I spoke to a hospital chaplain the other day to speak to her about my end of life doula services. Her initial response to me was, “that’s what we have hospice for.”
If you haven’t already, pause here to read https://willowsongmedicine.wordpress.com/2019/09/08/the-elephant-in-the-room-is-dying/ which gives relevant facts related to the systematic underutilization of hospice services and late referrals.
First of all, to be referred to hospice you must have a doctor state ‘if nature takes its course, death is likely to occur in six months or less.’ – There is no referral needed to employ an end of life doula. There is no criteria of ‘six months or less’. You call an end of life doula (EOLD) yourself, whenever you want. For instance, you could call for an EOLD consult at the same time you draft a will with a lawyer, to outline your choices for your end of life, whenever that might be. Or you can have your EOLD there at your doctor’s office visit as an extra set of ears and support while you take in the overwhelming information.
Secondly, hospice is not designed for long periods of interaction. A typical social work or chaplain visit is no more than one hour in length, not usually more than once a week. The hospice gets paid a specific amount per day to take care of a patient, so they are careful stewards of their resources. – With an EOLD you are the steward of the resources. You decide what services you want your resources to go towards. You both decide how long visits will last, how many times a week/month/year and what you want to accomplish during that time.
Third, you do not have a direct line of communication to your hospice staff, you must go through the hospice service. – You have your EOLD’s direct number and you’ve worked out between you the terms of service hours and accessibility.
Fourth, If an individual leaves that hospice agency you get a new staff assignment. – Your EOLD is your staff, unless you fire her/him or there is an emergency, she/he is not going anywhere. On the rare occasions that a back up doula is utilized you hopefully would’ve met them ahead of time, or at least been made aware of them.
Fifth, the scope of practice for hospice employees defines their role very specifically in assisting with certain aspects of dying. – The EOLD’s scope of practice includes what she is skilled at within the parameters of ‘non-medical support’. So that might mean taking your dog to the groomer. It might mean a marathon scrapbooking session. It might mean doing rituals to provide emotional and spiritual comfort. Or using crystals and essential oils to promote a feeling of wellbeing. Or doing energy healing for the relief of physical/spiritual/emotional pain and discomfort.
EOLDs endeavor to work in conjunction with hospice teams, palliative care teams, doctors, churches, hospital staff and family units. There is no such thing as ‘too much support’.