End-of-Life Care Depends on Volunteers
by FRANCES STEBBINS

Like many — though far from all — senior adults, I think often of how my husband and I will leave this world. I don’t consider that morbid but rather an interest in finding out what I can about an inevitable event that’s getting closer every year.

Since taking a 24-hour course offered by Good Samaritan Hospice for its future volunteers, I feel a lot better prepared. If, as statistics show, I am more likely to decline slowly than to pass quickly it’s good to know the Roanoke Valley’s five hospices are available to ease my transition to a state or place I believe will be better.

Not that I’m expecting to go soon, but the sudden passing of friends or serious illness of many acquaintances brings my mortality home.

“Good Sam,” the only community-based, not-for-profit hospice serving the Roanoke and New River valleys, offers its free training twice yearly. It’s required for anyone planning to volunteer help in the homes of people judged by their doctors to be nearing death. That isn’t my present goal, but the training is advised even for volunteers expecting to help in the office or on special projects.

It was a valuable use of eight mornings, each of which included three hours instruction and exercises taught by several members of the Good Samaritan staff.

At the Good Sam office at 3825 Electric Road seven of us who had previously been cleared for taking the classes gathered on Tuesdays and Thursdays from 9 to noon. Introductions on the first morning revealed that several of the women — no men were in this class though they are welcome — had lost loved ones in the past and some had benefited as families from hospice care.

For a key to the care hospices give is to use a team that helps the family as well as a dying patient. one would expect the doctor to be in close touch with one judged not likely to recover. Hospice care, however, includes a social worker, a chaplain, a bereavement coordinator and nurses experienced in working with families in the homes where most people would prefer to die. Our training was set up by the coordinator of volunteers.

In some communities, I learned in the classes, there are institutional hospices to which dying people are admitted. This is the model of care used in most European countries. Someday such a specialized hospital may come to our area, but for the present, hospice care is carried on mostly in patients’ homes.

Unlike most of those in my class — which also included several new staff members — I have had little experience with the death of close family, for my own parents died relatively young and I was an “only” with my extended family a generation older and living at a distance.

One of the few cousins my age living in the northern Shenandoah Valley, after surviving several bouts of cancer, was told four years ago that doctors had done all they could for her. With the Winchester hospice she lived mostly pain-free in her lifetime home until her death 18 months later.

Her husband and daughter credited hospice with the serenity she was able to achieve.. It reinforced what I had learned from writing about terminal health care over the past 30 years when the first news of hospices came to the Roanoke area.

Here are a few things I learned in our classes:

1. Though a doctor commonly suggests hospice care, a person can seek it on her own in cooperation with her doctor.

2. Medicare, Medicaid and many other medical plans pay for the home care as well as needed sickroom supplies so long as the hospice has met the standards of the National Hospice and Palliative Care Organization; Good Sam is among these.

3. Hospice is palliative care. That means its goal is to keep a dying person as pain free and comfortable as possible without the use of the expensive drugs or technical medical procedures aimed at curing a disease. It costs much less than prolonging dying in a hospital.

4. Most people with incurable illnesses don’t get hospice soon enough. Sue Moore, the executive director of Good Samaritan, says a week or two isn’t long enough to prepare a patient or family for the “good death” everyone would like to achieve. The hospice team working with a household over several months can do more to ease the transition to death.

5. Hospice care has nothing to do with assisted suicide.

It does, however, encourage attention to written documents that will guide medical personnel on how much is done to keep a dying person alive. one of our sessions provided valuable details on this. It’s a lot more complicated than filling out a “living will” and sticking it in a desk drawer.

6. Certain medical signs show that death is coming within hours or days. And, as a book “Final Gifts” written by two hospice nurses points out, it is common for dying people to be aware of the presence of loved ones who have gone before them. They may wait for certain events to take place before they give up or may speak of dreams or far-away places that experienced caregivers see as the terminally ill person’s glimpse of the future.

Often the dying person seems relieved. — Though “six months to live” is a popular idea of hospice, no one is kicked out after that time. People do improve enough for them to be placed on a stand-by status from which they can be restored to full supervision or a short stay in a hospital if needed at the end.

7. “Religious” and “spiritual” are seen as different in hospice terms with the former relating to activity centered on the beliefs of a group of people as in a church. Spiritual implies a relationship to a Higher Power, such as God, not necessarily connected with a community of faith. Toward the end of their lives concern about what’s coming next may or may not surface.

Hospices differ on how much to encourage a religious outlook. As volunteer trainees we were told just to listen, listen, listen.

Freelance writer Frances Stebbins lives in Salem.

Comments or questions? E-mail to comments@primeliving.net.