Also, some families are more active in taking care of end of life patients than other families. Indeed, hospice care providers have a significant number of responsibilities as it relates to taking care of the patient. The type of illness that the patient has can increase or decrease the number of responsibilities of the hospice care providers. In any case, hospice care providers provide services tat ensure the comfort of the patient and they also attempt to make the emotional and psychological issues associated with dyeing, more palatable for the patient.

In addition to the issues that arise for the patient, caring for a loved one that is terminally ill is also extremely difficult for family members. As was mentioned previously in the discussion the purpose of a hospice is to serve both the patient and the family of the patient.

The family must be educated concerning the condition of the patient and how to care for them. In addition, if the patient has a long-term debilitating illness such as Alzheimer's disease, the family may have to be educated concerning the needs of the patient and the progression of the disease (Jennings et al., 2003). Additionally the family of a patient often requires access to mental health professionals because of the stress and depression that may occur as a result of caring for a loved one or dealing with the inevitability of death (Jennings et al., 2003). The hospice care is also there to assist the family when the patient dies. Many hospice programs provide bereavement counseling and may even assist with funeral arrangements. All of these services are extremely valuable to the family when they are losing someone that is loved (Jennings et al., 2003).

Most hospice care programs hold family conferences. The first family conference usually takes place when hospice care first begins (Forman, 2003). During the initial conference difficult emotional issues are discussed and the patient identifies various caregivers within the family who will be responsible for making decisions (Forman, 2003). The family conference is also important for the hospice care givers because it allows them to see the family dynamics and whatever communications problems that may be present within the family (Forman, 2003). Having this information allows the caregivers to bridge some of the communications gaps that may already exist within the family (Forman, 2003).

The author points out that at least one member of the interdisciplinary team must be present during the family conference.

Although hospice care workers such as nurses, doctors and psychologist are the most prominent members of the interdisciplinary team, social workers also play an important role in hospice care as it relates to patients and their families. According to an article found in the journal Health and Social Work, social workers are often needed in a hospice care situation to assist families in dealing with ethical dilemmas related to patient care (Csikai, 2003). Ethical dilemmas may include the type and dosage of pain medication that the patient will receive. In addition ethical dilemmas may be inclusive of the patient desire not to be on any life sustaining machines or vice versa (Csikai, 2003). The article further states

Other frequently discussed issues were families' denial of the terminal illness and that families might not be following the patients' wishes, which could cause or increase the risk of patient-family conflict (another identified common issue). Social workers can provide significant input into the resolution of these issues and discuss with other team members strategies they can use during home visits with patients and families. The resolution of these difficulties in hospice might make a critical difference in whether the patient has a "good death;" often defined as a death that occurs at home in concert with the patient's wishes and preservation of self-determination (Reese, 2000; Csikai, 2003)."

Because the aforementioned issues exist within the context of hospice care, it is important that the social worker is qualified to take on this type of responsibility. The social worker can greatly impact the ability of patient to die in the manner they wish.

Hiring hospice care providers

As a result of the type of care that is provided by a hospice program, hiring employees to work at a hospice program can be a difficult and complex undertaking. The difficulty associated with hiring the proper people exist because hospice care can be stressful and emotionally taxing on caregivers. Just because of nurse is equipped at working in a hospital or some other type of medical facility, they may not have the capacity to work in a hospice care program.

These individuals are usually responsible for administering medicines. Taking care of patients' hygiene needs and making sure that the patient is comfortable. Other individuals such as doctors, and therapists also play a significant role, but nurses and their assistants are usually with the patient the most; in some cases the patient spends more time with these individuals than with their family. For this reason it is extremely important for these individuals to be properly trained and have the empathy to work in a hospice program.
According to Forman (2003) all hospice care workers must be carefully screened and must have credentials that exceed simply being trained in a certain field. An individual seeking a position in a hospice program should have an n interest in assisting terminally ill patients, but if they seem to have an obsession with death and dyeing it may be an indication that the individual is not right for the job. In addition, the person seeking the position should not be going through the grief process in their own life (Forman, 2003). The author points out those who have gone through losing a loved one can be a valuable asset in helping families (Forman, 2003). However, if an individual is still dealing with the death of a loved one, they may not be ideal for hospice care (Forman, 2003).

In addition to the aforementioned issues it is also important that individuals working in home hospice situations have some additional attributes that are necessary when working in that environment. For instance, individuals that work in home hospice programs must be comfortable working alone for a majority of the time but still sharing information with the entire interdisciplinary team (Forman, 2003).

Good communication is another extremely important aspect of working in hospice care (Forman, 2003). The hospice care worker must have the capacity to talk and listen to the patient, family of the patient and other members of the interdisciplinary team. Good communication allows the interdisciplinary team to come up with the best plan of action for the patient and to discuss the plan of action with the family. If proper communication does not take place the patient and the family may suffer (Egbert & Parrott, 2003).

Conclusion

The purpose of this discussion was to examine death and dying and hospice care workers roles in providing care not only to the patient but also the families of those that are dying. We began our discussion by defining hospice care and providing some background information. The research indicates that hospice care allows terminally ill patients to receive physical, psychological and social care before death. The research also indicates that hospice care is designed not only to assist patients but also their families as it relates to end of life care. We found that hospice care began in England and came to America in the 1970's. The research revealed that Connecticut was the first state to have a hospice care facility and Medicare began o offer hospice care in the 1980's.

According to the investigation hospice care workers are there to assist patients in several ways and to ease the difficulty associated with illness and death. Hospice care most often consists of an interdisciplinary team that includes doctors, nurses, psychologists and social workers. All of these individuals work together to ensure that the physical, emotional, spiritual and psychological needs of the patient and the family are met. In addition to assisting the patient, the hospice care workers are also there to assist the families with the bereavement process after the patient has died. The research also indicates that hospice workers must have certain attributes because of the stressful nature of hospice care.

Overall the research indicates that hospice care workers provide patients and their families with invaluable services and assist the terminally ill in a manner that is not found in a regular hospital setting. It is apparent that the presence of hospice care facilities and workers might continue to expand as people wit some terminal illnesses are living longer.