Hospice staff is generally divided according to Patient Care and non-patient care. Patient care includes a broad range of people who may not be nurses but who are in contact with Hospice Patients and attend to their needs. The nursing staff is divided into RNs, LPNs, and CNAs. The RN's are the supervisory staff, the LPN's the med techs, and the CNA's the basic body care workers. There are a wide variety of Massage and Energy workers who volunteer services or may be employed by the facility. Massage is very important in bridging the gap where meds can not alleviate pain. There are also a boatload of volunteers who help with feeding, or just hold hands and talk to patients.
Outside of direct patient care are the social workers, grief councilors, and other patient and family support staff.
Quite frankly the lowest paid people in the hierarchy are the CNA's and it is their responsibility to take care of the patients and monitor their needs. Even in good facilities they are overworked and patients suffer as a result. Six patients is a significant number, 8 to 10 are more often the norm. Hard to do more than change diapers, feed, and bath.
But like I said you have the money you do home care, go one on one with patient care, squirel away meds and take the night train out of town when it gets to be too much. This is the great untold truth. Kovorkian is irrelevant to a great extent. Most people have access to what they need to make an early exit if they desire. However it is just not human nature to leave the stage before one's time is up.
The major problem in Hospice care and dying in America is that outside of Hospice it is hard for people to just say 'Enough!'. The medical profession views people who face their own reality as quiters. Doctors don't want to have patients who are not being treated with the full venue of treatments on their lists. So people get hooked up to an array of crap and are more uncomfortable than need be in order to keep them alive but entirely miserable for a few more days or weeks.
The second problem is the inability of our system to deal with pain meds properly. These patients don't have to worry about addiction. They need to treat severe chronic pain. Too many doctors are not about to prescribe meds if it looks bad on their records. So the patient goes without.
Another problem is that more and more Hospice patients are living longer. They need access to physical therapy and massage to a greater degree. Facilities need to allow for more active patients prior to their last weeks of life. Activity is a key factor in minimizing pain. Activity means improved independence and a happier patient.
The important thing to remember is that patients are alive until they are dead. And often they are very alive and then they are suddenly very dead. Pushing these people into death beds and keeping them their does not really allow them to continue to live their lives as they could.
Unfortunately the boomers are going to stress the systems and things are likely to get worse just as we are formulating a lot of new and ground breaking methods of treating Hospice patients. Vonnegutt not Kevorkian likely saw the future. State sponsored suicide in one form or another is a sad reality in the next few decades--not on moral grounds, but out of pure economic necessity.
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