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The Nantucket Model of End-of-Life Care
by Charlene Thurston,RN,ANP,Hospice Director, from the Spring 1998 Hospice Currents Newsletter
The quality of care at the end of life has become the topic of hot public debate these days, especially in the light of the now fairly well know Support Study, which reported that, in the five excellent medical centers studied, the majority of the dying patients were receiving care that was far below the quality we’d like for ourselves or those we love. Since that report, many initiatives have been developing in hospitals and other care agencies around the country, in order to improve their end-of-life care.
Although hospices throughout the country have received very high marks for the quality of care which they provide to the terminally-ill, the fact is that most patients don’t die in hospice programs, but in mainstream hospitals. Since, in almost all other communities, hospice services are provided mostly in the patient's home or nursing home, terminally-ill patients in hospitals often do not access hospice care. Therefore, most hospitals are now trying to figure out how to improve their care of their patients who are dying.
Fortunately, in Nantucket, a group of people who represented both the community and the Nantucket Cottage Hospital, had the vision to create a program which would meet the needs of all terminally-ill patients, regardless of where they were located-at home, in the hospital, or in the nursing home-and developed a program which is now quite unique in the healthcare world. During this time of emerging concerns about how to integrate hospice services into hospitals and home health agencies, we have been participating in discussions and have been showing other communities our model-the Nantucket Model of End-of-Life Care. ( note the schematic which follows the article)
Interestingly, what we’ve been doing all along-focusing on the needs of the community, rather than on organizations or insurers - has caught the interest of others in the healthcare field, and we’ve been interviewed by reporters for two industry newsletters and invited to speak at the Annual Meeting of the Hospice Federation of Massachusetts. We’ve also participated in the Last Acts Conference, a national conference sponsored by the Robert Wood Johnson Foundation to increase the dialogue about end-of-life care.
Included in this newsletter is the schematic which we exhibited at the Last Acts Conference and which outlines how we in Nantucket join forces as healthcare programs to provide our island residents and visitors with high quality end-of-life care.
Francis Peabody said that, “the secret to the care of the patient is to care for the patient.” Keeping the patient, and , therefore, our community, at the center of all decisions we make, enables us to do what’s best to meet their needs, and to collaborate as healthcare providers in our effort to do so. Too many programs in other communities have lost their direction, side-tracked by demands of insurers and other economic or competitive organizational concerns. We’re very proud to have remained true to our mission and to the vision which was developed almost fifteen years ago.
The Nantucket Model of End-of-Life Care:
ONE SMALL COMMUNTIY’S APPROACH
GOAL: to integrate hospice philosophy, standards, and skills into the general healthcare system, thus empowering all healthcare staff to provide excellent care to all terminally ill patients in our community.
Concept: *”Sharing the Care” -The Hospice Team works “alongside of”, not “in place of,” the general healthcare team in providing care, thereby complementing care, mutually sharing skills, and fostering peer relationships among professionals.
*"Shared care" concept was described by Ms. Prue Clench of Dorothy House Foundation in England, as a model used by the National Society of Cancer Relief’s service of MacMillan Nurses in Great Britain, in which nurses who specialize in terminal care function within the primary care team.
Nantucket Cottage Hospital
Hospice Care of Nantucket Foundation operates program provides community oversight, support
Hospice Care of Nantucket
Supportive Care Program
Hospice Team works with Primary Care staff to provide care and consultations to patient/family with any stage of life-threatening illness in any setting-home, outpatient, hospital, nursing home
Home Care Hospice
Hospice Team works with the Home Health Department Staff to provide care to the patient/family in the home setting
Nursing Home Program
Hospice Team works with the Nursing Home staff to provide care to the patient/family in the nursing home
Inpatient Palliative Care Program
Hospice Team works with inpatient hospital staff to provide care to the terminally-ill patient/family in the hospital setting
Professional Education
Didactic ---Consultative -- Role Modeling
through shared patient care with health care staff throughout the community
Community Outreach & Leadership
Grief Counseling
Public Education
Consultation to schools, workplace, etc.
Hospital based resource center
Newsletter (community education)
Pain project
Community action response to needs
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