Workplace Wednesday

Hospice

It’s official…you can change your name to ANGEL. because your wings are showing. Straighten up that halo and read on to see why you are the ideal candidate to provide Hospice care to terminally ill patients.

All CNAs are special, but it takes a SPECIAL kind of special to be able to provide care to those living in their final days, weeks or months. Comfort is key, and you understand that in your soul. A bed bath is a bed bath, and any CNA can give one…but you know how to take that extra step to ensure comfort, you know that extra word needed to soothe a worried soul, you see that brief glimpse of pain and make sure it is addressed. You are a light in the darkness that surrounds this family.

Overview

As a home care CNA, you will be caring for one (usually) patient in their home. Remembering that you are a guest in their home is key to a successful patient/caregiver relationship. Being able to adapt the way you usually do things to their preferences, keeping busy during the slow times, and being able to maintain professional boundaries while still showing care and compassion takes a special kind of caregiver.

Home care CNAs often work in isolation, away from other medical professionals. Other than an occasional trip into the office, or a rare supervisory visit, it is usual to have little contact with other medical team members. So, home care CNAs need to be internally motivated, self-starters, and not require a lot of supervision to get their job done.

There are two types of home care assignments: visits and shifts. Visits means that you will see multiple patients in the same day, offering care in small time increments (usually around an hour) then moving on to the next patient. Shifts means you spend several hours with the patient in their home. Many home care agencies offer both types of schedules.

“We can all make a difference in the lives of others in need because it is the most simple of gestures that make the most significant of differences."

Miya Yamanouchi

Hospice CNAs are essential in providing compassionate care to both the patient and their loved ones in an extremely difficult time. Knowing that death is approaching and being able to face that knowledge with truth, bravery and compassion is not a skill that can be taught. got or bought, it is simply part of who you are.

Providing Hospice Care brings very specific challenges, and great rewards. Read below for some specifics!

1. Pace

Hospice is truly the only field left (in medicine) where you are encouraged to spend time getting to know your patient. While other settings are rushed, with way too many patients and too many tasks to possibly complete on time, Hospice takes a more leisurely approach to care. Rushing is discouraged. Rushing through tasks with Hospice patients makes them feel like an inconvenience and does not encourage conversation. And patients can’t work through grief without being able to talk through their thoughts and feelings. So, slow down, smile and breathe. These patients don’t care how much you know until they know how much you care.

Hospice care can occur anywhere the patient lives. ANYWHERE. In their home, in a nursing home, in an assisted living facility, in a family member’s home, in a homeless shelter, in a jail cell, in a hospice facility. Hospice is not a PLACE, it is a PHILOSOPHY. Since Hospice care will be determined by what the patient needs, and who else they have to depend on, visits may be short (an hour or so) to provide basic personal care or care may be provided in shifts to provide total care, depending on what the patient needs. But the pace will be dictated by the patient.

2. Type of Patient

Hospice patients are terminally ill – their condition is expected to result in death within the next 6 months. That doesn’t mean they HAVE to die in that time frame (and many will live longer with the exceptional care Hospice workers provide), but no treatment exists to cure their condition. These patients know that their death is imminent, and they will often suffer from the effects of their disease, which can make life uncomfortable. But with proper care, good observation skills and excellent team communication, these effects can be minimized to make the remaining time the patient has more comfortable and enjoyable. Patients may need to get their affairs in order, say final goodbyes or just focus on making memories with loved ones and good Hospice care can help make that happen. But there is a wide variety in the type of help that each one will need. You have to be very versatile and be able to adapt to the needs of each different patient, the symptoms they are experiencing, their varying emotional needs and their individual level of ability. You know that, when it comes to people, one size really does NOT fit all. Luckily, you are able to change your approach as needed.

3. Number of Patients

Hospice care is focused on the individual and their family. You will have one patient, but that patient may have loved ones that require compassion and reassurance, too.

But, the number of patients you are caring for does depend on WHERE you are providing Hospice care. Since Hospice patients are seen wherever they live, Hospice CNAs are often assigned to not only visit patients in private homes, but in Assisted Living Facilities or Nursing Homes as well. In these settings current staff CNAs will continue to provide daily care for these patients, but Hospice CNAs are able to take the extra time to provide extra special care, like backrubs, or foot care to encourage relaxation that regular staff are too busy to do. In a congregate setting, Hospice CNAs may provide care to several patients per visit, but care is still provided to one patient at a time.

Care provided at a Hospice dedicated care facility (a residential setting owned and operated by Hospice for those who have nowhere else to go), will be similar to Hospice care in a nursing home, except the Hospice CNA is now the primary care provider (rather than the Nursing Home CNA above). Staffing is generally adequate to provide socialization opportunities with patients and families.

A calm demeanor, unrushed actions and open-ended questions to encourage conversations are necessary traits for successful Hospice caregivers.

4. Oversight and Supervision

Hospice CNAs are part of a larger team, and will participate in weekly care plan meetings to update the team on each patient’s current status and ongoing needs. Hospice CNAs will relay their observations to other team members promptly and good communication skills are required. But they also spend a lot of independent time with patients, which requires that the CNA is able to work effectively without close supervision and manage their time effectively.

Successful Hospice CNAs are able to work well both independently, and as part of a larger team.

5. Length of Patient Interaction

Hospice care patient interaction is varied, depending on the setting, other caregivers, the patient’s needs and complexity of the dying process. Patient interaction may be short and task-focused, or may be performed over a long shift. But generally speaking, the Hospice patient is expected to die within 6 months of admission (often much sooner), so it is not considered a form of long-term care.

Despite this, Hospice CNAs often get to know their patients quite well, as the emotional nature of the patient’s care will usually prompt conversation and compassion.

6. Schedules and Shifts

Hospice care is widely varied from visits that last less than an hour to full shifts at the patient’s bedside. Schedules are varied as well. While most Hospice visits are done during weekdays, care must also be available on nights, weekends and holidays for emergencies (a rotating on-call schedule is usually used).

A set Monday – Friday daytime schedule, with only occasional coverage of nights, weekends or holidays are the norm for most Hospice care organizations.

Care provided in a Hospice care center will require 24 hour around the clock care provided in shifts (like a nursing home). There are many different schedule opportunities in Hospice, providing flexibility based on patient needs and caregiver availability.

7. Pay and Benefits

Hospices are non-profit entities that rely on government funding and donations to operate. Pay is usually competitive, and often on the higher range of pay based on the emotionally demanding nature of the work. Pay is generally computed on an hourly basis, but some Hospices may pay per visit. Shift differentials (additional hourly pay for nights, weekends or holidays) is offered when working in in-patient hospice care center settings or for shifts.

Many Hospice organizations also offer additional benefits like medical insurance, paid time off, tuition reimbursement, continuing education, staff training for new skills, etc.

8. Learning New Skills

Hospice CNAs have to be strong communicators and not afraid of deep conversations with strangers. But most of the actual care provided will be basic patient care skills revolving around ADLs and comfort actions. There will be very little opportunity to learn new medical skills while working with Hospice, although ongoing training opportunities around palliative care, the stages of grief, communication and comfort measures will be offered routinely.

9. Opportunity for Advancement

Hospice care generally won’t offer very many opportunities for advancement within the medical industry, although there may be internal opportunities for supervisory roles, administrative positions, etc. This setting does not generally offer tuition reimbursement or scholarship opportunities to further your career, although there is a Certified Hospice and Palliative Care Nursing Assistant (CHPNA) certification available through the Hospice and Palliative Care Credentialing Center that is generally reimbursed by employers for those that achieve that certification.

Summary

As a Hospice CNA, you will be caring for patients at the end of their life. These patients have exhausted all medical treatment options. There are no more cures, no magic pills, no desperate surgeries that can help them. Medicine has no more tricks up it’s sleeve to safeguard against the eternal journey. The patient, and their family, must now face the grim task of maintaining life while waiting on death. But this is not always as sad as it seems, as there can be joyful moments, happy reminisces, meaningful connections and beautiful experiences along the way, if the patient is well-cared-for and pain-free.

Helping these patients, and their families, enjoy the time they have left together by managing symptoms, helping with personal care and providing emotional support on the tough days is a truly significant honor – one that not everyone is well suited for.

Hospice CNAs work very closely with a small healthcare team including nurses, doctors, dieticians, grief counselors, clergy members and social workers to care for the terminally ill patient and their family. Being able to work well with others is important, but so is having autonomy and self-motivation when you are working in the patient’s home with the patient. It is truly the best of both worlds – autonomy and team. The most important skills you have are compassion, observation and communication – and you will be putting those to work daily, when providing patient-centered holistic care.

It pays to pick the right workplace…and your personality will have a huge impact on your overall success. Often, we have unrealistic expectations and the reality doesn’t live up to what we THOUGHT the work would be like. Knowing what to expect and making sure you have the skill set to perform well will go a long way to ensuring your success, no matter WHERE you decide to work in healthcare!

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