MEMORIAL WREATH: The Accolade Hospice team in Burleson, TX, hold a special memorial after the passing of every patient. The patient's name and date of death are inscribed on each ribbon and then tied to the wreath which hangs in the main hallway of their offer. Pictured in front of the wreath are (from left): Rebecca Helm, RN, agency director; Susan Henneberry, LVN, case manager; Sara Miller, LVN, on-call PRN; and Phil Hieger, MPA, LMSW, administrative director.

Hospice nurses are a different breed of healthcare professional. For these nurses, teamwork and camaraderie are especially important to doing their job well and providing the best possible care for their patients.

"If the nurses took on all of the issues surrounding hospice care, we would burn out in less than 6 months," said Rebecca Helm, RN, agency director with Accolade Hospice, Burleson, TX. "We have to have that support."

Accolade has 20 home care agencies throughout Texas as well as an Oklahoma home care agency in Sayre, hospices in Lubbock, Yoakum, and Burleson, TX, and a pharmacy in Corpus Christi, TX. Serving Tarrant, Denton, Johnson, Parker, and Hood counties, staff members at the Burleson agency treat terminal patients using an interdisciplinary team approach that integrates a staff of two LVNs, four RNs, social workers, chaplains, volunteers, CNAs and administrators, said Helm

"Knowing we have a team of professionals from several disciplines to care for each patient is priceless," said Susan Henneberry, LVN, case manager. "We do our part as nurses, but we also know when to let go and trust our team members to do their job."

Redefining Family
The company's motto is "You are not alone." These words apply to everyone - patients, family caregivers and hospice team members, said Phil Hieger, MPA, LMSW, administrative director.

"At the end of the day, we know our patients received special care because every member of the team did their part," he said. "We also know our nurses play a very special part in raising the level of that care."

Helm and Henneberry also believe that family caregivers are special as well, notably Muriel, a 70-something "go-getter" who loved working her full-time job at a cable TV company before resigning to care for her 80-year-old husband Ralph. Muriel's long-time spouse is slowly losing his memory, his personality and, ultimately, his life to Alzheimer's disease.

Once an outgoing, successful salesman, caring husband and loving father, Ralph has been under the care of Accolade Hospice for 6 months and was initially diagnosed with "adult failure to thrive," said Henneberry.

Muriel is struggling right along with Ralph. According to the Family Caregiver Alliance, family members between the ages 66-96 who experience caregiver-related stress have a 63 percent higher risk of dying than their peers who are not caregivers.

"Although Ralph and Muriel have two grown children, one lives in California and the other lives near their home but is too ill to care for her ailing father," said Henneberry.

"This is a good example of why hospice patients require a team of professionals," added Helm.

"Although the family of the Alzheimer's patient provides some care, they need our care and support as well."

Maximizing Caregiver Capacity
Accolade Hospice provides hospice care in the home, as well as in long-term care, foster care and assisted living facilities. The agency also works with local and regional hospitals for patients who may not wish to remain at home or for crisis intervention, Hieger said.

But Muriel told Accolade staff her top priority was to learn the skills necessary to care for Ralph and keep him out of a nursing home, Hieger said.

"But shortly after her husband joined our service, Muriel fell and broke her arm while carrying groceries into her home," he said. "At that point, her caregiver capacity diminished to a minimum."

That's when Accolade staff multiplied the strengths of each team member to maximize the care of both patient and caregiver so they could remain in the home together.

"I went over to their house every single day for 6 weeks," said Helm.

Although the couple has settled somewhat into a routine with the care of Accolade staff, Muriel is aware a long-term plan of care is needed.

Henneberry said the couple's children are considering an Alzheimer's care facility for their father and an assisted living facility for their mother. In the meantime, their son from California is in town for a greatly-needed visit, Helm said.

Managing Emotional Output
Ralph and Muriel's is just one of many stories that Accolade Hospice nurses have collected over the years. While the emotional side of this specialty presents challenges, there are also many rewards to the job, said Helm.

"In acute care, the length of time I would care for a patient was about 4 days," she said. "It was more short term and 'matter of fact.' In hospice care, Susan is there to remind me to slow down and pace out my energy because hospice nursing often means long-term care."

"It's important to 'evenly distribute your emotional output'," added Henneberry who was once a long-term patient herself surviving both uterine cancer at 17 years of age and breast cancer at 38. She said her own experiences have helped her develop an inner strength she shares with patients. Henneberry also enjoys working at Accolade because it's one of few hospice agencies that encourage LVNs to become case managers, she said.

And Helm is also happy about that.

"With Susan's extensive knowledge in hospice nursing, I am able to gain from her experience," said Helm. "In turn, Susan comes to me with the medical/clinical science issues. There is no possible way we could do what we do without each other."

Amy McGuire is regional editor at ADVANCE.