State of Connecticut Department of Health Services as a Short Term Hospital, Special, Hospice and as a Home Care Agency
• Certified by Medicare as a Hospice, Home Care Agency, and Hospital

The Connecticut Hospice was the first hospice in America. We were also one of the first to focus on the needs of terminally ill children. Our strategic ally, The John D. Thompson Hospice Institute, provides educational programs to organizations from all over the world interested in developing new or enhancing existing hospice programs.

Inpatient Care

Hospitalization can be a disorienting time. Confronted by new surroundings, new faces, and new regiments to adjust to, patients often feel unsettled and alone. When the prognosis is irreversible illness, the issues to be addressed spiral beyond the physical. They encompass the complex range of human emotions, be they anger, denial, hopelessness, or fear.

At The Connecticut Hospice, Inc., nurses blend their highly specialized skills and a rigorous dedication to their work with a sensitive awareness of the physical and emotional needs that surround an irreversible illness. Their unique contributions have made The Connecticut Hospice a leader in hospice care in the United States. Medically directed interdisciplinary care, given by a team of trained professionals and coordinated by the Hospice nurse, represents the very best our health care system can give to our patients and families.

The task is challenging, and far more than a technical or methodical one. It demands recognition of the patient's psychological, spiritual, emotional and physical needs, observation of family dynamics, and respect for cultural, ethnic and religious differences. Our nurses are #1, not just in terms of their clinical skill sets, but in their ability to respond with compassion to each new situation arising for each new patient/family.

At Connecticut Hospice, a patient's care plan is individually designed and based on clinical assessment and careful the documentation of symptoms. Patients who are critically ill and whose conditions are rapidly changing require constant attention and assessment.

The focus of Connecticut Hospice nursing process is on the patient and family. They are - together - one unit of care. No patient is assessed in isolation from his or her family. Family dynamics are as carefully assessed as other factors impacting a patient's physical and mental well-being. Patients and their families retain a voice in the care plan; they give as well as receive care.

As the patient and family's personal link to the rest of the caregiving team, the Hospice nurse coordinates the many details of the caregiving process. A highly supportive environment allows questions about the illness, its progress, and treatment to be discussed freely and honestly.

Families need not only someone to listen to them, but also someone to accurately interpret and explain the changes in the patient. It takes some time and patience to establish a level of trust. As the patient draws closer to passing on, time spent with the family increases. There must be time to confer with other team members to ensure that all the parameters contributing to the status of the patient are considered.

This is true whether the patient is cared for at home or in the inpatient units. Many people with an irreversible illness wish to remain at home, and The Connecticut Hospice strives to provide the most appropriate setting for care. Hospice home care nurses provide quality care in the patient's own environment.

Home Care

Since 1974, Connecticut Hospice Home Care nurses have served 132 cities and towns in Connecticut. On an average day, through five sites, 350 patients receive a series of interventions to keep them comfortable and at home. Caregivers are connected through a video-phone system, PictureTel. The Interdisciplinary team that provides care in the home has weekly meetings and daily conferences with the hospice pharmacists, dieticians, and chiefs of medical staff through PictureTel.

Quality patient care is possible because of individualized programs developed by the home care team with the cooperation of the family, family physicians, community health agencies, and involved Connecticut Hospice team members.

As in patient care, it is a task that requires constant assessment, support, and coordination to help patients pursue the goal of quality living. This coordinated approach allows patients to continue their lives at home whenever possible.

When home care becomes inappropriate, the Branford inpatient programs provide a home-like environment for care. Inpatient functions as a back-up for acute level care to assist in the management of pain and other symptoms.

Hospice nurses are given the opportunity to assist others in the learning process. They teach courses, lecture, and provide technical assistance to visitors and training experiences for nursing students. And they continue to learn themselves. Their goal is not only to provide outstanding, compassionate care, but also to constantly improve the quality of that care.

Hospice nurses uphold the broadest definition of nursing as an art, a science, and a philosophy. Because of their energy, dedication, and professional skills, they uphold a tradition of quality patient care.

Patient Service Offices [PSO]
Branford - Patient Service Office 100 Double Beach Road Branford, CT 06405 Telephone: (203) 315-7500 Facsimile: (203) 315-7697		The Connecticut communities served from this office are: Branford, Clinton, East Haven, Guilford, Hamden, Madison, New Haven, North Branford, North Haven, and West Haven.
Norwalk - Patient Service Office 1 Park Street Norwalk, CT 06850 Telephone: (203) 847-9210 Facsimile: (203) 847-9305		The Connecticut communities served from this office are: Bethel, Danbury, Darien, Easton, Fairfield, Greenwich, New Canaan, Newtown, Norwalk, Redding, Ridgefield, Stamford, Weston, Westport and Wilton. Since 1987, The Connecticut Hospice, Inc. has offered hospice home care services in Fairfield County through a collaborative effort with Norwalk Hospital. In addition, The Connecticut Hospice, Inc. has four beds at the Norwalk Hospital that are available to patients who require inpatient care closer to home.
Shelton - Patient Service Office 2 Trapp Falls Rd Suite 408 Shelton, CT 06484 Telephone: (203) 944-0900 Facsimile: (203) 944-0805		The Connecticut communities served from this office are Ansonia, Beacon Falls, Bethany, Bridgeport, Derby, Milford, Monroe, Naugatuck, Orange, Oxford, Prospect, Seymour, Shelton, Stratford, Trumbull and Woodbridge. Located in Shelton, CT, this office opened in February 1993. The Connecticut Hospice, Inc. and the Visiting Nurse Association of South Central Connecticut formed a collaborative effort sharing office space and in-service education with each other. With Connecticut Hospice and the VNA working as a team, each patient is assured of continuity of care should services change from one program to another.
Wallingford - Patient Service Office 110 Barnes Road P.O. Box 90 Wallingford, CT 06492 Telephone: (203) 294-9320 Facsimile: (203) 294-9344		The Connecticut communities served from this office are: Berlin, Bristol, Cheshire, Cromwell, Durham, East Hampton, Haddam, Killingworth, Meriden, Middlefield, Middletown, Plainville, Portland, Southington, Wallingford, and Wolcott. Located in Wallingford, CT, this home care office opened in 1995. This office offers the full range of hospital home care services.

Pain Management and Symptom Control

The spirit of The Connecticut Hospice, Inc. is to encourage quality of existence for patients and families. Because of this abiding philosophy, pain and symptom control lie at the very heart of the Hospice program of care. Medical and pharmacological therapies control a range of debilities that, if untreated, sap a patient's strength, will, and even human dignity.

Professional expertise and an individualized care plan make possible a control of pain rarely achieved in other health care settings. Nowhere is this more evident than in the work of the hospice physician, nurse, and pharmacist. The physician, nurse, and pharmacist are important team members in evaluating pain and treating it pharmacologically. Artists, social workers, clergy, nurses, and professional and lay volunteers work with psychological and spiritual pain. As a team, they review the patient's status daily. In addition, consultants in several fields of health care complement the efforts of the medical and nursing staffs.

Prior to admitting a patient to the Hospice program, the Hospice physician confers with the family's physician. They retain open lines of communication. In the home care program, the family's physician acts as the primary physician. The role of the Hospice physician varies from case to case. In the inpatient unit the Hospice physician assumes the primary physician role. In both programs, medical direction is available twenty-four hours a day.

The care plan must be creative, innovative, and flexible to respond to the constantly changing challenges of irreversible illness. Some symptoms can be relieved by simple measures such as repositioning, massage, relaxation techniques, and distraction through arts and other activities. Yet medications are often crucial in alleviating physical discomfort.

In treating the patient, the Hospice physician and pharmacist are guided by repeated assessments, with adjustments in medications, and times of administration so that the patient will be as comfortable as possible.

An important principle in The Connecticut Hospice approach is that drug doses are carefully adjusted to each patient's physical make-up. This assures pain relief without loss of alertness. The Connecticut Hospice goal is to control symptoms while maintaining optimum functioning.

At Hospice, the patient's needs dictate the medication level. Medications are administered on a regular schedule, to eliminate not only pain, but also the fear of pain. Ease of administering is a key consideration also. Patients are spared injections whenever possible to make their lives more comfortable. Over 90 percent of the medications at Hospice are taken orally. Because of this, it is often possible for patients to be cared for at home.

When a medication is not available commercially in the exact dosage needed, the Connecticut Hospice pharmacist is able to meet individual needs. An active participant in patient care, the pharmacist attends morning rounds and weekly team meetings, serving as a source for current drug information and a consultant for changing drug regiments. Both the Hospice pharmacist and physician strive to educate others on the goals and parameters of hospice caregiving. Advances in symptom control present diversified and constant challenges. As Hospice physicians and pharmacists discharge their demanding duties, they are in the forefront of palliative care. Hospice remains identified by its excellence of symptom management and support.