HJAR Mar/Apr 2021

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2021 23 we even take care of them after the patient dies. That just does not happen anywhere else in healthcare. When is a patient ready to enter hospice care? WOOTEN Hospice is designed for patients with a six-month or less life expectancy if the disease takes its normal course and whose goals of care have changed from cure to comfort. In your experience, what attracts someone to end-of-life care as a profession? What attracted you? BELL For me, working in a traditional fam- ily practice was not professionally fulfilling. I discovered hospice and palliative medicine that allowed me to practice what I call “slow medicine.”Visits are never rushed, and I get to knowmy patients in a more holistic way. What do you think makes a good hospice team? WOOTEN We have a saying that the best hospice workers are not hired, they are called. Clinical skills are an absolute must, but so are true compassion, commitment, empathy and kindness in caring for patients and families at such a sacred time of life. End of life often brings drama to those involved. Are there common experiences you see at this time, and how does a hos- pice worker or social worker deal with these issues? CARLY CLAUD Stress levels can definitely be high for patients and families at end of life. Some common experiences might include caregiver fatigue, family dynam- ics and conflict, unresolved issues and financial stressors. Especially with large families, we can see that different relatives have different opinions regarding plan of care as well as different acceptance levels regarding the death of their loved one and hospice goals and philosophy. Oftentimes, caregivers are physically and emotionally exhausted. They may feel isolated. Unre- solved issues between family members as well as among family members and the patient can definitely rear their heads at this time. The role of the social worker would be to de-escalate tension/conflict, educate, support and affirmpatient and family mem- bers’feelings and experiences. There is a big emphasis on education when it comes to the patient’s dying process, struggles with acceptance, and caregiver fatigue and resources. So, I would say my focus is on a lot of education and support for patient and family. In your experience, do you find forced end-of-life gatherings or goodbyes with estranged family helpful for the patient? CLAUD Regarding the matter of visits with estranged family members, I would never want to use the word or concept of force. We can encourage and advise, but ultimately the decision to ‘make amends’ would be in the hands of the patient and family members. We often hear someone say, “you need to give her permission to go.”But, some people are not able to do that. Everyone grieves in his/her own way, and the role of the social worker is to be present, start where she/he is in the process, and encourage expression of thoughts and feelings within his/her own level of comfort. Reconciliation and forgive- ness are important for both patient and family members. However, it is not our role to enforce this — only encourage, educate and support. Has the pandemic had an effect on how hospice is delivered (e.g., nursing home lockdowns, challenges with PPE for workers, etc.)? WOOTEN Like all healthcare providers, hospices have had to get creative to ensure that our patients and families receive the care they need while keeping them and our staff safe. Early on, the PPE shortage was very challenging, but we chased it down through multiple traditional and nontraditional sources to meet our needs. One of the most difficult parts of the pandemic has been dealing “We have a whole team that takes care of these families, and we even take care of them after the patient dies. That just does not happen anywhere else in healthcare.” —BRIAN BELL, MD