Catholic Health World

Franciscan program helps hospice patients find peace, reduce suffering

TACOMA, Wash. —When Nancy Wade's husband Merwin was dying of a brain tumor seven years ago, she was overwhelmed by the physical and emotional demands of caring for him. He suffered from dementia. She battled feelings of anger, frustration, exhaustion and loss while juggling medication schedules, financial challenges and household management.

Temporary respite and a measure of relief came in the form of a team of caregivers from Franciscan Hospice and Palliative Care of Tacoma, the winner of CHA's 2010 Achievement Citation. The award recognizes innovative programs that embody the Catholic health mission.

"I would have gone absolutely stark-raving mad without them," Wade said.

Launched in 1990 by Franciscan Health System, the program includes in-home hospice services; inpatient hospice care at Hospice House, a 20-bed Tacoma facility; palliative care consultation and services and caregiver support. It served more than 3,500 patients in the 2009 fiscal year. Administrators estimate Franciscan provides about 70 percent of hospice services in the organization's three-county service area.

Dr. James Shaw said the program stands out among hospice and palliative care programs nationally because "they were in the game early, and they do high-quality work."

Another reason the program stands out, according to Shaw, is its success in reaching patients early in their disease process to palliate pain and symptoms, an achievement that speaks to the program's relationship with referring clinicians. Shaw is medical director of the Providence Center for Faith and Healing in Spokane, Wash., and chair of the Supportive Care Coalition: Pursuing Excellence in Palliative Care.

Franciscan aims to be almost "aggressively evangelistic" about its services, trying to let clinicians, potential patients and caregivers know what's available, said Mark Rake-Marona, regional director of hospice and palliative care for the Franciscan Health System.

Georganne Trandum, manager of palliative care outreach for Franciscan Health System, said Franciscan is strengthening its outreach by providing palliative care consults in patients' homes.

The palliative care program is trying to build awareness of its services among diverse populations. Charles Horne, the program's multicultural coordinator, and other staffers are connecting with members of the area's Hispanic, American Indian, Korean and other ethnic communities. "We listen, learn and bring the information back here," Horne explained. For instance, after conversations with Cambodian community members revealed a low level of literacy, Franciscan developed videos and graphically illustrated handouts to communicate.

Dispelling myths
To reach more patients, the program must overcome incorrect assumptions that people may make in connection with hospice and palliative care services — including that palliative care and hospice care are just for the actively dying, said Dr. Mimi Pattison, medical director of hospice and palliative care for the Franciscan Health System.

Palliative care strives to provide effective pain management for anyone in serious pain, and it can help the chronically ill achieve better symptom management.

Many people wait until a patient is actively dying, or approaching that state, to enroll in hospice. Franciscan encourages earlier participation because staff can guide the patient and family members in building positive memories and working toward a sense of comfort and peace, Pattison said.

Total care
"People die in all different ways," Rake-Marona said. "We have to adjust our services and make them available to meet patients at whatever stage they are. If we do it right, we'll find out what they need, we'll listen a lot more than we'll talk and then figure out how what we do matches what they need."

Franciscan Hospice and Palliative Care provides a comprehensive continuum of care that includes comfort care, aromatherapy, music therapy, chaplain services and respite for caregivers — a portfolio that goes beyond what some other programs offer.

Not all the Franciscan hospice and palliative care services are reimbursable by Medicare, the main payer for hospice and palliative care, but the offerings are included because administrators are determined to deliver on the Catholic mission of holistic care. The size of the hospice program allows Franciscan to offset many of the costs of the less profitable aspects of the program, such as some of the palliative care services, Rake-Marona said. Donations help as well.

A safe haven
Dionne Hartman, 43, has been admitted several times to Franciscan's inpatient hospice facility. She suffers severe pain as a result of metastatic breast cancer and complications she suffered when she broke her femur recently. The hospice program is aggressively managing her pain and treatment. "I feel safe here in my recovery," Hartman said.

Franciscan chaplains "sat with me and prayed with me. I'm comforted here, and I'm thankful for that, because it's what I need right now, comforting."

Wade, the woman who lost her husband to cancer in 2003, turned to Franciscan again two years ago when her mother, Joy Thunemann, was terminally ill.

In both of those experiences, Wade felt staff listened to her and her vulnerable loved one.

"They were willing to talk about anything at any time," Wade said of the staff, "and no issue was too small." Gratitude led her to volunteer at Franciscan hospice.

'There's beauty here'
Dianna Kielian is senior vice president of mission and ethics for the Franciscan Health System. She said dying patients and their families deal with loss, feelings of helplessness, conflicts, joy, hope and resentment. Staff is there to support them on the emotional roller coaster.

Nurse Kristin Neufeld allows that when emotions run raw, it can be difficult to intervene in family disputes. She talks to families to encourage them to make the most of their time with their loved one. She'll sit on a patient's bed and offer words of comfort to ease anxiety and "bring peace in a very scary place."

Neufeld keeps a journal to process the intensely emotional encounters she has each day at Franciscan's inpatient hospice unit. Recently, she chronicled the interactions of an 81-year-old woman and her husband of 61 years, a man whose own health was failing. "Her husband was there, sleeping with her every night on the couch, and you could just see this man was just so incredibly devoted to his wife. She got worse and worse, and it became obvious she wasn't going to be able to go home. And it was so hard to see him crying every day, being there. But his love and his commitment were great, it was great to see the joy of love and the pain of love, all completely intertwined after 61 years together," Neufeld said.

"There's beauty here," Neufeld said. "You see how tenderly people love their loved ones. You see people's grandkids climbing up all over them on the bed. There's a little sense of Heaven here, and of the sacred."

Kielian said that even in families that are bickering, God's calming grace can bring all parties together so, at the moment of death, loved ones and patient can feel peace.

Visit chausa.org/videos to view a video on Franciscan hospice.

Copyright © 2010 by the Catholic Health Association of the United States
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