The Horizon Hospice Care Team

Horizon Hospice offers a holistic approach to end of life care.

Our interdisciplinary team supports the primary caregiver in addressing the physical, psycho-social and spiritual needs of our patients.





PATIENTS AND FAMILIES


In many cases, family members serve as primary caregivers, so you are the most important part of the team. You know best the wishes of your loved one, and can help guide our experts as we work together to ensure comfort.


Medical director

Care Planning

The most common role the Doctor plays is assisting the entire team with care planning, including making changes to medications and discussing psycho-social issues.


Staff Education

The Medical Director also provides training and information to other team members at their weekly meetings to discuss patient care. Each patient’s care is reviewed and specific approaches are identified to increase comfort and reach goals.


Consultation with Other Physicians

Our Doctor will coordinate medicines and maintain consistent approaches with your loved one’s other Doctors.


Appropriateness for Hospice

Medicare has specific requirements to determine if your loved one qualifies for the hospice benefit. Our Doctor will review all appropriate information and work with the team to determine initial and ongoing eligibility.


Nurse Case Manager

The Horizon Case Manager is a Registered Nurse with specialized training in evaluation and caring for the terminally ill patient and assisting their families.  Your Hospice Nurse is an expert in listening, observing, communicating, and providing compassionate care.  The RN Case Manager works with the interdisciplinary team to develop a specific plan of care to meet patient goals.  The RN case manager typically visits weekly, and can increase visits as needed for symptom management and medication teaching.


The RN case manager will be watching and observing for changes to adjust the plan of care accordingly.  Your Hospice Nurse will be managing and monitoring:


  • Medications and supplements
  • Symptoms related to your disease
  • Skin and wound care
  • Durable Medical Equipment
  • Care provided by the nurse aide
  • Communication with your primary care provider



sOCIAL WORKERS

Social Workers at Horizon Hospice hold master’s degree credentials (MSW), and provide a variety of services to patients and families as a key collaborative partner in the patient care team. Social Workers have expertise in many non-medical areas, providing education and support on the following topics:


Private Duty Care Agencies

  • Adult Family Homes, Assisted Living Facilities, and Skilled Nursing Facilities
  • Community support groups for caregivers


Financial Resources

  • Medicaid application/COPES program application
  • Food banks & local assistance agencies


Funeral Planning Resources

  • Written resources such as Life File and 5 Wishes
  • List of local funeral homes to assist families in planning
  • Tissue donation facilities resources such as MEDCURE and LIFE LEGACY


Veteran’s Benefits

  • Booklet of benefits and connection to VA resources
  • Veteran honoring ceremony

Power of Attorney and Advance Directives Paperwork

  • Social workers can provide the documents needed for Advance Directives and Power of Attorney paperwork.
  • Some MSWs are also notaries who will notarize documents directly related to health care. We do not notarize unrelated documents, such as car titles or wills.


Psycho-Social Support

  • In home visits and monthly phone calls  
  • Support, grief counseling and assistance with relational and emotional needs including information on the dying process, facilitating a life review,  referral to our grief groups and volunteer support.

Hospice Nurse Aides

Our Hospice Nurse Aides are specially trained to assist patients with comfort and dignity. They visit patients each week in their home or facility to help with activities of daily living. Nurse Aide duties are assessed and directed by the RN Case Manager, these tasks may include:

• Bathing

• Grooming

• Personal care

• Light housekeeping

• Meal prep


CHAPLAINS

Chaplains are integral partners in patient care. We understand that during a serious illness, family members and patients often benefit from spiritual support. Our chaplains assist and provide spiritual care during your time of need in a way that honors your own beliefs, bringing peace and comfort.


At Horizon Hospice, chaplains take their cues from the patients, and develop individualized care plans that respect your beliefs, wishes, particular spirituality, and emotional concerns. Each patient is assigned a chaplain who develops a care plan tailored to their specific needs, and spiritual care is available at any time.


All Horizon Hospice chaplains are ordained ministers with experience and professional training to provide spiritual care. The scope of care can cover not only the patient, but also everyone involved, including caregivers, family members, and facility staff.


Chaplains are resources to the community, providing grief support to local facilities that have experienced losses of their own, delivering training to agencies regarding spiritual needs at the end of life, and facilitating grief care groups. Chaplains are available to officiate at patient funerals and graveside services at no cost to the family.


BEREAVEMENT COORDINATOR

In conjunction with Social Workers, our Bereavement Coordinator ensures that support continues beyond medical care, to help surviving loved ones work through the difficult process of grieving their loss.


Services include:

• 13 month of bereavement support to families of patients

• Grief groups

• Written literature

• Annual memorial service

• Individual bereavement counseling

VOLUNTEER sERVICES

Horizon Hospice volunteers are thoroughly screened, (including a background check) and have been trained to assist you in providing practical help and support during your time with hospice. All patients and family members may request a volunteer at any time. Simply talk with your nurse, social worker, chaplain or call the Horizon office.

 

What Volunteers Do

  • Offer companionship
  • Be a listening ear
  • Share a game or hobby
  • Write a dictated letter
  • Run errands
  • Read to a patient
  • Provide wheelchair tours
  • Help with light housekeeping
  • Record a video message
  • Arrange visits from a certified pet therapy animal
  • Sit with patient so caregiver can get out to run errands
  • Act as a Vigil Volunteer to sit with an actively dying patient when family is not available
  • Give a hair cut
  • Massage hands
  • Paint fingernails


What Volunteers Do NOT Do:

  • Help a patient ambulate or transfer
  • Feed a patient
  • Transport a patient in a vehicle
  • Administer medications
  • Offer professional counseling
  • Re-position a patient
  • Change a patient
  • Cut or file nails
  • Answer medical questions
  • Provide ANY care-giving