Last week I wrote about dad’s experience with hospice in the hospital. Just over a week after his heart attack in the emergency room, we were fortunate in being able to get dad an inpatient hospice bed for dad as I wrote about in my last post.
During dad’s last Friday in the hospital he was still able to talk and ask for a drink of water or to use the commode. He asked to be repositioned for comfort, and drank just a little cola with his lunch. I was told the ambulance would come at 5 PM to pick dad up and take him to his hospice which was nearby. I rode in the ambulance also, but in the front with the driver.
I went to the hospital cafeteria around 4:30 to grab an early dinner since I thought I might miss out on a chance to eat while the move was taking place. Dad’s dinner tray arrived just before 5 but as usual he wasn’t hungry. The ambulance was delayed for almost 2 hours due to heavy demand at that time of day. In fact, we didn’t get dad into his room at the Hospice facility until 7 PM.
Immediately after we arrived, the staff made sure dad was comfortable in his bed. I put his clothing in the closet and prepared to go home. It had been a long day and immediately I could see dad would get the personal attention he needed. I didn’t have to worry about being there or having someone else there to advocate for him.
I want to tell you some of the wonderful features of this hospice. First, and foremost, the people were all angels. They were always friendly and smiling and ready to do anything to help us. If we pressed the call button, they responded within just a few minutes and a nurse or aide would come to dad’s room to make him comfortable or to answer our questions.
The hospice building was built within the past few years and was designed specifically for that purpose. There were 11 private patient beds – 5 in one “wing” and 6 in the other. There was also a huge “great room” which had a kitchen and living room. There was a pot of hot soup available for families and patients every day for lunch and supper. The type of soup changed for each meal except on weekends when they had the same type for lunch and dinner. There was also always a pot of coffee ready for families. The kitchen cabinets also contained many condiments and extras such as jam, sugar, crackers, tea bags, etc. I made myself tea each day since I am not a coffee drinker.
Some of the patients’ families sat around the dining table in the great room to eat or talk. The kitchen was well equipped with all the appliances and pots and pans anyone could want to cook a family meal (but I did not cook). I usually prepared myself a cup of soup or tea and took it to dad’s room since I wanted to spend as much time as possible with him.
The other end of the great room was a living room with a large screen television, sofas and chairs and a huge aquarium. Along one wall was a gas fireplace with a stone ledge where one could sit. There were cabinets containing puzzles and toys for families to spend the day there or to take to the patient’s room.
In addition, there was a small “quiet room” in each wing and a laundry room with a washing machine and a dryer and vending machines for snacks plus an ice/water machine. Everything was convenient and easy to use.
Each patient’s room had a large screen television and CD/DVD player. There was also a loveseat that turned into a bed so family members could spend the night if they wished. A shower was available to family members who slept there also.
Now, I will tell you about the staff. There was a full time doctor on staff Monday through Friday. Two individuals shared this position. Dr. A would be there for 1 ½ weeks and then Dr. B would be there. On their alternate weeks, the doctors worked in the palliative care department at the hospital. On weekends, one of the two doctors was on call.
In addition, there were registered nurses on duty 24 hours a day. I think there were 4 during the daytime hours and 2 in the overnight hours, but am not positive on that. In addition to the nurses, they had probably 4 nurses’ aides who came in to make the patient comfortable and respond to requests from the family. They worked in teams of 2 to turn the patient, etc.
Other staff included the social worker, the receptionist and the cleaning person. For only 11 patients, the staff to patient ratio was wonderful.
The morning after dad arrived, I telephoned to see how he had spent the night. They said he was comfortable. When I got there to visit, I found dad asleep. In fact, he slept all that day with few waking periods. Somehow the move from the hospital to the hospice had worn him out. Or perhaps he was just finally comfortable enough to sleep through for hours at a time.
At hospice they did not insist on making him sit up in bed or move to a chair. He stayed in the bed all the time. Nurses or aides came to turn him or change his position at least every 2 hours to prevent bed sores, etc. They positioned him with pillows on both sides. The doctor explained that they did not need to make him sit because he was not being prepared to be discharged to home or rehab. Now they could do whatever made them most comfortable, whether sitting or laying down.
In addition, he was now getting liquid oral medicine (morphine) for pain every 4 hours. Also the doctor or nurse checked him periodically to ascertain that he was not uncomfortable or in pain. Another medication was on orders if he needed it for anxiety.
The doctor came to dad’s room each morning to assess his condition and determine if any changes in standing orders were needed. Later he would explain to me what was happening based on this assessment.
Once in hospice, dad never talked again. He appeared comfortable and was able to shake his head to indicate yes or no. He didn’t like to be repositioned and moaned audibly when he was moved even a little. He liked to get some water from a syringe or small sponge on a stick. His mouth was drying out as he was mouth breathing all the time now.
I put my hand near dad’s hand on his bed when I arrived and periodically through the day. Most of the time those first few days, he reached out and grabbed my hand and squeezed it tight. That was how we communicated most. I talked to dad and waited for him to shake his head or squeeze my hand.
Each day I arrived around noon and late in the afternoon my son and or my daughter would arrive. We would then all visit for awhile. My daughter was great about going straight to dad. We weren’t sure if he could see the last few days, but she would go right up to him and speak loudly. “Hi Grandpa. It is your granddaughter (she gave her name). Give me a kiss!” Then he would pucker up his lips for a kiss. Until the last 2 days, she was still able to get him to pucker up and squeeze her hand.
My second daughter came from her home which was several hours away to spend the weekend and say goodbye to her grandfather. She was also able to take me places in the morning on the snowy icy roads as I had errands I needed to run. We also stopped at a deli each morning to pick up sandwiches before we went to visit dad. Over the weekend, my children and I spent most of each day with dad.
All the patient’s meals and the soups were sent over from the hospital which was just around the corner. Dad wasn’t hungry at all and never ate a meal, but most days I had soup at midday.
To be continued…