The SE Hospice Team

The Southeastern Health Care at Home (SE) Hospice team provides medical, emotional, physical, and spiritual support to our patients and family members through regularly scheduled visits in the comfort of the place they call home. The team is also available 24/7 via telephone and for additional visits as needed.

Hospice Team Members

As the healthcare provider who knows the patient best, the primary care physician may discuss the need for end-of-life care and make a hospice referral. SE encourages primary care physicians to remain involved as a member of the patient care team and to participate in the hospice plan of care.

The hospice medical director supervises and supports the hospice care team. At SE, the medical director, who is Board-Certified in Hospice and Palliative Medicine, attends weekly team meetings and participates in decision-making for each patient.

Each patient is assigned a Registered Nurse (RN) Care Manager who coordinates the plan of care with the primary care physician and the hospice medical director based on regular nursing assessments. The nurse visits the patient weekly and as needed to address and manage any symptoms and to ensure that patient and family needs are met.

The RN supervises all care provided by the Licensed Practical Nurse and home health aide and coordinates with other hospice care team members to ensure that patient and family spiritual and psychosocial needs are met.

Each patient receives care from a social worker who performs assessments and establishes a psychosocial plan of care. The social worker generally visits the patient once or twice per month to provide emotional support and ensure patient and family psychosocial needs are being met. Additional psychosocial visits can be requested at any time.

The social worker can provide assistance and hospice information to families and patients. The social worker may discuss advance directive options with patients, assist in finding community resources, or in making arrangements for respite or nursing home placement.

Each patient receives care from a chaplain who provides non-denominational spiritual support as needed. The chaplain generally visits once or twice per month, and more often as needed. Upon request of a patient or family, the hospice chaplain can address religious issues. In most cases, the care provided is more spiritual than religious.

The bereavement counselor can assist the patient with grief associated with disease process and declining health. For family and loved ones, the bereavement counselor provides support before and after their loss, as well as continuing bereavement services for a year after a loved one passes.

The certified nurse assistant (CNA) assists the patient and family by providing correct and safe methods of personal care to the patient, as well as teaching safe and correct methods to caregivers and family members. The RN care manager supervises the CNA.
Patients and families may request a hospice volunteer to provide companionship and support. All hospice volunteers are required to attend special training. SE hospice volunteers assist with general services and offer companionship for the patient.

SE also provides information on becoming a hospice volunteer and the services provided by SE hospice volunteers.