here and bereavement programs there and al smith a long term and very devoted volunteer with the hospice care program thank you so much andrea and al thank you for coming today and sharing your benefits of and the experience with hospice care programs thank you area would you begin by telling us something about the beginnings of in the history of hospice sure the hospice  when she took care of patients in hospital wards that when they were determined to be terminally ill people in the hospital from staff to the orderly as to even visitors would look the other way go to the patients that were determined to be well enough to go home she saw that there was both suffering emotionally and physically with with patients and determined to provide care to them to alleviate suffering on all  levels fast forward to the late seventy's early eighty's the movement had picked up steam in england and was brought to our country and you know hospitals would would have beds small parts of wings and hospital programs to take care of terminally ill people  by the nineteen eighties insurance companies were beginning to fund hospice it is covered now by medicare and most primary insurances for people under sixty five  the beauty of hospice is that it provides a team approach and palea to the care so those are the two outstanding features of hospice that make it different than let's say the visiting nurse programs we provide care to people not only alleviating their pain which is a very primary focus but also alleviating emotional suffering and spiritual anxiety all parts of the coping that people have to endure when they're terminally ill so the team approach i've been with boston as well and as the metro west area and i see in so many different settings how people are living very fully till the very end of life ok are there any special qualifications for receiving hospice care yes in order to be eligible for hospice care to doctors have to attest to the fact that a person is terminally ill  their own doctor in conjunction with whatever hospice program they choose that medical director they both agree that that person has six months or less to live and they become eligible for hospice ok and who does a family contact to print out if their loved going back does qualify for that it would be a dialogue with the patien physician chances are that specialists at this point have become involved or a primary care doctor has watched an illness with particular patient  progress and if the physician does not bring up hospice both the patient or the family you know can certainly raise the issue and that physician then will determine whether in his or her best guess that they have six months or less to live if so that the physician can recommend hospice diggler hospice or through research the family in the patient might get a name of a hospice and with any hospice program they would call the intake department and the screening will take place to make sure that they have six months or less to live in  hospices best guess so there are different types of hospice program sir there are there are different types of hospice programs and different types of hospice intervention location a hospice residence providing general hospice care and kind of a home away from home is one option hospice care can also be provided in the home where the hospice team which consists of the nurses the head of the team and then myself i'm a social worker so all the social work piece is part of a team then there's a chaplain to take care of spiritual for both the last three where my wife passed away back in march of two thousand and eleven i like what i saw and i got involved with various functions were dealing with what they were correct and we discussed hospice care about two years or so before she passed and the last time she was hospitalized up in mount auburn hospital she was suffering from the effects of bronchitis  ammonia and the doctor came in and she said mr smith what will happen is we will cure the the monia but her breathing level will be a different level than which she normally would do he was getting lower and lower on the scale of breathing capabilities two or illness and he said at some point there will be nothing more that medical science can do for your wife after hearing those words my heart sank from to the floor because i realized this was the end and the social worker came in and talked to us and recommend the various hospices and social worker mention parmenter and wayland being a resident i'll never forget that the day i die she raised their arm and said that's what i want and we made the arrangements and and that's we were discussing that for the last two years of real life and to this day i will always know in my heart that the reason one reason why she wanted hospice care was because she knew she was going to die and she didn't want to die in the in the in the bed we sleep in she wanted me to wake up one morning and look to my left and she would because that was the last thing she ever wanted from me because she was truly concerned so she says i a hospice care volunteer is there any special training and well there is training you know as as you do the you know the voluntary because you always run into circumstances that are a little bit different from the prior patient that you've seen but you have to be one really you have to be a caring person if in my case i was exposed to hospice care you know with my wife but that's not a prerequisite but you have to care you have to be concerned about the well being of the person you're saying no i do mostly residents calls rather than nursing home calls this is the living calls were even at the residence and what gives me the greatest pleasure and what i receive more than what i'm giving that client is for anyone who your audience who is a kid give it right now for a mother a father a husband a wife a child it's twenty four hours a day seven days a week fifty two weeks in the year that you have to be the kid giver and not only that you also have to be two people one you have to be your own person and the second person you have to be is you have to be the patients you have to know what they want what they don't want how they want to be treated and it's the biggest drain you will ever imagine on an you very being i my opinion being a caregiver is the hardest job you will ever ever do and that's why many people would families with the three children before children or ten children a lot of the children of the relatives of someone who is terminally ill shy away from it because they know they can't do it caregiving is a she is my expression is a stinker of a drug but it's rewarding it's helpful everyone it's caring i mean when you see the look of other patients face after you've washed them or fed them or given the medication or change their clothes or or put a blanket over them to keep them warm and you see the smile the look they give you if you pay attention to them it is worth everything right one of the things that al has done as a volunteer is give respite for those caregivers who are taking care of a loved one who is dying he shops for them sometimes brings the groceries and then chats he'll read to them help watch show with the patients him or herself and allow sometimes up to three four hours family member to go out with a friend catch a movie that sort of do something else yeah it is a go to a movie go shopping with one client the want to go to a bookstore because there was a book signing now you have the opportunity caregivers need relief yes or else it will eventually take its toll hospice and you asked a little bit about the training there is about two months of of training clinical training policies and procedural training and training but i have my volunteers in my perspective on two years shadow at our hospice residence the other volunteers as they go and provide friendly visiting to patien s bring them a snack or lunch that sort of thing so they do that a couple times and then they have an agency orientation and they're off and running so we put them through the ropes a little bit and you know al graduated with flying colors and you know has hit the road ever since but there's no licensing process or anything like that it's just well it's a certificate they get a certificate yes and they do have to do it's part of the regulation and the hospice team cannot exist without volunteers hospice programs through medicare and blue cross and  tufts and many other insurances will not be valid without volunteers day because they provide oh yeah no absolutely it is if we did not have if i did not have  r thirty volunteers we would not be a program you know every day i'm placing volunteers with with families that can provide the you know this the type of relief we're talking  about you know the nurses myself our chaplain even our children services coordinator if there are young children in the home you know we we don't spend the amount of time volunteers do and that's the whole point that's important you know in terms or everybody they say one hundred percent say yeah yeah that's right i'm curious now what's a patient has been accepted for hospice care by the two doctors and that andrea and andrea signs that patient to your care what is sort of the routine of your responsibilities you're going through the first time for this person well i try to introduce to the patient and also to the caregiver because i did not most of my calls are homes and one of the things that pops into my mind is my sister when she was very near passing away and the one thing she who do that's because if you don't have people available who do that right yes you do the part that they can't do that was just to stay there and be comforting and provide time and your heart and soul you know ye interesting way of sort of providing care because there's a sort of a daily budget that we all have to you know sort of behind the scenes we have to take that into account but hospice covers a quick men like oxygen wheelchairs a bed a commode you know to make for home you know to make it a comfortable setting to get the medical care that they provide they provide to aides in nursing homes our own aides and our own team and what stands out even in nursing facilities in assisted living that visiting nurse programs can't provide are volunteers again it all goes around the volunteers who spend long hours  providing respite even to families in nursing homes we have volunteers that are in process of being trained to do vigils for dying people in nursing facilities and in homes to see you again provide exhausted family members or respite so they are definitely an arm of this hospice team we actually have some volunteers meditative relaxation technique to help people that are tense and anxious i'm training a new volunteer that is an expert in chinese medicine and she's going sixty five if you are over sixty five are you no longer eligible for hospice also know you any age at all if you're terminally ill you're eligible for hospice there are even children's hospice programs we do not take care of children in our program but there definitely are programs that do that a hospice is only getting more in the mainstream  more accepted option for end of life care and the research shows that people with the same diagnosis one does not has have hospice one is that the person on hospice actually lives longer than the person not on hospice and you know you mentioned children you have a whole huge program of care group her mentor has a children's program it's called heart play we also have a three day summer camp we are the player named jamie moyer but that organization picked parmenter as the boston area site for the coordination of camp aaron we have  children's services coordinator that takes care of camp aaron but just as important throughout the year she holds workshops for children of all ages from three to early college who have lost somebody significant like a parent sibling a grandparent that might have been his or her primary caregiver and it gets children together that are coping with the same thing it gives them language for their feelings it helps them manage you know questions in school and the beauty of that program is the little kids that  going to heart play become mentors then to little kids behind them you know as they mature and grow it's it's it's a program not only for our hospice but also for our general loss and in fact you know from time to time in the news there are difficult situations about you know deaths sort of sudden deaths or homicide or whatever chances are if they're in the greater boston area our our program has been involved our heart play program ok wow that's that's wonderful ok we have just  are there any special things that we haven't covered that you wanted to mention for sure i would just walk through your audience though death is not to be feared death is just another phase of  and why you're here it's not the life you lead it's what you do with your life and think about that process now while you still can because if you wait and you wait too long then the decisions become extremely difficult and if you talk with your children let them know what you what you want out of the rest of your life what your plans are you i think you would be amazed to learn that your children probably have been waiting for that conversation for a long long time it's just that they don't like to bring it up because we don't want to talk to mum and dad about it right but you take away the fear of the process of dying and you and you put it in its context and you say there are things we can do now well we're still alive while there is no suffering there's no pain and we can make rational decisions one one place you could begin with besides  calling a hospice facility like us to talk to your doctor when you go for your yearly gain you a physical and then they'll say oh you're in great shape by the way dr i have some questions about my future tell me about what will happen as i get older i mean i'm seventy five years old so i know my time is shorter than longer but i've already had that conversation and in my mind there's a great relief i am relaxed about what will happen in the future  and i'm willing to accept whatever happens but i know my plans have been made that everything will be covered all the bases will be covered by that and that's what i would hope that through your audience would say you know it's time we had that conversation yes i've had that conversation with my children as well ok are there any and the other things that we want to touch on any myths or well i have a final thought  one of the biggest myths is that hospice hastens death it does just the opposite as i mentioned before but i'd like to say when i'm talking to various groups about hospices we're just recreating what we had in prior centuries the nineteenth century the eighteenth century where death occurred at home the person that was terminally ill was administered by family and friends in the community that parson would come over and say a prayer people would sing and even after death the body would be washed and you know the person would be  d and then buried in the churchyard or you know a local cemetery so and death was more of a reality you know people lived on farms children you  know many children and families would die of a young age i mean all very sad but there was dialogue you know there was community and we're just trying to bring that to the twentieth and now the twenty first