Care Team

MEDICAL DIRECTOR
• Co-certifies the terminal diagnosis with the attending physician
• Leads the interdisciplinary team in the development of a plan of care
• Provides consultation to other physicians regarding hospice care

ATTENDING PHYSICIAN
• Certifies the terminal diagnosis
• Assesses patient needs, manages symptoms, prescribes treatment
• Directs and approves the plan of care
• Coordinates care with the interdisciplinary team

HOSPICE NURSE
• Assesses patient and family needs
• Develops a plan of care to meet identified needs
• Coordinates team visits and ensures implementation of approved plan of care
• Coordinates care with attending physician, primary care giver, and/or care center staff
• Ensures symptom control and pain management
• Provides patient/family teaching as needed

HOME HEALTH AIDE
• Provides direct personal care to patient
• Provides comfort measures, reports identified needs to RN case manager
• Provides emotional support to patient and family

SOCIAL WORKER
• Assesses patient and family emotional, social, spiritual, and financial needs
• Develops a plan of care to meet identified needs
• Provides direct counseling or refers patients and families to appropriate community agencies

CHAPLAIN
• Assesses patient and family spiritual needs
• Develops a plan of care to meet identified needs
• Provides direct counseling
• Assists with memorial preparations
• Provides consultations and referrals to community clergy

BEREAVEMENT
• Provides emotional support by direct contact or by telephone
• Provides ongoing contact in the form of supportive letters and newsletters
• Provides regularly scheduled memorial services to celebrate the lives and memories of loved ones

VOLUNTEER
• Provides companionship and support to patient and family
• Provides needed non-medical services such as letter writing, time for care givers and family
• Provides support at time of death and during bereavement

EXTENDED SERVICES
• Extended Services will also be provided when identified by the Care Service Team as needed.
These include the services of the:

• Dietitian
• Physical Therapist
• Psychologist / Psychiatrist
• Respiratory Therapist
• Occupational Therapist
• Speech Language Pathologist
• Pharmacist
• Financial Services Representative
• Music or Art Therapist
• Funeral Director

Physical strength is measured by what we can carry; spiritual strength by what we can bear.-- Unknown