Alma was a long-time resident of one of our area nursing homes. Her bright smile and cheery "hello" welcomed all who had the pleasure of meeting her. She often sat in the lobby of the home so she could greet the staff and visitors as they came in. Most of Alma's family passed away so many years ago, that she thought of the staff at the home as family. Alma had been there so long that they loved her as much as they loved one of their own.
One day, after a number of trips to the doctor and a battery of tests, Alma and her nursing home family learned she had cancer. Her decision not to undergo extensive surgery was greeted with the same ambivalence one would expect in any family. There were those who agreed with her decision, while others felt she should have tried additional therapy. Most of the staff agreed that they would have a problem watching a loved one gradually leave their midst. They felt emotionally unprepared and even expressed concern for their ability to make her last days comfortable, especially with the many demands upon their precious time.
One of the nurses at the home knew of the Home Nursing Agency's Hospice Program because she volunteered there a few hours a week. She encouraged the headnurse to call and arrange for a visit. The day Carolyn, the Hospice Nurse, came to the home, Alma was her usual cheery self although staff confided that they felt she had already began to experience some pain and had not slept well recently. Carolyn explained that since Alma's legal place of residence was the nursing home, she would be eligible for the benefits of the Hospice Program.
Carolyn discussed the situation with the Hospice team of nurses, physicians, counselors, nutritionists, and therapists. Together with Alma and the nursing home staff, they developed a plan of care that included pain protocols, dietary guidance, and help with elimination problems. The Hospice physician discussed pain medications with Alma's doctor and together with the Hospice nurse met with the nurses at the home to review and explain the plan.
As Alma's condition worsened, a Hospice aide was scheduled to help with her daily personal care needs. Carolyn and a Hospice clergy volunteer met regularly with staff to help them cope with the impending loss. A special Hospice volunteer was selected to read to Alma and help her with correspondence when she felt able.
Alma died shortly after breakfast one morning with one of her favorite nurses holding her hand. Staff were pleased that they had helped in making her last days comfortable, and that she could spend those days in the midst of her own possessions surrounded by the many friends she had made at the home. They warmly thanked the Hospice staff at Alma's funeral for giving them the ability to help her in such a meaningful way.
The Hospice staff still stops in the unit where Alma lived on the way to attend inservices or to see other residents. They feel Alma's death has helped establish a sense of community between the nursing home and the home health agency, one that demonstrates the advantages of working together. I thought you, too, might enjoy knowing how gerontological nurses from two different settings of practice can pool their resources and benefit the people they are dedicated to serving.