Geriatrics. Palliative care. Hospice. For many people, each term denotes helplessness and hopelessness. But those are the very things healthcare workers and volunteers are dedicated to helping people avoid.
Geriatrics does indeed deal with the challenges of the aged and aging. The operative behaviors and illnesses and works to alleviate them.
Palliative care, explains Amy Warren, hospice coordinator at IU Health La Porte, is for helping patients manage life-threatening illness in the greatest comfort possible.
"(When illness is terminal), palliative care can eventually be a bridge program to hospice,” says Warren.
IU Health La Porte hospice administrator Virginia Davis emphasizes, “Patients go into hospice for quality of life." She said that can have its own rewards for patients, families, and hospice workers.
Helping families cope
All three disciplines can overlap. For instance, when patients are coping with a terminal illness, he or she may need assistance.
“In geriatrics, if someone’s ability to make decisions is affected by severe depression, they need help managing the depression," says Carol Schaaf, director of the Geriatric Behavioral Health Unit at Methodist Hospital’s Northlake Campus in Gary. The hospital’s 55-bed unit addresses a variety of psychological problems.
Many people worry that a loved one with dementia can’t be cured.
“We try to eliminate behaviors that limit their ability to stay in the home," says Schaaf. "There is rage and fear in the soul of someone with dementia. What you think is a further deterioration is actually like a very young child’s inability to tell you what’s wrong, and so has to act out by crying or getting angry. Connecting long-term memory with present-day stimuli such as familiar, pleasant smells can alleviate anxiety as the patient feels connected to the here and now."
When hospice referrals are unable to be managed in the home it’s usually because of their behavior and not because of their disease, says Shaaf. At Methodist there is a 12-bed geriatric unit. "(The unit) is very nice, compact (and secure). Because the patient is constantly under observation, we can figure out behaviors to help them integrate back into their living environment."
“Geriatrics is the next frontier,” says Schaaf. “So many people are living longer and they’re much more functional.”
Schaaf says schools may be getting more focused on courses in geriatrics. The pay varies according to the level of education. A registered nurse can earn $22 to $35 an hour; with a master’s or doctorate in nursing, it’s much more, says Schaaf. A technician might make $15 an hour.
Heading into hospice
“People think when they hear ‘hospice’ that they’re in their last days, but hospice is about quality of life and not being in the hospital,” says Warren.
“We’ve had a patient who elected hospice early enough that they could travel to visit relatives, with their oxygen and medications, and for management we connected them to the hospice in the area where they’re going,” says Davis.
But facing reality comes first. “When a person goes into hospice, they’re facing end of life. They stop trying chemo or radiation because they realize it’s not going to help. Sometimes the family wants them to keep trying; our chaplain plays a big role then,” says Davis. Warren adds, “So many of our patients are sick and tired of being sick and tired. They want to be home with their families.”
Hospice leaves decisions about care for the patient up to the family.
“The hospice patient and/or family decides the plan of care. We ask, ‘What do you need?’ and give them choices,” says Patty Warring, clinical nurse specialist at VNA Porter County Hospice and Palliative Care, affiliated with Porter Regional Hospital in Valparaiso, Ind. Again, reality has to come first, says Warring, “I can’t tell you how many people come to us and no one has told them they’re dying. I’m not blaming anyone. In this country, we don’t talk about it. It’s the elephant in the room. Yet usually the patient knows.”
If no one talks about it, “You may never have the chance to say things like ‘I love you,’ or, ‘I’m sorry.’ That’s why we encourage hospice earlier, so that people can tie up the loose ends of their lives and find closure,” Warren says, and adds, “People need to know that even though you will miss them immensely, you’re going to be okay. It’s so true that some will die when their person has left for home or to get coffee,” thinking to spare them the trauma.
The team is extensive and essential. “Hospice and palliative care includes RNs, a social worker (with a master’s in social work), chaplain, volunteers, home hospice aides, dietician, bereavement counselor, physician and volunteer coordinator. All have training for working with families and patients with end-of-life issues,” explains Davis.
Tuesday meetings are for debriefing; the staff helps each other get through the deaths. “Our social workers are a very tight-knit group, so we know to go to others for support. Everybody’s here for each other -- that’s part of the greatness of our staff,” says Warren
Warring at VNA says her team has been “phenomenal. I think people in hospice have a kindred spirit.”
Choosing to cope with grief
Everyone in the team is educated about grief, says Davis -- the sadness, sense of loss, and anxiety patients and families have at the end of life. So who chooses geriatrics, palliative care or hospice?
Warren speaks with conviction. “It’s a calling, to help people to be comfortable. It’s a gift to be able to go into a patient’s home; to help them be able to die a peaceful death in the home if possible; to give them and their family the sense that their life is complete.”
“It takes a special kind of person," says Schaaf. "You need to have willingness and heart to work with those emotional challenges. Our staff is compassionate, but is also able to see hope, and treat patients as if they were our own family members.”
“In one of my internship rotations the average age was 82,” recalls Dr. Kristine Teodori at Franciscan St. Anthony Health in Crown Point, Ind. “That experience told me I wanted to work in geriatrics. I love what I do. It’s difficult, we have people who pass and we get close to their families. I am blessed to be a part of that.”
Teodori takes an extensive patient history. “People tell me about their marriage, serving their country in the war, their lives. It’s important to recognize them for that.”
For some, working in geriatrics and hospice is what they've truly wanted to do.
“It’s been such a blessing in my life, it’s where I belong,” says Warring. “As a hospital nurse in oncology, I began to look at what we do at the end of life and thought, there must be a better way (than to continue treatment when it becomes futile). When we moved to this area, my Realtor told me about VNA, and VNA hired me 18 years ago as a visiting home nurse for hospice. It was the hand of God in my life.”
Looking to the future
“Hospice is a growing field. Not as fast as we would want, but the need is there, with baby boomers aging,” says Warring. “The numbers alone make it a growing field,” says Teodori, “yet It’s still underserved.”
Entry-level salary can be anywhere from $10 to $20 an hour; says Davis, depending on education and training.
To specialize, typically someone graduates medical school, does a residency in either internal medicine or practice, and then a geriatric fellowship, which can take one to two years.
“Having someone you’ve cared for years is emotionally trying, yet it’s not as hard as trying to work with the red tape of medicine,” says Teodori. “With the HIPAA privacy laws I’ll have children of patients who want information, but when you have patients who are still able to make their own decisions, the children still want to make decisions and have their questions answered."
“Once people have had experience with hospice, they recommend it to others,” says Warring.