Since 1991, Arohanui Hospice has supported patients and their families/whānau the Palmerston North, Manawatu, Rangitikei, Tararua, Horowhenua and Otaki regions. Here, Director of Clinical Services, Kate Bird, gives insight on the community service that Arohanui Hospice provides.

What is the first point of contact with Arohanui for a patient?

When somebody is referred to our service, one of the first things that happens is that a member of our Community Team – be it a social worker, nurse or doctor – will go out to meet with the patient and their family. This first visit is normally in someone’s home, but it doesn’t have to be. It can be here at Arohanui Hospice or in a cafe,  literally wherever they want. This is the first time that someone and their family has interaction with hospice; an opportunity for information sharing for everyone.

What type of information might be shared?

It’s an opportunity for hospice to understand the patient’s journey so far, some questions we may ask are what are concerns for them? What are issues for them? What’s going well? And they find out from us what we can and can’t offer, how the Inpatient Unit works and how our services can support them within the community.

What happens after this first meeting?

Our Arohanui Community team – which includes nurses, doctors and social workers – will continue to touch base with that patient; it may be by phone first for some period of time. Or, it could be through a visit. It would really depend where the patient is on their journey and associated issues.

Our nurses, doctors and social workers are not always working alongside each other at the same time, but they very much work as a team – they meet together and discuss their patients to formulate the best care possible.

What kind of issues might a patient have and how can you help?

They range and change over time. Sometimes a patient may show symptoms of pain or feeling nauseated. The nurse will then say, “Okay, well there’s some medications that we can use to help that.” Or a patient may be struggling to get showered or to eat, in which case the social worker and the nurse working together will facilitate carers to visit the patient at home.

Our Community Team is the coordinating umbrella for other support services that are out there – such as caregivers and district nurses. There are points where we might meet with district nurses, especially if the patient requires medication through a pump. Then the district nurses go out every day to refill that.

How do you incorporate GPs into the process?

We closely liaise with the patient and district nurse. And we continue to work closely with the GP, to ensure the GP’s involved. Often a patient’s had a GP for many years and we want to support them to continue to care for the patient, while we offer both specialist skills and knowledge to support them.

Where and when do your nurses provide palliative care?

It really does depend. For example, our nurses who work in the Horowhenua are an hour away from their patients and an hour away from our inpatient unit. They’ll drive to see patients every day. As our team visits a patient who’s approaching the end of their life, you initially may see them weekly; then as things change, you might see them a couple of times a week.  Ultimately, the contact becomes more frequent.

For patients who are reaching their end-of-life, our focus is supporting them and their families – nurses from our community team may ring them to check in, every day. We want to make sure any symptoms are well controlled and that the family has what they need so that they can continue to provide care. We can, of course, admit patients to Arohanui’s Inpatient Unit. If things become more difficult and challenging, then we would bring patients to rest here.

Do nurses and social workers visit patients at home no matter where they live?

No matter how remote you are and no matter what your circumstances are, Arohanui is here for you. We facilitate and enable people to have their last days in the place that they wish. None of us would want to be forced to be somewhere that they didn’t want to be. We can move people from the hospital to hospice. We can facilitate people to move from hospice, back to their home.  Many families may want to support their loved ones to die where they wish to die. But they need help and support and resource to be able to do that. We provide support to enable them to continue to stay with the people who are with them, delivering the care. Often people feed back to us that that knowing we are only a phone call away can make such a huge difference because they don’t feel alone and isolated.