The palliative care movement supports both the terminally ill and their families in the last phase of life. Angie Mezzatti reports
Flowers in bloom feature in everything to do with palliative care. The hospice movement chooses the sunflower, daffodils are the symbol of the Irish Cancer Society and one of the most beautiful features of the new Blackrock Hospice in Dublin is its garden - a gold medal prizewinner at Chelsea.
They are a fitting symbol for the hospice and the palliative care movement in Ireland which takes a holistic approach to this phase of life, and aims to support the family as well as the patient. The service is growing but some feel there still aren't enough "flowers" to go around.
Palliative care means total care for a patient and their family when there is no longer a medical expectation of a cure. Families in need of hospice care are normally referred through their GP or through a hospital doctor.
Each county has a specialist home care team with specialist nurses. Some operate under the direction of a specialist palliative medicine consultant, others under a medical director who could be a hospital consultant or a GP.
Laura Purcell lost her husband Joe to cancer last year and with the help of her local palliative care team she was able to nurse him at home. "He didn't want anyone else here but myself," she explains.
Sister Teresa of the Co Offaly home care team gave them great support near the end and took over the measurement of his weight and blood pressure from the hospital - an environment that Joe had found "very stressful". Laura was upset, however, by the dismissive way they were told he had cancer six months earlier. "The doctor simply said, 'If we put him on the table, we will kill him'. Straight out, he said it and then left the room," she recalls.
Most people prefer to die at home close to their family and in familiar surroundings and the Irish Cancer Society's (ICS) Daffodil Day raises money every year to fund its night nursing service. Last year, 1,031 families availed of it. This amounted to 3,700 nights of care and the demand for this service is on the increase. "There is no charge to the family and each patient is entitled to 70 hours' nursing care although this figure is flexible," according to Lorraine Clancy, ICS night nursing manager.
Rosemary Egan believes it was a priceless gift to be able to care for her husband Dony at home away from austere hospital surroundings. "When you opened the door they were there like angels," she says of the nurses who tended to him. "Their total gentleness and concern for my family were my crutch and support."
Home care at the end however is not always possible and there are hospices and palliative care units to cater for these needs throughout the country.
In-patient stays are provided at many specialist palliative care centres. These include Marymount Hospice in Cork, Milford Care Centre in Limerick, Our Lady's Hospice in Harold's Cross and its new satellite Blackrock Hospice and St Francis Hospice in Raheny in Dublin.
Our Lady's Hospice in Harold's Cross has 36 beds for end care patients but also has two other areas of care at the complex - a 40-bed unit for patients undergoing rehabilitation for conditions like arthritis and scleroderma and 100 beds for extended care.
Our Lady's also has a home care team, day care facilities and provides training for nurses in palliative care. The new Blackrock facility will cater for 12 in- patients when fully operational, according to Dr Eoin Tiernan, a specialist in palliative medicine who is based at the hospice and St Vincent's Hospital, Dublin. The design of the building and its gardens are a template for good hospital design, he adds.
St Francis Hospice provides day care for 75 people who return home in the evening and also has 19 in-patient beds that are used for respite - to give families a break from nursing a dying family member at home; for symptom control; and for the end phase of the patient's disease.
"Patients and their families love the gardens here," according to Ethel McKenna of St Francis Hospice, "and the rooms are laid out so that patients can go outside in beds or wheelchairs." Its home care team includes medical and nursing staff, a social worker and chaplain.
St Francis Hospice is looking for a site in the Blanchardstown/
Dublin 15 area to build a new hospice for the Dublin North West region. It took over this area from Our Lady's Hospice in September 2001 and it has a dedicated home care service for the whole Dublin North West area as well as its original North East catchment area.
There are palliative care teams in place in other acute hospitals in Dublin such as Beaumont, St Luke's, St Vincent's and St James's and around the Republic.
Rosemary Egan who is from Co Offaly says that when her husband died she was touched to receive a call from one of the casualty nurses in Beaumont - he had been in and out of casualty. She also advises getting in touch with the local cancer care support group which she said gave her practical help, reflexology treatments and emotional support.
No medical condition is precluded from hospice care, says Dr Tony O'Brien who work's in St Vincent's Hospice and Blackrock Hospice, who chaired the Report on The National Advisory Committee on Palliative Care that was published in 2001. However, cancer accounts for 85 to 95 per cent of referrals for hospice care.
Other conditions such as end phase motor neurone disease, HIV-related illness, end stage renal and cardio cases and scleroderma-related illnesses are occasionally catered for but the Department of Health expects the need from patients with these and other illnesses will increase.
The numbers of people dying from cancer due to Ireland's ageing population and the move to provide care at an earlier stage of disease management will also increase this demand.