Working in hospice has been one of the great joys and challenges of my life. I started out at the bedside working as a hospice nurse case manager. I was impacted by the sacredness and raw intimacy that is present at the end of life. It is from the dying that I have learned more about living than anything else I have been exposed to. I began to see how the youth- and beauty-driven culture of mainstream America avoids the elderly, the sick and the dying. These people have become our version of untouchables. By removing them from our lives, we have robbed ourselves of something profound. We no longer have a sense of the cycles that inform the nature of our lives and our connection to the natural world.
In the presence of a dying person, quality matters. Quality of relationships, quality of intent and quality of presence trump busywork, small talk and superficiality. It no longer matters what kind of car you drive or what your title was at work. Life is close to the bone. Meaning-making, resolution and kindness are what nourish us as we prepare to leave the physical body.
It was the contrast I experienced between mainstream media’s shallow and unrealistic portrayal of death as entertainment, and the rich world of humanity that filled my days in hospice, and inspired me to create a documentary on death and dying. In 2008, after eight years of filming and editing, Solace: Wisdom of the Dying screened in Santa Fe. Since then, I have directed and produced eleven related documentaries called the Solace Teachings to deepen the understanding of healthcare professionals, individuals and community groups.
When we think of dying people we think of illness and are expected to adhere to medical terminology like failure and decline. The lack of training for healthcare professionals in how to think, feel and work with people at the end of life translates to over-treatment and avoidance of a person’s humanity. This often increases suffering and confusion for dying people and their families.
It is possible to be well and dying, just as it is possible to be “unwell” and physically healthy. We have equated wellness with physical stamina and youth. Palliative care expert and author Ira Byock, MD once shared with me a question he routinely asks people facing a life-limiting illness, “How are you within yourself?” Through processes of inquiry we are able to address the whole person, not just an illness with symptoms to be treated.
The second phase of my work in hospice was in education and management. In my career as a nurse, I experienced hospice managers generally as unhappy, unsupported and therefore unable to be effective in their role as a leader. I learned that 83 percent of all nurses are first-born children of alcoholics. I was able to identify bullying, vertical or organizational violence and horizontal or peer-to-peer hostility that comes from many wounded people working together under stressful conditions. As one of the 83 percent, I began a deep investigation into the Greek myth of Chiron, the wounded healer.
In the middle of what I saw as an industry of wounded healthcare professionals and often even more wounded (and wounding) organizations, I saw the need for a new model that addresses sustainability. Green Hospice is the result of that investigation that is now part of the FairCare™ model of sustainable healthcare, available to hospice organizations (see accompanying article).
A movement to reclaim death and dying as a normal and sacred part of the life cycle rather than as a medical failure backs the philosophy of Green Hospice. Like birth, death is a rite of passage to be held by the individual, family and community, as it deepens and informs how we live and reminds us —like nothing else can—of the preciousness of time and the importance of making conscious choices about how we live and how we die.
A Green Hospice is required to provide all patients with information on Green Burial. Green Hospice has partnered with the Green Burial Council, who will supply the education, support and resources on Green Burial options. Green Hospice also requires organizations to incorporate a “saging” program, where seasoned and elder nurses are able to pass their skills and knowledge along to incoming nurses. Physicians are integrated as staff members rather than contractors with minimal impact on the team and organization. Staffing ratios comply with national standards and groups of interdisciplinary staff form teams to support communication and lateral accountability.
Hospices who become green adopt the philosophy that the people are the product. Without them, the organization would be unable to provide services. Many hospices, contrary to the spirit of the services provided, disregard the needs of the clinical staff and are closed to the valuable insights and feedback of hospice professionals, even though basic business motivation strategies teach about the relationship between weighing in and buying in.
An alarming number of hospice professionals express their feelings of futility and frustration with their organization. Here the disconnect between the administration and the field staff breeds discontent, which impacts the quality of patient care, retention rates and in turn the fiscal bottom line. Green Hospice holds to measurable standards for satisfaction and retention within hospice organizations as it speaks of concrete outcomes in business practices and culture that impact the staff, having a ripple effect on the overall industry.
Green Hospice applies the standard of Do No Harm, an ethic held by physicians, to be extended to organizations. Businesses whose bottom line comes from serving dying people are faced with high moral and ethical stakes. There are no “do-overs” in hospice, as my friend and colleague, Kim Mooney of Boulder hospice says. Therefore, a large part of sustainability in hospice lies in raising awareness and committing to ethical practices, which includes careful selection and treatment of staff so that the hospice workers are able to provide responsible and appropriate care of the dying.
Sustainability, like mindfulness is a practice that calls us to wake up and bring ourselves to the present moment in support of positive change. This requires humility, patience, persistence, humor and creativity. It is here that I combine my nursing practice with a daily practice of sustainability. The FairCare™ and Green Hospice models provide the framework. The people provide the change.
Advantage Home Care & Hospice of New Mexico will be the first certified Green Hospice as part of the FairCare™ Certification in sustainable healthcare.
Camille Adair, CEO of Sacredigm Alliances, LLC, is a healthcare consultant, speaker, educator and filmmaker. Camille is available to provide presentations and in-services on FairCare, Green Hospice, Leadership Development Training for Healthcare Sustainability and film screenings. 505.470.3838, Camille@CamilleAdair.com