The Nantucket Model of End-of-Life Care

by Charlene Thurston, RN, ANP, Hospice Director, from the Spring 1998 Hospice Currents Newsletter
The quality of care at the end of life has become the topic of hot public debate these days, especially in the light of the now fairly well know Support Study, which reported that, in the five excellent medical centers studied, the majority of the dying patients were receiving care that was far below the quality we’d like for ourselves or those we love. Since that report, many initiatives have been developing in hospitals and other care agencies around the country, in order to improve their end-of-life care.

Although hospices throughout the country have received very high marks for the quality of care which they provide to the terminally-ill, the fact is that most patients don’t die in hospice programs, but in mainstream hospitals. Since, in almost all other communities, hospice services are provided mostly in the patient’s home or nursing home, terminally-ill patients in hospitals often do not access hospice care. Therefore, most hospitals are now trying to figure out how to improve their care of their patients who are dying.

Fortunately, in Nantucket, a group of people who represented both the community and the Nantucket Cottage Hospital, had the vision to create a program which would meet the needs of all terminally-ill patients, regardless of where they were located-at home, in the hospital, or in the nursing home-and developed a program which is now quite unique in the healthcare world. During this time of emerging concerns about how to integrate hospice services into hospitals and home health agencies, we have been participating in discussions and have been showing other communities our model-the Nantucket Model of End-of-Life Care.

Interestingly, what we’ve been doing all along-focusing on the needs of the community, rather than on organizations or insurers – has caught the interest of others in the healthcare field, and we’ve been interviewed by reporters for two industry newsletters and invited to speak at the Annual Meeting of the Hospice Federation of Massachusetts. We’ve also participated in the Last Acts Conference, a national conference sponsored by the Robert Wood Johnson Foundation to increase the dialogue about end-of-life care.

Included in this newsletter is the schematic which we exhibited at the Last Acts Conference and which outlines how we in Nantucket join forces as healthcare programs to provide our island residents and visitors with high quality end-of-life care. Our goal is to integrate hospice philosophy, standards, and skills into the general healthcare system, thus empowering all healthcare staff to provide excellent care to all terminally ill patients in our community. To achieve this goal, we use the “Sharing the Care” concept, wherein the Hospice Team works “alongside of”, not “in place of,” the general healthcare team in providing care, thereby complementing care, mutually sharing skills, and fostering peer relationships among professionals. We learned of this concept during a Hospice Seminar in Great Britain, where it was described by Ms. Prue Clench of Dorothy House Foundation in England, as the model used by the National Society of Cancer Relief’s service of MacMillan Nurses in Great Britain, in which nurses who specialize in terminal care function within the primary care team. It has served us well in our community.

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