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The gifts of hospice and home health care

Posted: November 29, 2011 4:51 p.m.
Updated: November 30, 2011 5:00 a.m.
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Hunter Hornsby

“We had a little angel on earth for 17 years,” Brenda Peters said about her grandson, Hunter Hornsby.

Hunter passed away Oct. 11 having lived with a severe case of Cerebral Palsy since he was born.

On a feeding tube since his first birthday, he outlived his life expectancy three times over.

“Our lives revolved around Hunter,” his mother, Tara Bostick, said. “We always made sure he was taken care of first. This was one of the hardest things you’ll ever do to take care of a child with special needs, but it’s also the most rewarding.”

Even though Hunter couldn’t do everything other children could, he still enjoyed life to the fullest.

“He was always smiling, even when he was in the hospital,” his mother said. “He knew he was loved.”

Peters agreed.

“He got the most joy from the simple things that most people wouldn’t even realize,” she said. “Like rain, or bubbles, or balloons. He taught me to stop and notice the little joys in life.”

From September 2010 to this June, Hunter bounced back and forth from medicines and hospital visits, Bostick said.

“He was getting worse,” she said. “2009 was better than 2010. 2010 was better than 2011.”

At first, the family used KershawHealth Home Health Care services to help with Hunter’s care.

“He finally got to where he wasn’t able to stay well as long as he used to,” Bostick said. “Sometimes you have to know when enough is enough.”

Hunter hated staying in the hospital, his mother said, so she refused to see her son spend his final days in an unfamiliar place. The family began to consider hospice care and how it would help.

“It was a hard decision,” she said. “When they first sent the hospice nurses in to talk to us, my first reaction when they walked in the door, I put my head down and started crying. It was almost as if someone had sent the grim reaper in the room.”

Hospice is a multiple disciplinarian service offering care for patients with life-limiting illnesses through nursing, chaplain, social work and volunteer staffs.

Bostick said the more she learned about hospice, the more comfortable she became with the decision.

“Because when you hear the word ‘hospice,’ the first thing you think of is death. But hospice is so much more than that, and people don’t always know that,” she said. “Hospice doesn’t mean you’re going to die next week, or even next month. Hospice can be a short time or longer time, and they helped us to understand what they could offer.”

While Bostick knew in her heart hospice was the right direction for Hunter, her mother, Peters, struggled with the decision.

“They told us that, sometimes, hospice can cause conflict in families and, in the beginning, we were not on the same page about hospice coming in,” Peters said. “I felt like I was giving up on Hunter.”

Bostick said she understood how her mother felt.

“She felt like she was giving up, and I felt like if it had to be this way, that as his mother, I was going to help him go as easy as possible,” she said. “I already knew all the medical information. I had prayed about it. I had sat down and said ‘God, you gotta guide me. I don’t know what to do and I want to make the right decision.’ I knew that the hospitals and doctor’s offices was not the way for Hunter … I was not going to put him through this vicious cycle.”

Peters said she finally understood what her daughter was saying.

“It comes to a point that it’s out of your hands,” she said. “There is nothing you can do, when we’ve given our resources and we’ve given our all.”

“His little body is only going to fight so long,” Bostick said. “It’s not going to matter how long we want to fight for him or if we wanted to fight for the rest of our lives. No matter how hard we fight, it’s not going to matter if his body isn’t strong enough.” 

“Even though I understood, it was still very hard to accept,” Peters said.

Hospice served Hunter for three and a half months.

“They were only a phone call away, 24 hours a day. No matter when we needed them, or when we called and asked them to come, they were always there. Ready, willing and available,” Bostick said.

She said she was grieving while Hunter was on hospice.

“But I said to myself, I don’t have time right now to cry or to hurt. Right now I gotta do what I gotta do and get him through this. I’ve got to do whatever he needs. My hardest time is … now,” she said through tears. “You have to be a special person to work with hospice. You’ve got to have a big heart. We love him. We want to touch him. We want to smell him. We want him here. We miss him, but sometimes you have to think about quality of life, not quantity of life. I tried to do that with Hunter, but it was still hard.”

Peters agreed with her daughter.

“(Working for hospice) is not something I could do. It’s truly a gift these people have,” she said. “We miss him so much, but we know he’s in a better place where he can walk and play. When it’s our time, we’ll see him again one day.”

About Hospice

The goal of KershawHealth Hospice is to “manage our patients’ symptoms in the best possible way,” said Kathy McMaster, director of KershawHealth Home Health and Hospice. Death is the natural progression of life, she said, and as uncomfortable as that is, it’s going to happen to all of us. And that’s where hospice comes in.

“We cater to the medical care, social, personal and spiritual care needs of the patient, as well as the family,” she said.

One common misconception of hospice, McMaster noted, is that all hospice patients are cancer patients.

“We take care of many patients, not just those with cancer. They may have congestive heart failure, COPD or Alzheimer's disease and we cater to all of them,” she said.

Another part of hospice care is timing of services.

“One very important aspect of our services is the timing of the family bringing a patient in,” Susan Coats, RN, KershawHealth Hospice nurse manager, said. “Timing is very important so they can benefit from the hospice care. Many times, people will put these decisions off so we’re limited in terms of care that we can provide.”

Another aspect of the services hospice offers, McMaster said, is that they allow people to age in place and avoid unnecessary admissions into the hospital.

“Nine of 10 people say they want to die in their home,” she said, “but four out of five won’t.”

Not only does hospice allow patients to be in a familiar place during their final months, but it saves the family money.

According to the National Association of Home Care and Hospice, the average cost of spending one day in the hospital is $5,765. A day in a skilled nursing facility will cost $544 per day, but a home health visit will only cost $132.

“It’s a significant difference,” McMaster said.

In early November, KH Hospice was serving 25 patients

Another common misconception McMaster addressed is that some people think all hospices are the same.

“Sometimes people think that a hospice is the same hospice no matter where you are. That’s not necessarily true,” she said.

There is a difference between non-profit hospices, like KershawHealth Hospice, and other for-profit hospice agencies.

“The biggest difference between the two is who we cater to,” McMaster said. “Our mission is to take care of those in the community regardless of the person’s condition. We take care of all patients. We can’t turn anyone away.”

While McMaster emphasized that for-profit agencies can offer exceptional care, they may not be able to accept everyone into their programs.

“We can accept Medicare, private insurance and charity cases,” she said. “Some agencies might say ‘we don’t have the financial capabilities to take care of that patient’ whereas we see it as our mission to take care of those patients. We’ll find the funding to take care of them.”

KershawHealth Hospice serves eight counties: Kershaw, Lancaster, Chesterfield, Fairfield, Darlington, Lee, Richland and Sumter.

About Home Health

Home health care differs from hospice in that the patient receiving the services is expected to fully recover, and the services are limited to serving only the patient’s physical ailments.

Home health care is designed to provide “short intermittent care,” not custodial care, said Amy Williams, registered nurse manager for KershawHealth Home Health. The services are limited to patients within Kershaw County.

For a patient to qualify, he or she must have a skilled need of nursing or therapy. The home-based care is typically followed after a patient has been released from hospitalization, rehabilitation or a nursing facility and still needs assistance to recover.

“The goal is to get the person back to where they were before the injury or accident or incident,” Williams said.

Robert Powers of Camden broke his heel, dislodging his Achilles tendon earlier this year while working on a friend’s deck.

After returning home from the hospital, Powers’ foot became infected.

“If it hadn’t been for the nurses in home health, I could have lost my foot. They were able to advise me what I needed to do and when I needed more help,” he said.

Powers said the first doctor he saw thought his foot was healing fine, but his nurses urged him to get a second opinion just in case.

“Actually, if wasn’t for those ladies who encouraged me to get a second opinion when the first doctor said nothing was wrong, I may have lost my foot,” he said.

Powers got a second opinion from the Augusta Burn Center and, as it turned out, there was a second infection.

“I’ve still got too many youngins’ home to be losing a foot!” Powers said. “I still have a limp, still need time to get everything right, but I’m hoping for a full recovery. I’m a lot better now than I was, I see the light at the end of the tunnel. All I can do is sing praises for the nurses at home health. They’ve been very good to me.”

KershawHealth also offers a bridge program between home health care and hospice.

“Say a patient is actively seeking treatment,” Coats said. “They will be assigned a nurse trained for both Home Health and end-of-life care in the event that the patient needs to transition from one program to the other. This way they can keep the same nurse and social worker they’ve had all along, and we just add to their services.”

For more information on KershawHealth Home Health Care, call 425-1182. For information on KershawHealth Hospice, call 425-1916.

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