Updated March 25 at 6:25am

A new direction in care leads to more humane endings

The median time spent in hospice care in Rhode Island is 11 days.

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A new direction in care leads to more humane endings


The median time spent in hospice care in Rhode Island is 11 days.

For the staff at Home & Hospice Care of Rhode Island, that’s not good enough.

The nonprofit – the third-oldest hospice in the nation and the largest facility and program in the state – has been stressing the importance of its new palliative-care programs, aiming for patients in need to be in touch with HHCRI sooner than has been the custom. The initiative is just the latest for the more than 34-year-old nonprofit, a Rhode Island institution whose team includes doctors, registered nurse practitioners, physician assistants, nurses, hospice aides, social workers, grief counselors, chaplains and volunteers.

“Palliative care is a relatively new specialty,” said Diana Franchitto, CEO and president of HHCRI. “It’s really helping with chronic diseases. It bridges the gap between chronic disease and advanced illness when you only have months to live.

“[Palliative care] helps give an understanding of the disease trajectory,” Franchitto added. “It gives families and patients an opportunity to talk about … are the goals of care [and] puts in perspective what you want in the last years of life.”

Palliative care can be provided for up to two years and lead to comprehensive hospice service at life’s end. However, most patients remain underserved because of lack of information and outreach to their families and the medical community.

A study by Massachusetts General Hospital released in 2010 showed that patients who received palliative care lived longer than patents who did not, according to Dr. Ed Martin, chief medical officer for HHCRI.

Martin has been working for HHCRI for 24 years. On any given day, he spends the first half of his day at Rhode Island Hospital providing palliative care for patients.

“I might see them for pain management, to talk about other approaches to care in their final months of life or other options, such as hospice,” he said.

After the hospital, he works at HHCRI’s Philip Hulitar Inpatient Center, located on North Main Street in Providence’s Eastside neighborhood. The center is the only one in the state of its kind, providing 24-hour, individualized care and emotional support to not only residents of Rhode Island but also various parts of Massachusetts, Franchitto said, a footprint that did not spring up overnight.

In addition, HHCRI is an education partner with the Warren Alpert Medical School at Brown University and local nursing schools, providing hands-on training for students and residents. And through its new focus on palliative care, the nonprofit is helping train the next generation of the medical profession in the latest trend.

The need for this new dimension of end-of-life care is born out by the numbers. In the nine months that HHCRI’s Palliative Care Consultation Program, developed with The Miriam Hospital, has been operational, the program has grown from one to two consultations per week to more than three per day.

Also driving the program’s growth are consultations at Memorial Hospital of Rhode Island, Newport Hospital and South County Hospital, in addition to work at Rhode Island Hospital. In fact, HHCRI has seen a dramatic increase in the number of patients who have transferred from the acute-care setting to palliative care across the board. From 180 consults in all of 2009, the agency did more than 400 in the first six months of 2011. It is clearly a service that is needed and appreciated.

A recent state-by-state report card by the Center to Advance Palliative Care highlighted the current prevalence of hospital palliative care teams in the U.S., with only seven states receiving an “A,” including Rhode Island.

“One of the other pieces in terms of length of stay is as palliative and hospice medicine become part of mainstream medicine, it’s important to invest doctors-in-training on it,” Franchitto said, a role HHCRI takes seriously.

But the training isn’t limited to those in the medical community. HHCRI provides an orientation made up of sessions presented by the organization’s leaders on a monthly basis.

Clinicians receive an intensive three-day clinical orientation that teaches the practice of hospice care to all disciplines, including nurses, hospice aides, grief counselors, social workers, spiritual-care coordinators and volunteer coordinators. Sessions include reviewing the need for improved care at the end of life, individual assessments, case studies, roles of nurses, medication assessment and more.

Meanwhile, volunteers also endure orientations including more than 15 sessions over the course of eight hours. Those sessions could include anything from learning certain legalities to cultural competency, finance, philanthropy, clinical overviews and grief counseling.

“We have a fairly long training program because we want to make sure people will be comfortable working with our patients … [that] they feel confident delivering this kind of care,” said Martin.

But the behind-the-scenes work does not go without recognition. At least two years ago, HHCRI developed the Dame Cicely Saunders Employee Appreciation and Recognition Program to give staff members several ways to recognize each other for behavior that exemplifies the mission of the organization.

Dame Cicely Saunders was the founder of the first hospice in London.

Whether it’s a ‘thank you’ note, ‘thank you’ bear, On the Spot award or Making a Difference award, HHCRI finds a way to reward employees.

“I think it’s just in human nature. People love to be appreciated and recognized, and I think that’s an important component in any business,” Franchitto said. “[Our employees] wouldn’t be working in any other kind of career.”

Martin agreed.

“I’ve always enjoyed the work and just found it very gratifying to work for the patients and families,” he said. “I think everyone here is committed to high-quality, end-of-life care. They’re really dedicated and committed to what they’re working for.” •


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