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Melanie Cole (Host):   GHS Hospice of the Foothills provides care wherever the patient lives: at home, an assisted living long term care facility or at Cottingham House. How do you know when it's time to discuss hospice care with a loved one and what should you look for when choosing an agency? My guest today is Pamela Miller. She is the director at Hospice of the Foothills Cottingham Hospice House. Welcome to the show, Pamela. Tell us about hospice. First, for listeners that do not know what it is, tell us what hospice is?

Pamela Miller (Guest):  Hospice is a multidisciplinary group of people that's one of the health care providers in this nation that provides care to people who are at end of life or will be approaching end of life within the next six months, as determined by their physician. It's a group of people that would work with the patient, with the family, and with all of their support systems to help work through the issues that they will have to face as they approach the end of life.

Melanie:  How do you start that conversation about hospice with loved ones or with a family?

Pamela:  Well, that is one of the most difficult things, I think for people, including the health care professionals, such as the physician. We all want to make sure that we never ask anyone to give up hope and hospice is not about giving up hope. It's about helping people to live with a quality of life for the remainder of life that they have left. Oftentimes nobody wants to bring it up. Unfortunately, it's usually the patient or the family member that brings it up and says to the physician, "You know, we are really tired of fighting this battle. We don't want to continue all this aggressive treatment and painful treatment, at times. What are our other options?" And, oftentimes, when the family asks that question or when the patient asks that question, the physician will take the time then to talk about hospice as one of the options for that patient and that family. The way to bring it up is to simply ask the question, "Tell me about hospice and tell me about that option. Does it offer me something that maybe I'm not getting through the current treatments that I'm seeking?"

Melanie:   What if the families or the person refuses to think of the fact that this is an impending terminal situation?

Pamela:   The timing has to be right for the family and for the patient. We never would want to force on them anything that they were not ready for. Oftentimes, when we get a referral at our hospice, we go out and we talk with the family, we talk with the patient ,and we give them information about who we are, the services we provide, how we can help them, and how we can help the family as they approach end of life. They might tell us, "I'm not ready for this. I don't want to hear this. I don't want to give up hope. I don't want to quit these treatments. I want to continue seeking these aggressive treatments." That is certainly their choice and we support them in whatever choice they make, but we want to make sure that they have the information they need so that when the timing is right for them, when they have decided to no longer seek the curative care and they really, really just want the palliative care and the comfort and the quality for the remainder of their lives. We just want to have them that information, so when the timing is right they can make that choice but it's certainly their choice to make whenever the decision is.

Melanie:   Pamela, tell us about GHS Hospice of the Foothills and the different kind of care that you offer.

Pamela:   GHS Hospice of the Foothills is one of the oldest hospices in the state of South Carolina and certainly in the area in which we live in. We serve Oconee, Anderson and Pickens counties in South Carolina. That's who we're licensed to serve. We serve patients in their homes and assisted living facilities, in skilled nursing facilities that we have contracts with, and certainly in our Cottingham Hospice House, which is our in-patient facility. It's a fifteen bed facility where we can bring patients into the facility that maybe can't stay at home anymore, or their families can't take care of them anymore, their symptoms aren't being managed. We can bring those patients into the Cottingham House. Our hospice has been here since 1989. We're one of the oldest hospices in the area. We are not for profit organization. We are a part of the Greenville Health System. We have employees that have been with us a very long time. If you were to calculate the number of total years, it would be overwhelming. Our people are truly committed to what they do, to serving the families and the people in the area in which they live. I am proud to say that all of our employees do live in the communities that they serve and that's really important because they know these people that they are helping take care of. We're one of the oldest, again, and we've been an agency that has been committed to this county. We have very credential people. Our medical director is a Hospice and Palliative Care board certified, and you don't find that everywhere. We have about five of our employees now that are also Hospice and Palliative Care certified, so we're very excited about that. We provide a comprehensive set of hospice services, everything from the nursing care to the physician care, of course, to the social workers, to the certified nursing assistant, to chaplains that assist families in their spiritual needs. We have a bereavement coordinator as well that provides grief counseling and other services for people and families up to thirteen months after a patient has died. So, we have lots of different services within the scope of the interdisciplinary team.

Melanie:   Can you also help caregivers and patients with activities of daily life so that while they are in hospice, they still can go out and about, or do the things that they may want to do?

Pamela:   Absolutely. We encourage that because that's the quality that we are seeking for that patient and family. So, yes, we can send people in to assist them with their activities of daily living, whether it's a bath, whether it's a shampoo that maybe they can't do themselves. We have the people that go in and assist the family to learn how to help take care of that patient because a lot of people take these things for granted and we don't know how to help our loved ones when they need the help. So, yes, we also send people in to help the families to learn how to do that. We have gentlemen that we serve that all they want to do is continue to go fishing. We even have volunteers, male volunteers, that will come in and help the gentlemen who like to do sports type activities and they just want to do it one more time. We have volunteers who come in addition to our paid staff that help these people and provide services to them, to help them do the quality things they've always done and want to continue to do.

Melanie:   Are the physicians involved in hospice or do they then step back? How does that work?

Pamela:   There's a great myth about that out there. The myth is that “I cannot keep my own physician if I join under your hospice care,” and that is truly a myth. The attending physician that is always the primary physician that has always taken care of patients and their families can certainly also be the physician to help coordinate their hospice care and oversee the orders for that. We do have a medical director that works directly for the hospice that is involved in the care, the certification and signing the papers that the patient is, indeed, terminally ill as defined by Medicare. But, the physician that has always been that family's physician, can certainly have a big part in the hospice care and oversee it, write the orders, and control the day to day activities related to the physician orders without any problem whatsoever. So, yes, we encourage the physicians that have always been a part of their lives to continue to be a part of their care, if they choose to, and the medical director can act as the consultant as needed beyond that.

Melanie:   Wrap it up for us, Pamela--what great work you're doing for the community--about Hospice of the Foothills, what you want people to know?

Pamela:   The main thing I want people to know is what a hospice is--that we aren't about dying. We're about living; we're about quality; we're about providing compassionate care at a very vulnerable time in people’s lives. We honor the patient’s wishes; the family's wishes. We honor their rights and we do everything that we can to help them in the last--whether it's month or year--of their life, however long that life may last. To be able to provide things that are very important to them; to support them in the decisions that they make; and to help their family to learn how to cope and deal, not only with the time that they have left and the issues they'll face, but, again, up to thirteen months after they're gone so that they, too, can continue to live a productive life.

Melanie:   Thank you so much. You're listening to Inside Health with Greenville Health System and for more information on Hospice of the Foothills, you can go to ghs.org/hospice. That's ghs.org/hospice to learn more.  This is Melanie Cole. Thanks so much for listening.