INCORPORATING THE ESSENTIAL ELEMENTS OF HOSPICE
Founded in 1998, the hospice program has cared for more than 227 patients. Two nurses (director and coordinator), physicians, a social worker, and several chaplains of different faiths staff the program. A vital part of the program is a peer-care model which trains inmate volunteers to deliver hands-on care to hospice patients. The success of this system relies on five key elements: patient-centered care, an inmate volunteer model, safety and security, shared values, and teamwork.2
Patient-centered care Although all clinicians are familiar with this standard, it has a different meaning when defining end-of-life care in a prison hospice situation. The definition comprises four central concepts that are self-explanatory: offer unconditional care, be responsive, form real relationships, and know your patient.2
Inmate volunteers Highly trained inmate volunteers provide end-of-life care to their peers. They are assigned a case from admission on, offering a unique connection to the patient while supplementing the nurse by handling nonclinical bedside needs. These peer volunteers, who receive education in hospice care, clinical psychology, and spirituality, often apprentice with more experienced volunteers and mentors. They also speak at conferences and on radio. The volunteers take their roles seriously, as one explained, “That’s the whole point of not dying alone, knowing that somebody is there, that have to do that role [sic].”2
Safety and security Although this is a hospice, it is still a prison. There are considerations regarding the safety of staff and volunteers, as well as the volunteers’ motives. Boundaries created by policies, procedures, and protocol must be maintained without becoming actual barriers to the functioning of the hospice. Of course, the safety of the patients, who are often bedridden, is a major concern as they are helpless and defenseless.2
Shared values Caring for a gravely ill person can be thankless and stressful in the best of circumstances; giving that level of care to someone who may have committed heinous crimes can be a very difficult task. This might be impossible if the caregiver was without empathy and compassion, but the prison hospice encourages the volunteers to “do the right things for the right reasons” and be part of their community of caring. Each individual in that community commands respect, including the dying patient.2
Teamwork All the hospice program participants work together to achieve the goals of the program. The interdisciplinary team includes physicians, nurses, social workers, and chaplains. The volunteers also work in a highly organized team. They hold team meetings with the hospice coordinator to discuss the program and patient care. They communicate with one another off the unit as well, ensuring continuity of care.2
The hospice program at Louisiana State Penitentiary is just one prison hospice program, and it is a very successful one. Unfortunately, given the state of our prison population, the necessity of creating many such programs throughout the US correctional system needs to be addressed stat.
Bette Weinstein Kaplan is a medical writer based in Tenafly, New Jersey.
1. Fellner J. Dispatches: Ever more US prisoners growing old behind bars. Human Rights Watch web site. http://www.hrw.org/news/2015/02/09/dispatches-ever-more-us-prisoners-growing-old-behind-bars. Published February 9, 2015. Accessed April 17, 2015.
2. Cloyes KG, Rosenkranz SJ, Berry PH, et al. Essential elements of an effective prison hospice program [published online ahead of print March 2, 2015]. Am J Hosp Palliat Care. 2015.
3. Binswanger IA, Carson EA, Krueger PM, et al. Prison tobacco control policies and deaths from smoking in United States prisons: population based retrospective analysis. BMJ. 2014;349:g4542.
4. Carbonnaux M, Fossard G, Amzallag E, et al. Earlier onset and poor prognosis of lung cancer in imprisoned patients. Oncology. 2013;85(6):370-377.
5. Binswanger IA, Mueller S, Clark CB, Cropsey KL. Risk factors for cervical cancer in criminal justice settings. J Womens Health (Larchmt). 2011;20(12):1839-1845.