Your Hospice Care Team

Our Hospice Team provides the care, support, and love where and when it is most needed. Having a dedicated, compassionate, and skilled team of professionals to assess and address the pain and discomfort associated with disease progression can help make a difference in everyone’s well-being.

Hospice Team is available 24 hours a day 7 days a week 365 days a year with a one hour response time to assess the emergence or recurrence of pain and/or symptoms, resolve discomfort, and address patient and family questions/concerns.

• Primary Care Physician
• Hospice Medical Director
• Registered Nurse Case Manager
• Social Worker
• Chaplain
• Home health Aide
• Bereavement Staff

Primary Care Physician
The primary care physician is responsible for identifying the patient’s need for hospice and making the referral for hospice services. It is important to find out from the PCP what his/her role will be once hospice care begins. When the patient chooses to have his/her PCP involved, the PCP and Medical Director work together to coordinate medical care, especially when symptoms are difficult to manage. The patient may also choose to have the Medical Director solely responsible determining his/her medical care

Hospice Medical Director
The hospice medical director coordinates, directs, and oversees the patient’s medical care as well as the re-certification process for continued hospice appropriateness.

Registered Nurse Case Manager
The registered nurse case manager coordinates the plan of care with the primary care physician and hospice medical director through initial and ongoing nursing assessments. The nurse visits weekly and as needed to assess current health, ensure that all distressing symptoms are effectively managed, provide patient/family education about the disease process, recognizing the recurrence/emergence of symptoms, and meeting the care needs of the patient.

Chaplain
Chaplains provide spiritual support to patients and families, often serving as a liaison between them and their religious community. Chaplains often assist with memorial services and funeral arrangements.

Home Health Aide
The home health aide will assist your loved one with personal care needs and assist you with light housekeeping. They can also teach you and other family members correct and safe methods for providing personal care to your loved one.

Hospice Volunteer
The hospice volunteer provides companionship, support, and practical assistance to the patient and family. All hospice volunteers are required to attend volunteer training at the hospice and must follow a volunteer plan of care.

Social Worker
Social workers provide assistance with practical and financial concerns as well as emotional support, counseling and bereavement follow-up. They evaluate the need for volunteers and other support services needed by the family and facilitate communication between the family and community agencies.

Bereavement Counselor
The bereavement counselor assesses the grief of your family and can provide bereavement services for up to a year, or longer, after your loved one passes away. Your loved one may find great comfort in knowing that her/his family will continue to receive the support of the hospice team after she/he is gone. Support can include conversations with the person and family members, teaching caregiving skills, prayer, and telephone calls to loved ones, including family members who live at a distance and companionship and help from volunteers.

• Manage the patient’s physical pain and symptoms with medical and psychosocial interventions
• Regularly assess the patient’s disease process and changes in condition
• Provide immediate access to care 24 hours a day, 7 days a week, 365 days a year
• Provide medication, medical supplies and equipment as needed and as changes occur
• Provide emotional, spiritual, and social support to the patient and loved ones
• Encourage the patient and loved ones to be involved in all aspects of determining the plan of care
• Educate, support, and coach loved ones on how to care for the patient
• Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time
• Assesses social service needs, makes referrals to appropriate community resources, and assists the family/caregiver with obtaining necessary services
• Assist burial arrangements, POAs, and other end of life concerns
• Identify resources for meeting basic needs (food, shelter, clothing) when needed
• Provides assistance to the patient and family/caregiver with obtaining in home caregiving support, respite care, and out of home placement when needed
• Delivers special services like speech and physical therapy when needed;
• Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time; and
  Provides grief support to surviving loved ones, caregivers, and friends.
• Assist with applying for entitlements, identifying, accessing, and securing community resources/services to address unmet social needs.
• Bereavement support for family, caregivers, loved ones for 13 months following death

Our Hospice Team provides the care, support, and love where and when it is most needed. Having a dedicated, compassionate, and skilled team of professionals to assess and address the pain and discomfort associated with disease progression can help make a difference in everyone’s well-being. When the physical, emotional, social, and spiritual pain is addressed, patients and loved ones can spend the precious time remaining concentrating on things that are important to them.