Winsted-Lester Prairie Journal, February 2, 1998

Hospice programs offers patients dignified death


Whether one is rich or poor, has done much or nothing in their life, to all death will come.

For some, it is quick and painless, for others it is long and lingering.

The greatest gift the living can give is a dignified death surrounded by love, comfort, and care.

Such deaths were once common. The person dying stayed at home and was cared for by family.

Increased technology changed that. Beginning around the early 1960s, hospitals became the place terminally ill people went to die.

Now, the tide is changing, and some people with a terminal illness want to stay home. Families want to care for the loved one and hospice gives them that option.

Ridgeview Hospice, a division of Ridgeview Medical Center in Waconia, began providing hospice care in June 1997. The care is available 24 hours a day, seven days a week.

The type of care a dying person receives is termed "palliative care."

"It's a way to minimize the anguish and trauma at the end of life," said Terry Roufs, R.N. A Winsted resident, Roufs is employed by Ridgeview Hospice.

"It's not geared to heal people physically," she said. "It's to make the end of life as comfortable and as meaningful as possible."

To enter the hospice program, the person is diagnosed with a terminal illness and is expected to live six months or less.

"If the person lives longer than six months, we're not going to drop him," Roufs explained.

The person is then assigned a hospice team, which is supportive of both the family and the person who is dying. The team is composed of a registered nurse, a home health aide, social worker, chaplain, and a volunteer.

It provides nursing care, companionship, spiritual care, emotional support, and home health aide care. The hospice also offers bereavement care for up to a year.

"The family doesn't have to take all the services, but they are there if needed," Roufs said.

Under the guidance of the hospice team, family members or friends are often the primary care givers. About 90 percent of the hospice services are delivered in the patients' homes. The team works with each patient's physician to provide individualized care and service.

"The image people have of someone dying is a person in extreme pain," Roufs said. Dying, she said, doesn't need to be that way and the hospice program manages pain aggressively.

She said there are several alternatives for pain management, such as a morphine pump implanted into the patient. He or she can administer the medication as needed.

If hospice patients require an intravenous, the nurse would do the insertion of the needle and then teach the family and/or client how to maintain the IV line and administer the medications.

"At home, the patient always has someone there at their elbow," she said. "The family finds satisfaction in knowing they have been there to help the person be as comfortable as possible."

After family or friends take over the primary caregiving, the patient's condition continues to be monitored by a registered nurse.

Ridgeview Hospice is certified by Medicare, and the care is covered by Medicare, Medicaid, HMO, and most private health insurance companies.

The hospice also offers a drug benefit, which covers the expense of some medications not paid by traditional insurance coverage.

Equipment and supplies needed at home for hospice clients are generally paid for by insurance companies, Medicare, etc. Ridgeview Foundation, a non-profit partner of Ridgeview Medical Center, helps supplement costs not covered by other payors.

Patients under hospice care are not limited to receiving care only at home. Ridgeview Medical Center offers hospital stays for medication and symptom management, and up to a five-day stay as a respite for the caregiver.

Volunteers will care for patients for two to three hours, allowing the caregiver to take a break for whatever he/she would like to do.

Dying does not have to be the end, Roufs said. It can be a time for reconciliation and personal growth.

When a loved one is dying, "we really see the beautiful side of people," she said.

After the patient's death, Ridgeview Hospice will follow-up with bereavement care for up to a year. The social worker, chaplain, or both will visit and assess how those left behind are doing.

"They can determine who is having a tough time and who is more accepting with the death," she said.

The social worker is able to find services for the survivors, such as if the spouse needs help with finances or other day-to-day activities. Support groups are also available.

"A lot is involved in grieving. (The family) needs to deal with the hurt and the loss," she said.

After all the months of care, death will come, and the hospice team will be there for the family.

"We encourage the family to gather together," Roufs said. "If we know the end is near, we still want the family to talk to the person. They may not respond, but they may be aware family is with them and still can hear.

"The family may want to say things they want the dying person to know, or they may want to pray. The most important thing is being there to help the person die well," she said.

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