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February 1, 2018

Needham Nurse Practitioner writes about hospice care
Needham Patch

by Hallie Kasper, Care Dimensions Hospice & Palliative Care Nurse Practitioner

Jane’s adult son and daughter had flown in from the other side of the country for a family meeting I was holding to discuss goals of care and the possibility of hospice care for their mother, 93, who had a history of dementia and lung problems, and had just suffered a stroke. Jane required private care around the clock, while only weeks before, she had been independent. In tears, Jane’s daughter asked several questions; “If mom is going on hospice, does this mean she is dying now?” “No,” I answered. “Will her primary care doctor of 40 years still be able to take care of mom?” “Yes, her doctor will remain her doctor and in charge of her care.” “What if she falls or gets a fever?” “We will make her comfortable and decide the next steps together.”

Dying, although part of life, is frightening and lonely for both adults and children but it doesn’t have to be. With more than 15 years of experience in supporting and caring for adults and children living with a life-threatening disease, I have been witness to this unimaginable journey many times. As a hospice nurse practitioner at Care Dimensions, I work as part of a multidisciplinary team made up of a nurse, social worker, chaplain, volunteer, hospice aide, physician and bereavement counselor. This inclusive and collaborative approach is one of the founding core concepts of hospice. Together, we offer medical, psychosocial, spiritual, and bereavement support to the patient and his/her entire community. This can be at home, in the hospital, in assisted living and long-term care facilities, even at school. To many people, healthcare providers and the general public alike, the idea of hospice can be scary and suggestive of giving up hope. I would like to explain why inclusion of hospice care should be welcomed, and should be seen as a source of comfort and yes, hope. 

Hospice is focused on comfort and quality of life, ideas that I believe we can all relate to, especially in the setting of being very sick. Picture having your primary medical team in the hospital working to make you feel better and having a hospice team that comes to your home to execute that plan. The home hospice team can be very involved or just in the background, depending on what you want and need. When the time comes that a patient can no longer get to the office for check-ups, hospice is able to provide many of the same comfort measures that would have been provided at the doctor’s office or hospital. And we do this in collaboration with the patient’s primary clinicians. In addition to being able to bring hospital equipment such as a bed, oxygen or wheelchair, we have a hospice nurse conduct regular assessments that are reported back to the primary clinicians. We can have home health aides come to assist with dressing/bathing, if needed. If you are interested and it will help provide support, your hospice team can also include a music therapist, volunteer, social worker or chaplain to offer resources and emotional support, and a child life specialist for any children affected by the illness. Hospice provides comfort and support to the entire family; not just the patient. 

Early integration of hospice and collaboration between acute/chronic care providers and hospice offers continuity of care. The goal is for the patient to know the hospice team before a crisis. Enrolling in hospice enables the shift in focus from acute care to comfort care. And, it empowers patients to have control and choices when many other aspects of life are out their control.

Hope. If there is one message I would like to leave you with it is that hospice and comfort-directed care always includes hope. While hope for a cure or a return to good health may no longer be possible, hospice helps redefine hope. It can be hope of making sure every day is the best possible, hope to achieve personal goals, hope to be comfortable, or hope to enjoy time with friends and family. For Jane, because of hospice involvement, she was able to remain at home with her caregivers. Eight months later she died peacefully in her own bed with her children and family at her side.

Care Dimensions has had the privilege of providing hospice, palliative and bereavement care for patients and their families since 1978. We have an extensive arsenal of specialists, both medical and ancillary who provide individualized care and dedicated programs for special populations. These include a cardiac program, veterans program, pediatric program, to name just a few. As we continue to grow our services, we are looking to team up patients, families, and healthcare providers to offer comfort and hope at the end of life. If you would like to learn more about hospice care, please visit www.CareDimensions.org or NHPCO.org.


Since 1978, Care Dimensions has provided comprehensive and compassionate care for individuals and families dealing with life-threatening illnesses. As the non-profit leader in advanced illness care, we offer services in more than 90 communities in Eastern Massachusetts.