Sept 12, 2002

Dear Sir,

I read with some interest the letter from Dr. Harries and I absolutely agree with him that the hospice staff is "highly motivated, dedicated and well trained".

However, the medical staff provides one side of the care at Agape House with the other side of care properly being provided by other kinds of caregivers such as bereavement counselors, on staff massage therapist and art/music therapists, a chaplaincy service and legal assistance.

These other professionals provide the assistance to the patient and family that take care of the unfinished business so that the medical symptom control has the possibility of success. Worries, anxieties, problems all go together to make the patient as uncomfortable as he can be - unless these problems are solved for him in a physical, emotional or spiritual way, the likelihood of the doctors achieving amelioration of his condition becomes uncertain. One can easily die of unremitting pain if it is ongoing and severe enough.

The family also have their own agony and when they are fully acquainted with these other services they are incredibly grateful and the grief is thereby lessened. It is not good enough simply to treat the patient only and to be "pleasant" to the family - he/she belongs to the greater part of his family and this is a work in progress for their greater good.

The needs of the community do not change when it comes to a death in the family - as I said in the opinion piece this is the time to pull out all the stops and give a complete service to this particular family that contains the patient.

As for the three beds that belong to the Extended Care Unit. Those patients come from their "home", which is already a nursing facility. Many of those patients die eventually in that facility with familiar faces around them. and it is akin to them dying as if they were home in reality. So why would they be transferred to an unfamiliar place in their last days? There is some flawed logic here.

So I wonder if Dr. Harries would consider examining the possibilities of reinstitution of those services, that were available, which are no longer and asking for the other services to be brought on line soon, so that the Hospice can work as a true hospice and not just be part of another programme.

The nurses are indeed overworked. They have to bathe patients as early as 6 a.m. in the morning so that they can get through their daily amount of work, because they are few in numbers. This is not how a hospice should work. A patient need not necessarily be fully bathed on any given day, It is often up to that patient to say what he wishes to be done and the hospice staff honour that, and be allowed to sleep for as long as he wishes.

Recently, a patient's family told me of their dying father and husband who asked for admission to Agape House. They were told the hospice was full. The patient died at home, a week or so later, without the benefit of the hospices "symptom control services", with the son-in-law taking care of the patient, 24 hours per day, for that week. Apparently Extended Care Unit patients filled three beds! So the Hospice does not have the capacity to admit bona fide patients when nine of their beds are filled.

Appropriate patients referred from the community and hospital are the answer to the bed capacity at the hospice.

Obviously, there are broader issues at work here and I can empathise with Dr. Harries as he is faced with them. Such as more extended care unit patients requiring admission as the population is living longer, with less and less space all round. I wish him well with his work. and hope that the strategic planning at the hospital takes his proposals into consideration.

HILARY SOARES, MBE, JP

City of Hamilton