Who Is on the Hospice Care Team? Understanding the People Who Support You
One of the most frequent questions when families start to learn about hospice care is, who will be providing care?
A hospice does not consist of a single person. It is a team effort that involves trained personnel to help with physical comfort, emotional well-being, spiritual needs and quality of life of the patient. The hospice team also educates, guides and supports family members and caregivers emotionally.
The interdisciplinary hospice care team is the group that these professionals are part of. The members of each team provide a different kind of support. Some are concerned about pain and symptom relief, others help with personal care, emotional issues, spiritual needs, practical resources, or loss and or grief support.
Knowing the members of the hospice care team can help relieve patient and family anxiety and doubt. It may also help to understand who to reach out to, what services are available, and how hospice services work for the entire family.
This guide discusses who staff members on the hospice team are and what they do, and how each person on the team works with the others to deliver compassionate, patient-centered care.
Hospice services will vary based on the patient’s specific needs, plan of care, geographic area and type of coverage. Talk to your hospice provider about your situation.
What Is the Hospice Care Team?
A hospice care team is a special team of professionals that supports the person with the life-limiting illness when they are striving to keep the person as comfortable as possible and have as good a quality of life as possible.
Hospice care isn’t about curing the terminal illness as much as it is about relieving the pain, controlling the symptoms, maintaining dignity and helping the patient to be as comfortable as possible.
Hospice care focuses on the person patient but extends care to the families and caregivers. In addition to physical health, a serious illness can impact emotions, routines, relationships, spiritual beliefs and responsibilities.
That’s why hospice takes a holistic approach to the whole person. No one member of the team should be responsible for fulfilling all needs. Each professional brings their unique expertise and collaborates with the others to develop a plan of care that is tailored to the patient’s needs, values and wishes.
The hospice team can consist of:
The Hospice Nurse
One of the most important people involved in the patient’s care is the hospice nurse. Hospice nurses evaluate patients, monitor symptoms, orchestrate care and educate families and caregivers about what to expect.
The hospice nurse can assist with:
Hospice nurses
A physician who is trained in hospice medicine or medical director of the hospice.
The doctor who is taking care of the patient.
Hospice aides
Social workers
Chaplains or spiritual care providers
Trained volunteers
Bereavement support professionals
Self-management of pain and symptoms
- Breathing difficulties
Nausea and/or anxiety or restlessness
Medication review and education
Any changes in condition of the patient.
We will address skin care and comfort issues
Medical equipment and supplies coordinated - Caregiver education
Information on when to call Hospice
The nurse can also describe what physical and emotional changes might be experienced during the course of an illness. This information may make family caregivers feel better about what is “normal” and how to make their loved one feel comfortable.
In the event that the symptoms and/or needs of the patient change, the hospice nurse discusses the situation with the physician and other members of the interdisciplinary team to assist in revising the care plan.
The Hospice Physician or Medical Director
The medical aspect of the hospice plan of care is provided under the direction of the hospice physician or medical director. The medical director collaborates with nurses and other staff closely to provide comfort-oriented care.
The hospice physician or medical director will:
- Reassess patient’s medical status
Coordinate care for those who are dying with hospice services.
In certain instances, certify patient’s terminal illness
Review and approve plan of care.
- Recommend comfort-focused treatments
Identify medications that help with symptoms - Give medical advice to the hospice staff
Coordinating with the attending physician of the patient.
Some patients receive care from the physician with whom they are already seeing during hospice care. On other occasions, the hospice doctor might be more involved.
The exact set-up will depend on the patient’s wishes, the role of the attending physician and the care plan.
The Hospice Aide
A hospice aide, who may also be referred to as a certified hospice aide or home health aide, provides personal care and support for the patient to help him or her feel clean, comfortable and respected.
A hospice aide can help with:
- Bathing
- Grooming
- Dressing
Shampooing and hair care - Oral care
- Skin care
- Changing bed linens
- Repositioning for comfort
Other personal care needs referred to in the care plan
Personal care is more than just doing daily tasks. It contributes to the patient’s comfort, dignity, and quality of life.
The hospice aide cannot take the place of the main caregiver. Rather, the aide receives scheduled care under the care of a hospice nurse and as outlined in an individual plan of care.
The Hospice Social Worker
The social worker at the hospice provides counseling for emotional, practical and family needs.
Difficult conversations, caregiver stress, financial, family disagreement, and complicated decisions can come along with a life-limiting illness. Hospice social workers are available to assist patients and families with compassion and practical advice in coping with these challenges.
The social worker at the hospice can help with:
Emotional support for patient and family members.
Caregiver stress and coping
- Family communication
- Advance care planning
- Funding and resources for the community
- Support for practical issues
Support provided during transitions in care.
Provide assistance in challenging conversations - Anticipatory grief support
Families may be able to benefit from social workers when they are feeling overwhelmed, require assistance in understanding resources available to them or wish assistance in discussing end-of-life options.
The Chaplain or Spiritual Care Provider
The hospice chaplain or spiritual care provider meets the spiritual and emotional needs of the patient, using personal beliefs and values, culture and preferences.
Patients do not have to be religious in order for spiritual care to be offered to them. Hospice chaplains are available to assist people of all faiths and those who have no faith.
There are various ways that spiritual care can be provided, such as:
Listening to patients’ fears, questions and hopes
When asked, giving prayer
- Supporting spiritual reflection
Talking about peace, forgiveness, or legacy, or meaning.
Supporting the patient’s faith community
Providing rituals and/or blessings when requested
*Supporting others in times of distress
The chaplain’s job is to attend to the patients and their families, and to communicate in a way that is meaningful to them, rather than forcing personal views on them.
The Hospice Volunteer
Well trained hospice volunteers can offer companionship and supportive presence with the clinical team in a way that supports the clinical care.
Support can be provided as follows:
- Companionship and conversation
- Reading aloud
- Listening to music
Seeking privacy with the patient
Helping patients to engage in meaningful activities
Providing a chance for caregivers to momentarily rest and relax
The volunteers at Hospice do not give medical or personal care. They are expected to provide companionship, connection and supportive presence.
Bereavement Support
Support from hospice does not stop when you die! There may be bereavement services to assist loved ones in understanding and grieving.
Grief is unique for each person. Grief does not have any one right or wrong sequence, there is no “right” or “wrong” way to grieve.
Hospice bereavement support can provide:
Supportive calls and outreach
- Grief education
Employees receive information about common grief reactions. Counselling of staff on common grief reactions.
Provide community grief resources on referral - Memorial opportunities
Offer assistance during holidays and anniversaries
Information for family members following a loss
Bereavement services let families know that they are not alone in their experience of bereavement.
The Hospice Care Team works as a team.
Cooperation is one of the greatest assets of hospice.
The patient is not provided with fragmented services by professionals who do not communicate with each other. Information is shared on a regular basis among members of the hospice team, patient’s condition reviewed for changes, and services planned for in the plan of care coordinated.
For example:
When the patient develops new or worsening symptoms, the nurse can consult with the physician.
Where the caregiver feels overwhelmed, the social worker can make an emotional and practical support available.
The chaplain can be more involved if the patient requests spiritual support.
When personal care becomes more challenging, the hospice aide’s care may be modified based on Plan of Care.
The bereavement team can provide advice and support to the family if requested if they have any concerns relating to grief.
This collaborative effort ensures care is responsive, caring and patient-centered.
Families can expect to receive the following from the Hospice Care Team:
While each individual’s plan of care will vary, the hospice team typically educates, guides and supports a family through the hospice process.
Families and/or caregivers can be supported by:
Knowing how patient is changing
Knowing how and when to reach out to hospice.
Understanding how to care for the child on a day-to-day basis
- Knowledge of medicines and soothing techniques
Managing pain and other symptoms
- Co-ordinating hospice related equipment and supplies
- Driven to try to heal the wound of the cross for everyone.* Seeking spiritual and emotional encouragement.
Planning ahead for the stages of the disease
Post loss bereavement resources – after loss access
Hospice does not mean that the family alone will have to do it all. The care team will be available to guide and support the patient and family.
Does Hospice Care only have to be in the home?
Hospice care is not restricted to a private home, it can be provided in the patient’s home.
Hospice services can be delivered in:
- A private home
An assisted living community:
A memory care community is located here.
A facility wherein the patients are cared for by skilled nurses.
A residential care center
An alternative residence that the patient feels is home.
In any situation, the aim is the same – to keep patient comforted, to make life easy for them, and give them compassionate care.
Should anything change, who should you call?
One of the best pieces of comfort in hospice that a patient can have is that they know they have a care team that they can reach out to in case their condition shifts.
If the patient has any of the following symptoms, the family should contact the hospice team:
For any new or worsening pain
- Difficulty breathing
- Uncontrolled body movements and/or inability to stay still while seated *
- Trouble swallowing
- A fall
- Medication concerns
Changes in alertness or behavior 11.2% of the time.
New or worsened symptoms
Any change that relates to the patient/caregiver
The nursing team member who is the first to notice a difference in condition is typically the hospice nurse. The nurse will be able to offer advice and consultation to the doctor or other team members if needed.
The hospice team is always available to answer your questions and address your concerns.
The Hospice Care Team is important because…
End-of-life care is more than medical care. The patient may require symptom management, personal care, emotional support, spiritual guidance and support for maintaining comfort and dignity.
Caring for a loved one can require family members to be educated, reassured, provide practical resources and support.
These are all aspects of support combined in a coordinated way by the hospice care team. Each team member plays a part and has the same objective, to maximize the patient’s comfort and quality of life and to support the people who love them.
One of the single best things about hospice is that it is not a service that is provided by one person. They are accompanied by an experienced and caring team.
What is the Hospice Care team? Who is the Hospice Care team?
Who makes up the hospice care team?
Members of the hospice care team can include nurses, a physician or medical director, hospice aides, social workers, chaplains, volunteers, and bereavement support professionals. In what services are provided depends on each patient’s specific needs and treatment plan.
What is a hospice nurse’s role?
The hospice nurse evaluates the patient’s condition, works to manage pain and symptoms, reviews medications, accompanies patient on comfort issues, teaches caregivers, and coordinates with the physician and other care team.
What does a hospice aide do?
The hospice aide may provide assistance with bathing, grooming, dressing, skin care, oral care, changing linens, and other personal needs outlined in patient’s plan of care.
What is the role of a hospice social worker?
A hospice social worker offers emotional support, assists caregivers with stress and family communication, links family to practical resources and counsel through challenging decisions and transitions.
Is religion required for one to be supported by the chaplain?
No. Chaplains in hospice work with people of varying cultures, personal belief systems, and faiths. They also might be a source of assistance for individuals who do not follow a religion but would like to be listened to and supported in a compassionate manner.
Are hospice volunteers nurses?
No. Hospice Volunteers are not trained in providing medical or personal care. They can provide companionship, talk, read, play a song or provide a quiet, supportive presence.
Are relatives welcomed into hospice?
Yes. Hospice provides education, emotional support, spiritual care, practical guidance, community resource and bereavement services to family members and caregivers.
Does hospice care just happen at home?
No. Hospice care can be delivered in a private home, assisted living community, memory care community, skilled nursing facility, residential care facility or other suitable setting.
You can find additional answers in our frequently asked questions about hospice care.
Who should be notified if the patient’s condition should change?
If you notice new or worsening symptoms, or if you are concerned about pain, breathing, restlessness, medications, swallowing, falls or other changes in your patient you should get in touch with the hospice team. The hospice nurse is usually the first person that a person goes to.
The provision of hospice care is a team effort.
Hospice is NOT a singular service from a single person. It’s a multi-agency, cohesive team approach focusing on comfort, dignity, respect and quality of life.
Support from different professionals is different – Nurses, doctors, hospice aides, social workers, chaplains, volunteers and bereavement professionals all offer different kinds of support. They collaborate as a team to respond to a patient’s holistic needs and convey information and support to family members.
Learning more about the hospice care team will help you feel less overwhelmed. Hospice is not leaving patients or families alone. It’s about providing them with compassionate professionals who can assist them.
If you would like to learn more about hospice care, please contact Canestro Care Hospice. Please give Canestro Care Hospice a call to learn more about hospice care.
Compassionate, patient centered hospice care for patients & families throughout Southern California is offered by Canestro Care Hospice.
Contact the hospice care team for questions regarding hospice eligibility, the hospice care team itself, and/or how soon care can start. We are here to listen, answer your questions and provide you with information about your choices.
Contact Call Canestro Care Hospice at (844-978-2100) or visit their website to find out more at canestrocarehospice.com