Hadassah's holistic approach to hospice care

The Hospice provides care to terminally ill patients, helping them meet the challenges of end-stage illness through a holistic approach.

Director of palliative care services Dr. Daniel Azoulay and head nurse of the Hospice in Hadassah Mount Scopus Gal Sapir spend time with a patient (photo credit: HADASSAH MOUNT SCOPUS)
Director of palliative care services Dr. Daniel Azoulay and head nurse of the Hospice in Hadassah Mount Scopus Gal Sapir spend time with a patient
“To lighten the burden for patients and their families is a privilege.”
These were the words of Gal Sapir, head nurse of the Hospice in Hadassah Mount Scopus, recently visited by The Jerusalem Post. Medical, nursing and support staff at the hospice provide care to terminally ill patients, helping them meet the challenges of end-stage illness with dignity, physical ease and emotional comfort.
“What we have here is unique,” explained Dr. Daniel Azoulay, director of palliative care services at the hospital. “There are very few hospices in Israel. Our main goal here is the care of the patient and their family. Each patient receives personalized care. We don’t go to extreme measures to extend the patient's life, and we also take care not to shorten their lives. We give the patients as much pain control as needed, and if the patient is suffering we make sure to treat their symptoms.  At the same time, we try to help them be alert, so that they can enjoy their time with their family.”
Decisions on what measures will most help a patient are made together with the patient and their family, along with input from the multidisciplinary team of doctors, nurses and the hospice’s social worker.
“We try to give the patients not only medical care, but also care for their spirit, like physiotherapy and reflexology,” Azoulay said. “We have a ‘Coffee Shop’ event once a month, where volunteers come as waiters, bring sweet treats and pastries, and live music. Patients, family members and staff join the volunteers in dancing and singing."
Sapir added that activities for the patients and families, like listening to music, taking walks in the garden and family outings are important for the well-being of both patients and family members.
“Hospice is a place where the families can focus on spending time with their family member, and don’t have to attend to the physical demands of taking care of [them]” she said. "We want to help the family be with the patient, so that they can enjoy every day, and every hour, and every moment possible."
The atmosphere of the Hospice, which houses up to fourteen patients, is warm and homey. There are paintings on the walls, a balcony with a view of the Judean desert, a lounge area and a welcoming garden for families and patients to spend time together in the open air. There is a recently refurbished family room to provide a welcoming space for group meetings, and important discussions with families about patient care.
FOR EZRA, whose mother is a cancer patient in the unit, the hospice “is a unique and positive place to live out the end of life.  The nurses are so compassionate, and they create a personal relationship with the families and the patients,” he said.
Ezra’s mother has been in the hospice for five months.  He made it clear that she is conscious, “but she has dementia, and she is unable to speak.”
“She doesn’t feel like she is suffering,” he said. “Everybody takes such care of her with such warmth and love. For me it is also special to see how they take care of her.”
Ezra said he spends a lot of time at the hospice, “and it is hard, but we knew it was going to be hard.”
He called the staff and volunteers “a gift from God… They help with everything and they give meaning. They bring music and joy to the patients.”
Simona Cohen-Schwartz, who is a volunteer at the unit, said coming back to the hospital’s hospice is full circle for her.
“I did my internship as a nurse in the Oncology Ward, but I am also a cancer survivor – I am an oncology patient.  It's been 16 years since surgery, but I’m still connected to the cancer issue,” she said. “I know cancer both as a patient and as a nurse.”
Asked about the difficulties of the job, Cohen-Schwartz said that when patients pass away, it’s tough.
“You build a connection with the patients, whether it’s through holding their hands, staying and listening to them and their families, or giving them a smile and stroking their face, which is very comforting for the patient – so it’s not easy when they pass away,” she explained, adding that she does make a concerted effort to separate work from home life. 
  PROF. JEREMY JACOBS, department head of Geriatric Rehabilitation at the hospice, told the Post that “we deal with an awful lot of death and dying, and the Hospice in-patient unit is a highly specialized niche providing exceptional care for people with complex end-of-life needs.”
He said that there is a growing awareness both inside and outside the hospital concerning the need for palliative care, but a lack of services.
He mentioned that “the quality of death” differs depending on where the patient is cared for – whether it's in an internal medicine unit, an old age home or in the hospice.
He also referred to The Quality of Death Index, which measures the quality of palliative care available to adults in 80 countries. Israel is rated number 26, “but we are always aiming to improve.”
Jacobs stressed that “palliative care is something that involves a multi-dimensional, multi-disciplinary approach,” and this is characteristic of the care in Hospice at Hadassah Mount Scopus.
He explained that as a terminal “illness progresses, the need for palliative care increases while the need for curative care decreases,” emphasizing that palliative care includes not just addressing pain, “but also a need to control a wide range of symptoms, including: abdominal discomfort, shortness of breath, agitation – and the more existential side for conscious patients as they get closer to the end, irrespective of age.”   
He said that his experience in medicine, and being around older people, has encouraged him to get involved in hospice care. 
“It’s an inevitable and desired part of being a good physician, especially today in the world of medicine," he said. "Physicians are going to need to deal with a lot of palliative needs for patients who are in their last year or stage of life. To be a good physician, you have to know how to deal with it and get deeper into that area of care.
“Modern medicine is dealing with this a lot now, and the debate today often concerns finding the balance, and knowing when to give curative or palliative care,” Jacobs said, concluding that both hospice and home hospice services are very important.
For Anna Kochin, the hospice's social worker, there are different aspects of easing the pain of the patients, which include physical, mental, spiritual and social ones.
“There are things that patients don’t want to talk to their families about like their fears or wishes, and their pain, but they may be comfortable talking with staff.  Afterwards, they feel more able to be positive and calm, because they've dealt head-on with difficult issues,” she explained. “Or even better, they will be able to talk to their families because they have already talked it through with someone else.”
She emphasized the need to take care of the emotional needs of the families, as well, “talking with them and helping them to accept what the patient needs without being judgmental, and helping them express and accept their own needs, and helping them locate the resources to address those needs."
"In short, we see the importance of providing for the emotional needs of everyone involved – the patients, the families, and the staff members — in this place which is small, but has a big heart."