When an individual is reaching the last stages of their life, it can be scary attempting to come to terms with it. However, there are many hospice companies that help provide comforting assistance to patients and families in their time of need. At Brandywine River Valley Home Health and Hospice, a company located off of route 10 in Oxford, P.A., they do just that, serving as the sixth largest business in the world. Recently, Brandywine River Valley Home Health and Hospice was bought out by Optum, a healthcare company with over a dozen locations throughout the nation.
Hospice is more than just giving medical help or an overrated branch of hospital care, but rather a field that serves as a liaison to help “design a specific plan to help you or your loved one live as fully and comfortably as possibly in the final stages of life — in the comfort of your own home or place of residence” according to their website, making sure to “include family in the process, offering valuable information, guidance and — most of all — support.”
Jennifer Washkalavitch, executive director of Brandywine River Valley Hospice, does just a little bit of everything in the company, from overseeing clinical management to monthly budgeting. “We know people,” Jennifer says, “[and] I think you feel a sense of duty to the community if you live and work in it — especially in hospice.”
However Jennifer didn’t always work in the field hospice. Initially Jennifer started out in an oncology unit stationed in Christiana Hospital before she eventually had to leave for scheduling reasons, consequently entering the field of hospice due to the influence of a friend. “I valued what they could do because I saw a lot of unnecessary suffering,” Jennifer reflects, starting out as a lead palliative care nurse at Neighborhood Health in West Chester before switching over to Brandywine River Valley Hospice to get away from the corporate model, saying she “felt like it was more personal in the community.”
For the healthcare workers in hospice, there is no such thing as an average day. “Hospice is ever changing,” Jen acknowledges, “the whole day is changing all the time because the status of the patients changes pretty rapidly in hospice, so we have to be flexible.” While Brandywine treats patients already under hospice care, there comes the extended difficulty of balancing continued care and new admissions, which alone begins with covering medical, clinical, medication, and equipment needs, all alone covered during the start of their day. “It’s all fluid,” Jennifer states.
As hard as it is to believe, Brandywine wasn’t always a well-oiled machine. In fact, on Jennifer’s second day on the job, her boss and administrator of the office at that time, was fired. “Well I do think that my biggest accomplishment has been this office,” Jennifer proudly admits, reminiscing the progress Brandywine has made since those first few days in the office from a noncompliant organization with low census and low quality care that caused the company to run a risk of being fined by the state to almost quadrupling their census in the past seven years.
And yet, people not directly involved or affected by hospice in the general public are sometimes ignorant of the differences between hospice and hospital care. “We try to get to patients before they’re in an ICU,” Jennifer relays “[trying] to get them earlier in their disease process so that they have more time to utilize bereavement and psychosocial care.”
To many, the term hospital and hospice are thought of interchangeably, but in reality they are completely different domains. While the purpose of hospitals is to help individuals recover, centered more around rehabilitation with the purpose to assist in the healing process with the goal of getting the patient home, for hospice staff, they acknowledge that a patient is close to the end of their life, aiming more so to make an individual’s journey as comfortable and emotionally fulfilling as possible. “In a hospital situation, you know, it’s cold, it’s not personal” says Jennifer, whereas with hospice, patients receive care in a more familiar setting: within the confines of their own home. “Who doesn’t want to be at home with their dogs?” Jennifer remarks warmly.
An important component at the core of this hospice agency is comfort — specifically care at home and symptom management. Yet it is not uncommon for people to still have a very negative perception of what hospice is, picturing cold rooms and isolation. For Brandywine River Valley Hospice, this cannot be further from the truth. “A lot of these patients who are hospice eligible don’t take the benefit soon enough because they don’t like the word” Jennifer sympathizes “they always think hospice means imminently dying, and it doesn’t.” And plenty of research would suggest that individuals receiving hospice care actually live longer in comparison to individuals who don’t.
That is just what hospice is all about: entering the final moments of your life surrounded by those you love rather than removed from everything you once knew, vulnerable in a strange place that is sure to make anyone fearful. However, giving someone care within the confines of something that is already so familiar to them can be alien territory for a hospice healthcare worker, an issue that Jennifer completely acknowledges.
It can be hard to teach new nurses entering the field who may not have community health experience, which, as Jen puts it, means being able to meet people where their needs are rather than forcing a patient to adapt to your care. “Sometimes people want to fix everything” Jennifer says, “[but] people have lived like this all their lives and it’s what they know. We have to provide care in the environment they choose.”
Brandywine River Valley Hospice holds many fundraising events for the nonprofit Hospice Promise Foundation, an effort towards making hospice more financially accessible than people might realize, paying for patients’ electric bills, rent, medications, medical equipment and helping fund burial after a patient has passed, using the money that Brandywine receives through a per diem rate for each patient. Other additional services are offered outside of regular hospice care, ranging from bereavement groups open to the whole community to caregiver support groups for patients and their families in an effort to promote community involvement.
One of hospice’s biggest challenges still exists in getting patients referred to hospice care, something that might seem so simple, but in practice, is actually a lot more difficult than it seems. Although many people might think that hospice patients must experience a lot of anxiety in hospice, when in reality “a lot of anxiety leaves once [patients] make the official decision” Jennifer says, contradicting the misconception, stating that “the anxiety is before [hospice], when the people are trying to make that decision,” which is where Jennifer and the other dedicated employees of Brandywine River Valley Hospice step in to work with families who might be considering hospice, helping to take an emotional and financial burden off of patients’ relatives and caregivers.
Looking to the future, Jennifer faces many obstacles towards improving Brandywine’s care: post-COVID staffing issues, education to the community about hospice, and most importantly, education to physicians who might be referring patients to hospice in late stages of their disease or when they are left with a couple days left to live. “I think doctors don’t like to have the conversation, and they put it off too, it’s uncomfortable to them,” Jennifer says, but there are many more avenues that Brandywine tries to provide for these physicians, offering personally to have a conversation regarding hospice with patients in need with their extensive sensitivity training.
“People really believe that patients need to be bed bound and are in their last days of life and that is just not the truth” says Jennifer, sympathetic to the many individuals who fear their own preconceptions of everything hospice has wrongly been depicted as. But at the end of the day, Jennifer and her team will continue to put forth their passionate dedication to bringing comfort to those who have reached the final stages of their life, always working to put patients first.
Regan Robinson is a third-year Secondary Education major with a concentration in English and minors in Spanish and Psychology.