Programs address cultural, religious needs
The growing number of patients from culturally and ethnically diverse communities has caused some hospices to create programs designed to answer the specific needs of patients of different religious faiths.
Hospice of Michigan, in Southfield, MI, has two special religious programs, Jewish Hospice Services and Islamic Hospice Services. While on the West Coast, the San Francisco-based Zen Hospice Project (ZHP) answers the spiritual needs of its patients with Zen Buddhist principles.
Hospices that address the religious needs of their patients are gaining popularity in the communities they serve. Experts say hospices and home care services can implement these kinds of programs by reaching out to community centers, or coordinating their services with religious organizations within these communities. (See related story on addressing the spiritual needs of hospice patients, p. 15.)
The Jewish model
Patients enrolled in Jewish Hospice Services have a wide network of support. The program is affiliated with 14 different organizations ranging from the local Jewish hospital to local chapters of the National Council of Jewish Women and Kosher Meals on Wheels. Reaching out to Jewish patients with special needs, the hospice service offers assistance to Holocaust survivors, children, the developmentally handicapped, AIDS sufferers, residents of adult foster care homes, and indigent and isolated individuals.
Rabbi E. B. (Bunny) Freedman manages Jewish Hospice Services of Southfield, MI, sponsored by Hospice of Michigan and Jewish Family Services. Patient-directed, it is open to all Jews, from the most orthodox to those unaffiliated with a synagogue or Jewish organization.
The program serves 20 to 30 patients daily, providing them with medical, social, and spiritual aid. Committed to the principles of palliative care, the medial and nursing staff are either Jewish or taught Judaic traditions and rites. Most volunteers are Jewish.
Hospice staff entering a patient’s home must follow the family’s direction and guidance regarding dietary practices, Sabbath and holiday customs, attitudes toward God, and other spiritual issues. Freedman has administered the program since its inception six years ago. For him, "reconnecting" patients with their religious community, synagogue, or rabbi is the most important part of his work.
"Many people go through life without much religious attachment, or they’ve lost touch with their belief," Freedman explains. "When they get to the end of life, they often change but are afraid to call on their rabbi or synagogue. That’s when I step in and re-establish the contact. Dying is a painful experience — emotionally too. It is my job to make it easier for our patients and their families so that they don’t have to face it without spiritual help and loving support."
The Islamic model
Dan Layman, MBA, manager of the Islamic hospice program, has seen a constantly rising demand for this service. With a population of about 300,000 Muslims in the Detroit area, the need for hospice service that incorporates Islamic traditions and rites became obvious six years ago. The Islamic hospice service was organized in 1996 and has since cared for 20 to 25 patients annually.
"We try to reach out to all patients of Islamic faith, which gives us a wide spectrum of Muslims — from those who are Muslims by name only to those who are devout Muslims," says Layman. "This also brings us in contact with many different cultures, because our patients come from all Islamic countries, anywhere from Pakistan to Africa and from every Arab country in the Middle East. We also serve African-Americans who are Muslim."
Though the hospice employs six medical directors, most of the medical assistance within the program is offered by one Muslim physician and two Muslim nurses. All staff and volunteers have to go through an eight-hour training session, which includes lectures on Islamic religion, culture, and tradition. According to Layman, most volunteers are Muslim, many functioning as translators for Farsi and Urdu, and the Arabic tongues of Syria, Jordan, Iraq, Lebanon, and Egypt.
Depending on the request of the patient or family, the care is administered according to Islamic practices, avoiding cross-gender contact. At their request, patients will be visited by an Imam who leads them in prayer and reads the Koran. All hospice staff and volunteers must be familiar with the significance of basic Islamic rules, such as removing shoes before entering a home and administer "Vozou," the ritual washing before engaging in religious rites.
The Buddhist model
Largely in response to the exploding AIDS crisis in 1987, Frank Ostaseski, a Buddhist, founded ZHP as a part of the San Francisco Zen Center. Today, ZHP operates a residential hospice program that offers care in a four-bed "guest house," a renovated Victorian home, and a 28-bed hospice unit in the Laguna Honda Hospital, the nation’s largest public long-term care facility.
Before ZHP, patients without home nor family who lingered in the final stages of AIDS, cancer, or other diseases, would end up in the acute-care center at San Francisco General Hospital. If they did not die there, they would be transferred to a non-hospice unit at Laguna. Without a permanent address, these patients could not draw government entitlements. By offering them the address of the Zen Guest House, they became eligible for hospice home care; and through collaboration with Hospice by the Bay in San Francisco, ZHP now provides comprehensive medical management and 24-hour hospice care.
The staff at ZHP works closely with an interdisciplinary team of volunteers, physicians, nurses, social workers, nursing assistants, activity therapists, nutritionists, and spiritual and bereavement coordinators. A major component of the ZHP is public education and professional training for health care providers. ZHP has arranged workshops and retreats to share its approach to the care of AIDS and cancer victims with professionals in this country and abroad.
According to Michael Vargas, MSW, residence manager of the guest house, this approach is built on a philosophy influenced by the Buddhist principles of "mindfulness, loving kindness, dedication to the service of others, and acknowledging the impermanence of life."
Meditation and the "search for stillness in chaos" are recommended, but not required. Sometimes, patients accept meditation and introspection after having been exposed to skillful touch, rhythmic breathing, or massage, says Vargas.
"While we expose our patients to Buddhism and its principles, specifically to the Zen practices, we make no attempt to convert anyone," says Vargas.
Sources
• Rabbi E. B. (Bunny) Freedman, director, Jewish Hospice Services, Hospice of Michigan, 16250 Northland Drive, Suite 212, Southfield, MI 48075. Telephone: (248) 559-9209.
• Dan Layman, MBA, Market Services, Hospice of Michigan, 16250 Northland Drive, Suite 212, Southfield, MI 48075. Telephone (248) 559-9209.
• Michael Vargas, MSW, residence manager, Zen Hospice Project, 273 Page St., San Francisco, CA 94102. Telephone: (415) 863-2910.
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