Hospice coordinater dedicated to her patients

Q and A

Melba Montague, 45, a registered nurse, is clinical coordinator for Plains Regional Medical Center’s Home Health and Hospice program. This is the 25th anniversary of National Hospice Month, first declared by President Jimmy Carter.

Q: In your words, describe the hospice program.

A: It is being able to allow our loved ones to die in the homes where they would rather be and to provide good, quality, end-of-life care. … One thing a lot of people don’t understand is that in Lubbock or Amarillo they have a hospice home that provides 24-hour care. In the rural area where we are, we don’t provide intermittent care. The family is the primary caregiver. We provide supplemental care through nursing and different disciplines.

Q: Who qualifies for the program?

A: They have to have a terminal illness with an expected death within six months. That’s basically it. They have to have a physician willing to call us with a referral.

Q: How many hospice patients are involved in the PRMC program now?

A: We’re at six (on Wednesday). We normally run from five to a dozen.

Q: Will insurance cover costs for the program?

A: A lot of our (services) fall under the Medicare benefit. … In my experience, most of your different insurances do have a hospice benefit as well. … We will not turn someone away based only on finances and the ability to pay.

Q: As the program coordinator, do you become involved with the patients?

A: As part of the home healthcare and hospice staff, we take turns being on call. So I do make home visits. This month, I have admitted three patients to home healthcare and hospice after hours. So I do some nursing.

Q: Do you feel like your work is more stressful than that of any healthcare professional?

A: The stress in our job is the amount of involvement you have with family. In the hospital you have so many doctors and patients and aides all wanting you at the same time. In home healthcare and hospice you have the luxury of attending to patients one at a time. You devote your attention to their needs.
You come to know family members, come to learn the name of the dog; you get more involved in their care, so the stress is when you lose them you feel like you’re losing a family member.

Q: How do the caregivers avoid depression?

A: We’re required to have 12 hours of ongoing education a year. I think more importantly it’s our team approach. When one of us hurts, we all jump in and console one another. We listen to one another and help one another problem solve. We try to help keep one another lifted up. When one of us is having a bad day, others pitch in.

Q: How many staff are involved in home healthcare and hospice?

A: We have 12-15 nurses (and) about 10 home health aides (required to have 80 hours of on-the-job training).

Q: How do you deal with matters of faith?

A: When you take someone into the program we are not judgmental; we are not going to inflict our own beliefs on them.
As part of the hospice program you are offered spiritual assistance.
We have two hospice ministers. If they have their own minster who will follow them through the process, that’s great. If they do not and they wish for us to send out our hospice chaplain or minister, then we will do that.
But we are going to respect the patient’s desires. We have had atheists and they have their own beliefs and we have to honor their beliefs.

Q: How do you deal with requests for assisted suicide?

A: That’s not hospice. We do not go there.
In hospice philosophy, you do nothing to prolong death, but you also do nothing to promote death.
We explain that in the hospice philosophy we see to it they have their symptoms controlled — pain, constipation, urinary problems, nausea or vomiting (for example). If they ask us to assist them with medication to promote death we would have to decline. That’s not our belief or philosophy.

Q: Do families ever argue on issues related to patient care?

A: It happens a lot. There are a lot of family dynamics that we help to resolve. We have a social worker we call if things become extremely bad.
Normally you have a sibling (or other family member) who’s really a gung-ho caregiver … who has been through it all and then (another family member) will show up from out of town in the last days and they are alarmed. … It’s just a lot of family dynamics that we deal with on an individual basis.
Every family is different.

— Compiled by CNJ Editor David Stevens