COLUMBUS, Ohio (WCMH) — Ohio laws don’t allow for physicians to be involved in medically assisted death. Instead, seriously ill people get care from hospice workers who provide services to sick patients and their families.
Christina Massey, director of palliative care and hospice at Riverside Methodist Hospital, and Kim Graffis, administrative manager, spoke with NBC4 about the process of dying with dignity.
The pair addressed what they cannot do with a patient, pain management, and creating a plan that puts the wishes of the dying person in the driver’s seat. The program cares for about 500 people in 21 counties, most of them at home.
NBC4: What is a death with dignity in hospice care?
Christina Massey: Part of hospice’s goal is to be able to, through our interdisciplinary team, get to know patients and their family and really understand what their wishes are, what their preferences are, and what dignity means to them.
So, to us, dying with dignity is being able to die in a way that somebody wants to die, and that is different for every different person that we get to meet. And to be able to help through our interdisciplinary team, which is social workers and nurses, and spiritual care team members, home help aides, our volunteer team, providers, art, massage therapists, and then being able to help them die in the way they want to die.
We also have a really robust bereavement team that helps to continue to support either patients pre-death and their anticipatory grief as they’re going through the dying process, or families after the death of their loved one.
NBC4: What are you not allowed to do when you are helping a patient die with dignity?
Kim Graffis: We are not allowed to assist in any sort of suicide, that’s obviously illegal here in Ohio. Sometimes that is a topic of discussion for our patients depending on their diagnoses. And also shaping that (question) — what is dignity to them?
If patients are used to being very independent and doing everything on their own, and then they have to rely on caregivers, that a lot of times is a discussion because they truly do not want to be a burden to somebody. The sooner hospice can be involved to help with those discussions (the better) — we have an entire interdisciplinary team. We have social workers and chaplains that can really focus on those different sorts of pain.
But social workers and chaplains are geared to focus on that depression, as folks start to decline. Really trying to shape that dignity aspect for them, and reassure them that we are here to give you a quality of life, but we’re also going to support your family, just as much as we can support you. So if they need help in assisting with your care, we are going to be here to figure out a plan for that.
NBC4: How are people kept comfortable as they face the end of their life?
Graffis: Everyone’s plan is going to look different. It’s really key for our nurses to collaborate with our physicians about what needs to happen. We also have nurse practitioners as well that do the majority of home visits for us.
So, we just need to take a look at the patient as a whole, look at their past history, what have we been giving them, and formulate a plan. And sometimes, that simply is: I don’t want to die in my home because I have young children.
Or I do want to die at home, but this is how I would want that to look. It all goes back to literally from our first visit, shaping the plan of care for patients and family, and making it individual.
Massey: It’s very similar to if you’re an expectant mom and you make your birth plan. Essentially, we are at the other end of the life spectrum, and that’s our goal — to have those conversations and allow them to make that plan.
There are a lot of different symptoms that can come up at end of life: anxiety, pain, nausea, some of those other more existential kinds of things, that Kim was mentioning, that social workers and chaplains may be working through.
And so, as we get to know patients and get to know their families, we start to get an idea of what are those symptoms that might come up? Either physical symptoms or those more emotional/spiritual kinds of symptoms.
And start to develop a plan with that patient and their family around what they want that to look like. And again — that might be at home, it might be them saying, “I don’t want to die at home and this is why,” so working on a plan that works for them and addressing those different symptoms.
NBC4: It sounds like a wraparound service. It goes around the patient and then wraps around the family, too.
Graffis: It’s the first time in your life that you actually have the ability to be in the driver’s seat, and everyone else that’s providing the healthcare to you is in the backseat.
Massey: If we ever hear people express regrets when it comes to hospice and hospice care, it’s that they didn’t allow hospice to come in sooner. There’s a lot of fear around hospice, and the conversation of dying, but people often will say once they get into hospice, “Oh, I wish I’d done this sooner.”