The overall challenge that faces the movement, in New Zealand and elsewhere is to maintain the vision that led to the founding of modern hospices – the holistic care of the dying – which was outlined in my previous blog. This is despite growing administrative demands and funding pressures.
- The widespread assisted dying debate has profound implications for the hospice movement and has forced palliative care into a defensive position. Proponents of assisted dying support their case by maintaining that hospice cannot provide effective pain relief and adequate symptom control. The End of Life Choice Bill passed its third reading in the New Zealand Parliament, seeks to give people with a terminal illness the option of requesting assisted dying.
- Palliative care in New Zealand is currently substantially under-resourced. The Government recognised the need in its 2000 New Zealand Palliative Care Strategy Document. Full implementation of this strategy requires continuing advocacy to ensure that it retains priority among other healthcare needs, especially when obtaining funding for the medical and technical aspects of end of life care may be seen as a high priority.
The Government provides, on average, around 50% of hospice core functions (some hospices receive just 38% of their total budget while others receive up to 75% – Mary Potter 45%). The remaining amount is funded by public donations and bequests, grants, and fundraising, including charity shops. Mary Potter Hospice has 8 shops, which provide 15% of its income – around $2 million a year. Interesting innovations in this area include an agreement with SKY TV, whereby shops in Thorndon and Porirua are drop-off points for SKY decoders, remotes and cables. This additional revenue stream is worth around $30,000 a year. The Hospice has a TradeMe page and shop volunteers keep a lookout for unusual, rare or popular items that might appeal to online shoppers. Recently a grandfather clock was sold for $521 and a Japanese katana sword for $178. Ceramics, vintage glass, and other collectable items have added to hospice income.
A logistics operation is essential for the pickup and delivery of goods. Hospice trucks are on the road seven days a week, providing work for four drivers. All this is in addition to the Mary Potter Hospice Strawberry Festival in November and pop-up shops at festivals and at Christmas.
In 2018 Work on the Mary Potter Apartments site began. These units, adjacent to the Wellington site will be rented out for additional income.
- Much of the hospice activity depends on volunteers, for fund-raising but also general activities for in-patients and in the community, so recruitment may also be a challenge as demand grows. The Mary Potter Inpatient Unit offers a family room with kitchen facilities, which is maintained by volunteers.
The Mary Potter 2018 annual report records 676 volunteers, providing 60,132 free hours of work. All the board members are volunteers. In 2018 a Companion Volunteer Programme was started for patients at home and support to their carers. This is likely to expand as more people receive palliative care services at home, but there will be competition for volunteers from other befriending services such as Age Concern’s AVS. Patients have a parade of medical, nursing and support staff coming into their homes, but non-medical social contact is also beneficial.
- A key goal of the hospice movement is education and training in palliative care for the medical and nursing professions and wider community.
Mary Potter Hospice offers an extensive palliative care education programme to health professionals and the community, as well as to staff and volunteers. This provides specialist workshops, seminars and symposia. Hospice staff are encouraged to engage in postgraduate study and to present their research and case studies at conferences and seminars.
At the community level a series of workshops to provide practical help for carers and patients is being launched. Topics include home alone, managing money, cooking for one, calming the mind and socialising, funeral and advance care planning, time off for carers, holiday season resilience.
- The recognition of cultural diversity is now an essential part of service planning and delivery. In 2007first Māori Liaison position at Mary Potter was established and in 2016 Pasifika Liaison. Te Pou Tautoko, the Māori support and advice group, helps the hospice to implement the Māori Service Plan. It ensures that services meet the needs of Māori communities and that a Māori voice is maintained through all levels of operation – Board, Executive, patients, whānau, volunteers and in the community. Each of the Mary Potter bases has Māori and Pasifika liaison staff, administrators and volunteers.
- The multi-disciplinary and holistic approach of hospice calls for a wide range of skills among staff, and recruitment may pose a challenge, as well as issues arising from working together. As well as nursing care and symptom management, services may include (as at Mary Potter) emotional and spiritual support, regardless of religion or beliefs. Other professionals needed may include social workers, occupational therapists, counsellors, physiotherapist, massage therapists, oral history recorders and music therapists. Some hospices encourage animal visits.
- Liaison needs to be developed and maintained with other health professionals and therapists. These include workers in Aged Residential Care, regional hospitals and hospital palliative care teams, GP practice teams, district nurses, ambulance services, oncology and other specialist nurses, iwi health services and home support, assistive technology and social care agencies (some in the private sector). Medical students, student nurses and massage students are offered placements in the in-patient and community teams at Mary Potter.