Franciscan Hospice and Palliative Care
Cindra Jones
BSHS301
September 29, 2012
Christopher Bingham

FRANCISCAN HOSPICE AND PALLIATIVE CARE
I chose Franciscan Hospice and Palliative Care because I am interested in the valuable service they provide to the community. I wanted to know exactly what they do and how it is paid for so I made an appointment to talk to someone at the Franciscan Hospice and Palliative Care facility.
Hospice is care designed to give supportive care to people in the final phase of a terminal illness and focus on comfort and quality of life, rather than a cure. The word “hospice” comes from the Latin “hospitum” meaning guesthouse. It was originally a place of shelter for sick and weary travelers.
Palliative care is the treatment and relief of mental and physical pain for those with a life threatening illness. This treatment uses several types of therapy to make a person comfortable and free of pain.
I was very fortunate to meet Pam Ketzner, the hospice educator and registered nurse at the Franciscan Hospice and Palliative Care facility located in University Place, Washington. Pam is in charge of educating the hospice nursing staff. With new equipment and medications always becoming available, she instructs the nurses on their proper use. She has been a nurse for 35 years. She was a visiting nurse to begin with and then became the head of education so she spends most of her time at the facility. She feels very privileged to be a part of incredible moments she has observed with the patients and their families she has worked with. She describes her job at Franciscan Hospice and Palliative Care as very gratifying. Pam is very passionate about her career. She was nice enough to take time out of her busy day to tell me about Franciscan Hospice and Palliative Care.

NATURE OF THE PRACTICE SETTING AND INTERVENTIONS PROVIDED
Franciscan Hospice is a service organization for patients that have a terminal illness that has advanced to the point where curative treatment is no longer effective or desired. Franciscan Hospice is the largest most comprehensive provider of hospice care in the South Puget Sound. Their goal is to help people with life limiting illness to live with comfort, and meaning and to retain their individuality and control over their lives. Hospice care is flexible by nature with care programs that are put together according to each individuals physical, emotional, and spiritual needs.
The treatment starts with a recommendation from a physician for their patient to attain hospice care.
Palliative care is another service offered to any patient without restriction to disease or prognosis and can be appropriate for anyone with a serious, complex illness, whether they are expected to recover fully, to live with chronic illness for an extended time, or to experience disease progression.(Palliative Care) Franciscan Hospice and Palliative Care offers a Palliative Outreach Program. This program is to help with advanced care planning, pain and symptom management and an expert care assessment. These consultations are usually done at the person’s residence. The residence could be a private family home or a long term care facility. Usually an advanced registered nurse, (ARNP) or a physician assistant, (PA) will visit and share the outcome with the patients’ physician. Social workers are also available to help patients find valuable community resources.

TARGET POPULATION
Franciscan Hospice offers services and support to all people and their families regardless of gender, nationality, creed, sexual orientation, disability, diagnosis, and availability of a primary care giver or ability to pay. They offer services to those eighteen and above. Mary Bridge Children’s Hospice is available to those younger than 18. (Ketzner, P) Franciscan Hospice is trying to make improvements in the diversity of care. They want people to know that everyone no matter where they are from are able to receive hospice care. They have started making pamphlets in different languages and have received feedback from some nationalities how they would like their pamphlet to look like. For example the Spanish speaking people requested their pamphlet to be one sheet with Spanish on the front and English on the back. The Korean people preferred a pamphlet in their language with a picture of a Korean family on the front. They are making pamphlets for as many different languages as they can so everyone is included. Homeless people, developmentally delayed, and people with mental health illness are included as well.
Franciscan Hospice and Palliative care serves all of Kitsap and Pierce counties and as of October 01, 2012, King county will also be served. This may cause a need for another building to be built most likely in the Seattle area. In the state of Washington hospitals and hospices are approved only with a certificate of need (CON). (Certificate of Need) The Franciscan Hospice and Palliative Care has been granted with a certificate of need for a 20 bed unit. If they find they need more room, they will need to apply to the State.

MISSION STATEMENT
The mission statement of Franciscan Hospice is made up of several statements. * To affirm life. * To ask people how they want to live their final days. * To appreciate and remain sensitive to the ethnic, cultural, religious and lifestyle diversity of terminally ill patients and their families. * To support, affirm and empower families as caregivers. * To provide quality hospice services in a timely manner to all who qualify regardless of race, religion, sexual orientation, ethnic background or ability to pay. * To meet the patient and family in the least intrusive way. * To recognize the unique stressors inherent in hospice work and provide access to ongoing support for all staff and volunteers. * To enhance the care of all dying in the community by education and example.
Franciscan Hospice exists in the hope and belief the through appropriate care, and promotion of a caring community sensitive to their needs, patients and their families may be free to attain a degree of mental and spiritual preparation for death that is satisfactory to them.
HOW AND WHAT SERVICES ARE PROVIDED
Franciscan Hospice is made up of many professionals and volunteers. It starts with a recommendation from a physician for their patient to have hospice care. The physician is informed of how the patient is doing all through the process. There is a hospice nurse that visits the patient and keeps track of vital signs and medications. The primary nurse is available Monday through Friday. There is an on call staff available 24 hours a day, and for evenings and weekends. If for some reason the regular doctor can not follow the care needs of the patient, the hospice medical director takes over.
A social worker is a trained counselor who will help prioritize what is important to the patient. The social worker educates and makes referrals to resources to meet needs such as caregiving, homemaking, respite, food, shelter, legal assistance and financial arrangements. Social worker visits vary from one patient to another. The hospice chaplain is available for emotional and spiritual support. They have specialized training in hospice care and they can be very good listeners. The chaplain will follow whatever gives the patient’s life meaning. It is up to the patient if they need a chaplain or not. The chaplain can help with funeral plans but they are not permitted to officiate over the service. Certified nurse’s aides help with the personal care of the patient. They usually spend an hour with the patient and help them bathe, brush their teeth, get dressed, or whatever the patient needs. There is a bereavement counselor that provides support and education to help families understand their grief after the death of a loved one. Grief classes are also offered for those that want to take them,
Volunteers are also an important part of hospice care. They are trained to provide emotional support and usually help from one to four hours per week. The number of volunteers has to equal five percent of the patients that are in hospice care. There is also a special teenage volunteer program where teenagers are allowed to obtain credit for school. Since they are usually good with electronics, they often put together pictures and other memories for the family. Therapies are also available for a maximum of eight sessions. Massage therapy requires a physician’s order. There is also hypnotherapy which helps with relaxation. It also helps control pain, nausea and other medical symptoms. A patient can also choose to have aroma therapy, art therapy, or music therapy. There is also physical, occupational, and speech therapies available. A pharmacist and a dietician are also part of the hospice team.
Franciscan Hospice owns all their medical equipment that can be used in a patients home. This includes hospital beds, oxygen tanks, wheel chairs and many other items a patient may need. If a hospital bed is requested with side rails, there has to be a signed release since patients have been known to hurt themselves on the rails.
A patient may be admitted to the hospice house if everything has been tried in the home but the patient needs more treatment. They would be admitted to the 20 bed unit. They would then be treated and if things go well, the patient is sent home. There are times when the patient may pass away at the hospice house and the family is helped to deal with their loss by the hospice workers. Family members can stay overnight with the patient while they are being treated at the hospice house. There is also food and beverages offered to the families while they are there with the patient.
MOST COMMON CLINICAL ISSUES
The most common clinical issue is pain. The hospice care team is concerned with the comfort of the patient so they do what they can to alleviate their pain.
HOW ARE THEY FUNDED
The funding for hospice mainly comes from Medicare and Medicaid. Private insurance is also another source and charity is another way of funding hospice care. Franciscan Hospice and Palliative care is part of the Catholic Health Initiatives. They own many hospitals here in our country. Franciscan health system is part of Catholic Health Initiatives. The Franciscan hospice house is a department of St Joseph hospital. The Franciscan Foundation also funds St Joseph hospital and The Franciscan Hospice and Palliative care facility.
The Franciscan Hospice is proud to be the first to be using electronic medical records. The nurses use a tablet in the homes. They can pull up all information needed for the patient they are working with. The certified nurse’s assistant has an Ipad 2 to keep records of their visits.
Franciscan Hospice and Palliative Care is a very organized group of professionals and volunteers that are specifically educated in hospice care. They truly do anything they can to make the end of a person’s life as comfortable and pain free as possible. They give special education and care to the family members that are caretakers. They also support other family members and friends of the patient, through the grieving process. Because of hospice, a person can leave this world with the dignity they deserve.

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